WEBVTT - A New Strategy in the Fight Against COVID-19 0:00:15.396 --> 0:00:22.196 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.236 --> 0:00:25.676 where we explore the stories behind the stories in the news. 0:00:26.196 --> 0:00:30.476 I'm Noah Feldman. The CDC, also known as the Centers 0:00:30.516 --> 0:00:33.956 for Disease Control and Prevention, has been emphasizing that a 0:00:33.996 --> 0:00:37.276 strategy called contact tracing is going to be essential to 0:00:37.316 --> 0:00:41.356 reopening the country. Here's Robert Redfield, the head of the CDC, 0:00:41.876 --> 0:00:44.596 speaking at a White House press conference earlier this month. 0:00:44.996 --> 0:00:51.516 We're going to be very aggressively focused on early case recognition, isolation, 0:00:51.556 --> 0:00:55.436 and contact tracing. Contact tracing is the process of identifying 0:00:55.476 --> 0:00:58.596 people who've come into contact with an infected person and 0:00:58.676 --> 0:01:01.596 alerting them so that they can get tested and isolate 0:01:01.636 --> 0:01:05.796 themselves to slow the spread of the disease. This is 0:01:05.796 --> 0:01:08.076 a job that has traditionally been done by public health 0:01:08.076 --> 0:01:13.396 workers in several countries around the world, including Singapore, South Korea. 0:01:13.596 --> 0:01:16.716 Much contact tracing was done digitally with the help of 0:01:16.796 --> 0:01:20.836 apps the people downloaded onto their phones. To learn more 0:01:20.876 --> 0:01:23.996 about contact tracing, how it works, what it's good for, 0:01:24.116 --> 0:01:27.676 and what the challenges are facing contact tracing. We're joined 0:01:27.676 --> 0:01:31.556 by doctor Louise Iverse. She's the executive director of the 0:01:31.596 --> 0:01:35.596 Massachusetts General Center for Global Health at the Massachusetts General 0:01:35.636 --> 0:01:39.156 Hospital in Boston. She's a doctor who specializes in infectious 0:01:39.196 --> 0:01:42.836 disease and IT outbreaks, and she's been thinking very deeply 0:01:42.956 --> 0:01:46.436 about that question. Louise, thank you for being here. I 0:01:46.476 --> 0:01:48.996 wonder if you could start by just explaining to us 0:01:48.996 --> 0:01:51.836 contact tracing one oh one, what is it? And then 0:01:51.836 --> 0:01:55.716 we'll move to what's it for. So contact tracing is 0:01:56.236 --> 0:02:03.156 basically identifying and then isolating people who have been exposed 0:02:03.196 --> 0:02:07.636 to an infectious disease. And the idea is that by 0:02:07.676 --> 0:02:11.636 isolating those people who been exposed, you can interrupt the 0:02:11.716 --> 0:02:17.436 chains of transmission and in good quality contact tracing. Explain 0:02:17.476 --> 0:02:19.716 to me what the mechanics are. First we discover that 0:02:20.076 --> 0:02:23.676 person X call M Noah has been exposed to the 0:02:23.756 --> 0:02:28.316 virus and is infectious. Then what happens. So the first 0:02:28.356 --> 0:02:32.356 step is identifying what we call an index case. So 0:02:32.476 --> 0:02:35.516 an index case is a person who is confirmed to 0:02:35.556 --> 0:02:39.236 have the illness in this situation COVID nineteen. So let's 0:02:39.276 --> 0:02:43.756 say you have a positive COVID nineteen test. Then that 0:02:43.836 --> 0:02:48.316 triggers a notification to the public health authorities. So then 0:02:48.356 --> 0:02:52.356 what they do is call you up and speak with 0:02:52.396 --> 0:02:56.756 you and try to motivationally interview you to remember where 0:02:56.796 --> 0:03:00.476 you've been, who you've been in contact with. For COVID nineteen, 0:03:00.596 --> 0:03:05.636 we think especially about being with someone within about six 0:03:05.676 --> 0:03:09.436 feet of distance physically for about ten or fifteen minutes more. 0:03:09.996 --> 0:03:12.516 And we make a list of all your contacts, and 0:03:12.556 --> 0:03:16.116 then we set about communicating with those people who are 0:03:16.196 --> 0:03:20.036 contacts and giving them particular pieces of advice. You might 0:03:20.276 --> 0:03:23.436 offer contacts a test. You certainly want to know if 0:03:23.516 --> 0:03:27.116 any contact is already having symptoms, because they might actually 0:03:27.156 --> 0:03:29.276 become a case. Then if you have symptoms and a 0:03:29.276 --> 0:03:33.316 positive test, you become a case. You definitely want those 0:03:33.356 --> 0:03:39.356 folks to quarantine. And you know, many people are not 0:03:39.396 --> 0:03:42.916 in a position to easily self isolate, so many people 0:03:42.996 --> 0:03:47.116 talk about supported isolation or supported quarantine. You know, where 0:03:47.156 --> 0:03:50.996 you investigate in speaking with the contact what their barriers 0:03:51.036 --> 0:03:53.276 are to being able to stay home for two weeks. 