Using technology and data analysis to contain the spread of the coronavirus , slow infections, and prevent new outbreaks, especially as we ease the lockdown and attempt to return to our daily lives. This is also true in South Korea, where infections have seen a significant slowdown thanks to widespread testing and the implementation of a system based on digital technologies, including the Corona 100m app , which provides for the tracing, testing, and isolation of people who have come into contact with those who tested positive for Covid-19. This protocol has allowed the country (50 million inhabitants) to curb infections, without requiring the closure of entire cities, shops, bars, and restaurants, or other restrictive measures like those implemented in China and subsequently in Italy and the rest of the world.
APP TO TRACK MOVEMENTS
Thus, on March 23, having exceeded the threshold of 50,000 confirmed infections ( 168.941 total cases, 106.607 currently positive, 40.164 recovered and 22.170 deaths, based on the latest data released by the Civil Protection and relating to April 16, 2020 ), the Ministry of Innovation, in support of the Ministry of Health and the Istituto Superiore di Sanità and in collaboration with the World Health Organization and the support of a multidisciplinary scientific committee, launched a call to identify "the best digital solutions available relating to telemedicine apps and home care for patients and technologies and strategies based on technologies for the active monitoring of the risk of contagion". An invitation to public administrations, companies, public and private research institutions and centers, as well as associations, cooperatives, consortia, foundations, and institutes, to coordinate the adoption of these tools at the national level to combat the spread of Covid-19. Over 800 applications were received: the call for applications lasted just three days due to the ongoing health emergency, and officially closed at 1:00 PM on March 26, 2020.
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APP TO TRACE INFECTIONS
In both telemedicine and contact tracing applications , technological obstacles are compounded by concerns about privacy protection . This is a particularly pressing issue for healthcare data. A system capable of rapidly monitoring people's health conditions, allowing doctors to remotely check data and, if necessary, intervene, should offer optimal guarantees regarding the security of the information collected.
TELEMEDICINE APPLICATIONS
Obviously, using an app wouldn't replace the doctor's role, but it would, for example, help patients better self-assess their symptoms to determine whether they have Covid-19, thus also easing the workload of emergency numbers and healthcare advisories, both nationally and regionally.
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CONTACT TRACING APP
Specifically, in order to monitor citizens for the purpose of containing the spread of the virus , anyone who tests positive for Covid-19 should download an app to their smartphone. This will allow authorities, through careful data analysis, to verify who else they have come into contact with, contact them, and subject them to any necessary testing, from a swab test to home isolation.
As Silvio Brusaferro, president of the Italian National Institute of Health (ISS), also stated : "The app will serve not only for tracing, but also for assistance, and will combine the values of democracy and freedom with social distancing ."
APP TO LIMIT INFECTIONS
The Ministry of Innovation, led by Minister Paola Pisano, has appointed a multidisciplinary group of experts tasked with evaluating and proposing data-driven technological solutions for managing the health, economic, and social emergency related to the spread of the SARS-CoV-2 virus. This technological task force is made up of 74 experts , divided into eight subgroups. As reported in a statement from the Ministry of Technological Innovation and Digitalization, they will work pro bono to identify and evaluate, in compliance with privacy regulations, technological solutions based on data collection and analysis , suitable for containing the number of infections, facilitating the timely adoption of social distancing measures essential to stem the spread of the virus, and addressing the ongoing crisis.
IMMUNI APP TO TRACE INFECTIONS
On the evening of April 16, 2020, the government selected the app for tracing coronavirus infections based on the shortlist presented by the Ministry of Innovation's technology task force. The app will be called " Immuni " and will use Bluetooth to determine whether users have been in contact with people who tested positive for coronavirus.
Domenico Arcuri, the Special Commissioner for the Health Emergency, has signed the ordinance establishing a free software license and service contract with the Milanese company Bending Spoons , which will also handle all necessary updates. Use of Immuni will be voluntary : the app can be downloaded from the App Store (Apple) and Google Play Store (Android). To be effective, it must involve 60 percent of Italians.
HOW THE IMMUNI APP WORKS
Immuni will include a sort of "clinical diary" where you can record your health status and any symptoms related to the coronavirus. Bluetooth technology will allow your smartphone to recognize and save the codes of different devices on which the same app is installed. GPS is not supported.
ALLERTALOM APPLICATION FOR THE LOMBARDY REGION
Meanwhile, also on April 16, 2020, Lombardy residents received a text message requesting them to download the AllertaLOM app to their phones . As Fabrizio Sala, vice president of the Lombardy Region, explained, the message was sent free of charge by telephone companies (Vodafone, Tim, Wind 3, and Iliad) and authorized by the Civil Protection Department. It is a text message sent in the event of emergencies or disasters. In these situations, institutions do not acquire or process citizens' data but simply provide operators with a text message to send to users.
