1
00:00:15,396 --> 00:00:22,196
Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show

2
00:00:22,236 --> 00:00:25,676
Speaker 1: where we explore the stories behind the stories in the news.

3
00:00:26,196 --> 00:00:30,476
Speaker 1: I'm Noah Feldman. The CDC, also known as the Centers

4
00:00:30,516 --> 00:00:33,956
Speaker 1: for Disease Control and Prevention, has been emphasizing that a

5
00:00:33,996 --> 00:00:37,276
Speaker 1: strategy called contact tracing is going to be essential to

6
00:00:37,316 --> 00:00:41,356
Speaker 1: reopening the country. Here's Robert Redfield, the head of the CDC,

7
00:00:41,876 --> 00:00:44,596
Speaker 1: speaking at a White House press conference earlier this month.

8
00:00:44,996 --> 00:00:51,516
Speaker 1: We're going to be very aggressively focused on early case recognition, isolation,

9
00:00:51,556 --> 00:00:55,436
Speaker 1: and contact tracing. Contact tracing is the process of identifying

10
00:00:55,476 --> 00:00:58,596
Speaker 1: people who've come into contact with an infected person and

11
00:00:58,676 --> 00:01:01,596
Speaker 1: alerting them so that they can get tested and isolate

12
00:01:01,636 --> 00:01:05,796
Speaker 1: themselves to slow the spread of the disease. This is

13
00:01:05,796 --> 00:01:08,076
Speaker 1: a job that has traditionally been done by public health

14
00:01:08,076 --> 00:01:13,396
Speaker 1: workers in several countries around the world, including Singapore, South Korea.

15
00:01:13,596 --> 00:01:16,716
Speaker 1: Much contact tracing was done digitally with the help of

16
00:01:16,796 --> 00:01:20,836
Speaker 1: apps the people downloaded onto their phones. To learn more

17
00:01:20,876 --> 00:01:23,996
Speaker 1: about contact tracing, how it works, what it's good for,

18
00:01:24,116 --> 00:01:27,676
Speaker 1: and what the challenges are facing contact tracing. We're joined

19
00:01:27,676 --> 00:01:31,556
Speaker 1: by doctor Louise Iverse. She's the executive director of the

20
00:01:31,596 --> 00:01:35,596
Speaker 1: Massachusetts General Center for Global Health at the Massachusetts General

21
00:01:35,636 --> 00:01:39,156
Speaker 1: Hospital in Boston. She's a doctor who specializes in infectious

22
00:01:39,196 --> 00:01:42,836
Speaker 1: disease and IT outbreaks, and she's been thinking very deeply

23
00:01:42,956 --> 00:01:46,436
Speaker 1: about that question. Louise, thank you for being here. I

24
00:01:46,476 --> 00:01:48,996
Speaker 1: wonder if you could start by just explaining to us

25
00:01:48,996 --> 00:01:51,836
Speaker 1: contact tracing one oh one, what is it? And then

26
00:01:51,836 --> 00:01:55,716
Speaker 1: we'll move to what's it for. So contact tracing is

27
00:01:56,236 --> 00:02:03,156
Speaker 1: basically identifying and then isolating people who have been exposed

28
00:02:03,196 --> 00:02:07,636
Speaker 1: to an infectious disease. And the idea is that by

29
00:02:07,676 --> 00:02:11,636
Speaker 1: isolating those people who been exposed, you can interrupt the

30
00:02:11,716 --> 00:02:17,436
Speaker 1: chains of transmission and in good quality contact tracing. Explain

31
00:02:17,476 --> 00:02:19,716
Speaker 1: to me what the mechanics are. First we discover that

32
00:02:20,076 --> 00:02:23,676
Speaker 1: person X call M Noah has been exposed to the

33
00:02:23,756 --> 00:02:28,316
Speaker 1: virus and is infectious. Then what happens. So the first

34
00:02:28,356 --> 00:02:32,356
Speaker 1: step is identifying what we call an index case. So

35
00:02:32,476 --> 00:02:35,516
Speaker 1: an index case is a person who is confirmed to

36
00:02:35,556 --> 00:02:39,236
Speaker 1: have the illness in this situation COVID nineteen. So let's

37
00:02:39,276 --> 00:02:43,756
Speaker 1: say you have a positive COVID nineteen test. Then that

38
00:02:43,836 --> 00:02:48,316
Speaker 1: triggers a notification to the public health authorities. So then

39
00:02:48,356 --> 00:02:52,356
Speaker 1: what they do is call you up and speak with

40
00:02:52,396 --> 00:02:56,756
Speaker 1: you and try to motivationally interview you to remember where

41
00:02:56,796 --> 00:03:00,476
Speaker 1: you've been, who you've been in contact with. For COVID nineteen,

42
00:03:00,596 --> 00:03:05,636
Speaker 1: we think especially about being with someone within about six

43
00:03:05,676 --> 00:03:09,436
Speaker 1: feet of distance physically for about ten or fifteen minutes more.

44
00:03:09,996 --> 00:03:12,516
Speaker 1: And we make a list of all your contacts, and

45
00:03:12,556 --> 00:03:16,116
Speaker 1: then we set about communicating with those people who are

46
00:03:16,196 --> 00:03:20,036
Speaker 1: contacts and giving them particular pieces of advice. You might

47
00:03:20,276 --> 00:03:23,436
Speaker 1: offer contacts a test. You certainly want to know if

48
00:03:23,516 --> 00:03:27,116
Speaker 1: any contact is already having symptoms, because they might actually

49
00:03:27,156 --> 00:03:29,276
Speaker 1: become a case. Then if you have symptoms and a

50
00:03:29,276 --> 00:03:33,316
Speaker 1: positive test, you become a case. You definitely want those

51
00:03:33,356 --> 00:03:39,356
Speaker 1: folks to quarantine. And you know, many people are not

52
00:03:39,396 --> 00:03:42,916
Speaker 1: in a position to easily self isolate, so many people

53
00:03:42,996 --> 00:03:47,116
Speaker 1: talk about supported isolation or supported quarantine. You know, where

54
00:03:47,156 --> 00:03:50,996
Speaker 1: you investigate in speaking with the contact what their barriers

55
00:03:51,036 --> 00:03:53,276
Speaker 1: are to being able to stay home for two weeks.