0:03:53.276 --> 0:03:56.276 So that's kind of the process. And why does that 0:03:56.396 --> 0:03:59.356 not very quickly spiral to enormous numbers. I mean, I 0:03:59.396 --> 0:04:02.476 can understand that under social distancing it might not spiral 0:04:02.516 --> 0:04:04.556 that much because I'm not sure I've actually been in 0:04:04.596 --> 0:04:07.076 contact that much with anybody except from my kids. But 0:04:07.156 --> 0:04:09.356 if I had been out and about because there wasn't 0:04:09.396 --> 0:04:12.316 social distancing, there would presumably be many people, and then 0:04:12.356 --> 0:04:14.076 that would lead to many other people and the tree 0:04:14.116 --> 0:04:17.956 would grow very, very rapidly. So how is this doable 0:04:18.196 --> 0:04:22.396 in a non socially distanced environment. I mean, you just 0:04:22.676 --> 0:04:28.236 perfectly described the pandemic, you know, because that's exactly why 0:04:28.396 --> 0:04:32.676 there's exponential spread, is because every person potentially infects other people. 0:04:33.036 --> 0:04:37.116 So you're totally right. Contact tracing is a big task. 0:04:37.756 --> 0:04:42.156 It quickly becomes very many people, and you are essentially 0:04:42.196 --> 0:04:46.276 trying to chase ahead of the speed of the virus 0:04:46.516 --> 0:04:52.796 and at least take out of circulation enough people so 0:04:52.836 --> 0:04:55.876 that they don't go on to contribute to that exponential spread. 0:04:56.036 --> 0:04:58.876 So it is a very very big task. It is 0:04:59.116 --> 0:05:02.436 certainly normally in public health what we try to do 0:05:02.556 --> 0:05:06.676 at the beginning of epidemics, and so there's certainly debate 0:05:06.756 --> 0:05:11.396 at the moment in Massachusetts, say about how helpful it 0:05:11.476 --> 0:05:14.916 is to be trying to do contact tracing. I do 0:05:15.036 --> 0:05:21.516 think that the human capacity to do it gets quickly stretched. 0:05:21.916 --> 0:05:24.876 If we had over two thousand positive cases and new 0:05:24.996 --> 0:05:28.516 positive cases in Massachusetts yesterday and the same amount the 0:05:28.596 --> 0:05:32.676 day before you quickly get into the number of contacts. 0:05:32.676 --> 0:05:35.916 It's very, very many. And this is why I personally 0:05:36.076 --> 0:05:39.836 became interested in the idea that technology should be able 0:05:39.876 --> 0:05:43.956 to somehow help us in trying to deal with this 0:05:44.036 --> 0:05:47.636 huge task. In a place like Massachusetts is a good 0:05:47.636 --> 0:05:50.756 example where we both are, where there's already what you 0:05:50.836 --> 0:05:55.436 epidemiologists call community spread. What would the scale of contact 0:05:55.436 --> 0:05:58.436 tracing have to be actually to use it to beat 0:05:58.476 --> 0:06:01.276 the virus down? Has that ever been done? I mean, obviously, 0:06:01.316 --> 0:06:03.316 contact tracing has been used successfully as it was in 0:06:03.316 --> 0:06:05.716 South Korea to help control the virus, but only a 0:06:05.716 --> 0:06:08.196 few people have it. But are there any examples in 0:06:08.236 --> 0:06:11.036 the world where contact tracing has been used to knock 0:06:11.076 --> 0:06:14.876 back community spread? I think you could look at Ebola 0:06:14.956 --> 0:06:19.316 virus disease as a example of a very frightening illness 0:06:20.076 --> 0:06:23.076 with a much higher mortality rate that we're seeing for 0:06:23.116 --> 0:06:29.556 COVID nineteen, where contact tracing has essentially been a major 0:06:29.636 --> 0:06:33.156 contributor to ending the outbreak. Certainly in the twenty fourteen 0:06:33.236 --> 0:06:37.796 twenty fifteen outbreak in West Africa before there was a vaccine. 