To contain COVID, empowering individuals vastly outperformed Washington’s bureaucratic systems
During the next several years, health researchers will look at the COVID pandemic to learn lessons about how to deal with future outbreaks and understand how to improve the performance of our health system. Based on the experience in Washington state, one lesson should be clear: while government programs failed badly, technology that provided information directly to potentially exposed individuals gave hundreds of thousands of people a tool that could help contain the pandemic.
This approach is not only more effective, but it is more moral, allowing people to make important personal decisions rather than having costs imposed on them arbitrarily by politicians.
To see why, we can compare the results from the state’s program to contain the spread of the illness and a the COVID-exposure app developed by Google and others to provide people with information about potential exposure.
At the beginning of 2022, as COVID rates in Washington state spiked to their highest level of the pandemic, the Washington State Department of Health’s (DOH) system to notify those who may have been exposed virtually collapsed. Known as “contact tracing,” the state pledged to call those who tested positive and see who they might have exposed to help contain the spread of the illness.
DOH’s leadership pledged to reach 90% of those infected within one day of a positive test. During the worst two months of the outbreak, the highest percentage DOH reached in any week was 7 percent of COVID-positive patients. At the peak of the outbreak in mid-January, they reached only three percent. During that critical period, DOH reached fewer than 12,000 people. At no point in the nearly two years of the program did it come anywhere close to reaching 90 percent.
By any metric – including the state’s own – the results were abysmal. A failure.
By way of contrast, those who voluntarily signed up for information about potential exposure using a privately developed app on their phone received immediate and actionable information.
Since it was launched at the end of November 2020, the WA Notify app sent about 3.5 million notifications letting people know they were close to someone who tested positive. Those who chose to put the app on their phone – like me – received a notification, encouraging them to pay attention for symptoms and get tested if they feel ill.
Some worried about privacy, and I understand that. The app is designed to protect privacy and doesn’t keep information. Both Apple and Google prohibited the use of GPS location when reporting exposure. Understandably, some don’t trust those promises. My response is that companies have many ways to get more useful personal information than this app. And if you test positive at your doctor’s office, it is reported to DOH, so the app isn’t giving information that isn’t collected in other ways.
The numbers are somewhat difficult to pin down because the app doesn’t track any personal identification information, but the state estimates that 1.2 million people used the app.
In the 91 weeks since it was launched, WANotify sent an average of 38,400 notifications – more per week than DOH reached during nine weeks of the worst outbreak.
Although the app was voluntary – people didn’t have to download if they were uncomfortable – it vastly outperformed DOH’s contact tracing effort. Unlike the state’s contact tracing effort that encouraged the few COVID-positive patients they reached to notify others they might have exposed, the app did it immediately and anonymously. Patients who used the app could report a positive test and the app would contact others directly without disclosing who might have exposed them. That is far more effective and comprehensive, and eliminates the potential embarrassment of having to tell a friend they might have been exposed.
This approach reached many more people, more quickly, and it made more sense. The strategy employed by Governor Inslee was summed up when he said that “only one man” (him) could address the COVID pandemic in Washington state. That is not only extremely undemocratic, but the harm done by bad policies are felt by individuals, not the governor. We saw the government notification system’s failure when the two largest outbreaks occurred after the governor declared he had won the “Super Bowl” of COVID policy. That arrogance had consequences.
Government systems that failed badly were never fixed and were, in fact, ignored because the failure would be a political embarrassment. Contact tracing never came close to meeting its goal. Poor systems of testing were fixed belatedly, only after media attention. Washington’s rollout of vaccines was one of the slowest in the country. These government failures had a cost, and the mindset of centralized authority made it difficult (or impossible) for individuals to get services outside failing government systems.
Giving individuals the information they need to monitor their own health and prevent the spread to others around them is more respectful of individual circumstances and doesn’t rely on bureaucratic systems working as planned. It can reach more people, more reliably, and more quickly.
Of course, many people will choose not to participate for one reason or another. But when the government alternative is reaching fewer than 10 percent of people they know tested positive, quibbling about the non-participation of some people seems trivial.
Before there were tools available to empower individuals to take action, a top-down, government-centered approach could be justified on the basis that while they may perform poorly, they were the only option. That is no longer the case. The technology that is now available allows a more effective and ethical response, that honors the rights and dignity of individuals. In the future, that voluntary, technology-based approach should be the center of our response rather than the failed government-heavy approaches that characterized Washington’s COVID response.