How East Asian Countries Are Using Technology to Contain COVID-19
Much has been made of the responses by various East Asian nations to the COVID-19 pandemic that is currently scourging the globe. While nearly every East Asian country has managed to get the spread of the virus down to at least a double-digit daily increase by April 2020, compared to the thousands of new cases appearing daily in the United States, little has been discussed about their variations in strategy. One key factor in the efficacy of East Asian viral outbreak control has been identification of infected persons and contact tracing to manage its spread. The methods employed for network-based identification, however, differ depending on the value systems of different nations and their broader risk-management objectives. Exploring how these countries use data to deal with the threat of COVID-19 and the reasons for their particular approaches can yield insights for American policy makers on which strategies to employ, what would be suitable for US objectives, and how present policy changes can be made effective in the context of the viruses current exponential growth.
The COVID-19 response strategies of China, South Korea, Singapore, and Taiwan will be compared to highlight the relationships between response objectives, data usage, and containment efficacy to argue that the United States must take lessons from various aspects of East Asian nations in order to formulate an effective response.
The epicenter of the outbreak, China’s strategy has drawn significant global attention. In many ways China was very late to act in responding to the virus, making its approach attractive to nations, such as Italy and Spain, which have been particularly hard hit. Relative to its neighbors who learned hard lessons from SARS and H1N1, China failed to build a sufficient public health infrastructure to respond rapidly to the crisis, necessitating a more radical response. China’s draconian measures from widespread lockdowns, shutdown of the Hubei province around Wuhan where the disease first spread, mandatory temperature readings, to quarantining of the suspected sick, are all difficult to enforce, however, without the big data and analytics tools that they have utilized.
For example, in Hangzhou, capital of the Zhejiang province that neighbors Hubei, Health QR codes were implemented to be able to have proactive information on the diseases spread and incentivize compliance with state measures. The system, developed by Alibaba, had citizens take daily temperature readings which were uploaded to an app that gave them a health status. Their movement was restricted if their status drops from green to either yellow or red, with mandated self-quarantine. Businesses are meant to track both their employee’s status and those of their patrons, enabling shops with high track records to operate as normal. This QR system has been expanded throughout the province and is expected to be scaled nationally.
Beyond proactive measures that create incentives for normal operations and the quarantining of the sick are more intensive reactive measures to penalize violations. Cell phone location data is accessible to Chinese officials, which is used to cluster together infected persons and identify those in their vicinity. Violations of quarantine are often identified through combinations of cell phone tracking and behavioral observation, such as the purchase of fever medication. Enforcement of mandatory mask wearing is monitored through facial recognition systems in surveillance cameras which are meant to identify those who are unmasked, though their accuracy is questionable. Social credit scores are adjusted based on the accuracy of one’s personal health reporting creating additional incentives to provide honest information.
These data-driven enforcement mechanisms have been criticized for their hodgepodge nature, with significant variation between cities and provinces. Under the direction of the central government, however, effective approaches were scaled, which helped China reduce the intensity of its lockdown measures as the rate of viral spread decreased. Early in the government’s measures, drones were often used to notify those violating emergency policies. As restrictions on movement have slowly been lifted, the incentives created by information sharing have allowed safety to be maintained without requiring regular police patrols.
The brevity of China’s most extreme lockdowns and mobility restrictions would be hard to imagine without the tools developed by technology giants such as Alibaba and Baidu, the latter of which has been making computing power and providing resources to develop AI diagnostic tools. As technological responses scaled, major privacy concerns came into play. Numerous leaks of the data collected by officials have been reported, negatively affecting citizens’ lives.
China’s approach compares with its neighbors in being essentially reactive, using technology to enforce stringent measures and create the infrastructure for life to return to normal. The quality of the data produced allowed the country to move around resources internally, surging ICU capacity in areas that were projected to be the hardest hit. These initiatives were led by state entities and large companies, often developing quickly due to the non-democratic nature of Chinese politics. Their efficacy is hard to replicate in areas without the authority or technological capability seen in China.
In February South Korea became the first country outside of China to experience a significant COVID-19 outbreak, after one infected individual, dubbed “Patient 31”, managed to elude the country’s isolation strategy, becoming a “super-spreader”. Despite this, the country managed very quickly to get the infection rate under control and has been widely praised for its swift response. The approach South Korea took relied heavily on widely available testing and public transparency about case information, all in the hopes of getting the outbreak under control with minimum social disruption. Much of the success of South Korea’s non-intrusive COVID-19 strategy resulted from the government’s ability to rapidly access and share data, partner with startups ,and make information public in a way to protect citizen safety.
An expansive biosurveillance system is maintained by South Korea’s health minister and Korean Centers for Disease Control and Prevention (KCDC), an institutional capacity created in the wake of South Korea’s particularly disastrous experience with the Middle Eastern Respiratory Virus (MERS), the last coronavirus outbreak. Data requested from medical institutions, private companies, and the national police on the medical status of current or potentially infected individuals must be shared without warrant. Much of South Korea’s contact-tracing ability comes from this near limitless access to private citizen data, which can reconstruct an individual’s behaviors and movement patterns to map out the disease’s transmission. The analysis of this data is then made publicly accessible through various government open data projects including Corona 100 Plus, a system that notifies Koreans when they are approaching an area where there has been a confirmed case. This information has also proven invaluable for startups, who have released mapping applications to help Koreans understand risk levels in different areas, as well as to map out access to masks and testing facilities. The liberty the state has to make data accessible increases the returns to collection, allowing rapid release of effective response tools.
