Mass-surveillance technologies to fight coronavirus spread: the case of Israel

Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review

BACKGROUND

The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups).

OBJECTIVE

We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance.

METHODS

Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines.

RESULTS

We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability.

CONCLUSIONS

A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi.org/10.1136/bmjopen-2021-053962.

Pediatric Trauma During COVID-19: What Have We Learned?

BACKGROUND

In December 2019, an outbreak of a novel pneumonia-like illness, COVID-19 (C-19), emerged in Wuhan, China. In March 2020, as the incidence of C-19 rose, the Israeli government, like that of other nations, declared a national state of emergency, and a full, general lockdown was announced.

PURPOSE

The purpose of this study is to determine the incidence and characteristics of pediatric maxillofacial trauma presentation during the 2020 C-19 lockdown restrictions and compare them to periods outside lockdown between 2019 and 2020 (pre-C-19).

STUDY DESIGN, SETTING, SAMPLE

A retrospective cohort study was conducted and included all pediatric patients (0-18 years) referred to the emergency department (ED) at Tzafon Medical Center, Israel, and diagnosed with maxillofacial injuries. Patients with missing demographic data and patients who did not complete the medical examination were excluded.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The exposure variable is the date of injury-2020 C-19 lockdown period compared to the previous year (pre-C-19).

MAIN OUTCOME VARIABLE(S)

The main outcome variable was the number of pediatric maxillofacial trauma ED arrivals out of total pediatric ED arrivals and out of total maxillofacial ED arrivals.

COVARIATES

Covariates included patient demographics, etiology, and place of injury.

ANALYSES

The association between categorical variables was tested using the Fisher exact test or χ2 test for binary variables with relative risk when appropriate, logistic regression model used to predict outcome variable. P values were 2-tailed and statistical significance was defined as P < .05.

RESULTS

The study sample comprised 1174 patients. Relative risk of presenting with oral and maxillofacial trauma out of all pediatric ED patients was 1.85 comparing C-19 period to pre-C-19 period (confidence interval [1.65; 2.073], P < .0001). Most of the injuries recorded during the C-19 restrictions occurred in the domestic environment (56.1% compared to 47.5% in pre-C-19, P < .001). Incidences necessitating treatment increased from 45.8 to 55% during C-19 (P = .002).

CONCLUSION AND RELEVANCE

During C-19, there was a higher rate of pediatric injuries compared to pre-C-19. The incidence of domestic oral and maxillofacial injuries increased despite the considered home safety.

The Israeli health system's rapid responses during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic posed numerous challenges to health systems around the world. In addressing many of those challenges, Israel responded quite rapidly. While quick action is not an end in it itself, it can be important in responding to disease outbreaks. Some of Israel's rapid responses to the pandemic contributed significantly to population health and provided important learning opportunities for other countries.

MAIN BODY

Some of the most prominent Israeli rapid responses were related to vaccination. Israel led the world in the pace of its initial vaccine rollout, and it was also the first country to approve and administer booster vaccines to broad segments of the population. In addition, Israeli scholars published a series of timely reports analyzing vaccination impact, which informed policy in Israel and other countries. Israel was a rapid responder in additional areas of public health. These include the partial closure of its borders, the adoption of physical distancing measures, the use of digital surveillance technology for contact tracing, the use of wastewater surveillance to monitor viral spread, and the use of vaccine certificates ("green passes") to facilitate a return to routine in the face of the ongoing pandemic. Many factors contributed to Israel's capacity to repeatedly respond rapidly to a broad array of COVID-19 challenges. These include a national health insurance system that promotes public-private coordination, a system of universal electronic health records, a high level of emergency preparedness, a culture of focusing on goal attainment, a culture of innovation, and the presence of a strong scientific community which is highly connected internationally. In addition, some of the rapid responses (e.g., the rapid initial vaccination rollout) facilitated rapid responses in related areas (e.g., the analysis of vaccination impact, the administration of boosters, and the adoption of green passes). While rapid response can contribute to population health and economic resilience, it can also entail costs, risks, and limitations. These include making decisions and acting before all the relevant information is available; deciding without sufficient consideration of the full range of possible effects, costs, and benefits; not providing enough opportunities for the involvement of relevant groups in the decision-making process; and depleting non-renewable resources.