0:06:38.436 --> 0:06:41.476 They're very different diseases, so I'm not trying to say 0:06:41.556 --> 0:06:44.676 that they are transmitted the same way. But the question 0:06:44.716 --> 0:06:49.716 for COVID nineteen is if we don't try to contain 0:06:49.876 --> 0:06:55.916 the virus, what is our alternative. We don't have a treatment, 0:06:56.756 --> 0:07:00.476 we don't have a prevention, a vaccine. I think from 0:07:00.476 --> 0:07:04.356 the perspective of public health folks, if we don't try 0:07:04.396 --> 0:07:07.116 to do contact racing, we're just kind of sitting back 0:07:07.156 --> 0:07:10.716 to say, well, it escaped and there's nothing we can do. 0:07:10.756 --> 0:07:12.836 We just have to wait. So I think when you 0:07:12.876 --> 0:07:15.836 look at the numbers in the United States and certainly Massachusetts, 0:07:15.876 --> 0:07:19.796 it just seem overwhelming. But basically, the two features around 0:07:19.796 --> 0:07:22.996 contact tracing that are important are you have to be fast, 0:07:23.716 --> 0:07:26.476 because you need to identify the contacts and put them 0:07:26.476 --> 0:07:29.796 in isolation quickly, and then you have to have good 0:07:29.876 --> 0:07:33.436 quality testing. So if you have an accurate test that's widespread, 0:07:33.836 --> 0:07:37.836 and you have contact tracing that's fast, then you could 0:07:37.876 --> 0:07:41.276 be successful. You know, Massachusetts just hired or is in 0:07:41.316 --> 0:07:44.596 the process of hiring a thousand people to work on 0:07:44.676 --> 0:07:48.316 contact tracing, and I think that's a big start. I 0:07:48.356 --> 0:07:51.316 think even if we don't really believe that it's possible 0:07:51.396 --> 0:07:55.276 right now at the peak of our epidemics, we definitely 0:07:55.316 --> 0:07:58.796 need to have contact tracing set up and established and 0:07:58.956 --> 0:08:02.236 robust for when we do all start coming back into 0:08:02.636 --> 0:08:05.276 circulation and moving around, when we get to the bottom 0:08:05.276 --> 0:08:08.356 of our plateau, because we're going to have other waves 0:08:08.356 --> 0:08:10.876 of illness and we need to be able to blunt 0:08:10.916 --> 0:08:13.756 those much more aggressively than we did with this first wave. 0:08:14.316 --> 0:08:17.076 If you have a thousand contact tracers up and doing 0:08:17.116 --> 0:08:21.156 their jobs at their phones, and you have two thousand 0:08:21.196 --> 0:08:24.996 cases in a day, does that ratio work? I mean, 0:08:25.036 --> 0:08:28.116 how long does it take one contact tracer to trace 0:08:28.196 --> 0:08:30.596 all of the contacts of a person? So I think 0:08:30.636 --> 0:08:34.316 the first job is really the case investigation, so they 0:08:34.316 --> 0:08:37.196 speak to the case. I've spoken with some people who 0:08:37.236 --> 0:08:39.996 are working on this now and they say that first 0:08:39.996 --> 0:08:43.556 call can be forty minutes, forty five minutes. Speaking to 0:08:43.676 --> 0:08:47.516 contacts can be shorter. Some contacts don't answer the phone. 0:08:48.116 --> 0:08:52.356 Some contacts immediately say okay, no problem. Others may take 0:08:52.396 --> 0:08:56.916 a little more time. Others may be in difficulties, you know, 0:08:56.956 --> 0:08:58.916 they're worried about their job. They need to be referred 0:08:58.916 --> 0:09:02.756 to social services. It's not a fast task, so that 0:09:03.196 --> 0:09:06.916 I grant you, It is not fast. And how does 0:09:06.956 --> 0:09:10.156 one find people whose phone numbers one doesn't know, or 0:09:10.156 --> 0:09:11.716 whose name is one doesn't know. Do you just have 0:09:11.716 --> 0:09:13.236 to sort of give up on that person you try 0:09:13.236 --> 0:09:15.596 to use some reasonable detective efforts to find them. Yeah, 0:09:15.636 --> 0:09:19.996 I think you know. Again. Contact tracing historically is a 0:09:19.996 --> 0:09:24.436 pretty nuanced activity, and the people who are trained to 0:09:24.476 --> 0:09:29.516 do it in normal public health circumstances are like investigators. 