- The government has made Aarogya Setu app compulsory for citizens in containment zones as well as for office goers.
- The app was launched on April 2 with a vision to track the spread of coronavirus infections in India.
- Several district officials have their own protocols and apps in place for contact tracing and are not using Aarogya Setu data.
A furore erupted a few days ago in India after the government made it compulsory for citizens living in containment zones as well as those going to offices to download the Aarogya Setu app. The basic idea behind the app, when it was first launched, was that it would help the government identify cluster zones while freeing up those that were COVID-19 free. The app tracks all those who have downloaded it. In case India saw an explosion of cases out of nowhere, the government could quickly use the information from the app to manage human resources to cope with the situation. But now confusion reigns and there are questions about the privacy and data security aspects of Aarogya Setu.
The reality is a little different from what the app was originally meant for—quick contact tracing. Several district officials and administrators who are fighting the battle against COVID-19 on the ground have their own protocols in place. Dr B M Mishra, the district magistrate of South Delhi, uses two apps to identify cluster zones as well as keep people at home.
Delhi has seen a constant rise in COVID-19 cases—it has had above 100 new cases from April 22 until the end of the month and the number has only gone up in the first few days of May. It also has 93 containment zones. Early on, B M Mishra's team used to jot down notes about people's health history by making door-to-door visits.
But crunching that data to arrive at an efficient decision—who would need tests or who would need to go to the hospital —took a lot of time. Soon, he began working with the National Informatics Centre (NIC) to develop two apps, the Containment Survey and the Home Quarantine. Now, about 15-20 teams use the Containment Survey app to collect information about the household members in a containment zone. Each team can interview 60-70 households a day so it doesn't take very long for the teams to go about the process.
By using the Home Quarantine app, B M Mishra's team makes sure that persons placed under home quarantine—they're so far COVID-19 suspects—are not violating orders. Those quarantined upload a selfie every two hours on the app (they have to give their consent before downloading the app), and if they don't, receive a phone call from an official to check up on their status. The protocol has been working well for two reasons.
One, it gives the team the data they need to contain the spread of COVID-19. It does not include data of those living outside containment zones but teams can easily gather that data in a couple of hours. It was exactly by running this app that Delhi was quickly able to place people who a pizza delivery boy who had tested positive for COVID-19 had come in contact with. B M Mishra's team were able to declare they were risk-free, and place them under home quarantine.
Two, it makes decision making a hundred times faster. After collecting information about each member of the household, the team crunches data to see who they should follow up with. Did someone report shortness of breath? If yes, the team sends an ambulance and a doctor by early next day.
So where does Aarogya Setu play a role? "It gives me information about my own health," says B M Mishra. Since he can't have all persons in Delhi download the apps he's created for a target audience, the Aarogya Setu app helps citizens become aware of their surroundings. So far, he hasn't used the app to identify cluster zones but adds that he will look into it.
In Punjab, Vinay Bublani, the district collector at SAS Nagar, which has the highest number of COVID infections in the state, says that it's hard to get people to download the Aarogya Setu app, especially under time pressure. Bublani instead relies on human-to-human interaction. When someone tests positive, he has a medical professional talk to the patient to understand the whereabouts of the patient. If the patient is reluctant, as is often the case, Bublani and his team reach out to someone the patient is close with to tease out information about the possible source of COVID-19. If nothing works, Bubali reaches out to the sarpanch of the area. He established the processes after the state reported its first case in Pathlawa village (in early March). Ever since, no new cases have been reported from the village.
In the Wayanad district in Kerala, which reported three fresh cases in the state on May 5 after no new cases were reported for two days, the district collector, Dr Adeela Abdullah has been banking on teams which consist of what she calls the "golden five." Each team consists of—an ASHA volunteer, a junior health inspector, a local ward member, an Anganwadi worker, and a volunteer—who assists in contact tracing. To verify if a COVID-19 positive patient is telling the truth, she contacts police personnel to grab CCTV footage wherever possible.
In each instance, there's a protocol already in place. Active surveillance—as opposed to passive surveillance where an official collects information from a given authority—has been a norm for any notifiable disease so long as it anonymizes the individual. In a recent online discussion, Amar Patnaik, the head of the BJD IT Wing, explained that it wasn't new to surveil people during a public health crisis in India. The real question is striking a balance between protecting data and using data to monitor the crisis. It is because we know so little about the virus and how it strikes that it's hard to formulate recovery plans.
The question then is what is happening with the data that Aarogya Setu app is collecting. How is this data helping the government and officials, who are on the ground fighting coronavirus infections? The app has been downloaded by close to 90 million people in India, but there is no clarity on how the data that the app is collecting is being used by the government.
One thing though seems to be getting clear: the app data in itself will not do much in tracing and containing coronavirus infections because the scale is just too big, and particularly so in India. No amount of data can automate the whole process. Jason Bay, the product lead for Singapore's contact tracing app, best captures it in a sentence—you cannot "big data" your way out of a "no data" situation. In India, so far it seems that Aarogya Setu app might be generating a lot of data but government officials on the ground have either not found good use of this data or have not found it good enough to use.