CONCLUSIONS

Based on our findings, we encourage leaders in the Israeli government to ensure that its emergency response system will continue to have the capacity to respond rapidly to large-scale challenges, whether of a military or civilian nature. At the same time, the emergency response systems should develop mechanisms to include more stakeholders in the fast-paced decision-making process and should improve communication with the public. In addition, they should put into place mechanisms for timely reconsideration, adjustment, and-when warranted-reversal of decisions which, while reasonable when reached, turn out to have been ill-advised in the light of subsequent developments and evidence. These mechanisms could potentially involve any or all branches of government, as well as the public, the press, and professional organizations. Our findings also have implications for health system leaders in other countries. The Israeli experience can help them identify key capacities to develop during non-emergency periods, thus positioning themselves to respond more rapidly in an emergency. Finally, health system leaders in other countries could monitor Israel's rapid responses to future global health emergencies and adopt selected actions in their own countries.

Rapidly Establishing an Ultra-Cold Supply Chain of Vaccines in Israel: Evidence for the Efficacy of Inoculation to Mitigate the COVID-19 Pandemic

The agenda of this research was to investigate how to mitigate the spread of coronaviruses by rapidly establishing an ultra-cold supply chain of vaccines. Data analysis was conducted by linear regression utilizing a dataset publicly available from the Israel Ministry of Health regarding the daily rates of people vaccinated, tested, hospitalized, etc., since the start of the pandemic. The data provide statistical evidence for the efficacy of the Pfizer vaccines in diminishing a wide variety of disease factors, such as the number of patients who were lightly, moderately, or severely sick, and daily deaths, as well as the rate of spread (R-ratio) and number/percentage of people infected. Insightfully, the data corroborate how the first and second doses of the vaccines were able to decrease the wave of COVID-19, which hit Israel in January 2021, while the booster third dose was able to diminish a subsequent COVID-19 wave occurring in Israel in July 2021.

Pandemetrics: systematically assessing, monitoring, and controlling the evolution of a pandemic

The still ongoing pandemic of SARS-CoV-2 virus and COVID-19 disease, affecting the population worldwide, has demonstrated the need of more accurate methodologies for assessing, monitoring, and controlling an outbreak of such devastating proportions. Authoritative attempts have been made in traditional fields of medicine (epidemiology, virology, infectiology) to address these shortcomings, mainly by relying on mathematical and statistical modeling. However, here, we propose approaching the methodological work from a different, and to some extent alternative, standpoint. Applied systematically, the concepts and tools of statistical engineering and quality management, developed not only in healthcare settings, but also in other scientific contexts, can be very useful in assessing, monitoring, and controlling pandemic events. We propose a methodology based on a set of tools and techniques, formulas, graphs, and tables to support the decision-making concerning the management of a pandemic like COVID-19. This methodological body is hereby named Pandemetrics. This name intends to emphasize the peculiarity of our approach to measuring, and graphically presenting the unique context of the COVID-19 pandemic.

Use of digital technologies for public health surveillance during the COVID-19 pandemic: A scoping review

Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequently used technologies included mobile phone devices and applications, location tracking technologies, drones, temperature scanning technologies, and wearable devices. The utility of digital technologies for public health surveillance was impacted by factors including uptake of digital technologies across targeted populations, technological capacity and errors, scope, validity and accuracy of data, guiding legal frameworks, and infrastructure to support technology use. Our findings raise important questions around the value of digital surveillance for public health and how to ensure successful use of technologies while mitigating potential harms not only in the context of the COVID-19 pandemic, but also during other infectious disease outbreaks, epidemics, and pandemics.