Despite this wide-ranging data collection and sharing power, South Korea nonetheless possesses one of the world’s most stringent privacy regimes. The Personal Information Protection Act (PIPA) mandates that information about data collection be made transparent to individuals, including what is known about them, how it is to be used, and with whom it is to be shared. It provides them with opt-out abilities from many forms of data collection, with strong financial penalties for violations. It is likely the case that the strong compliance and participation with the biosurveillance infrastructure South Korea has built comes from the trust that affording such privacy protections builds.
The handling of the COVID-19 situation, however, shows that having legal protections alone may not be enough to prevent violations from occurring. The public health alerts being sent out to warn individuals of being near potentially affected persons have been criticized for revealing too much information, well beyond what is needed to keep others safe. These potential privacy violations have been noted as causing an uptake in social stigma and harassment against the suspected affected. Balancing the need to make information transparent with the countries own regime of protecting individual privacy has been a challenge in the midst of the epidemic.
South Korea’s strategy differs from China in its more proactive nature, which was likely afforded by the amount of power the state had in collecting vital citizen data. Despite not being as authoritarian as China, the state’s initiatives could be implemented quickly due to the particular danger zoonotic diseases have presented in South Korea in the past. The executive data collection powers that KCDC has may be hard to grant in countries with less confidence in their state, and run the risk of devolving into a highly technocratic approach.
After the outbreak of SARS, Singapore invested heavily in building an infrastructure for dealing with the threat of another contagion. Their approach was put to the test with the 2009 H1N1 outbreak and was updated in a way that enabled them to have a proactive response to the current pandemic. Isolation hospitals for influenza-like systems enabled the country to have large scale testing without risking the spread of the disease, while extensive contract tracing was deployed to isolate suspected cases. An SMS-based quarantine system was put in place, notifying those who had come into contact with an infected person self-isolate, with regular location checks that help reduce spread without major shutdowns to the economy. Positive cases in hospitals are kept in isolation units until they show no signs of being able to spread the virus. Travel restrictions were enacted early on, before the outbreak was even noticeable.
The swift and decisive action taken in the early days of the virus’s spread relied on communication and trust-building with the Singaporean public. Massive public information campaigns made everyone aware of the threat that COVID-19 posed and the steps the government was taking to ensure their safety. Publicly administered websites are updated regularly with statistics and information about the government’s initiatives and a government WhatsApp account sends out information rapidly in an easily accessible manner to limit social panic. These steps were intended to allow society to function with minimal disruption. Singaporeans have until recently been allowed to move around relatively freely, with mandatory temperature readings taken when entering into places of business and public areas. Stickers are given to those who show no symptoms and have normal temperature readings, allowing others to easily understand their fellow citizens’ conditions.
Singapore’s data strategy enables the government to maintain credibility, support enforcement, and get the public to provide them with necessary information To ramp up contact-tracing efforts, an app called TraceTogether was released, which uses Bluetooth signals to detect individuals within a certain proximity. The frequency and duration with others is stored in the app for 21 days, allowing health officials to develop fleshed out contact maps if a user is diagnosed with COVID-19. This information sharing is mandated, with harsh penalties for non-compliance.
While effective in reducing the spread of the virus, Singapore’s efforts have not removed the virus’s growth entirely. The government has recently moved to embrace more wholesale social distancing strategies to supplement its contact-tracing driven approach, as gaps in its technology prevented it from being entirely successful. Having developed its technology through government engineers initially, it was announced its intention that an API for TraceTogether would be released to recruit developers to assist in community-driven improvements to the technology.
Singapore’s efforts differ markedly from both China and South Korea in its cooperative approach between the state and the public. While the government is the first mover in developing its data strategy, a significant emphasis is placed on getting Singaporeans on board. In contrast to surveillance systems, most of the initiatives in Singapore are done through its contact tracing apparatus, which has enabled it to be one of the most proactive in prevented potential cases from actualizing. Singapore’s notification strategy for those with potential contacts with COVID-19 victims has come under less fire than South Korea’s due to the anonymization built into its app that only public health officials are allowed to reidentify. Often penalties are stiff for violating government measures, which ensures public buy in, and enforcement is possible through gaining the cooperation of all the businesses within the country. This partnership approach has many lessons in decentralizing efforts to follow a centralized strategy.
Much like Singapore, Taiwan had a very rapid response to the crises, with the government quickly putting together a list of 124 action items when early warnings of the viruses spread outside of China were sounded. The list was drafted by its Central Epidemic Command Center (CECC), a body created in the aftermath of SARS that is given wide-ranging authorities to create a unified response to potential pandemics. The actions included border controls, work from home policies, public information campaigns, and hospital resource assessments, among various other initiatives that became a comprehensive national strategy.
