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Countries around the world have taken different measures to slow down or stop the spread of the virus. While China, South Korea, and Taiwan quickly dove into AI-powered screening and tracking, western democracies took a more human-driven direction. Almost ten months after the WHO declared the pandemic a global emergency, has one approach proven better than the other?
The first case of a person suffering from the COVID-19 virus was reported to the World Health Organization in December 2019. Since then, the pandemic has impacted economic activity worldwide and changed — perhaps permanently, the way we work and communicate with each other.
Very few people would have anticipated, earlier this year, that this would become the biggest crisis of our generation, one that would leave an indelible mark on our collective memory.
During the last months, we’ve learned more about the virus. We know, now, that the transmission of COVID-19 occurs through respiratory droplets when a person coughs, sneezes, speaks, sings, or breathes heavily. The virus can also spread after infected people are in contact with objects such as tables, handrails, or doorknobs. A lot of the COVID-19’s impact has significantly affected urban centers. Cities have become hubs for quick transmission of the illness, a process that global travel has only accelerated.
When first faced with the reality of a rapidly-expanding virus that we knew very little about, the countries of the world began the race to slow down or stop its spread. To do this, different approaches were drawn moderated by regional social and political contexts.
In China, South Korea, Taiwan, and Singapore, among others, governments enforced a techno-driven approach that incorporated digital technology into healthcare and policy — this approach was based on IoT, big data, and AI. In the Western Democracies, the focus was placed instead on human capital and educating citizens on reducing the danger, especially for those at higher risk through persuasion and consensus.
While the first approach seems to have been proven more effective for identifying, isolating, and quarantining infected people (although, according to a study published recently, it also has resulted in citizens’ views being censored), the second (in which people retain agency in the use of technology) might have been too slow to effectively contain the virus.
China had one specific advantage when it comes to surveying and identifying citizens who have been infected with the virus. Most of the Chinese investment in smart cities has been fone around improving surveillance. In Chongqing alone, there are approximately 2.6 million cameras that monitor 15.35 million people — that’s one camera for every six residents. During the quarantine, the Chinese government even installed CCTV cameras on people’s doors to make sure residents could not leave their houses without authorization.
The WHO-China Joint Mission report has deemed China’s response as “the most ambitious, agile, and aggressive disease containment in history”. On the other hand, the Western response has been considered inadequate — with cases rising again and new peaks of infection being reached on a daily basis. As of June this year, South Korea showed a 0.5 death rate per 100,000 people who contracted the virus, while the U.S. had sustained ten times that number.
Artificial intelligence and big data have played a significant role in facilitating the tracking of infected and exposed people around the world. While CT scans can take up to 15 minutes to diagnose someone, AI technology can complete the task in just 10 seconds.
During the early days of the pandemic, Chinese authorities decided to use mobile phone applications and payment and social media data to track the movement of people that had visited the epicenter of the virus, the Wuhan market (apps like Alipay and WeChat helped with the task). Machine learning models were then applied to analyze transmission dynamics to border checks and surveillance teams. AI was also able to track down citizen’s travel history, while drones were equipped with cameras to conduct surveillance and issue instructions to not wearing masks or following emergency protocols. Specific technologies were also adopted in Chinese public transportation; for instance, Megvii Technology Limited developed an AI body temperature screening system for metro stations, while Chinese train stations are now actively using thermal scanners to detect infected people and collect their travel history in order to identify other cases. This data is shared with a central server and analyzed using AI in order to supply medical resources.
Body temperature detection in Beijing. Image courtesy of Kian Zhang.
Since the onset of COVID-19, several other countries have installed high-performance infrared thermal cameras in airports, workplaces, schools, shopping malls, and public transport, facilitating the identification of hotspots of infection. Taiwan began testing travelers from Wuhan soon after the virus was communicated, comparing a patient’s travel and health histories with immigration records. Although both regions were geographically close, the use of big data has received praise due to the resulting low number of cases and deaths. South Korea also has, since early in the pandemic, implemented aggressive contact tracing using GPS, bank card records, facial recognition, and security camera footage. This detailed following of cases has allowed the country to maintain a very low per-capita mortality rate.
AI can also help with the rapid detection and diagnosis of COVID-19. In China, a cloud-based AI-assisted service can detect pneumonia cases in just seconds, and machine learning algorithms can predict the likelihood of infected patients developing acute respiratory distress syndrome and other critical illnesses. And on a global level, an open-source deep convolutional neural network called COVID-Net can detect COVID-19 cases from other diseases of the lung on chest x-rays.
In addition to technologies specifically developed for dealing with the spread of the virus, virtual care platforms are also benefitting from video conferencing and digital monitoring and have been used to successfully treat patients remotely — protecting healthcare workers and allowing family members to participate in treatments.