Equitable Design and Use of Digital Surveillance Technologies During COVID-19: Norms and Concerns

Given the unprecedented scale of digital surveillance in the COVID-19 pandemic, designing and implementing digital technologies in ways that are equitable is critical now and in future epidemics and pandemics. Yet to date there has been very limited consideration about what is necessary to promote their equitable design and implementation. In this study, literature relating to the use of digital surveillance technologies during epidemics and pandemics was collected and thematically analyzed for ethical norms and concerns related to equity and social justice. Eleven norms are reported, including procedural fairness and inclusive approaches to design and implementation, designing to rectify or avoid exacerbating inequities, and fair access. Identified concerns relate to digital divides, stigma and discrimination, disparate risk of harm, and unfair design processes. We conclude by considering what dimensions of social justice the norms promote and whether identified concerns can be addressed by building the identified norms into technology design and implementation practice.

Global key concepts of civil-military cooperation for disaster management in the COVID-19 pandemic-A qualitative phenomenological scoping review

Background

In the context of a holistic and comprehensive disaster response effort to the COVID-19 pandemic, many countries across the globe mobilized their military forces in order to cope with sudden and exponential surges of critically ill patients with COVID-19 in stretched healthcare systems.

Objective

The purpose of this work is to identify, map, and render world-wide key concepts of civil-military cooperation (CIMIC) in disaster management during the COVID-19 crisis visible.

Material and methods

Literature was systematically searched in three databases (PubMed, Web of Science, Cochrane Library) on 26 January 2022, and analyzed with qualitative, mixed narrative-phenomenological methods in compliance with PRISM-ScR and SRQR.

Results

Forty-five publications were included in the analysis; pertinent authors were from 22 countries covering five continents. We identified three key thematic clusters in the published literature: Cluster (1) Medico-scientific contributions with the participation of military medical personnel or institutions: members of the military acted as subject matter experts, clinical and experimental (co-) investigators as well as co-founders for enabling COVID-19 relevant research. Areas covered were relevant to the COVID-19 patient's clinical journey from prevention, exposure, diagnostics, and treatment and included pertinent fields such as digital health and telemedicine, global and public health, critical care, emergency and disaster medicine, radiology, neurology, as well as other medical specialties, i.e., respiratory care, pulmonology, burn medicine, and transfusion medicine, in addition to environmental and occupational sciences as well as materials science. Cluster (2) CIMIC field experiences or analyses included areas such as political framework, strategy, structure, nature of civil-military interaction, and concrete mission reports in selected countries. Themes covered a broad spectrum of pandemic disaster management subjects such as capacity and surge capacity building, medical and pharmaceutical logistics, patient care under austere circumstances, SARS-CoV-2 testing support, intelligent and innovative information management, vaccination support, and disaster communication. Cluster (3) The military as a role model for crisis management.

Conclusion

Civil-military cooperation made a significant contribution to the level of resilience in crisis management on a global scale, positively impacting a broad spectrum of core abilities during the COVID-19 pandemic.

COVID-19 surveillance in Israeli press: Spatiality, mobility, and control

In March 2020, Israel passed emergency regulations authorizing its internal security agency to track citizens' mobile phone geolocations in order to tackle the spread of COVID-19. This unprecedented surveillance enterprise attracted extensive media attention and sparked a vigorous public debate regarding technology and democratic values such as privacy, mobility, and control. This article examines press coverage of Israel's surveillance of its citizens during the COVID-19 pandemic by four leading news sites to identify and map the frames that informed their reports. Based on a thematic analysis, our findings point to supportive and critical constructions of mobile phone location-tracking and organize them within two scapes: personal; and international. These attest to the collective imagining of intimacies and public life, respectively. We draw on the case study to articulate mobile phones as devices that reduce movement into manageable mapped information and individuals into controllable data. Mobile phone location-tracking during the COVID-19 pandemic is understood as turning mobility into order and control.