56
00:03:53,276 --> 00:03:56,276
Speaker 1: So that's kind of the process. And why does that

57
00:03:56,396 --> 00:03:59,356
Speaker 1: not very quickly spiral to enormous numbers. I mean, I

58
00:03:59,396 --> 00:04:02,476
Speaker 1: can understand that under social distancing it might not spiral

59
00:04:02,516 --> 00:04:04,556
Speaker 1: that much because I'm not sure I've actually been in

60
00:04:04,596 --> 00:04:07,076
Speaker 1: contact that much with anybody except from my kids. But

61
00:04:07,156 --> 00:04:09,356
Speaker 1: if I had been out and about because there wasn't

62
00:04:09,396 --> 00:04:12,316
Speaker 1: social distancing, there would presumably be many people, and then

63
00:04:12,356 --> 00:04:14,076
Speaker 1: that would lead to many other people and the tree

64
00:04:14,116 --> 00:04:17,956
Speaker 1: would grow very, very rapidly. So how is this doable

65
00:04:18,196 --> 00:04:22,396
Speaker 1: in a non socially distanced environment. I mean, you just

66
00:04:22,676 --> 00:04:28,236
Speaker 1: perfectly described the pandemic, you know, because that's exactly why

67
00:04:28,396 --> 00:04:32,676
Speaker 1: there's exponential spread, is because every person potentially infects other people.

68
00:04:33,036 --> 00:04:37,116
Speaker 1: So you're totally right. Contact tracing is a big task.

69
00:04:37,756 --> 00:04:42,156
Speaker 1: It quickly becomes very many people, and you are essentially

70
00:04:42,196 --> 00:04:46,276
Speaker 1: trying to chase ahead of the speed of the virus

71
00:04:46,516 --> 00:04:52,796
Speaker 1: and at least take out of circulation enough people so

72
00:04:52,836 --> 00:04:55,876
Speaker 1: that they don't go on to contribute to that exponential spread.

73
00:04:56,036 --> 00:04:58,876
Speaker 1: So it is a very very big task. It is

74
00:04:59,116 --> 00:05:02,436
Speaker 1: certainly normally in public health what we try to do

75
00:05:02,556 --> 00:05:06,676
Speaker 1: at the beginning of epidemics, and so there's certainly debate

76
00:05:06,756 --> 00:05:11,396
Speaker 1: at the moment in Massachusetts, say about how helpful it

77
00:05:11,476 --> 00:05:14,916
Speaker 1: is to be trying to do contact tracing. I do

78
00:05:15,036 --> 00:05:21,516
Speaker 1: think that the human capacity to do it gets quickly stretched.

79
00:05:21,916 --> 00:05:24,876
Speaker 1: If we had over two thousand positive cases and new

80
00:05:24,996 --> 00:05:28,516
Speaker 1: positive cases in Massachusetts yesterday and the same amount the

81
00:05:28,596 --> 00:05:32,676
Speaker 1: day before you quickly get into the number of contacts.

82
00:05:32,676 --> 00:05:35,916
Speaker 1: It's very, very many. And this is why I personally

83
00:05:36,076 --> 00:05:39,836
Speaker 1: became interested in the idea that technology should be able

84
00:05:39,876 --> 00:05:43,956
Speaker 1: to somehow help us in trying to deal with this

85
00:05:44,036 --> 00:05:47,636
Speaker 1: huge task. In a place like Massachusetts is a good

86
00:05:47,636 --> 00:05:50,756
Speaker 1: example where we both are, where there's already what you

87
00:05:50,836 --> 00:05:55,436
Speaker 1: epidemiologists call community spread. What would the scale of contact

88
00:05:55,436 --> 00:05:58,436
Speaker 1: tracing have to be actually to use it to beat

89
00:05:58,476 --> 00:06:01,276
Speaker 1: the virus down? Has that ever been done? I mean, obviously,

90
00:06:01,316 --> 00:06:03,316
Speaker 1: contact tracing has been used successfully as it was in

91
00:06:03,316 --> 00:06:05,716
Speaker 1: South Korea to help control the virus, but only a

92
00:06:05,716 --> 00:06:08,196
Speaker 1: few people have it. But are there any examples in

93
00:06:08,236 --> 00:06:11,036
Speaker 1: the world where contact tracing has been used to knock

94
00:06:11,076 --> 00:06:14,876
Speaker 1: back community spread? I think you could look at Ebola

95
00:06:14,956 --> 00:06:19,316
Speaker 1: virus disease as a example of a very frightening illness

96
00:06:20,076 --> 00:06:23,076
Speaker 1: with a much higher mortality rate that we're seeing for

97
00:06:23,116 --> 00:06:29,556
Speaker 1: COVID nineteen, where contact tracing has essentially been a major

98
00:06:29,636 --> 00:06:33,156
Speaker 1: contributor to ending the outbreak. Certainly in the twenty fourteen

99
00:06:33,236 --> 00:06:37,796
Speaker 1: twenty fifteen outbreak in West Africa before there was a vaccine.

100
00:06:38,436 --> 00:06:41,476
Speaker 1: They're very different diseases, so I'm not trying to say

101
00:06:41,556 --> 00:06:44,676
Speaker 1: that they are transmitted the same way. But the question

102
00:06:44,716 --> 00:06:49,716
Speaker 1: for COVID nineteen is if we don't try to contain

103
00:06:49,876 --> 00:06:55,916
Speaker 1: the virus, what is our alternative. We don't have a treatment,

104
00:06:56,756 --> 00:07:00,476
Speaker 1: we don't have a prevention, a vaccine. I think from

105
00:07:00,476 --> 00:07:04,356
Speaker 1: the perspective of public health folks, if we don't try

106
00:07:04,396 --> 00:07:07,116
Speaker 1: to do contact racing, we're just kind of sitting back

107
00:07:07,156 --> 00:07:10,716
Speaker 1: to say, well, it escaped and there's nothing we can do.