0:09:29.516 --> 0:09:33.276 They're like disease detectives. They tried to understand what's going on. 0:09:33.396 --> 0:09:37.596 They tried to look at how many contacts became sick, 0:09:37.636 --> 0:09:40.396 and so if many of the contacts became sick, you 0:09:40.476 --> 0:09:43.876 might need to do a deeper investigation. It's nuanced, and 0:09:43.996 --> 0:09:46.716 we are in the middle of this massive crisis in 0:09:46.756 --> 0:09:52.836 some ways, you know, trying to adapt what's a thoughtful 0:09:52.876 --> 0:09:56.956 and specialized and very human interaction into perhaps something that 0:09:56.996 --> 0:10:00.876 can happen faster. But yes, one may not know all 0:10:00.876 --> 0:10:03.036 of the people that you were in contact with. If 0:10:03.076 --> 0:10:06.316 you took a bus or a commuter rail, you may 0:10:06.316 --> 0:10:08.876 have been in the same car as someone for twenty minutes. 0:10:09.236 --> 0:10:11.516 You don't know who they are. So there are certainly 0:10:11.516 --> 0:10:17.036 weaknesses in the capacity at this level of scale to 0:10:17.196 --> 0:10:20.596 do it. If we look at say South Korea, who 0:10:20.956 --> 0:10:26.556 had a very successful containment effort. They used many components 0:10:26.596 --> 0:10:30.916 to their contact tracing activities. They looked at closed circuit television, 0:10:31.436 --> 0:10:35.676 they looked at credit card transactions. They had a lot 0:10:35.756 --> 0:10:38.476 of components to their contact tracing, and they had large 0:10:38.556 --> 0:10:42.636 numbers of people doing it. So I think on principle, 0:10:43.036 --> 0:10:45.636 it's clear that it works. And I think the question 0:10:45.676 --> 0:10:48.876 that you're coming back to me with is really is 0:10:48.916 --> 0:10:53.076 this feasible at the scale that we're at. And my 0:10:53.636 --> 0:10:56.996 response to that is, we have to make it feasible, 0:10:57.236 --> 0:11:01.076 because in the absence of a vaccine, in the absence 0:11:01.116 --> 0:11:06.036 of a treatment, if we don't try to expand our 0:11:06.076 --> 0:11:09.316 contact tracing, I don't really see other solutions for us 0:11:09.596 --> 0:11:12.356 for the eyebreak. We'll be back in just a moment. 0:11:21.596 --> 0:11:26.236 You mentioned the obvious appeal of so called digital contact 0:11:26.276 --> 0:11:30.196 tracing or automated depending on what terminology you like better, 0:11:30.236 --> 0:11:32.156 as opposed to the manual or what I would call 0:11:32.196 --> 0:11:36.436 the human form. And South Korea has gotten attention for 0:11:36.676 --> 0:11:40.956 what it's done. Israel has also gotten attention, positive and negative, 0:11:41.076 --> 0:11:44.596 for the fact that it's internal intelligence services. Just told 0:11:44.636 --> 0:11:46.716 everybody one day, by the way we've been tracking where 0:11:46.756 --> 0:11:50.196 you all are on your GPS phone data this entire time, 0:11:50.396 --> 0:11:53.196 and now we're going to put that to COVID. I 0:11:53.196 --> 0:11:55.276 actually know somebody who, as far as she knows, she 0:11:55.396 --> 0:11:57.636 was just in her house and she got a text 0:11:57.676 --> 0:12:00.996 message from the Internal Security Services in Israel saying you've 0:12:01.036 --> 0:12:04.116 been close to somebody who has the virus, and you know, 0:12:04.156 --> 0:12:06.716 she tried to reach some human being to say no, 0:12:06.836 --> 0:12:09.436 I wasn't you know, maybe someone stood outside my housin 0:12:09.476 --> 0:12:12.196 smoked a cigarette, but she wasn't able to reach anybody, 0:12:12.236 --> 0:12:16.396 so she self isolated. So that's a very immediately intrusive 0:12:16.396 --> 0:12:19.316 form of this. My questions about this are really fond 0:12:19.396 --> 0:12:23.956 of two categories. One is can it work? That's question one, 0:12:24.076 --> 0:12:26.916 and then question two will be can it be ethical? 0:12:27.436 --> 0:12:31.356 So I think we see that it can work because 0:12:31.516 --> 0:12:38.196 it has worked. So it worked in South Korea, some 0:12:38.236 --> 0:12:41.716 component of it worked in Wuhan, and actually, from a 0:12:41.756 --> 0:12:46.236 public health perspective, if we could identify every case and 0:12:46.916 --> 0:12:50.036 identify every person who'd been in contact with that case 0:12:50.796 --> 0:12:55.516 and isolate them, we would be able to stop transmission. 