With the detection of the first case of Covid-19 in Male’ from an individual with no recent travel history, Greater Male’ and K. Kaashidhoo has been placed under lockdown, and President Solih and the Health Protection Agency (HPA) have announced that contact tracing is currently ongoing. As for now, some of the people the positive patient came into contact with have been identified and the HPA has stated that every person who visited the address of the positive patient within the last 14 days will be tested.
This is a horrific development as it is now almost a certainty that Covid-19 is spreading through Male’ City. Given the population density (the highest in the world), our chances of avoiding rapid community spread were always slim. And our dismal record with social distancing measures isn’t encouraging.
Over the next few days, effective contact tracing will be a matter of life and death. During a pandemic, one of the best tools in the arsenal of public health experts is figuring out the people each infected person recently interacted with. HPA will now have to start aggressively contact tracing at a much higher rate that they have been so far. The number of infections we can avoid, and the lifting of the lockdown depends on how effectively this process can be carried out. This is no easy feat, given how congested Male’ is and the large number of people anyone who steps out of the house could likely interact with. The current contact tracing method involves staff interviewing patients about their travels and whereabouts (the accuracy depends solely on good memory or them having kept records) and calling or knocking on the doors of contacts.
In a situation like this, a contact tracing app can be very helpful. Such apps are already being used in the US, South Korea and Singapore, among others. So how would an app like this work? Proximity or location data will be used to notify someone who has recently been near an infected individual, so that they can then take preventative action such as self-isolation. Hence, a Bluetooth enabled phone with the app could help pinpoint exactly who interacted with whom and needs to be in quarantine. Users can also voluntarily opt-in to record details of their symptoms when they start to feel unwell, following which a warning will be sent to others who have the app and have been in close contact with the unwell person.
There is currently a global race to develop these apps with Google and Apple leading the way by planning to build contact tracing into their operating systems. And government built apps like Singapore’s TraceTogether have already gotten over a million users, though this still isn’t enough to make it meaningful. The number of users is crucial as stated in a report published by medical researchers and bioethicists at the University of Oxford which confirms that a digital contact tracing app has the potential to achieve epidemic control if used by enough people. Some epidemiologists have said that at least 60% of a country needs to activate digital contact tracing for it make an impact. This will surely be a challenge in Maldives, since we struggle to enforce even the most rudimentary social distancing measures.
The challenges don’t end here, there are accuracy concerns with the Bluetooth technology and privacy concerns with regards to the potential for the encroachment on civil liberties if the use of such an app becomes widespread. We argue that given how bleak and dangerous the alternative is, it might still be worth encouraging the use of a contact tracing app with adequate privacy-preserving controls. The alternative can easily be, as we have already seen in parts of the US, a situation where the public health authority runs out of resources to trace contacts for every new infection as case numbers increase. This would be an unyielding tragedy. Therefore, though it would be a challenge for a critical mass of people to start using the app, and though there are accuracy and privacy concerns; we must do everything in our power to contain Covid-19. And we must adjust to the new normal that we find ourselves in. Also, if we have such an app ready, with enough people encouraged to use it by the time the lock down is lifted, a second wave can be avoided. This is the time to come together and fight this pandemic as one force. We urge the government to seriously consider digital contact tracing and we urge the public to voluntarily opt in if at all such an app is available. Not all heroes wear capes, many around the world stay home and enable Bluetooth on their phones. If there was ever a time for individual responsibility, unity and heroism, this is it.