Evidence for content-dependent timing of real-life events during COVID-19 crisis

How do people estimate the time of past events? A prominent hypothesis suggests that there are multiple timing systems which operate in parallel, depending on circumstances. However, quantitative evidence supporting this hypothesis focused solely on short time-scales (seconds to minutes) and lab-produced events. Furthermore, these studies typically examined the effect of the circumstance and the psychological state of the participant rather than the content of the timed events. Here, we provide, for the first time, support for multiple content-based timing systems when estimating the time of real-life events over long time-scales. The study was conducted during the COVID-19 crisis, which provided a rare opportunity to examine real-life time perception when many were exposed to similar meaningful events. Participants (N = 468) were asked to retrospectively estimate the time that has passed since prominent events, that were either related or unrelated to the pandemic. Results showed an overall time-inflation, which was decreased for events related to the pandemic. This indicates that long-term subjective timing of real-life events exists in multiple systems, which are affected not only by circumstances, but also by content.

Fostering participation in digital contact tracing

Digital contact tracing is a promising digital public health intervention to manage epidemics. However, in order to reach its full potential, the technology has to be widely adopted and used. During the SARS-CoV-2 pandemic, this has not necessarily been the case. We review the literature with a focus on how participation in digital contact tracing could be fostered and provide policy recommendations on how to increase its adoption and usage as well as recommendations for further research.

A modified UTAUT model for the acceptance and use of digital technology for tackling COVID-19

COVID-19 pandemic expedites the development of digital technologies to tackle the spread of the virus. Several digital interventions have been deployed to reduce the catastrophic impact of the pandemic and observe preventive measures. However, the adoption and utilization of these technologies by the affected populace has been a daunting task. Therefore, this study carried out exploratory investigation of the factors influencing the behavioural intention (BI) of people to accept COVID-19 digital tackling technologies (CDTT) using the UTAUT (Unified Theory of Acceptance and Use of Technology) framework. The study applied principal components analysis and multiple regression analysis for hypotheses testing. The study revealed that performance expectancy (PE), facilitating conditions (FC) and social influence (SI) are the best predictors of people's BI to accept CDTT. Also, organizational

influence and benefit (OIB) and government expectancy and benefits (GEB) influence the people's BI. However, variables such as age, gender and voluntariness to use CDTT have no significance to influence BI because the CDTT is still nascent and not easily accessible. The results show that the decision-makers and regulators should consider inciting variables such as PE, FC, SI, OIB and GEB, that motivate the acceptance and use of CDTT. Furthermore, the populace must be sensitized to the availability and use of CDTT in all communities. Also, the path diagram and hypothesis testing results for CDTT acceptance and use, will help government and private organizations in planning and responding to the digitalization of COVID-19 protective measures and hence revise the COVID-19 health protection regulation.

Age-related mortality in 61,993 confirmed COVID-19 cases over three epidemic waves in Aragon, Spain. Implications for vaccination programmes

BACKGROUND

Risk for severe COVID-19 increases with age. Different vaccination strategies are currently being considered, including those aimed at slowing down transmission and those aimed at providing direct protection to those most at risk.

METHODS

The objectives of the current study were i) to assess age-related incidence and survival between PCR-diagnosed COVID-19 cases (n = 61,993) in the Autonomous Community of Aragon from March to November 2020, and ii) to characterize age differences regarding the course of the disease in hospitalized patients in a tertiary university hospital.

RESULTS

We found a similar incidence of COVID-19 in individuals between 10 and 79 years. Incidence increased in those over 80 years possibly because of the elevated transmission within the nursing homes. We observed a profound disparity among age groups; case fatality rates (CFRs) were near 0 in cases younger than 39 years throughout different waves. In contrast, there was an age-dependent and progressive increase in the CFRs, especially during the first pandemic wave. SARS-CoV-2 infection caused a more severe and rapid progression in older patients. The elderly required faster hospitalization, presented more serious symptoms on admission, and had a worse clinical course. Hospitalized older individuals, even without comorbidities, had an increased mortality risk directly associated with their age. Lastly, the existence of comorbidities dramatically increased the CFRs in the elderly, especially in males.

CONCLUSION

The elevated incidence of COVID-19 and the vulnerability of the elderly call for their prioritization in vaccination and targeted prevention measures specifically focused on this aged population.