0:12:56.196 --> 0:13:00.196 So theoretically it can work, and in practice we've seen 0:13:00.396 --> 0:13:03.316 places being able to implement it, especially at the beginning 0:13:03.396 --> 0:13:08.596 of their eyebreaks. So I do think it's feasible. The 0:13:08.716 --> 0:13:14.476 question is, in terms of technology, what can work Bluetooth. 0:13:14.596 --> 0:13:18.716 I'm learning a lot about. It's very interesting because our phones, 0:13:18.836 --> 0:13:22.556 if they have Bluetooth in it, are emitting Bluetooth signals 0:13:22.636 --> 0:13:26.116 all the time. And the idea that your phone itself 0:13:26.356 --> 0:13:30.236 could identify other phones that you have been around and 0:13:30.396 --> 0:13:33.556 hold that information for some period of time and then 0:13:33.676 --> 0:13:38.116 notify you if and only if another phone gets flagged 0:13:38.156 --> 0:13:42.356 as being infected. It's an interesting opportunity to use a 0:13:42.396 --> 0:13:45.436 piece of technology that already exists, that many of us 0:13:45.516 --> 0:13:48.876 already have. So I think the idea of using Bluetooth 0:13:48.916 --> 0:13:53.116 proximity to try to help discover contacts is a very 0:13:53.156 --> 0:13:57.076 interesting and intriguing idea, And I think we have to 0:13:57.116 --> 0:14:01.556 figure out how it can be used, how accurate it is, 0:14:02.156 --> 0:14:05.836 how many false alarms it might give, how well it 0:14:05.916 --> 0:14:08.716 is at picking up whether you've been within six feet 0:14:08.876 --> 0:14:10.596 or if that's an error, If it can tell if 0:14:10.596 --> 0:14:12.396 there's a wall between your six feed like. There are 0:14:12.436 --> 0:14:15.236 many questions about it, but I do think it's intriguing 0:14:15.916 --> 0:14:20.276 and it's very laborious to do all the manual tracing yourself. 0:14:20.676 --> 0:14:23.116 So I think technology should be able to help us. 0:14:24.356 --> 0:14:27.116 Here's what seems to me to be the biggest challenge 0:14:27.116 --> 0:14:30.156 there in order to do the human contact tracing, the 0:14:30.236 --> 0:14:34.036 manual contact tracing. You said, what triggers the whole thing 0:14:34.116 --> 0:14:36.996 is that the public health authorities are informed that someone 0:14:37.076 --> 0:14:39.516 has had a positive test, and the people who are 0:14:39.516 --> 0:14:42.356 doing the contact tracing are indirectly working for the government. 0:14:42.356 --> 0:14:46.516 And if you're going to connect up the digital data 0:14:46.716 --> 0:14:50.116 to actual human tracing in order to give people the 0:14:50.236 --> 0:14:54.676 support and advice that you need, at some point you're 0:14:54.676 --> 0:14:57.636 going to have to connect the digital data that's been 0:14:57.676 --> 0:15:00.436 gathered to the real human being who is connected to 0:15:00.476 --> 0:15:02.836 the government. And I imagine there are some barriers we 0:15:02.876 --> 0:15:06.116 could put there to maybe keep certain aspects of the 0:15:06.196 --> 0:15:08.716 data from the government. But I think for the ordinary 0:15:08.716 --> 0:15:12.116 person going to think, well, look if my phone tells 0:15:12.476 --> 0:15:15.276 somebody everyone I've seen and what that means where I've been, 0:15:15.396 --> 0:15:19.436 that effectively the government is going to know that. How 0:15:19.476 --> 0:15:22.676 does one begin to think about making people feel safe 0:15:22.676 --> 0:15:27.996 and secure under those circumstances in the normal process. COVID 0:15:28.076 --> 0:15:32.876 nineteen is a notifiable illness Therefore, anyone who runs a 0:15:32.916 --> 0:15:37.116 test a laboratory, who runs the test, they must notify 0:15:37.556 --> 0:15:41.716 the public health authorities of a positive result. So already 0:15:42.076 --> 0:15:46.476 there's a kind of trust given to the state about 0:15:46.476 --> 0:15:49.836 a medical condition. I think many people don't realize that 0:15:49.836 --> 0:15:53.916 that exists. Already. There are notifiable diseases. They've always been 0:15:53.956 --> 0:15:58.476 notifiable diseases that the public health authorities