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In lieu of a vaccine, contact tracing is one of the few tools we have to contain the spread of COVID-19. A contact tracer interviews people diagnosed with COVID-19, finds out who they’ve been in close physical contact with for a sustained amount of time, then informs those individuals they’ve been exposed to COVID-19 and should get tested and self-isolate. But in order for large-scale contract tracing to work and for people to willingly participate, they need to trust that their health data will be managed safely.
The Bowser administration has been relatively transparent about how contact tracing works in D.C. In a recent press conference, DC Health explained how contact-tracing investigators ask individuals who have tested positive for COVID-19 about their location history in order to track who’s potentially been exposed to the virus. The agency posts the percentage of cases and their close contacts that investigators attempted to reach in an online dashboard that is updated daily.
Civil liberties advocates, however, argue the administration has not fully explained how the health data that contact tracers gather is handled—specifically who has access to this information and how long it will be stored. Local and national organizations, including the ACLU of D.C., Center for Democracy & Technology, and Stop Police Terror Project DC, sent a letter to Mayor Muriel Bowser and the D.C. Council in June that requested D.C.’s contact-tracing efforts be transparent and uphold the privacy, civil rights, and civil liberties of residents, but received no response from the executive.
Contact tracers are gathering detailed and private information from tens of thousands of D.C. residents about their whereabouts and who they came in close contact with. In the letter, advocates insisted the public needs to know that this information stays within DC Health and is deleted once it is no longer needed. Now that Bowser is, according to DC Health, “actively assessing” whether to use smartphone applications for contact tracing, advocates tell City Paper clear assurances about how contract-tracing data will be used and stored are urgently needed.
D.C.’s contact-tracingefforts have quickly evolved since the Bowser administration announced D.C.’s first coronavirus case on March 7.
DC Health already had a contact-tracing team of about 65 at the start of the public health emergency on March 11, as case investigation is used to track other infectious diseases and is not unique to COVID-19. As COVID-19 cases increased, D.C. expanded its team. In April, Bowser announced that the District would hire hundreds of contact tracers and by mid-June, the team grew to about 300. At that level, contact tracers can at least attempt to investigate more than 90 percent of coronavirus cases and their close contacts within one or two days of a case notification reaching DC Health, a metric D.C. must reach in order to relax social distancing requirements. (That said, Bowser had D.C. enter Phase 2 of reopening before the city met DC Health’s requirements related to contact tracing.)
During a June 10 press conference dedicated to contact tracing, DC Health Director Dr. LaQuandra Nesbitt explained what residents should expect if contact tracers reach out to them. While they should be asked a series of questions related to their health status, living situation, and recent movements, they will not be asked to provide their imigration status, Social Security number, or bank account information. Contact tracers are also instructed to never tell individuals who exposed them to the virus. A week later, Nesbitt further described how investigators are told to phrase questions so as to not stigmatize any activities individuals participated in and to encourage honesty.
“What I would say, to my experience, is that … even as you see the slides and you see the schematic flow of how we do interviews, how we do contact tracing, the most important aspect of that is the participation of the community that has tested positive,” Malachi Stewart, a contact tracer for DC Health, said during the June 10 press conference. “It is that participation that allows us to continue to achieve success and really see the curve be flattened.”
The June 10 press conference contained little detail about how the health data is managed. It is “only used for statistical and public health purposes,” said Nesbitt, “and so its use is very restricted and is governed by very unique and strict sets of laws.”
A D.C. resident who tested positive for COVID-19 in late March recently found herself thinking about what DC Health will do with health information they gathered during four phone calls with her. She asked that her name not be used in this story due to privacy concerns. The interviews were not very detailed—they did not ask her about her location history or close associations— leading her to believe D.C. did not investigate her case as thoroughly as they currently do. (City Paper asked DC Health how contact tracing was conducted for March cases, but did not immediately hear back.)
The woman’s fourth call with DC Health really got her thinking. A person who identified themself as a health department official contacted her in May, weeks after her first three phone calls with the agency, and after she’d recovered, and conducted what felt like a customer service survey. They did not ask her anything that made her feel uncomfortable, and instead asked about her general experience with COVID-19. She recounted the dates she was sick and her COVID-19 symptoms.
“I trust the government,” she tells City Paper. “The only thing I wonder now is who retains that information? Will it ever be held against me?”
“We don’t have a lot of transparency into what’s going on,” says Lauren Sarkesian, senior policy counsel at New America’s Open Technology Institute.
Her organization is one of 13 groups, most members of the Community Oversight of Surveillance coalition, that wrote to the mayor and the Council on June 2, raising privacy and transparency concerns related to contact tracing. Their concerns would only be more pronounced if D.C. decides to launch a contact-tracing app as a few other states have.
