Major concerns over South Africa’s COVID-19 contact tracing
The National Department of Health’s use of the COVIDConnect platform as a contact tracing solution is a misguided attempt to make its previously failed contact tracing more palatable.
This is according to Associate Professor Co-Pierre Georg of the University of Cape Town, a fintech expert who is part of the team behind the development of the Covi-ID QR-based contact tracing solution.
Health Minister Zweli Mkhize recently announced the launch of COVIDConnect – the government’s contact tracing solution which runs on platforms like WhatsApp, SMS, and USSD, and employs a chatbot for its user interface.
COVIDConnect provides patients with their COVID-19 test results and prompts them with questions to help gauge how severe their symptoms are. It then advises patients to either self-quarantine or seek medical attention depending on the severity of the case.
Patients can also upload the information of people they have been in close contact with in the days before they tested positive for the coronavirus.
These “declared contacts” are then sent an SMS and taken to a different part of the COVIDConnect system which also begins with a symptom questionnaire.
Failed attempt at cellphone tracking
Government has abandoned a previous attempt to conduct contact tracing through cellphone tower location triangulation.
Georg explained this method was flawed because the spatial resolution for cellphone tracking was too low, which meant that a particular device could only be pinpointed to within a certain radius.
“In an urban environment, it’s a radius of about 400m,” Georg explained. “But within that radius, in a township, you can have up to 5,000 people. In rural areas, the spatial resolution is much worse.”
“I know that the NDoH had been warned about the shortcomings of this technology and I don’t understand why they chose to still go that route,” Georg noted.
“This could never have worked, and anyone who does even a cursory Google search would have been able to tell that to Zweli Mkhize,” he added.
Not a true contract tracing app
Georg explained that COVIDConnect cannot be considered a contact tracing app in the strict sense.
“This is a misguided attempt to make the Department of Health’s previously failed contact tracing more palatable. But South Africa cannot afford to get a ‘second-hand contact tracing system’.”
“The platform uses an existing platform the Praekelt Foundation had built for a different purpose – to provide users with verified information – and wants to turn it into a contact tracing application,” Georg noted.
While it augments the manual contact tracing process, it does not actually trace contacts itself, Georg noted.
In the case that the system would send an automated WhatsApp to the contact details you upload, it would at least qualify as exposure notification, Georg said, albeit the least effective exposure notification he has seen.
Less effective than manual contact tracing
Georg claimed that COVIDConnect did not address what researchers label the biggest risk for COVID-19 contraction, which comes from what sociologists call “weak links”.
These are people that you are in contact with only briefly, such as in a taxi or at a shopping centre, whom you may or may not know personally.
COVIDConnect only allows users to upload names of close contacts that they know.
“What is worse, because the process is no longer human-guided, many important questions about the length of a contract, the type of exposure, and other context are no longer asked.”
“This makes the system less effective than the previous manual process,” Georg said.
Certain European countries have opted to use smartphone-based solutions such as Google and Apple’s Bluetooth-based tracking API.
Georg said that while this would allow for recording “weak link” exposures, its use was limited in South Africa, as around only half of citizens own a smartphone.
He noted that other countries have shown that manual contact tracing can be effective.
“In many cases, it is one component of a bigger system, but the advantage of human contact tracers is that they can ask the context of an exposure, which is key to understanding transmission.”
“But we would have needed many more contact tracers and more efficient management for manual contact tracing to be effective.”
Privacy concerns
Georg said he was also worried about the issue of privacy and sensitivity in dealing with confirmed cases.
“Do we really want a WhatsApp message [or SMS] to tell a patient that she has a life-threatening disease? I find this callous,” he stated.
Additionally, there are no precautions to ensure that the patient receives this information in a private and safe environment, Georg claimed.
“What if she is in a taxi and receives the message that she has COVID-19? What if communities force their members to prove that they are not positive?”
“We have so much stigma around COVID in South Africa that I am concerned about the security of patients using the app.”
“The fact that the data ends up in a centralised database just makes it worse, because it creates a huge and unnecessary cybersecurity risk,” he said.
Mixing technology and manual tracing
Georg maintained there were superior hybrid contact tracing solutions which combine the benefits of manual and digital contact tracing.
This is why his team suggested a QR-code based system, which could allow a user to receive a QR code that they can print to present to appointed officials at key areas, such as when entering or exiting a taxi, building, or area with large concentrations of people.
“Singapore, for example, has deployed a QR code-based system to augment their original TraceTogether app,” Georg said.
He said that Covi-ID team had contacted the NDoH several times and offered that they can use the solution for free.
“This way you can record exposures of users who don’t know each other easily,” Georg said.
The NDoH, however, has not responded to Covi-ID’s offer.
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