A key part of Taiwan’s early stage assessment relied on data from its immigrations and customs databases to identify travel-related risks. Travel data was combined with clinical symptoms to classify individuals returning from abroad based on their risk level. Those deemed as high risk were sent SMS notifications to self-quarantine at home with regular location tracking updates to verify that they were complying.
Health insurance data was also used to find all cases with influenza-like symptoms who nonetheless tested negative for the flu, retesting them for COVID-19. This proactive approach was taken well before a large number of cases were documented. A hotline was created for each major city to allow for citizens to report their own symptoms or the symptoms of people in their area. To reduce the likelihood of stigma, personalized messages and government assistance was provided to those under quarantine.
Compared to approaches in other East Asian countries, the Taiwanese government relied on a bottom-up approach, seeking citizen input and cooperation in shaping its response. Rather than simply acting in a way to earn the public’s trust in the competency of the state’s decisions, the public was made to be a key partner. The Taiwanese digital ministry has created several platforms inspired by the city-state’s hacker community, such as the vTaiwan and Join platforms, that allow citizens to directly engage in policy discussions to build consensus. Around half of the Taiwanese population has participated in these sorts of platforms.
Many of Taiwan’s more data-centric initiatives, such as tracking the availability of face masks, were built out rapidly by citizen-programmers, rather than by government engineers. Data collection for many projects was voluntary, resulting from the transparency with which the government and the developer community provided for its use. The health ministry facilitated in administering the large pools of data collected in a way that made it accessible while protecting privacy.
The collaborative approach that Taiwan developed for coordinating an effective containment strategy has allowed it to contain the virus more effectively than all its East Asian neighbors. In many ways, the value system of Taiwan, emphasizing democratic accountability and public-private partnership, is the most consistent with Western regimes. Despite these values, Taiwan’s small geographic size and dense population allows for centralized responses in way that is more enforceable than geographically expansive and diverse countries.
Lessons for the United States
The United States has much to learn from the differences in East Asian COVID-19 responses, fitting them into its own broader relief strategy. Each approach has its own particularities to the local population being governed and must be taken in that context to yield actionable insights for US policymakers. The large geography of the United States, its diverse population, and liberal values make a 1:1 adoption of any individual East Asian approach impracticable.
From China, however, the United States can adopt partnerships with large technology giants in order to increase the efficacy of its response. US companies have been leaders in responding to the crisis, and their partnerships to aid foreign governments should be replicated domestically in order to scale up government efforts. Palantir has been developing comprehensive approaches to tracking COVID-19 and partnering with both the CDC and NHS to aid in ramping up their capacities. Amazon has managed to create effective supply chains for essential equipment as distribution networks falter amidst the crisis, partnering with the Canadian government to supply medical staff. Just as China’s most innovative responses were driven by Alibaba and Baidu, the US would benefit by putting aside its current confrontations with tech companies and recruiting them into its efforts.
Partnering with large technology companies cannot however come at the expense of public cooperation. Singapore teaches the US the importance of maintaining open and transparent communication with the public, seeing them as partners in responding to the crisis. By streamlining information sharing and making action items for its COVID-19 response more digestible and accessible, the US can increase public compliance. Working with social media companies to have a coordinated information campaign would benefit immensely.
More bottom up engagement is also essential in order to advance a response to COVID-19 that nonetheless fits into America’s liberal values. Taiwan’s initiatives to make data accessible to the public and have public input drive policy responses proves useful in this regard. While this approach cannot be fully replicated in the United States, given the lower density of its population and greater diversity, public participation on more targeted efforts would benefit immensely. Initiatives such as CORD-19, which have made medical research on coronaviruses more accessible to technologists are a step in this direction. Using Natural Language Processing (NLP), to improve the processing of medical literature, however, provides only marginal accelerations to understanding the disease. Making more types of data accessible would allow more tools, such as Singapore’s contact-tracing app or Taiwan and South Korea’s mask tracking platforms, accessible to Americans.
Finally, the United States needs to take lessons on preparing for the next pandemic. It is highly likely that the frequency of zoonotic virus outbreaks will increase, making viral epidemics the new normal. Building the necessary infrastructure to cope with this possibility must be an essential component of the current pandemic response. The Trump Administration has now invoked the Defense Production Act in order to increase the US’s production of vital medical equipment, an acknowledgement of the gravity of the threat. Viral diseases must be treated like the national security threat they are, and surveillance systems of the style built in South Korea, which simultaneously collect information while providing privacy guarantees to the public must be considered.
The response to the current crisis highlights the importance of data strategies in threat preparedness and response. The United States failed to have effective protocols in place in the run up to the COVID-19 outbreak, but it must now act in order to save lives and not be caught off guard in the future. The embrace of data-driven responses across East Asia can yield valuable insights for US policymakers and learning from effective decisions abroad must be a critical part of any strategic decisions made. There is an urgency in acting, which necessitates learning from what has worked, rather than going it wholly alone.