(UN)MASKED COVID-19 TRENDS FROM SOCIAL MEDIA

Background

The adoption of nonpharmaceutical interventions and their surveillance are critical for detecting and stopping possible transmission routes of COVID-19. A study of the effects of these interventions can help shape public health decisions. The efficacy of nonpharmaceutical interventions can be affected by public behaviors in events, such as protests. We examined mask use and mask fit in the United States, from social media images, especially during the Black Lives Matter (BLM) protests, representing the first large-scale public gatherings in the pandemic.

Objective

This study assessed the use and fit of face masks and social distancing in the United States and events of large physical gatherings through public social media images from 6 cities and BLM protests.

Methods

We collected and analyzed 2.04 million public social media images from New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis between February 1, 2020, and May 31, 2020. We evaluated correlations between online mask usage trends and COVID-19 cases. We looked for significant changes in mask use patterns and group posting around important policy decisions. For BLM protests, we analyzed 195,452 posts from New York and Minneapolis from May 25, 2020, to July 15, 2020. We looked at differences in adopting the preventive measures in the BLM protests through the mask fit score.

Results

The average percentage of group pictures dropped from 8.05% to 4.65% after the lockdown week. New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis observed increases of 5.0%, 7.4%, 7.4%, 6.5%, 5.6%, and 7.1%, respectively, in mask use between February 2020 and May 2020. Boston and Minneapolis observed significant increases of 3.0% and 7.4%, respectively, in mask use after the mask mandates. Differences of 6.2% and 8.3% were found in group pictures between BLM posts and non-BLM posts for New York City and Minneapolis, respectively. In contrast, the differences in the percentage of masked faces in group pictures between BLM and non-BLM posts were 29.0% and 20.1% for New York City and Minneapolis, respectively. Across protests, 35% of individuals wore a mask with a fit score greater than 80%.

Conclusions

The study found a significant drop in group posting when the stay-at-home laws were applied and a significant increase in mask use for 2 of 3 cities where masks were mandated. Although a positive trend toward mask use and social distancing was observed, a high percentage of posts showed disregard for the guidelines. BLM-related posts captured the lack of seriousness to safety measures, with a high percentage of group pictures and low mask fit scores. Thus, the methodology provides a directional indication of how government policies can be indirectly monitored through social media.

Smart City and Crisis Management: Lessons for the COVID-19 Pandemic

COVID-19 shocked cities around the world and revealed the vulnerability of urban lives and functions. Most cities experienced a catastrophic disturbance that has lasted for a long time. Planning plays a critical role in responding efficiently to this crisis and enabling rapid functional recovery in the post-disaster era. Cities that have implemented digitalization initiatives and programs are likely to have more capacity to react appropriately. Specifically, digitalized cities could ensure the well-being of their residents and maintain continuity of urban functions. This research aims to analyze the role of technology in crisis management in the last two decades and provide appropriate policy recommendations for dealing with the COVID-19 pandemic. Systematic literature review and subjective content analysis are employed to investigate the effects of technology on community well-being and making cities more resilient in past crises. This study shows that different technology-driven policies and actions enable crisis management, enhance community well-being, and increase urban resilience. Technology has enhanced coping and recovery capacities by increasing participation and social connectedness, enhancing physical and mental health and maintaining the functionality of education and economic systems. These have been achieved through various solutions and technologies such as social media, telehealth, tracking and monitoring systems, sensors and locational applications, teleworking systems, etc. These solutions and technologies have also been used during the COVID-19 pandemic to enhance community well-being and sustain urban functions. However, technology deployment might have adverse effects such as social exclusion, digital divide, privacy and confidentiality violation, political bias and misinformation dissemination, and inefficient remote working and education. It is suggested that to mitigate these side effects, policymakers should liberate the process of digitalization, increase the accessibility to digital services, and enhance digital literacy.

Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature

BACKGROUND

Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are.

OBJECTIVE

This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app.

METHODS

A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing.

RESULTS

Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app.

CONCLUSIONS

In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.

Participatory COVID-19 Surveillance Tool in Rural Appalachia : Real-Time Disease Monitoring and Regional Response

INTRODUCTION

Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia.

METHODS

A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution.