are told about 0:15:59.116 --> 0:16:01.276 with your name, not just that there is a kise. Yes, 0:16:03.836 --> 0:16:08.116 effilment has this problem, and that is what normally triggers 0:16:08.796 --> 0:16:13.596 case investigators and contact tracers for other illnesses, although of 0:16:13.636 --> 0:16:16.636 course they're much more snow moving in general, so it 0:16:16.676 --> 0:16:19.436 happens at a much smaller volume. So no one has 0:16:19.476 --> 0:16:22.876 really heard of contact tracing before. So if in a 0:16:22.956 --> 0:16:25.916 perfect I'm calling it a human system. But of course 0:16:25.956 --> 0:16:28.276 the people who do this for a living keep reminding me, 0:16:28.436 --> 0:16:32.796 like we use software, it's not an unaided human process exactly. 0:16:33.076 --> 0:16:36.316 But if you had a perfect process, there would be 0:16:36.356 --> 0:16:41.036 this huge notebook or database that already did have all 0:16:41.076 --> 0:16:44.116 your contacts and all your information, and we already allow 0:16:44.236 --> 0:16:49.436 that to happen in the public interest because of notifiable infections. 0:16:50.156 --> 0:16:53.596 The interesting thing is that the human ability to do 0:16:53.636 --> 0:16:57.396 that is flawed, and so that massive database is not 0:16:57.476 --> 0:17:02.556 really there. And also in Massachusetts, for example, there are 0:17:02.596 --> 0:17:05.396 three hundred and fifty one boards of health. Those are 0:17:05.476 --> 0:17:08.956 municipal boards of health essentially county and municipal authorities exactly, 0:17:09.196 --> 0:17:13.396 And so there's some decentralization of the process, there's some 0:17:13.756 --> 0:17:16.756 kind of enactment of local authorities to do things. So 0:17:16.796 --> 0:17:22.476 there's not one massive, big data set of where everyone 0:17:22.516 --> 0:17:24.276 has been and who they've been in contact with, but 0:17:24.356 --> 0:17:28.076 in theory there could be. And yet when we propose 0:17:28.196 --> 0:17:32.196 to do that through technology, it does increase I think 0:17:32.276 --> 0:17:35.316 both the power of that creation of a data set, 0:17:35.316 --> 0:17:38.836 which makes us concerned rightly so, and I think it 0:17:38.956 --> 0:17:44.996 also would potentially increase the scale of the data that's available, 0:17:44.996 --> 0:17:47.676 and it would congregate it in a single place potentially, 0:17:48.116 --> 0:17:52.876 and it makes people concerned understandably about having a data 0:17:52.876 --> 0:17:57.516 set that others could access or use. So two people 0:17:57.556 --> 0:18:00.596 who I've been listening very carefully to and learning a 0:18:00.596 --> 0:18:05.756 lot from in the discussion about digital tools, especially bluetooth tools, 0:18:05.796 --> 0:18:09.356 have been a professor Ron Revest and Dannie Weisner, both 0:18:09.436 --> 0:18:15.436 at mit Ron actually created this group which creates a 0:18:15.476 --> 0:18:23.196 protocol a Bluetooth Proximity protocol CULPACKED that would ostensibly always 0:18:23.236 --> 0:18:27.476 have the information remaining on the phone and really only 0:18:27.516 --> 0:18:32.956 allow anonymized information into a centralized cloud. What Apple and 0:18:32.996 --> 0:18:38.716 Google have proposed to do with their operating systems on 0:18:38.836 --> 0:18:42.516 iPhones and androids to as far as I can see, 0:18:42.756 --> 0:18:46.836 is following the recommendations that are in the PACKED protocol 0:18:47.396 --> 0:18:51.116 that Ron has led, and that will maintain a degree 0:18:51.276 --> 0:18:57.596 of privacy for individuals. That seems robust technological solutions, I'm 0:18:57.636 --> 0:19:00.276 sure are part of the answer here, but they will 0:19:00.276 --> 0:19:04.116 also have to be a policy component to it as well, 0:19:04.276 --> 0:19:08.916 especially if we need to ultimately connect the data on 0:19:08.956 --> 0:19:12.676 people's phones about their contact to human tracing. The state 0:19:12.716 --> 0:19:15.556 will have to make a policy decision about that in 0:19:15.676 --> 0:19:18.876 light of the full set of public values and public 0:19:18.916 --> 0:19:20.836 norms and constitutional rules in it. That's