108
00:07:10,756 --> 00:07:12,836
Speaker 1: We just have to wait. So I think when you

109
00:07:12,876 --> 00:07:15,836
Speaker 1: look at the numbers in the United States and certainly Massachusetts,

110
00:07:15,876 --> 00:07:19,796
Speaker 1: it just seem overwhelming. But basically, the two features around

111
00:07:19,796 --> 00:07:22,996
Speaker 1: contact tracing that are important are you have to be fast,

112
00:07:23,716 --> 00:07:26,476
Speaker 1: because you need to identify the contacts and put them

113
00:07:26,476 --> 00:07:29,796
Speaker 1: in isolation quickly, and then you have to have good

114
00:07:29,876 --> 00:07:33,436
Speaker 1: quality testing. So if you have an accurate test that's widespread,

115
00:07:33,836 --> 00:07:37,836
Speaker 1: and you have contact tracing that's fast, then you could

116
00:07:37,876 --> 00:07:41,276
Speaker 1: be successful. You know, Massachusetts just hired or is in

117
00:07:41,316 --> 00:07:44,596
Speaker 1: the process of hiring a thousand people to work on

118
00:07:44,676 --> 00:07:48,316
Speaker 1: contact tracing, and I think that's a big start. I

119
00:07:48,356 --> 00:07:51,316
Speaker 1: think even if we don't really believe that it's possible

120
00:07:51,396 --> 00:07:55,276
Speaker 1: right now at the peak of our epidemics, we definitely

121
00:07:55,316 --> 00:07:58,796
Speaker 1: need to have contact tracing set up and established and

122
00:07:58,956 --> 00:08:02,236
Speaker 1: robust for when we do all start coming back into

123
00:08:02,636 --> 00:08:05,276
Speaker 1: circulation and moving around, when we get to the bottom

124
00:08:05,276 --> 00:08:08,356
Speaker 1: of our plateau, because we're going to have other waves

125
00:08:08,356 --> 00:08:10,876
Speaker 1: of illness and we need to be able to blunt

126
00:08:10,916 --> 00:08:13,756
Speaker 1: those much more aggressively than we did with this first wave.

127
00:08:14,316 --> 00:08:17,076
Speaker 1: If you have a thousand contact tracers up and doing

128
00:08:17,116 --> 00:08:21,156
Speaker 1: their jobs at their phones, and you have two thousand

129
00:08:21,196 --> 00:08:24,996
Speaker 1: cases in a day, does that ratio work? I mean,

130
00:08:25,036 --> 00:08:28,116
Speaker 1: how long does it take one contact tracer to trace

131
00:08:28,196 --> 00:08:30,596
Speaker 1: all of the contacts of a person? So I think

132
00:08:30,636 --> 00:08:34,316
Speaker 1: the first job is really the case investigation, so they

133
00:08:34,316 --> 00:08:37,196
Speaker 1: speak to the case. I've spoken with some people who

134
00:08:37,236 --> 00:08:39,996
Speaker 1: are working on this now and they say that first

135
00:08:39,996 --> 00:08:43,556
Speaker 1: call can be forty minutes, forty five minutes. Speaking to

136
00:08:43,676 --> 00:08:47,516
Speaker 1: contacts can be shorter. Some contacts don't answer the phone.

137
00:08:48,116 --> 00:08:52,356
Speaker 1: Some contacts immediately say okay, no problem. Others may take

138
00:08:52,396 --> 00:08:56,916
Speaker 1: a little more time. Others may be in difficulties, you know,

139
00:08:56,956 --> 00:08:58,916
Speaker 1: they're worried about their job. They need to be referred

140
00:08:58,916 --> 00:09:02,756
Speaker 1: to social services. It's not a fast task, so that

141
00:09:03,196 --> 00:09:06,916
Speaker 1: I grant you, It is not fast. And how does

142
00:09:06,956 --> 00:09:10,156
Speaker 1: one find people whose phone numbers one doesn't know, or

143
00:09:10,156 --> 00:09:11,716
Speaker 1: whose name is one doesn't know. Do you just have

144
00:09:11,716 --> 00:09:13,236
Speaker 1: to sort of give up on that person you try

145
00:09:13,236 --> 00:09:15,596
Speaker 1: to use some reasonable detective efforts to find them. Yeah,

146
00:09:15,636 --> 00:09:19,996
Speaker 1: I think you know. Again. Contact tracing historically is a

147
00:09:19,996 --> 00:09:24,436
Speaker 1: pretty nuanced activity, and the people who are trained to

148
00:09:24,476 --> 00:09:29,516
Speaker 1: do it in normal public health circumstances are like investigators.

149
00:09:29,516 --> 00:09:33,276
Speaker 1: They're like disease detectives. They tried to understand what's going on.

150
00:09:33,396 --> 00:09:37,596
Speaker 1: They tried to look at how many contacts became sick,

151
00:09:37,636 --> 00:09:40,396
Speaker 1: and so if many of the contacts became sick, you

152
00:09:40,476 --> 00:09:43,876
Speaker 1: might need to do a deeper investigation. It's nuanced, and

153
00:09:43,996 --> 00:09:46,716
Speaker 1: we are in the middle of this massive crisis in

154
00:09:46,756 --> 00:09:52,836
Speaker 1: some ways, you know, trying to adapt what's a thoughtful

155
00:09:52,876 --> 00:09:56,956
Speaker 1: and specialized and very human interaction into perhaps something that

156
00:09:56,996 --> 00:10:00,876
Speaker 1: can happen faster. But yes, one may not know all

157
00:10:00,876 --> 00:10:03,036
Speaker 1: of the people that you were in contact with. If

158
00:10:03,076 --> 00:10:06,316
Speaker 1: you took a bus or a commuter rail, you may

159
00:10:06,316 --> 00:10:08,876
Speaker 1: have been in the same car as someone for twenty minutes.

