Contact Tracing Via Old Shoe-Leather Epidemiology While Spurning the Techno-Fix Fairy: How Hong Kong Quells COVID-19 Without Killing Civil Liberties
By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.
Many countries are trying to quell their COVID-19 outbreaks by submitting to the tender ministrations of the technofix fairy, willingly sacrificing civil liberties to untested tracking apps.
Now, I’m not going to deny that technology – including some form of contact tracing via mobile ‘phones – is part of future COVID-19 management. But the necessity of over-reliance on such tracking is far less clear.
And we just have to look to the case of Hong Kong, which has so far registered only four COVID-19 cases, to see that health authorities can effectively track and trace via old shoe-leather epidemiology and not rely on any app at all.
Naomi Klein penned a chilling account in The Intercept recently, describing the future that New York state’s politicos, led by NY governor Andrew Cuomo, and Silicon Valley, spearheaded by Google CEO Eric Schmidt, have teed up. I encourage you to read this article if you have not done so already (Screen New Deal). Following Rahm Emmanuel’s advice – “You never let a serious crisis go to waste” – and realizing most people are so petrified by the prospect of catching COVID-19, those who seek to construct a high-tech dystopia know the mass of people are all too willing to capitulate:
It has taken some time to gel, but something resembling a coherent Pandemic Shock Doctrine is beginning to emerge. Call it the “Screen New Deal.” Far more high-tech than anything we have seen during previous disasters, the future that is being rushed into being as the bodies still pile up treats our past weeks of physical isolation not as a painful necessity to save lives, but as a living laboratory for a permanent — and highly profitable — no-touch future.
It’s a future in which our homes are never again exclusively personal spaces but are also, via high-speed digital connectivity, our schools, our doctor’s offices, our gyms, and, if determined by the state, our jails. Of course, for many of us, those same homes were already turning into our never-off workplaces and our primary entertainment venues before the pandemic, and surveillance incarceration “in the community” was already booming. But in the future under hasty construction, all of these trends are poised for a warp-speed acceleration.
This is a future in which, for the privileged, almost everything is home delivered, either virtually via streaming and cloud technology, or physically via driverless vehicle or drone, then screen “shared” on a mediated platform. It’s a future that employs far fewer teachers, doctors, and drivers. It accepts no cash or credit cards (under guise of virus control) and has skeletal mass transit and far less live art. It’s a future that claims to be run on “artificial intelligence” but is actually held together by tens of millions of anonymous workers tucked away in warehouses, data centers, content moderation mills, electronic sweatshops, lithium mines, industrial farms, meat-processing plants, and prisons, where they are left unprotected from disease and hyperexploitation. It’s a future in which our every move, our every word, our every relationship is trackable, traceable, and data-mineable by unprecedented collaborations between government and tech giants.
The Case of Hong Kong
I checked in again this week with my old friend, Dr. Sarah Borwein, who has practiced medicine for the past fifteen years in Hong Kong. Sarah has on two other occasions shared with Naked Capitalism readers what this city of 7.5 million residents has done to stem the spread of COVID-19, while limiting cases to just over 1000, and deaths to four. (See Tale of Two Cities Redux: HK to Ease its COVID-19 Restrictions, While NYC Situation Remains Dire and A Tale of Two Cities: How Hong Kong Has Controlled its Coronavirus Outbreak, While New York City Scrambles).
She sent me an excellent article from The Atlantic: How Hong Kong Did It. One thing I’ve found troubling in discussing the U.S. and especially the NYC situation is that people are all too willing to blame the failed COVID-19 response on Donald Trump – as if he alone is responsible for the debacle. What the Atlantic piece makes clear is that Carrie Lam, Hong Kong’s hapless chief executive, also bungled Hong Kong’s initial response. Badly. From The Atlantic:
Lam fumbled the response to the pandemic as well, reacting with ineptitude, especially at first. Hong Kong’s first coronavirus case was reported when she was having dim sum with world leaders in Davos, Switzerland, and there was an outcry over the fact that she did not quickly return. She dragged her feet in closing the city’s borders, and never fully closed down the land border with China. The hospitals suffered from shortages of personal protective equipment. Lam wavered on masks, and even ordered civil servants not to wear them. There were shortages of crucial supplies and empty shelves in stores, as well as lines for many essentials. In early February, the financial outlet Bloomberg ran an opinion piece that compared Hong Kong to a “failed state”—a striking assessment for a global financial center and transportation hub usually known for its efficiency and well-functioning institutions.
And yet there is no unchecked, devastating COVID-19 epidemic in Hong Kong. The city beat back the original wave, and also beat back a second resurgence due to imported cases. But unlike in Taiwan or South Korea, this success can’t be attributed to an executive that acted early and with good governance backed by the people.