going to be 0:19:20.876 --> 0:19:26.076 a tricky moment. Yeah, no single component of addressing the 0:19:26.116 --> 0:19:31.196 pandemic will work on its own. It just won't. Outbreaks 0:19:31.236 --> 0:19:38.876 are complex social phenomena as well as scientific events, so 0:19:39.196 --> 0:19:45.756 we have to have a comprehensive, integrated approach that acknowledges 0:19:45.876 --> 0:19:51.516 that humans don't make rational choices, that the virus is 0:19:51.756 --> 0:19:55.236 brand new and we're still learning about it. That we 0:19:55.316 --> 0:19:58.516 have to test more, that we have to connect testing 0:19:58.556 --> 0:20:02.916 to contact tracing, that some people can't self isolate without support, 0:20:03.556 --> 0:20:06.876 that some people a particularly vulnerable boat to being infected, 0:20:07.356 --> 0:20:11.116 and to the solutions we're proposed here, like the contact racing, 0:20:11.556 --> 0:20:15.716 and that we have to have a smart approach that 0:20:16.556 --> 0:20:20.156 can take care of the most vulnerable people, take care 0:20:20.196 --> 0:20:24.356 of sick people, help other people from getting infected, and 0:20:24.476 --> 0:20:28.876 allow us to start going back into society. Again, no 0:20:29.276 --> 0:20:32.636 one thing is a silver bullet, and it really requires 0:20:33.396 --> 0:20:38.476 strong leadership that has good scientific understanding and that embraces 0:20:39.036 --> 0:20:43.156 the social component of disease as well as just the 0:20:43.236 --> 0:20:47.836 medical component of disease. Sometimes when I'm listening to the 0:20:47.836 --> 0:20:52.356 debates about should we quote unquote reopen things, it starts 0:20:52.396 --> 0:20:55.796 with some people saying no, too dangerous, other people saying 0:20:55.796 --> 0:20:58.756 we must do it, and then comes a sort of 0:20:58.836 --> 0:21:03.356 reasonable voice saying, well, we can reopen once we have 0:21:03.756 --> 0:21:09.716 sufficient testing and sufficient contact tracing and supported isolation, and 0:21:09.836 --> 0:21:13.076 in a kind of Goldilocks way that seems to be, 0:21:13.516 --> 0:21:16.956 you know, the reasonable middle answer. One takeaway from me 0:21:17.036 --> 0:21:19.396 of our conversation is that it actually may not be 0:21:19.436 --> 0:21:23.116 that simple, and that the presence of robust testing and 0:21:23.196 --> 0:21:28.756 robust contact tracing where there's community spread doesn't guarantee successful 0:21:28.916 --> 0:21:32.676 control of the epidemic. Am I hearing you correctly in 0:21:32.716 --> 0:21:35.956 that regard? I think you know so. I'm an infectious 0:21:35.956 --> 0:21:39.876 diseases doctor at Mass Journal Hospital in Boston, and as 0:21:39.956 --> 0:21:43.196 a doctor in the hospital, it's been really terrifying over 0:21:43.236 --> 0:21:45.996 the last few weeks to see our cases going up 0:21:46.036 --> 0:21:48.796 and up and up. So I think that some of 0:21:48.836 --> 0:21:53.236 the hesitancies about reopening, so to speak, are that we 0:21:53.316 --> 0:21:58.196 fear that reopening in a trickle wouldn't really work and 0:21:58.276 --> 0:22:02.756 that we would quickly become overwhelmed. And I think the 0:22:02.956 --> 0:22:08.436 tentativeness over the medical side's capacity to care for sick 0:22:08.476 --> 0:22:14.716 people is really understandably a large part of the hesitancy 0:22:15.356 --> 0:22:18.276 in terms of opening up. I do think if we 0:22:18.356 --> 0:22:21.636 have really widespread testing, but we have to scale up 0:22:21.636 --> 0:22:24.676 testing really a lot, a lot more than we're doing, 0:22:25.276 --> 0:22:29.236 and if we have robust contact tracing in place, we 0:22:29.356 --> 0:22:34.236 could start reopening. The fear is that that brings us 0:22:34.276 --> 0:22:37.076 into a certain amounte of uncertainty, and none of us 0:22:37.116 --> 0:22:41.316 like uncertainty. We're really fearful that our hospitals will be 0:22:41.556 --> 0:22:45.276 overwhelmed and that people will die unnecessarily. And that's a 0:22:45.316 --> 0:22:50.076 scary thought. But at some point, you know, my opinion 0:22:50.196 --> 0:22:53.436 is that we have to make a plan. I think. 