Digital Platforms Invade Public Health

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Internet technology in health

Prior to the COVID-19 era, Internet technology such as big data analytics has become the hyped catalyst to build an integrated healthcare network. From daily disease monitoring, diagnosis, and treatment, different types of healthcare information becomes more accessible. Back in 2013, scholars envisioned the trend of applying big data to health case as “inevitable” (Murdoch, 2013). The following four major potential applications of big data in health care are discussed: 

  1. Big data can exploit the massive amount of clinical data available to provide more understanding of diseases. 
  2. Big data can help in distributing customized training and knowledge to health practitioners, who might be too busy to keep updated about the latest treatment developments
  3. Big data enables personal medicine, which can be created based on individuals’ customised needs
  4. Lastly, big data helps deliver information directly to patients, making communication more convenient and direct 

Two decades after the emergence of big data technology in 1997, this technology has gained significant success in health care applications. The most useful data comes from patient behaviour data, pharmaceutical research and development, clinical data. A meta-analysis study shows that the major benefits can be summarised into 5 categories: IT infrastructure benefits, operational benefits, organizational benefits, managerial benefits, and strategic benefits (Wang et al., 2018).  

Image: Big data analytics architecture in health care (Wang et al., 2018)

While data analytics technology gained significant success, the role of digital platforms remained limited. While it became more popular to manage bookings through apps or online platforms, the year 2020 is the year when drastic changes in applications of Internet technology takes place. Once optional or alternative choices, such as telehealth, now become a must-have technology during COVID-19. Some technologies such as remote diagnosis have been developed pre-COVID, and the pandemic speeds up the implementation of such technologies. Other emerging technologies, such as the health code in China, are newly invented. This post will further explore the explosion of Internet technology during COVID-19 and the associated risks and benefits.  

 

Smart technology for virus suppression

Image: Comparison between seasonal flu and Covid-19, Vox

What makes COVID-19 the most suitable case for adopting technology in health-care? The disease itself has no vaccine at the current stage, so the most effective prevention method remains social distancing. The infection rates remain high in many countries, despite strict lockdowns. Furthermore, the virus has an extended incubation period and symptoms usually start showing up after at least 5 days. The situation is likely to persist in the next 1-2 years while effective vaccines are under trials (Hart et al., 2020). Due to these characteristics, COVID-19 brings tremendous challenges to the current public health system. 

There is an urgent need to develop technological solutions to slow down the spread of the disease by providing the following support (Hart et al., 2020):

  1. Accurate contact tracing while protecting user privacy 
  2. Accessible digital medical records and results for patients 
  3. Medical tracking for medical providers and government

Coronavirus apps

Image: COVIDSafe app, Australia Government-Department of Health

In the year 2020, at least 47 countries have launched contact-tracing apps during the COVID-19. Government is forced to step up during a public health crisis, speeding up the adoption of technologies in health care. While a lot of the big data analytics technology mentioned earlier were managed in private research sectors, coronavirus apps are launched by the government. A comprehensive review of the technology has been recently released (O’Neill et al., 2020). The review is based on 25 countries’ coronavirus apps and 5 categories including voluntary, limited, data destruction, minimized, transparent, and tech. Some of the services are provided by large tech companies such as Apple and Google, and others use Bluetooth and GPS to provide tracking. Australia’s COVIDSafe app, for example, is fully based on Bluetooth technology. Nea Zealand’s NZ COVID Tracer is using QR codes in conjunction with Bluetooth. The majority of the apps are voluntary and encouraged by the government.  

Australia’s COVIDSafe app is completely voluntary, and the government claims that this app can be used to help quickly identify potential exposures to COVID-19 through close contacts. According to the latest update, users first provide personal details and turn on Bluetooth while using the app. The app uses advance technology to find people next to COVID positive patients without tracking their location. Information gathered includes a name (can be a pseudonym), age, phone number, and postcode. All the users’ information will be deleted after the pandemic (COVIDSafe app, 2020). When the app first launched, however, it received numerous criticism on its lack of transparency and privacy considerations. Due to criticism, Parliament passed the Privacy Amendment ACT to provide legal protection to ensure users’ privacy is protected while using COVIDSafe app. Now the official website contains detailed information about the privacy policy, what technology is behind the app, and what happens to the data after the pandemic. Data is not deleted immediately after users deleting the app, but there is an additional feature to submit a request to delete the data sooner. Besides privacy concern, a recent survey of 1500 Australians concludes that the main reasons for people’s unwillingness to download the  COVIDSafe app not only includes privacy concerns but also phone capabilities and beliefs of limited benefits. Indeed, there is a trade-off between effectiveness and the amount of information collected. Without location information, it remains questionable whether tracing close-contacts is efficient.

A unique case: China’s health code

O’Neill et al.,2020 describes China’s coronavirus tracking system as “pervasive and invasive”. Indeed, China’s Health Code system is an extreme example of how citizens are required to exchange their privacy for public health purposes under government’s monitoring, and without a choice. This tracking system is very different from what other countries have been using. Very little information is provided on the actual technology, and the scope of monitoring is beyond the ethical and privacy guidelines, which are essentially non-exist.

So what is China’s COVID Health Code?