" AllertaLOM " is an application capable of mapping the risk of contagion . Developed by the regional holding company Aria Spa and created in collaboration with doctors and researchers from San Matteo Hospital and the University of Pavia, the app collects data anonymously through a questionnaire requiring users to provide their age, habits during lockdown (office or smart working), any symptoms, and contact with people who tested positive for Covid-19. This serves as a sort of remote triage to try to identify potential infections and stop the spread of the virus. Responses to the questionnaire are not linked to a user's phone number, and users do not receive any feedback on the information provided, but the data allows for tracking the evolution of infections. The app, of course, does not replace a swab test or medical checks, but it is an additional tool for locating potential outbreaks or identifying a resurgence of the infection in areas considered less at risk.
Serological tests to find out who is immune
Phase two, Italy's gradual reopening, could also coincide with mass testing to identify those who have already been immunized against SARS-CoV-2 but are not yet aware of it. These would involve rapid blood tests capable of identifying the presence or absence of coronavirus antibodies. Currently, however, there are no truly reliable serological tests: the Ministry of Health and the Civil Protection Technical Scientific Committee are working to validate the rapid tests.
THE SYSTEM FOR CONTROLLING MOVEMENTS IN LOMBARDY
Previously, around mid-March, the Lombardy Region announced the use of a system to measure population movements during the coronavirus epidemic and thus verify compliance with the restrictions established by the government to contain the spread of the virus. The data, provided to the Lombardy Region by the main mobile operators, and collected in aggregate and anonymous form, is used to visualize the flow of people, not to monitor individuals. This "quantitative" system for analyzing cell-to-cell cell phone movements was made necessary by the high number of movements within Lombardy, despite the measures adopted by the government, namely staying at home and traveling only for proven work needs, health reasons, or other absolutely urgent situations.
The space between cells is 300-500 meters, meaning that this does not include anyone walking out into the garden or going to the local grocery store. However, it does include those authorized to move around for work, health, or family reasons.
DRONES FOR MOVEMENT CONTROL
Meanwhile, precisely to "ensure containment of the coronavirus health emergency," the Italian National Civil Aviation Authority (ENAC), following requests from local police commands, has authorized the use of drones until April 3 to monitor the movements of citizens within municipal areas , and "also in urban areas with a low population exposed to the risk of impact." The use of drones allows for the detection of areas where potential gatherings of people or prohibited behavior are occurring, thus allowing the municipal police to intervene.
While in certain cases, telephone companies may provide this type of data (always in aggregate and anonymous form) to certain companies, such as those that deal with traffic statistics or applications, it is extremely rare for this information to be used by governments, regions, and other institutions.
CONTACT TRACING AND PRIVACY
The Italian Data Protection Authority , Antonello Soro , also weighed in on the issue of contact tracing : in an interview with Repubblica, he explained that "it's not about suspending privacy but about adopting effective tools to contain the infection, while always respecting citizens' rights." Soro also specified that "a measure like contact tracing, which impacts a very large number of people, requires a regulatory provision that complies with these principles. A decree-law could combine the timeliness of the measure with parliamentary participation. It goes without saying that its duration must be closely linked to the duration of the emergency."
Yes to contact tracing, then, but through a temporary decree also to avoid an "unwitting slide from the Korean model to the Chinese one, mistaking the renunciation of all freedom and the blind delegation of the algorithm for the life-saving solution for efficiency."
HOW CHINA DEALED WITH THE CORONAVIRUS EPIDEMIC
In China , as we know, the fight against the coronavirus has been carried out through very drastic containment measures, starting with the total quarantine of the entire city of Wuhan, with its nearly 15 million inhabitants, and the blocking of all forms of private transportation not only in the epicenter of the coronavirus outbreak but also in other major cities in Hubei. But that's not all: in parallel with the quarantine, the Chinese government has launched a campaign to identify citizens affected by Covid-19, through a very technologically impressive solution: an application capable of assessing a person's risk by assigning each citizen a different level of epidemic danger. After registration and the release of certain data, the system is able to track people's movements and encounters, assigning them a green , yellow, or red code depending on their health status or risk of infection . It is impossible to move without first showing the code stored on the app. The fear now is that, once the emergency phase is over, certain tools, including facial recognition software, may remain in use.
"The Lockdown – One Month in Wuhan": The Chinese TV documentary (in English)
SOUTH KOREA'S STRATEGY TO STOP THE CORONAVIRUS
South Korea 's response to the coronavirus is also highly technological , albeit less invasive than the Chinese model. Simply download the Corona 100m app to your smartphone, on a voluntary basis, to find out if there are any outbreaks within a 100-meter radius of your location. Those who can't download the app can still view the location of infected people and their movements by consulting the online map "Coronamap." Rather than quarantine, the Korean government has focused heavily on identifying , examining ( through widespread testing), and isolating citizens who have come into contact with infected individuals . This data monitoring and analysis system is also made possible by the fact that Korean law allows the health authority to access data from surveillance cameras, GPS tracking of phones and cars, and credit card transactions. Security camera images have also been used to reconstruct the movements of people who tested positive for coronavirus. All information was then shared anonymously on a dedicated app, allowing everyone to be aware of potential risk situations in real time. In addition to contact tracing, as previously mentioned, South Korea implemented a very high number of tests: swabs were also administered to people with mild or asymptomatic symptoms who had come into contact with infected patients . Furthermore, this action plan was implemented with a relatively low number of infections. This strategy, according to the WHO, has made South Korea one of the leading models for dealing with the coronavirus epidemic.