160
00:10:09,236 --> 00:10:11,516
Speaker 1: You don't know who they are. So there are certainly

161
00:10:11,516 --> 00:10:17,036
Speaker 1: weaknesses in the capacity at this level of scale to

162
00:10:17,196 --> 00:10:20,596
Speaker 1: do it. If we look at say South Korea, who

163
00:10:20,956 --> 00:10:26,556
Speaker 1: had a very successful containment effort. They used many components

164
00:10:26,596 --> 00:10:30,916
Speaker 1: to their contact tracing activities. They looked at closed circuit television,

165
00:10:31,436 --> 00:10:35,676
Speaker 1: they looked at credit card transactions. They had a lot

166
00:10:35,756 --> 00:10:38,476
Speaker 1: of components to their contact tracing, and they had large

167
00:10:38,556 --> 00:10:42,636
Speaker 1: numbers of people doing it. So I think on principle,

168
00:10:43,036 --> 00:10:45,636
Speaker 1: it's clear that it works. And I think the question

169
00:10:45,676 --> 00:10:48,876
Speaker 1: that you're coming back to me with is really is

170
00:10:48,916 --> 00:10:53,076
Speaker 1: this feasible at the scale that we're at. And my

171
00:10:53,636 --> 00:10:56,996
Speaker 1: response to that is, we have to make it feasible,

172
00:10:57,236 --> 00:11:01,076
Speaker 1: because in the absence of a vaccine, in the absence

173
00:11:01,116 --> 00:11:06,036
Speaker 1: of a treatment, if we don't try to expand our

174
00:11:06,076 --> 00:11:09,316
Speaker 1: contact tracing, I don't really see other solutions for us

175
00:11:09,596 --> 00:11:12,356
Speaker 1: for the eyebreak. We'll be back in just a moment.

176
00:11:21,596 --> 00:11:26,236
Speaker 1: You mentioned the obvious appeal of so called digital contact

177
00:11:26,276 --> 00:11:30,196
Speaker 1: tracing or automated depending on what terminology you like better,

178
00:11:30,236 --> 00:11:32,156
Speaker 1: as opposed to the manual or what I would call

179
00:11:32,196 --> 00:11:36,436
Speaker 1: the human form. And South Korea has gotten attention for

180
00:11:36,676 --> 00:11:40,956
Speaker 1: what it's done. Israel has also gotten attention, positive and negative,

181
00:11:41,076 --> 00:11:44,596
Speaker 1: for the fact that it's internal intelligence services. Just told

182
00:11:44,636 --> 00:11:46,716
Speaker 1: everybody one day, by the way we've been tracking where

183
00:11:46,756 --> 00:11:50,196
Speaker 1: you all are on your GPS phone data this entire time,

184
00:11:50,396 --> 00:11:53,196
Speaker 1: and now we're going to put that to COVID. I

185
00:11:53,196 --> 00:11:55,276
Speaker 1: actually know somebody who, as far as she knows, she

186
00:11:55,396 --> 00:11:57,636
Speaker 1: was just in her house and she got a text

187
00:11:57,676 --> 00:12:00,996
Speaker 1: message from the Internal Security Services in Israel saying you've

188
00:12:01,036 --> 00:12:04,116
Speaker 1: been close to somebody who has the virus, and you know,

189
00:12:04,156 --> 00:12:06,716
Speaker 1: she tried to reach some human being to say no,

190
00:12:06,836 --> 00:12:09,436
Speaker 1: I wasn't you know, maybe someone stood outside my housin

191
00:12:09,476 --> 00:12:12,196
Speaker 1: smoked a cigarette, but she wasn't able to reach anybody,

192
00:12:12,236 --> 00:12:16,396
Speaker 1: so she self isolated. So that's a very immediately intrusive

193
00:12:16,396 --> 00:12:19,316
Speaker 1: form of this. My questions about this are really fond

194
00:12:19,396 --> 00:12:23,956
Speaker 1: of two categories. One is can it work? That's question one,

195
00:12:24,076 --> 00:12:26,916
Speaker 1: and then question two will be can it be ethical?

196
00:12:27,436 --> 00:12:31,356
Speaker 1: So I think we see that it can work because

197
00:12:31,516 --> 00:12:38,196
Speaker 1: it has worked. So it worked in South Korea, some

198
00:12:38,236 --> 00:12:41,716
Speaker 1: component of it worked in Wuhan, and actually, from a

199
00:12:41,756 --> 00:12:46,236
Speaker 1: public health perspective, if we could identify every case and

200
00:12:46,916 --> 00:12:50,036
Speaker 1: identify every person who'd been in contact with that case

201
00:12:50,796 --> 00:12:55,516
Speaker 1: and isolate them, we would be able to stop transmission.

202
00:12:56,196 --> 00:13:00,196
Speaker 1: So theoretically it can work, and in practice we've seen

203
00:13:00,396 --> 00:13:03,316
Speaker 1: places being able to implement it, especially at the beginning

204
00:13:03,396 --> 00:13:08,596
Speaker 1: of their eyebreaks. So I do think it's feasible. The

205
00:13:08,716 --> 00:13:14,476
Speaker 1: question is, in terms of technology, what can work Bluetooth.