Image: Examples of Health Code: (a) shows a green code, ( b) shows a yellow code, and (c) shows a red code. Personal information and QR-codes remain anonymous

Health Code was launched on WeChat and Alipay in February 2020 rather than a stand-alone app. Alipay is China’s most popular digital payment platform, and WeChat is the most popular social media/ digital payment platform. The main purpose of the Health Code is to help the government accurately track people who have potential exposure to covid. Three colour codes are assigned according to the exposure risk level. Green means low risk, yellow means medium risk, and red means high risk. Health Code has been applied to more than 900 million users across China (Liang, 2020). Users are required to provide personal details, including their names, national ID, physical conditions. Everyday, users need to update their physical conditions. Additionally, “spatial-temporal” data is captured by Alipay or Wechat, while location data is provided by GPS services (Liang, 2020). If a user enters an area with potential exposure to infected patients, the Health Code automatically turns colour. Additionally, strict monitoring is applied based on Health Code. People are only allowed to freely move if they have a green Health Code. The actual enforcement is extremely efficient as well. Any entrances to public facilities, such as transportation, schools, restaurants, and etc., have people checking the status of Health Code. Without the Green Health Code, people are forbidden to enter public space. With this technology, all citizens in over 300 cities are required to update Health Code every day. A similar technology, without location tracking, is mandatory for overseas citizens who are planning to return home within 2 weeks. They are required to fill out personal information and daily physical condition everyday prior to boarding. 

What’s unique about Alipay or Wechat Health Code is that they are launched on existing popular apps, which are essential on every citizen’s mobile phones. This model is uniquely different from a standalone app which only takes specific information related to COVID-19. Health Code is able to acquire all personal data on a financial related app, and with this code alone police is able to track down individuals with high risks of exposure. More controversially, Health Code completely lacks privacy protection policy and transparency. It remains unclear how the government uses the information and what specific technology is involved in the tracing. Despite these concerns, Health Code is undoubtedly successful in controlling COVID-19 in the  shortest amount of time possible. The effectiveness of China’s Health Code system exceeds way beyond other technologies.  

Technology and government 

The Health Code model has been summarised as “The sharing of personal data with the authorities further erodes the thin line separating China’s tech titans from the Communist Party government” (Mozur, Zhong, and Krolik, 2020). Indeed, while China’s tech companies remained relatively autonomous pre-COVID, this fine line has been further challenged during the pandemic. Previously, the Chinese government issued censorship rules which require social media companies to filter content (Robers, 2018). The degree of filtering is down to post to post level rather than a reporting system on popular western social media platforms. Yet Health Code is a non-precedent “platform ecosystem” China has been trying to build over the past years (Liang, 2020). A so-called platform ecosystem is an integrated network of must have technologies on a centralised platform. One platform can cover all digital functionalities, including digital payment, credit record, social media, communication, news, and now extended to personal tracking and healthcare. While the technology might be existing for a long time, Health Code further reveals that “governments and tech giants have achieved unprecedented collaborations” (Liang, 2020). 

China adopted a “closed Internet” model which was directly opposite to “open-access” which took place prior to the “new neutrality movement” (Pickard and Berman, 2019). Digital rights in China remains a forbidden issue for discussion in China, while providing an extreme example of government interference and infiltration into digital technology. Meanwhile, the relationship between government and technical companies are rather bilateral. While companies are obligated to comply with the government, the government also heavily relies on these digital platforms to perform numerous tasks. In contrast to people’s unwillingness to download COVIDSafe apps discussed previously, the advantage of WeChat or Alipay’s platforms is that the majority of the population already have these apps installed and heavily rely on these apps in daily life. it remains unclear whether digital rights will be addressed by authority in the near future. However, looking at the effectiveness of disease control and monitoring public health, if prioritising controlling COVID-19 and resuming public life, more governments are likely to learn from the lesson and adopt some of China’s advanced technical models.

 

References

Murdoch, T. B., & Detsky, A. S. (2013). The inevitable application of big data to health care. JAMA – Journal of the American Medical Association, 309(13), 1351–1352. 

Liang, F. (2020). COVID-19 and Health Code: How Digital Platforms Tackle the Pandemic in China. Social Media and Society, 6(3).

O’Neill, H. P., Ryan-Mosley, T., & Johnson, B. (2020, May 7). A flood of coronavirus apps are tracking us. Now it’s time to keep track of them. MIT Technology Review. https://www. technologyreview.com/2020/05/07/1000961/launching-mittr- covid-tracing-tracker/

Mozur, P., Zhong, R., & Krolik, A. (2020, March 1). In Coronavirus fight, China gives citizens a color code, with red flags. The New York Times. https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html

Roberts, M. E. (2018). Censorship in China. In Censored : Distraction and Diversion Inside China’s Great Firewall. Princeton University Press.

Pickard, V., & Berman, D. E. (2019). The Making of a Movement. In After Net Neutrality: A New Deal for the Digital Age (pp. 69–101). Yale University Press.

Wang, Y., Kung, L. A., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change

COVIDSafe app. (2020, October 28). Australian Government Department of Health. https://www.health.gov.au/resources/apps-and-tools/covidsafe-app

Thomas, R. et al, (2020, July). More than privacy: Australians’ concerns and misconceptions about the COVIDSafe app: A short report. https://doi.org/10.1101/2020.06.09.20126110

Hart, V. et al, (2020, April). Outpacing the Virus: Digital Response to Containing the Spread of COVID-19 while Mitigating Privacy Risks. Edmond J. Safra Center for Ethics. https://ethics.harvard.edu/files/center-for-ethics/files/white_paper_5_outpacing_the_virus_final.pdf?m=1586179217