However, let's not forget that South Korea, compared to Europe, has greater knowledge and capabilities in managing a coronavirus epidemic, having already dealt with SARS and MERS. The 2015 MERS outbreak, in particular, prompted South Korea to further strengthen its efforts to combat epidemics.
So, can the South Korean model be replicated in Italy?
As Professor Enrico Bucci , a Systems Biology lecturer at Temple University in Philadelphia, explained to Adnkronos : "By fully following South Korea's strategy, that is, even using tools that invasively affect personal privacy, it is possible to track epidemic outbreaks early; provided, of course, that the sampled area is in the initial phase of an epidemic (that is, when we can actually speak of epidemic outbreaks and not of a widespread epidemic)."
We may still have time, therefore, to track and curb infections in Italian regions where numbers are still low ( real-time map, created by Corriere della Sera ). Adopting the Korean model could also prove important to avoid a second wave of infections as life gradually returns to normal.
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UMBRIA AND THE SOUTH KOREA MODEL
Meanwhile, while a BVA Doxa survey of 5,000 people found that 93 percent of Italians said they were willing to "sacrifice some fundamental rights if it helps prevent the spread of the virus," Umbria is poised to become the first Italian region to follow the "South Korea model" in the fight against the spread of Covid-19. The region has fewer than 900,000 inhabitants and currently has 802 total cases, of which 770 are currently positive, 12 have recovered, and 20 have died (data released by the Civil Protection Department, as of March 26, 2020).
STOP COVID-19 APP
This trial, which could pave the way nationwide, is being conducted using the Stop Covid-19 app , developed by the Italian company Webtek . Like the Corona 100m app, Stop Covid-19 can reconstruct the network of people who may have come into contact with an infected citizen and report their data to health authorities. Using the GPS location of each user's smartphone, the app collects information, monitors the movements of those who download it, and alerts them if they have come into contact with people who have tested positive for coronavirus. This mechanism allows for the chain of infection to be reconstructed : all those involved will always remain anonymous and can only be contacted by the health authority, without knowing the name of the person who may have infected them.
Obviously, the choice to use the app is completely voluntary , and citizens can decide at any time to suspend the dissemination of their data or permanently delete it, as required by the European General Data Protection Regulation (GDPR).
Already available in the iOS App Store and the Android Play Store, Stop Covid-19 requires significant user collaboration to be useful. Otherwise, data collection would be incomplete and would not allow for the accurate tracing of other exposed individuals.
In Umbria , “contact tracing” would be accompanied by an increase in the number of swabs and rapid tests.
CONTACT TRACING PLANS
Meanwhile, the Massachusetts Institute of Technology in Boston has also developed "Private Kit: Safe Paths," a specific app that allows users to reconstruct the chain of infection. The system alerts users if they have come into contact with a positive person without revealing who they are. Those who test positive can choose whether or not to share their diagnosis on the app. This helps slow the spread of the infection without sacrificing privacy.
Singapore, on the other hand, is relying on a tracking system entirely based on Bluetooth, which will save data only on the user's smartphone, while still providing healthcare workers with the information needed to reconstruct the chain of infection should a citizen test positive for coronavirus.
In Spain , however, currently only in the Madrid area , citizens can use an application supported by Telefonica and Google that helps identify symptoms and carry out self-diagnosis, easing the overload of requests received by emergency telephone lines.
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ANALYZE INSTAGRAM TO SLOW THE SPREAD OF CORONAVIRUS
According to the Economist , analyzing social networks , and Instagram in particular , can also prove an important tool for understanding the spread of the coronavirus . Analysts from the British weekly identified more than 20 users who posted on the platform, geolocating themselves in cities that initially had at least 50 confirmed cases of Covid-19. By tracking their movements, based on subsequent posts in which they indicated their location, and based on over 50 photos published in over 2 cities in 125 countries, they discovered that "the movements of Instagram users identified as potential carriers of the coronavirus tended to track the movement of the virus itself , as revealed by cases reported by official sources." Some users, the Economist explains, traveled to virus-free locations that were subsequently hit by an outbreak, raising the possibility that they themselves brought the virus there. Others offered clues to possible transmission routes, such as a trip back from a holiday in a Swiss ski resort.
Analyzing movements through Instagram could therefore provide support in the attempt to contain the spread of the virus and limit infections.
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