They sent a letter proactively, aiming to limit the harms other countries experienced when governments took location data without permission. The letter requests that contact tracing be led by public health officials and that data only be used for public health purposes. “Data should not be used for secondary purposes including commercial advertising use and any punitive or law enforcement purposes,” the letter says. The Bowser administration could very well be protecting information in this way already, Sarkesian says. The group’s concern is that no one is explicitly saying one way or another.
The letter also requests transparency around the administration’s contact-tracing strategy, what tools it plans to use, and at what cost, as well as for how long and where contact-tracing data will be stored. If the District decides to use an app to automate what its contact tracers are already manually doing, the letter continues, its use should be voluntary and the design should rely on Bluetooth proximity data rather than geolocation to “put community members at ease that they aren’t under surveillance.”
“We would strongly recommend that they have a public input process before going forward with adopting any digital tools,” Nassim Moshiree, policy director of the ACLU-DC, tells City Paper. “We think there needs to be more transparency, oversight, and accountability whenever the District is looking to adopt any technologies that have the potential to track people’s movements or to surveil them in any way.”
The only lawmakers to respond to the letter were At-Large Councilmember David Grosso and Ward 1 Councilmember Brianne Nadeau, who said they would look into the matter. Their offices did not immediately respond to City Paper’s request for comment.
“There’s just not enough transparency or awareness of what they’re planning,” says Sarkesian. “Unfortunately, that’s a pattern we’ve seen with Mayor Browser’s administration.”
In email responses, DC Health spokesperson Alison Reeves says it is the only agency with direct access to the contact-tracing system, and it would only share data with other District agencies “when needed per communicable disease regulations” or to connect individuals to services. (These regulations cite the Health Insurance Portability and Accountability Act, which would apply to manual contact tracing but not necessarily contact-tracing applications managed by a third party, says Sarkesian.) Reeves declined to say how long data will be stored, but did say it is “stored and managed according to District government standards and accordance with strict security provisions.”
“The District is actively assessing different technologies, including proximity tracing mobile applications for their ability to enhance contact tracing, while safeguarding privacy,” Reeves says. She declined to elaborate any further.
Coalition members want the Council to hold at least one hearing on contact tracing and want members to consider passing legislation that safeguards residents absent federal action. New York state legislators, for example, introduced multiple bills that seek to protect the privacy of individuals who give their information to contact tracers. One bill would bar law enforcement agents or immigration authorities from being contact tracers or engaging in the process. So far during the public health emergency, the Council required DC Health to make its best effort to hire District residents for 50 percent of contract-tracing jobs. Twenty-five percent of investigator jobs should go to graduates of the city’s workforce and adult education programs.
Some COVID-19 contact tracing overlaps with protests against anti-Black racism and police violence, during which residents expressed their distrust of the Metropolitan Police Department. Some advocates want public assurances that MPD officers will not become contact tracers and not be given access to this data. During the June 10 press conference, Bowser confirmed that all District employees were expected to participate in basic contact-tracing training—including police officers, a MPD spokesperson confirmed—so they can answer residents’ questions.
The Bowser administration is already contracting with two private companies, Accenture and Salesforce, for its existing contact-tracing efforts. These companies are helping numerous states manage large-scale manual contact-tracing programs. Salesforce CEO Marc Benioff tells CNBC that more than 30 states are using Salesforce’s Work.com technology for their contact-tracing efforts.
Governors of states like California and Louisiana have informed their residents of these partnerships. If you were to search coronavirus.dc.gov for information regarding these partnerships, no results would be found as of July 15. City Paper only learned that D.C. is contracting with Accenture and Salesforce after the Office of Contracting and Procurement, on behalf of DC Health, issued an emergency procurement on May 5 to hire a contractor to “implement a comprehensive disease investigation/contact tracing IT application solution to support critical operations” related to COVID-19. An OCP spokesperson says the contract was awarded to Accenture on May 20. It’s unclear how much money these companies were awarded.
Reeves, the DC Health spokesperson, says its “state-of-the-art” contact-tracing platform is “based primarily off Salesforce cloud technologies,” and Accenture was a “major deployment partner.” When asked to explain the May 5 request for proposal, she went on to use a lot of industry speak when describing what technologies these companies are offering, like “management and interoperability of multiple data streams” and “messaging functions and customer relationship management.”
A Salesforce spokesperson confirmed the company is supporting D.C., and sent a link to a demo that governments can preview if they’re looking into using its technology for traditional contract tracing, but ultimately referred all questions to D.C. The demo shows how a government might manage contact tracing through a call center and case management console developed by Salesforce. The spokesperson only added that its contact-tracing solution is compliant with HIPAA.
“Our work includes development and deployment of a technology platform and related processes and capabilities to support the work of case interviewers, contact tracers and other key functions involved in reaching out to COVID-19 positive cases and their exposed contacts,” an Accenture representative said, before referring other questions to the D.C. government.