So, why is Hong Kong showing such success in COVID-19 management? For starters, their public health authorities knew what to do to control a pandemic, having learned painful lessons from two previous outbreaks Hong Kong wasn’t so successful in managing: the 1968 influenza epidemic, later dubbed “the Hong Kong ‘flu”; and the 2003 SARS episode.
Yet equally if not more important was the role played by Hong Kong’s people themselves in stemming the spread of COVID-19. Over to The Atlantic again:
The secret sauce of Hong Kong’s response was its people and, crucially, the movement that engulfed the city in 2019. Seared with the memory of SARS, and already mobilized for the past year against their unpopular government, the city’s citizens acted swiftly, collectively, and efficiently, in effect saving themselves. The organizational capacity and the civic infrastructure built by the protest movement played a central role in Hong Kong’s grassroots response.
In a way that eerily foreshadows a similar debate in the US, but with one crucial difference, Hong Kong residents took the lead in promoting the use of masks – despite initially contrary advice from the World Health Organization and lack of support from the government and Lam (who had banned mask wearing during the recent period of political unrest):
In response to the crisis, Hong Kongers spontaneously adopted near-universal masking on their own, defying the government’s ban on masks. When Lam oscillated between not wearing a mask in public and wearing one but incorrectly, they blasted her online and mocked her incorrect mask wearing. In response to the mask shortage, the foot soldiers of the protest movement set up mask brigades—acquiring and distributing masks, especially to the poor and elderly, who may not be able to spend hours in lines. An “army of volunteers” also spread among the intensely crowded and often decrepit tenement buildings to install and keep filled hand-sanitizer dispensers. During the protest movement, I had become accustomed to seeing shared digital maps that kept track of police blockades and clashes; now digital maps kept track of outbreaks and hand-sanitizer distribution.
A key takeway from The Atlantic:
There’s a lesson here, as the United States deals with staggering levels of incompetence at the federal level. Stories have been written by doctors in major hospitals in the U.S. about how they tried to source masks in the black market and disguised PPE shipments in food trucks to avoid their seizure by the federal government. As Taiwan and South Korea show, timely response by a competent government can make the difference between surrendering to a major outbreak and returning to a well-functioning, open society without lockdowns or deaths. But Hong Kong also teaches that people aren’t helpless, even when their government isn’t helpful.
Test and Trace
Yet it’s not due to its people alone that Hong Kong has dodged a severe COVID-19 outbreak. The Atlantic article affirms that Hong Kong has proactive, effective medical expertise, which was brought to bear in framing its COVID-19 strategy:
Thanks partly to their long history of fighting epidemics, Hong Kong also has some of the world’s most prominent experts in infectious diseases. They were cautious about picking open fights with their government or with China, but were clear in prioritizing public health. Defying China’s pronouncements about lack of evidence for human-to-human transmission and ignoring the WHO, which relayed those pronouncements to the world, the experts stated from very early on that they suspected the disease was transmitted among people, and acted accordingly in their recommended safeguards. Despite the Hong Kong government’s continuing ban on face masks, Hong Kong’s health authorities openly credited the near-universal mask wearing among the people for avoiding a surge in cases.
Something the article doesn’t emphasize – but should is the importance of painstaking test and trace measures to plot and thwart the course of COVID-19 spread.
Sarah described what has been undertaken as “old shoe leather epidemiology.” No app. No technofix fairy. Just hard work.
I asked her to explain what test and trace means to Hong Kong health authorities.
Sarah Borwein: So we had 21 days with no local cases and then a case was detected 2 days ago, and now her grand-daughter and husband have tested positive. What they are doing reflects their strategy:
They did extensive interviews with the index case (the 66 year old grandmother) and retraced everywhere she’d been in the 2-3 days prior to getting sick – every market stall etc. She looks after her 5 year old grand-daughter who is also positive – so they have also traced all her contacts. She attends a tutorial school, so the teachers and other kids.
And now they are conducting testing for 860 families who live in her housing block or the grand-daughter’s, or work in the market or work in or attend the tutorial center. At least 5000 people from 1 case!
They actually do something similar whenever we have a local case of dengue fever (not endemic here) – so they do have practice.
Jerri-Lynn Scofield: So, that’s what test and trace means! And not via an app.
Sarah Borwein: No, not via an App
Although there are websites where you can see the locations of all the positive cases, and any flights etc (including seat number) they have been on – so you can self-report if you were near them. But mainly they do the shoe-leather work as the mainstay.
We concluded our chat with some reflections on history, an important factor that has been neglected by many authorities in planning for this pandemic – particularly remembering what happened with the Spanish ‘flu that followed the First World War.
The tragedy with COVID-19 is that things didn’t have to shake out the way they have in the United States. With a bit of knowledge and understanding of history, medicine, and epidemiology, combined with hard work, we could be looking at a very different scenario.
But the work is hard, and in the most recent Hong Kong case, public health authorities are testing and tracing more than 5000 contacts of just one index case. It is this level of effort that has limited the number of deaths to just four of the 7.5 million residents of Hong Kong.