RESULTS

Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups.

PRACTICAL IMPLICATIONS

This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

Use of wearable sensors to assess compliance of asthmatic children in response to lockdown measures for the COVID-19 epidemic

Between March and April 2020, Cyprus and Greece health authorities enforced three escalated levels of public health interventions to control the COVID-19 pandemic. We quantified compliance of 108 asthmatic schoolchildren (53 from Cyprus, 55 from Greece, mean age 9.7 years) from both countries to intervention levels, using wearable sensors to continuously track personal location and physical activity. Changes in 'fraction time spent at home' and 'total steps/day' were assessed with a mixed-effects model adjusting for confounders. We observed significant mean increases in 'fraction time spent at home' in Cyprus and Greece, during each intervention level by 41.4% and 14.3% (level 1), 48.7% and 23.1% (level 2) and 45.2% and 32.0% (level 3), respectively. Physical activity in Cyprus and Greece demonstrated significant mean decreases by - 2,531 and - 1,191 (level 1), - 3,638 and - 2,337 (level 2) and - 3,644 and - 1,961 (level 3) total steps/day, respectively. Significant independent effects of weekends and age were found on 'fraction time spent at home'. Similarly, weekends, age, humidity and gender had an independent effect on physical activity. We suggest that wearable technology provides objective, continuous, real-time location and activity data making possible to inform in a timely manner public health officials on compliance to various tiers of public health interventions during a pandemic.

Effects of Covid-19 on orthopaedic trauma services: early experiences in South Africa and Israel

South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included being under-resourced, particularly related to trauma, and severe and radical measures had to be undertaken that included extended strict lockdowns, bans on alcohol sales, and cancellation of the majority of the elective surgery during this initial period of the pandemic. Although Israel is much smaller and thereby theoretically easier to control, a complex political situation created difficulties and delays in controlling the pandemic after the initial response, leading to a second wave and additional lockdown. Although massively engaged initially, the Israeli trauma systems had continued functioning almost normally throughout the COVID-19 crisis.

Pandemica Panoptica: Biopolitical Management of Viral Spread in the Age of Covid-19

The current pandemic period has triggered a series of changes in society, at both individual and collective behavioral levels. These changes were perceived as either positive or negative by the impacted bodies, leading to both social change and positive interactions in a tense context. In this paper, the authors will deal with Pandemica Panotpica, subjugation infiltrating all levels of society, and the approach adopted by several countries in trying to find countermeasures to combat the virus' proliferation. Our research scope began at the onset of the pandemic and ended on early January 2021.

Fear of panoptic surveillance: using digital technology to control the COVID-19 epidemic

BACKGROUND

In a bid to reduce infection rates by COVID-19 the authorities in some countries, in collaboration with medical regulators and experts, have employed digital technologies to control and regulate citizens' behavior. Public opinion and the public's compliance with these technologies come into play here. The objective of the present study was to examine attitudes expressed in the public discourse toward the use of digital technologies to control people's behavior during the COVID-19 pandemic, as reflected in the media.

METHODS

Qualitative analysis was performed on posts and comments submitted in response to 12 articles that appeared on the four leading Israeli news sites, on three significant occasions: first, upon the announcement of the use of surveillance technologies by the Israeli security agency (ISA); second, upon the announcement of the launch of the Health Ministry's app that tracks contacts with COVID-19 patients; and third, following reports of petitions lodged with Israel's supreme court challenging the use of surveillance technologies. The analysis was performed using ATLAS-Ti software for systematic analysis.

RESULTS

A total of 2551 posts and comments referring to these 12 articles were found, 714 of which were relevant to the purpose of the study. The analysis revealed disagreement between those who supported the measures taken and opponents. Supporters regarded contact tracing by means of digital technologies as essential to the effort to protect people during the pandemic, and believed that employing the ISA's capabilities was the correct way to combat the epidemic. Opponents of the measures rejected the use of tracking technologies, regarding this step as a move toward dictatorship and a violation of fundamental civil rights. Some proposed alternative measures that would obviate the use of such tracking.