206
00:13:14,596 --> 00:13:18,716
Speaker 1: I'm learning a lot about. It's very interesting because our phones,

207
00:13:18,836 --> 00:13:22,556
Speaker 1: if they have Bluetooth in it, are emitting Bluetooth signals

208
00:13:22,636 --> 00:13:26,116
Speaker 1: all the time. And the idea that your phone itself

209
00:13:26,356 --> 00:13:30,236
Speaker 1: could identify other phones that you have been around and

210
00:13:30,396 --> 00:13:33,556
Speaker 1: hold that information for some period of time and then

211
00:13:33,676 --> 00:13:38,116
Speaker 1: notify you if and only if another phone gets flagged

212
00:13:38,156 --> 00:13:42,356
Speaker 1: as being infected. It's an interesting opportunity to use a

213
00:13:42,396 --> 00:13:45,436
Speaker 1: piece of technology that already exists, that many of us

214
00:13:45,516 --> 00:13:48,876
Speaker 1: already have. So I think the idea of using Bluetooth

215
00:13:48,916 --> 00:13:53,116
Speaker 1: proximity to try to help discover contacts is a very

216
00:13:53,156 --> 00:13:57,076
Speaker 1: interesting and intriguing idea, And I think we have to

217
00:13:57,116 --> 00:14:01,556
Speaker 1: figure out how it can be used, how accurate it is,

218
00:14:02,156 --> 00:14:05,836
Speaker 1: how many false alarms it might give, how well it

219
00:14:05,916 --> 00:14:08,716
Speaker 1: is at picking up whether you've been within six feet

220
00:14:08,876 --> 00:14:10,596
Speaker 1: or if that's an error, If it can tell if

221
00:14:10,596 --> 00:14:12,396
Speaker 1: there's a wall between your six feed like. There are

222
00:14:12,436 --> 00:14:15,236
Speaker 1: many questions about it, but I do think it's intriguing

223
00:14:15,916 --> 00:14:20,276
Speaker 1: and it's very laborious to do all the manual tracing yourself.

224
00:14:20,676 --> 00:14:23,116
Speaker 1: So I think technology should be able to help us.

225
00:14:24,356 --> 00:14:27,116
Speaker 1: Here's what seems to me to be the biggest challenge

226
00:14:27,116 --> 00:14:30,156
Speaker 1: there in order to do the human contact tracing, the

227
00:14:30,236 --> 00:14:34,036
Speaker 1: manual contact tracing. You said, what triggers the whole thing

228
00:14:34,116 --> 00:14:36,996
Speaker 1: is that the public health authorities are informed that someone

229
00:14:37,076 --> 00:14:39,516
Speaker 1: has had a positive test, and the people who are

230
00:14:39,516 --> 00:14:42,356
Speaker 1: doing the contact tracing are indirectly working for the government.

231
00:14:42,356 --> 00:14:46,516
Speaker 1: And if you're going to connect up the digital data

232
00:14:46,716 --> 00:14:50,116
Speaker 1: to actual human tracing in order to give people the

233
00:14:50,236 --> 00:14:54,676
Speaker 1: support and advice that you need, at some point you're

234
00:14:54,676 --> 00:14:57,636
Speaker 1: going to have to connect the digital data that's been

235
00:14:57,676 --> 00:15:00,436
Speaker 1: gathered to the real human being who is connected to

236
00:15:00,476 --> 00:15:02,836
Speaker 1: the government. And I imagine there are some barriers we

237
00:15:02,876 --> 00:15:06,116
Speaker 1: could put there to maybe keep certain aspects of the

238
00:15:06,196 --> 00:15:08,716
Speaker 1: data from the government. But I think for the ordinary

239
00:15:08,716 --> 00:15:12,116
Speaker 1: person going to think, well, look if my phone tells

240
00:15:12,476 --> 00:15:15,276
Speaker 1: somebody everyone I've seen and what that means where I've been,

241
00:15:15,396 --> 00:15:19,436
Speaker 1: that effectively the government is going to know that. How

242
00:15:19,476 --> 00:15:22,676
Speaker 1: does one begin to think about making people feel safe

243
00:15:22,676 --> 00:15:27,996
Speaker 1: and secure under those circumstances in the normal process. COVID

244
00:15:28,076 --> 00:15:32,876
Speaker 1: nineteen is a notifiable illness Therefore, anyone who runs a

245
00:15:32,916 --> 00:15:37,116
Speaker 1: test a laboratory, who runs the test, they must notify

246
00:15:37,556 --> 00:15:41,716
Speaker 1: the public health authorities of a positive result. So already

247
00:15:42,076 --> 00:15:46,476
Speaker 1: there's a kind of trust given to the state about

248
00:15:46,476 --> 00:15:49,836
Speaker 1: a medical condition. I think many people don't realize that

249
00:15:49,836 --> 00:15:53,916
Speaker 1: that exists. Already. There are notifiable diseases. They've always been

250
00:15:53,956 --> 00:15:58,476
Speaker 1: notifiable diseases that the public health authorities are told about

251
00:15:59,116 --> 00:16:01,276
Speaker 1: with your name, not just that there is a kise. Yes,

252
00:16:03,836 --> 00:16:08,116
Speaker 1: effilment has this problem, and that is what normally triggers

253
00:16:08,796 --> 00:16:13,596
Speaker 1: case investigators and contact tracers for other illnesses, although of

254
00:16:13,636 --> 00:16:16,636
Speaker 1: course they're much more snow moving in general, so it

255
00:16:16,676 --> 00:16:19,436
Speaker 1: happens at a much smaller volume. So no one has

256
00:16:19,476 --> 00:16:22,876
Speaker 1: really heard of contact tracing before. So if in a

257
00:16:22,956 --> 00:16:25,916
Speaker 1: perfect I'm calling it a human system. But of course

258
00:16:25,956 --> 00:16:28,276
Speaker 1: the people who do this for a living keep reminding me,

259
00:16:28,436 --> 00:16:32,796
Speaker 1: like we use software, it's not an unaided human process exactly.

260
00:16:33,076 --> 00:16:36,316
Speaker 1: But if you had a perfect process, there would be

261
00:16:36,356 --> 00:16:41,036
Speaker 1: this huge notebook or database that already did have all

262
00:16:41,076 --> 00:16:44,116
Speaker 1: your contacts and all your information, and we already allow

263
00:16:44,236 --> 00:16:49,436
Speaker 1: that to happen in the public interest because of notifiable infections.