0:22:53.916 --> 0:22:57.076 I think the biggest challenge right now is that I 0:22:57.116 --> 0:23:00.436 don't really see the plan. I haven't seen the plan. 0:23:02.076 --> 0:23:05.556 You have you seen the plan? The plan, you know, 0:23:05.796 --> 0:23:08.276 and if you haven't seen it and I haven't seen it, 0:23:08.316 --> 0:23:10.836 there is no plan. I mean, I think, Yeah, there's 0:23:10.836 --> 0:23:14.436 a lot of magical thinking. There's a lot of thought about, well, 0:23:14.476 --> 0:23:17.396 maybe we could hold out until there's a vaccine, but 0:23:17.436 --> 0:23:19.076 there may not be a vaccine. There's a lot of 0:23:19.076 --> 0:23:21.236 thought of we have to hold out until the therapies 0:23:21.276 --> 0:23:23.396 get much better, but we don't have any guarantee that 0:23:23.396 --> 0:23:25.916 the therapies will work. And then the fallback is when 0:23:25.916 --> 0:23:28.556 people say herd immunity in some generic sense, as though 0:23:28.556 --> 0:23:32.236 they knew exactly what that meant. And that's obviously a 0:23:32.276 --> 0:23:34.236 scenario in which you will be very difficult to avoid 0:23:34.276 --> 0:23:37.996 overwhelming the hospital. So I agree with you. So I 0:23:38.076 --> 0:23:41.116 have in my global health career, spent a lot of 0:23:41.156 --> 0:23:45.916 time responding to eyebreaks. You know, none like this but 0:23:46.956 --> 0:23:50.836 in disaster settings, you know, you have to move quickly 0:23:51.476 --> 0:23:55.996 and make decisions in the context of uncertainty. You know, 0:23:56.156 --> 0:23:58.956 in the US we are not as used to doing 0:23:58.996 --> 0:24:04.796 that because we have always really got the resources to 0:24:05.116 --> 0:24:07.796 do the modeling and get the science and wait until 0:24:07.836 --> 0:24:11.076 it's perfect. And I think we have to move ahead 0:24:11.996 --> 0:24:16.476 with making decisions that are imperfect using the best data 0:24:16.516 --> 0:24:18.196 that we have. But we do have to use the 0:24:18.276 --> 0:24:21.756 data that we have. I mean, we have to move forward. 0:24:22.556 --> 0:24:26.916 So you know, technology and other ideas they may seem ambitious, 0:24:26.956 --> 0:24:30.316 contact tracing might seem oh, it's not feasible, it's too many, 0:24:30.396 --> 0:24:34.716 But the way to be successful is just to take 0:24:35.036 --> 0:24:39.236 the next step forward and believe it's possible and keep 0:24:39.276 --> 0:24:42.636 building it as you're doing it. I think that's what 0:24:42.796 --> 0:24:46.276 we have to think about, or else, you know, we're 0:24:46.276 --> 0:24:49.476 just going to be struck. Thank you so much. This 0:24:49.636 --> 0:24:52.516 is tremendously clarifying, and there are bits of it that 0:24:52.596 --> 0:24:55.556 are inspiring and make one think there is a way forward, 0:24:55.556 --> 0:24:57.636 and then there are bits of it that cause one 0:24:57.676 --> 0:25:00.636 to feel a bit more panic. And I really appreciate 0:25:00.636 --> 0:25:02.796 it your honestly about it. Thank you all right, thank 0:25:02.796 --> 0:25:07.436 you Here on deep background. We've spoken to several guests 0:25:07.636 --> 0:25:10.836 who focused on the mechan that we can use gradually 0:25:10.836 --> 0:25:13.676 to emerge from the conditions of social isolation that we're 0:25:13.676 --> 0:25:17.356 presently in. Testing has been a consistent theme that we've 0:25:17.396 --> 0:25:20.876 heard about again and again and again, more and better testing. 0:25:21.676 --> 0:25:24.796 Speaking to doctor Ivers makes it clear that the testing 0:25:24.956 --> 0:25:28.436 is primarily valuable, however, to the extent that it is 0:25:28.476 --> 0:25:32.596 then used to lead to contact tracing, and the idea 0:25:32.676 --> 0:25:35.996 is that contact tracing itself can help manage the disease. 0:25:36.836 --> 0:25:39.276 This may be the only long run strategy that can 0:25:39.316 --> 0:25:41.836 be used in the absence of a vaccine and in 0:25:41.876 --> 0:25:45.836 the absence of better therapies. But contact tracing on its 0:25:45.836 --> 0:25:49.396 own is not a magic bullet. You have to reach 0:25:49.556 --> 0:25:52.956 enough people and that's a challenge. It's also very difficult 0:25:52.996 --> 0:25:55.876