Lockdowns were imposed early in China. For instance, 15 cities in Hubei were completely locked down from 23rd January. The transport system was suspended in its entirety, and citizens were not allowed to leave their houses. Today, the Quick Response (QR) Code System acts as a sort of certificate and travel pass that tracks movement over a hundred Chinese cities. The system requires an individual to fill out a survey of symptoms and record their temperature so authorities can monitor their movement as they use public transportation or visit a supermarket. Different colors represent low, medium, and high risk, and people with green codes can travel without restrictions (while other colors must isolate for 14 days).
In Taiwan, the government has issued electronic monitoring devices for home-quarantined of individuals that use GPS and can trigger messages and fines if the person breaks the isolation. The same has been done in South Korea and Hong Kong.
Human rights experts argue that China’s extreme surveillance measures would probably not work in countries where fewer restrictions are imposed. For example, several American states have banned facial recognition, while the 2018 European Union General Data Protection Regulation ensures personal data protection so that it’s not used against individual freedom and privacy.
In western democracies, smart cities invested instead in human capital to create consensus and persuasion, and control the transmission of the virus. Instead of accessing citizen’s mobile phones, the governments of Italy and Germany gathered anonymous aggregated data from tracking the concentration and movements of people. When these were not available, governments opted for drive-through testing and apps that ask people to share their data voluntarily.
Image courtesy of Kate Trifo.
Germany has a smartwatch application that collects pattern data for signs of the virus, while the United Kingdom has actively promoted the use of a track and trace smartphone application that uses venue check-in and can alert others when there’s been an infection. In the United States, national studies are capturing resting heart rate through a smartwatch and collecting real-time data on clusters of febrile illness — although neither initiatives have been integrated into policy.
Another measure implemented in the west was the isolation of those infected from others. Lockdowns were put in place not only in affected areas but on a nation-wide level. Yet, “no prime minister wants to enact measures like this”, UK’s Prime Minister claimed. This marks a clear difference with the authoritative regimes that can force the use of smart technologies to address the pandemic and where communities are seen more as passive beneficiaries of them rather than active participants.
Western democracies had time to plan their crisis management before the cases exited China, however, the dangers of the virus were frequently downplayed by American and European governments. According to the aforementioned study, this was due to a combination of decentralized political systems, gaps in governance, and laws of privacy protection. The result was a downplay of the impact of the virus and an accelerated transmission.
“While China has denied the impact of the virus by adopting the means of suppression, the Western democracies have denied by freely sharing the information with their citizens.” Rama Krishna Reddy Kummitha
This unexpected crisis finds us at the peak of a technological revolution. As Yang Fei, the vice chief of Fuhe town in the Suizhou smart city, stated:
“The technology we use today in epidemic control was hard to imagine in the past” (Jie & Quao, 2020, p. 1).
In an unprecedented initiative, the Chinese manufacturing industry and technology-based ecosystems were able to assist authorities in fighting COVID-19 using the surveillance infrastructure to impose discipline among its citizens. This strategy seems to have been more successful in stopping the spread of the virus in the region, at least in comparison to the use of technology limited by anonymized data in Western democracies. In large part, this can be also explained by delayed and frequently disorganized initiatives.
Both approaches can, I believe, benefit from analyzing each other’s successes — in particular, because human mediation is at the center of both approaches. The question is one of distribution of autonomy: How much is given to the government and how much to the citizen.
Iceland was among the first nations to collect data on asymptomatic people using mobile technology and clinic and genome sequencing data. To date, the country has the highest per-capita testing rate and one of the lowest per-capita mortality rates. In order to balance the need for track and trace, European countries have agreed on not using GPS or a central database, anonymizing data, and retaining it for only 14 days. This is a great example of a type of intervention that takes advantage of advances in technology while keeping privacy a central concern.
There’s, however, a real concern that the government might take advantage of the changes triggered by the pandemic to reinforce surveillance on citizens even after the virus has been controlled.
If governments can ensure that the data they collect will be handled responsibly and for the benefit of society as a whole, if they can guarantee transparency in the collecting and sharing of such data with their citizens and the global community, as well as the ceasing of more restrictive measures once the situation becomes under control, then a techno-approach is proven to provide better results than a merely human-driven one.
It’s also worth noting that large areas of the world, as well as groups within high-income countries, don’t have access to the Internet, mobile phones, or smartwatches. Digital health can contribute to disparities in healthcare and has the potential to amplify socioeconomic inequalities. In order for digital solutions to have a balanced impact on the prevention and treatment of COVID-19, interventions need to be tailored to different regions through subsidies for mobile phone plans, free wi-fi spots, and training programs, among others.
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