264
00:16:50,156 --> 00:16:53,596
Speaker 1: The interesting thing is that the human ability to do

265
00:16:53,636 --> 00:16:57,396
Speaker 1: that is flawed, and so that massive database is not

266
00:16:57,476 --> 00:17:02,556
Speaker 1: really there. And also in Massachusetts, for example, there are

267
00:17:02,596 --> 00:17:05,396
Speaker 1: three hundred and fifty one boards of health. Those are

268
00:17:05,476 --> 00:17:08,956
Speaker 1: municipal boards of health essentially county and municipal authorities exactly,

269
00:17:09,196 --> 00:17:13,396
Speaker 1: And so there's some decentralization of the process, there's some

270
00:17:13,756 --> 00:17:16,756
Speaker 1: kind of enactment of local authorities to do things. So

271
00:17:16,796 --> 00:17:22,476
Speaker 1: there's not one massive, big data set of where everyone

272
00:17:22,516 --> 00:17:24,276
Speaker 1: has been and who they've been in contact with, but

273
00:17:24,356 --> 00:17:28,076
Speaker 1: in theory there could be. And yet when we propose

274
00:17:28,196 --> 00:17:32,196
Speaker 1: to do that through technology, it does increase I think

275
00:17:32,276 --> 00:17:35,316
Speaker 1: both the power of that creation of a data set,

276
00:17:35,316 --> 00:17:38,836
Speaker 1: which makes us concerned rightly so, and I think it

277
00:17:38,956 --> 00:17:44,996
Speaker 1: also would potentially increase the scale of the data that's available,

278
00:17:44,996 --> 00:17:47,676
Speaker 1: and it would congregate it in a single place potentially,

279
00:17:48,116 --> 00:17:52,876
Speaker 1: and it makes people concerned understandably about having a data

280
00:17:52,876 --> 00:17:57,516
Speaker 1: set that others could access or use. So two people

281
00:17:57,556 --> 00:18:00,596
Speaker 1: who I've been listening very carefully to and learning a

282
00:18:00,596 --> 00:18:05,756
Speaker 1: lot from in the discussion about digital tools, especially bluetooth tools,

283
00:18:05,796 --> 00:18:09,356
Speaker 1: have been a professor Ron Revest and Dannie Weisner, both

284
00:18:09,436 --> 00:18:15,436
Speaker 1: at mit Ron actually created this group which creates a

285
00:18:15,476 --> 00:18:23,196
Speaker 1: protocol a Bluetooth Proximity protocol CULPACKED that would ostensibly always

286
00:18:23,236 --> 00:18:27,476
Speaker 1: have the information remaining on the phone and really only

287
00:18:27,516 --> 00:18:32,956
Speaker 1: allow anonymized information into a centralized cloud. What Apple and

288
00:18:32,996 --> 00:18:38,716
Speaker 1: Google have proposed to do with their operating systems on

289
00:18:38,836 --> 00:18:42,516
Speaker 1: iPhones and androids to as far as I can see,

290
00:18:42,756 --> 00:18:46,836
Speaker 1: is following the recommendations that are in the PACKED protocol

291
00:18:47,396 --> 00:18:51,116
Speaker 1: that Ron has led, and that will maintain a degree

292
00:18:51,276 --> 00:18:57,596
Speaker 1: of privacy for individuals. That seems robust technological solutions, I'm

293
00:18:57,636 --> 00:19:00,276
Speaker 1: sure are part of the answer here, but they will

294
00:19:00,276 --> 00:19:04,116
Speaker 1: also have to be a policy component to it as well,

295
00:19:04,276 --> 00:19:08,916
Speaker 1: especially if we need to ultimately connect the data on

296
00:19:08,956 --> 00:19:12,676
Speaker 1: people's phones about their contact to human tracing. The state

297
00:19:12,716 --> 00:19:15,556
Speaker 1: will have to make a policy decision about that in

298
00:19:15,676 --> 00:19:18,876
Speaker 1: light of the full set of public values and public

299
00:19:18,916 --> 00:19:20,836
Speaker 1: norms and constitutional rules in it. That's going to be

300
00:19:20,876 --> 00:19:26,076
Speaker 1: a tricky moment. Yeah, no single component of addressing the

301
00:19:26,116 --> 00:19:31,196
Speaker 1: pandemic will work on its own. It just won't. Outbreaks

302
00:19:31,236 --> 00:19:38,876
Speaker 1: are complex social phenomena as well as scientific events, so

303
00:19:39,196 --> 00:19:45,756
Speaker 1: we have to have a comprehensive, integrated approach that acknowledges

304
00:19:45,876 --> 00:19:51,516
Speaker 1: that humans don't make rational choices, that the virus is

305
00:19:51,756 --> 00:19:55,236
Speaker 1: brand new and we're still learning about it. That we

306
00:19:55,316 --> 00:19:58,516
Speaker 1: have to test more, that we have to connect testing

307
00:19:58,556 --> 00:20:02,916
Speaker 1: to contact tracing, that some people can't self isolate without support,

308
00:20:03,556 --> 00:20:06,876
Speaker 1: that some people a particularly vulnerable boat to being infected,

309
00:20:07,356 --> 00:20:11,116
Speaker 1: and to the solutions we're proposed here, like the contact racing,

310
00:20:11,556 --> 00:20:15,716
Speaker 1: and that we have to have a smart approach that

311
00:20:16,556 --> 00:20:20,156
Speaker 1: can take care of the most vulnerable people, take care

312
00:20:20,196 --> 00:20:24,356
Speaker 1: of sick people, help other people from getting infected, and

313
00:20:24,476 --> 00:20:28,876
Speaker 1: allow us to start going back into society. Again, no

314
00:20:29,276 --> 00:20:32,636
Speaker 1: one thing is a silver bullet, and it really requires

315
00:20:33,396 --> 00:20:38,476
Speaker 1: strong leadership that has good scientific understanding and that embraces

316
00:20:39,036 --> 00:20:43,156
Speaker 1: the social component of disease as well as just the