CONCLUSIONS

The primary task of medical practice is to heal illness and alleviate suffering. The debate surrounding the employment of digital technologies during the COVID-19 pandemic highlights the complexity of the close connection between social control and care in times of pandemic. The context of this pandemic has highlighted the interrelatedness of advanced digital surveillance technologies, medical care, and social control exercised by authorities and medical regulators and experts, which raises issues of transparency, trust and mistrust among the public. These issues become all the more relevant when the number of patients grows rapidly, the authorities need to deal with the extended ongoing COVID-19 pandemic, the country has entered a second lockdown, and the public must be persuaded to comply with highly restrictive regulations. Recommendations to policy makers, practical implications, and suggestions for future research are discussed.

COVID-19 testing and infection surveillance: Is a combined digital contact-tracing and mass-testing solution feasible in the United States?

In December 2019, the novel COVID-19 virus spread from a cluster of pneumonia cases in Wuhan, China, to every corner of the globe, creating a worldwide pandemic pushing hospital systems past capacity and bringing economies worldwide to a halt. The COVID-19 pandemic is unique in comparison to prior coronavirus epidemics in its superior ability to be spread by asymptomatic and presymptomatic patients, allowing the virus to silently evade traditional symptoms-based screening approaches. Countries have implemented cutting-edge digital solutions to enhance traditional contact-tracing methodologies in combination with novel testing strategies to combat the virus, with variable levels of success. Despite having one of the most advanced and expensive health care systems in the world, the United States (U.S.) response is arguably one of the world's largest failures, as it leads the globe in case number as well as deaths. Until a successful vaccine can be broadly distributed, it is imperative that the U.S. curb the viral spread by rapidly developing a framework implementing both enhanced tracing and testing strategies balancing the needs of public health while respecting individual liberties. This review will explore the role of technology-augmented contact-based surveillance in tracking the outbreak in select countries in comparison to the current U.S. approach. It will evaluate barriers in the U.S. to implementing similar technologies, focusing on privacy concerns and a lack of unified testing and tracing strategy. Finally, it will explore strategies for rapidly scaling testing in a cost-effective manner.

Privacy in emergency circumstances: data protection and the COVID-19 pandemic

The way we conceive our privacy and the importance which we attach to the protection of our personal data has been heavily impacted by the COVID-19 pandemic. By first providing legal insights on the general discussion about the balance between the fundamental right to privacy and the general public interest, this article describes the most critical and controversial processing operations employed by states to contain the pandemic and mitigate its effects. A focus on the increase in cybercrime during the pandemic then provides insights on the relevant risks and remedies for the security of personal data.

Would You Sacrifice Your Privacy to Protect Public Health? Prosocial Responsibility in a Pandemic Paves the Way for Digital Surveillance

Digital surveillance methods, such as location tracking apps on smartphones, have been implemented in many countries during the COVID-19 pandemic, but not much is known about predictors of their acceptance. Could it be that prosocial responsibility, to which authorities appealed in order to enhance compliance with quarantine measures, also increases acceptance of digital surveillance and restrictions of privacy? In their fight against the COVID-19 pandemic, governments around the world communicated that self-isolation and social distancing measures are every citizen’s duty in order to protect the health not only of oneself but also of vulnerable others. We suggest that prosocial responsibility besides motivating people to comply with anti-pandemic measures also undermines people’s valuation of privacy. In an online research conducted with US participants, we examined correlates of people’s willingness to sacrifice individual rights and succumb to surveillance with a particular focus on prosocial responsibility. First, replicating prior research, we found that perceived prosocial responsibility was a powerful predictor of compliance with self-isolation and social distancing measures. Second, going beyond prior research, we found that perceived prosocial responsibility also predicted willingness to accept restrictions of individual rights and privacy, as well as to accept digital surveillance for the sake of public health. While we identify a range of additional predictors, the effects of prosocial responsibility hold after controlling for alternative processes, such as perceived self-risk, impact of the pandemic on oneself, or personal value of freedom. These findings suggest that prosocial responsibility may act as a Trojan horse for privacy compromises.