317
00:20:43,236 --> 00:20:47,836
Speaker 1: medical component of disease. Sometimes when I'm listening to the

318
00:20:47,836 --> 00:20:52,356
Speaker 1: debates about should we quote unquote reopen things, it starts

319
00:20:52,396 --> 00:20:55,796
Speaker 1: with some people saying no, too dangerous, other people saying

320
00:20:55,796 --> 00:20:58,756
Speaker 1: we must do it, and then comes a sort of

321
00:20:58,836 --> 00:21:03,356
Speaker 1: reasonable voice saying, well, we can reopen once we have

322
00:21:03,756 --> 00:21:09,716
Speaker 1: sufficient testing and sufficient contact tracing and supported isolation, and

323
00:21:09,836 --> 00:21:13,076
Speaker 1: in a kind of Goldilocks way that seems to be,

324
00:21:13,516 --> 00:21:16,956
Speaker 1: you know, the reasonable middle answer. One takeaway from me

325
00:21:17,036 --> 00:21:19,396
Speaker 1: of our conversation is that it actually may not be

326
00:21:19,436 --> 00:21:23,116
Speaker 1: that simple, and that the presence of robust testing and

327
00:21:23,196 --> 00:21:28,756
Speaker 1: robust contact tracing where there's community spread doesn't guarantee successful

328
00:21:28,916 --> 00:21:32,676
Speaker 1: control of the epidemic. Am I hearing you correctly in

329
00:21:32,716 --> 00:21:35,956
Speaker 1: that regard? I think you know so. I'm an infectious

330
00:21:35,956 --> 00:21:39,876
Speaker 1: diseases doctor at Mass Journal Hospital in Boston, and as

331
00:21:39,956 --> 00:21:43,196
Speaker 1: a doctor in the hospital, it's been really terrifying over

332
00:21:43,236 --> 00:21:45,996
Speaker 1: the last few weeks to see our cases going up

333
00:21:46,036 --> 00:21:48,796
Speaker 1: and up and up. So I think that some of

334
00:21:48,836 --> 00:21:53,236
Speaker 1: the hesitancies about reopening, so to speak, are that we

335
00:21:53,316 --> 00:21:58,196
Speaker 1: fear that reopening in a trickle wouldn't really work and

336
00:21:58,276 --> 00:22:02,756
Speaker 1: that we would quickly become overwhelmed. And I think the

337
00:22:02,956 --> 00:22:08,436
Speaker 1: tentativeness over the medical side's capacity to care for sick

338
00:22:08,476 --> 00:22:14,716
Speaker 1: people is really understandably a large part of the hesitancy

339
00:22:15,356 --> 00:22:18,276
Speaker 1: in terms of opening up. I do think if we

340
00:22:18,356 --> 00:22:21,636
Speaker 1: have really widespread testing, but we have to scale up

341
00:22:21,636 --> 00:22:24,676
Speaker 1: testing really a lot, a lot more than we're doing,

342
00:22:25,276 --> 00:22:29,236
Speaker 1: and if we have robust contact tracing in place, we

343
00:22:29,356 --> 00:22:34,236
Speaker 1: could start reopening. The fear is that that brings us

344
00:22:34,276 --> 00:22:37,076
Speaker 1: into a certain amounte of uncertainty, and none of us

345
00:22:37,116 --> 00:22:41,316
Speaker 1: like uncertainty. We're really fearful that our hospitals will be

346
00:22:41,556 --> 00:22:45,276
Speaker 1: overwhelmed and that people will die unnecessarily. And that's a

347
00:22:45,316 --> 00:22:50,076
Speaker 1: scary thought. But at some point, you know, my opinion

348
00:22:50,196 --> 00:22:53,436
Speaker 1: is that we have to make a plan. I think.

349
00:22:53,916 --> 00:22:57,076
Speaker 1: I think the biggest challenge right now is that I

350
00:22:57,116 --> 00:23:00,436
Speaker 1: don't really see the plan. I haven't seen the plan.

351
00:23:02,076 --> 00:23:05,556
Speaker 1: You have you seen the plan? The plan, you know,

352
00:23:05,796 --> 00:23:08,276
Speaker 1: and if you haven't seen it and I haven't seen it,

353
00:23:08,316 --> 00:23:10,836
Speaker 1: there is no plan. I mean, I think, Yeah, there's

354
00:23:10,836 --> 00:23:14,436
Speaker 1: a lot of magical thinking. There's a lot of thought about, well,

355
00:23:14,476 --> 00:23:17,396
Speaker 1: maybe we could hold out until there's a vaccine, but

356
00:23:17,436 --> 00:23:19,076
Speaker 1: there may not be a vaccine. There's a lot of

357
00:23:19,076 --> 00:23:21,236
Speaker 1: thought of we have to hold out until the therapies

358
00:23:21,276 --> 00:23:23,396
Speaker 1: get much better, but we don't have any guarantee that

359
00:23:23,396 --> 00:23:25,916
Speaker 1: the therapies will work. And then the fallback is when

360
00:23:25,916 --> 00:23:28,556
Speaker 1: people say herd immunity in some generic sense, as though

361
00:23:28,556 --> 00:23:32,236
Speaker 1: they knew exactly what that meant. And that's obviously a

362
00:23:32,276 --> 00:23:34,236
Speaker 1: scenario in which you will be very difficult to avoid

363
00:23:34,276 --> 00:23:37,996
Speaker 1: overwhelming the hospital. So I agree with you. So I

364
00:23:38,076 --> 00:23:41,116
Speaker 1: have in my global health career, spent a lot of

365
00:23:41,156 --> 00:23:45,916
Speaker 1: time responding to eyebreaks. You know, none like this but

366
00:23:46,956 --> 00:23:50,836
Speaker 1: in disaster settings, you know, you have to move quickly

367
00:23:51,476 --> 00:23:55,996
Speaker 1: and make decisions in the context of uncertainty. You know,

368
00:23:56,156 --> 00:23:58,956
Speaker 1: in the US we are not as used to doing

369
00:23:58,996 --> 00:24:04,796
Speaker 1: that because we have always really got the resources to

370
00:24:05,116 --> 00:24:07,796
Speaker 1: do the modeling and get the science and wait until

371
00:24:07,836 --> 00:24:11,076
Speaker 1: it's perfect. And I think we have to move ahead

372
00:24:11,996 --> 00:24:16,476
Speaker 1: with making decisions that are imperfect using the best data

373
00:24:16,516 --> 00:24:18,196
Speaker 1: that we have. But we do have to use the

374
00:24:18,276 --> 00:24:21,756
Speaker 1: data that we have. I mean, we have to move forward.

375
00:24:22,556 --> 00:24:26,916
Speaker 1: So you know, technology and other ideas they may seem ambitious,

376
00:24:26,956 --> 00:24:30,316
Speaker 1: contact tracing might seem oh, it's not feasible, it's too many,

377
00:24:30,396 --> 00:24:34,716
Speaker 1: But the way to be successful is just to take

378
00:24:35,036 --> 00:24:39,236
Speaker 1: the next step forward and believe it's possible and keep

379
00:24:39,276 --> 00:24:42,636
Speaker 1: building it as you're doing it. I think that's what

380
00:24:42,796 --> 00:24:46,276
Speaker 1: we have to think about, or else, you know, we're

381
00:24:46,276 --> 00:24:49,476
Speaker 1: just going to be struck. Thank you so much. This

382
00:24:49,636 --> 00:24:52,516
Speaker 1: is tremendously clarifying, and there are bits of it that

383
00:24:52,596 --> 00:24:55,556
Speaker 1: are inspiring and make one think there is a way forward,

384
00:24:55,556 --> 00:24:57,636
Speaker 1: and then there are bits of it that cause one

385
00:24:57,676 --> 00:25:00,636
Speaker 1: to feel a bit more panic. And I really appreciate

386
00:25:00,636 --> 00:25:02,796
Speaker 1: it your honestly about it. Thank you all right, thank

387
00:25:02,796 --> 00:25:07,436
Speaker 1: you Here on deep background. We've spoken to several guests

388
00:25:07,636 --> 00:25:10,836
Speaker 1: who focused on the mechan that we can use gradually

389
00:25:10,836 --> 00:25:13,676
Speaker 1: to emerge from the conditions of social isolation that we're

390
00:25:13,676 --> 00:25:17,356
Speaker 1: presently in. Testing has been a consistent theme that we've

391
00:25:17,396 --> 00:25:20,876
Speaker 1: heard about again and again and again, more and better testing.

392
00:25:21,676 --> 00:25:24,796
Speaker 1: Speaking to doctor Ivers makes it clear that the testing

393
00:25:24,956 --> 00:25:28,436
Speaker 1: is primarily valuable, however, to the extent that it is

394
00:25:28,476 --> 00:25:32,596
Speaker 1: then used to lead to contact tracing, and the idea

395
00:25:32,676 --> 00:25:35,996
Speaker 1: is that contact tracing itself can help manage the disease.

396
00:25:36,836 --> 00:25:39,276
Speaker 1: This may be the only long run strategy that can

397
00:25:39,316 --> 00:25:41,836
Speaker 1: be used in the absence of a vaccine and in

398
00:25:41,876 --> 00:25:45,836
Speaker 1: the absence of better therapies. But contact tracing on its

399
00:25:45,836 --> 00:25:49,396
Speaker 1: own is not a magic bullet. You have to reach

400
00:25:49,556 --> 00:25:52,956
Speaker 1: enough people and that's a challenge. It's also very difficult

401
00:25:52,996 --> 00:25:55,876
Speaker 1: to make contact tracing work in a scenario where as

402
00:25:55,916 --> 00:25:59,116
Speaker 1: we have, the disease has spread into the entire community

403
00:25:59,116 --> 00:26:01,716
Speaker 1: and we're not just tracking down a handful of names.

404
00:26:03,356 --> 00:26:05,676
Speaker 1: Contact tracing is going to be central to our public

405
00:26:05,676 --> 00:26:10,276
Speaker 1: discussion in the weeks and months ahead, its successes, its limitations,

406
00:26:10,396 --> 00:26:13,076
Speaker 1: and the challenges that it faces. We will keep a

407
00:26:13,076 --> 00:26:15,996
Speaker 1: close eye on this subject going forward and come back

408
00:26:15,996 --> 00:26:19,236
Speaker 1: to you with more about contact tracing as this story develops.

409
00:26:20,236 --> 00:26:23,516
Speaker 1: Until I speak to you next time, Be careful, be safe,

410
00:26:23,756 --> 00:26:27,236
Speaker 1: and be well. Deep Background is brought to you by

411
00:26:27,316 --> 00:26:31,276
Speaker 1: Pushkin Industries. Our producer is Lydia gene Coott, with research

412
00:26:31,316 --> 00:26:34,876
Speaker 1: help from zooe Wynn. Mastering is by Jason Gambrell and

413
00:26:34,916 --> 00:26:38,876
Speaker 1: Martin Gonzalez. Our showrunner is Sophie mckibbon. Our theme music

414
00:26:38,956 --> 00:26:42,316
Speaker 1: is composed by Luis GERA special thanks to the Pushkin Brass,

415
00:26:42,596 --> 00:26:46,516
Speaker 1: Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feldman.

416
00:26:46,956 --> 00:26:49,676
Speaker 1: I also write a regular column from Bloomberg Opinion, which

417
00:26:49,676 --> 00:26:52,956
Speaker 1: you can find at Bloomberg dot com slash Feldman. To

418
00:26:53,036 --> 00:26:56,596
Speaker 1: discover Bloomberg's original slate of podcasts, go to Bloomberg dot

419
00:26:56,636 --> 00:27:00,356
Speaker 1: com slash Podcasts. You can follow me on Twitter at

420
00:27:00,436 --> 00:27:03,556
Speaker 1: Noah R. Feldman. This is Deep Background.