Across the country universities are opening or preparing to open within an extraordinarily challenging environment. As places that have high potential for outbreaks, universities are attempting to use the best possible methods for testing and tracing COVID-19 cases on their campuses.
Contact tracing is at its core a simple and intuitive activity. If someone tests positive for SARS-Cov-2, the testing site or the healthcare facility that administered the test reports that information to the local public health department. That health department then contacts the infected person and asks them to identify people who they have encountered for a defined length of time prior to the test. From there the health department contacts those people to request that they receive a test. If any of those patients test positive, then the process is repeated until a set of all negative testing patients is reached. Often, health departments will advise patients who have tested positive of the amount of time that they need to remain in quarantine and will give them formal notification once they are “recovered”.
Yet what is not simple about the “test and trace” program is the logistical and administrative apparatus that enables it. To perform the above process correctly, several elements are needed:
1) Timely, accurate tests
2) A system that enables patient information to be passed from provider, to public health department, to patient contacts
3) A workforce to call patients and possible contacts
While none of this infrastructure existed at the beginning of the pandemic, all elements are now developed to varying extents here in the United States. Tests are reliable and are reaching viable quantities, and the workforce of contact tracers has surged, but the system for communicating information is still very fragmented and exists almost entirely within state and local government domains.
Many proposed solutions to contact tracing are premised on a level of privacy invasion that is unpopular and ultimately unacceptable to most Americans and most students. Any solution that allows for the successful implementation of a testing and tracing regime will need to provide a satisfactory answer to questions and concerns about privacy inherent in any system of tracing, especially on college campuses where legal and privacy concerns are enhanced.
Initial attempts to surmount the challenges surrounding the technology system were based upon the smartphone geo-location data that is generated by nearly everyone in the US. Under these systems a positive test result could be entered into the smartphone, upon receipt of this information the phone would leverage the geolocation database and ping every phone that had been within 6 feet of its location a message that stated the owner of the phone had come into contact with someone who had been infected and that they should submit for a test.
Given that case counts continue to increase across the nation despite the best efforts of state and local governments, colleges and universities are wondering how they can provide a level of contact tracing internally, in order to enable a return to work of employees and students. Since testing is publicly available and institutions have the capacity to contact their own employees, the primary challenge they encounter is preparing a system for tracking and using the data. Our solution imagines the application of blockchain technology to the university setting, as the reopening of educational institutions is the highest national priority at this time.
Blockchain Based Solution
Most current universities have health systems that monitor student’s physical records and general health. As universities approach the re-opening of campuses, university health departments must designate a testing interim for their students and staff and feed those test results into their health systems. While current health systems are adequate at storing general health information, they are not effective at processing large amounts of tests and determining if students are infecting each other. Furthermore, most current healthcare systems provide access to groups, such as billing specialists, that do not need access to COVID-19 test results. As additional data in the form of COVID-19 test results are added to the health systems, it is critical that universities limit the access to this sensitive information.
Currently, most universities and healthcare facilities are leveraging standard relational databases (i.e., SQL) to store student health records. This type of data storage insufficiently protects student health records; as this type of data storage provides too many user groups access to students health records and the security of these data storage systems is often obsolete.
In contrast, blockchain technology can anonymize patient records and provide further levels of security to ensure the security of student’s health records. Through linking test results to a student’s public/private key instead of their university ID, the name or identity of students cannot be found through simply viewing or querying the blockchain. Additionally, since all records on the blockchain are cryptographically signed, bad actors cannot alter a record without invalidating all future records. Further safeguards can be added on to restrict what information an individual can view on the blockchain using identity access management software.
Atlas Research has built a blockchain solution that builds upon existing healthcare systems by incorporating student relationships and interactions with other students and staff, to more quickly identify and quarantine students that have been contaminated. The blockchain would store test results in the form of transactions, and have built in relationships that interconnect students that live in close proximity or students that share similar in-person classes. Should a student test positively, smart contracts will be executed to inform contaminated and related students to quarantine.
Before students arrive on campus, universities will work to identify and record relationships between students. Our system defines relationships as students that will often be in close proximity to each other based on shared living arrangements or are enrolled in the same in-person class. To populate this data, universities will extract each student’s class schedule and require students to self-report who they are living with. Additionally, universities can track which students are present in common areas (i.e., libraries, cafeterias) by reviewing when they swipe in and out. Once these relationships are defined, smart contracts are written to create linkages between any one student and any student they share relationships with.
Once test results are administered, they are automatically sent to the blockchain where they are stored. As discussed above, data stored on the blockchain is both secure and immutable, so students do not need to worry about the accuracy or safety of their test results. If a student’s test result is returned as negative, a smart contract will be executed identifying that student as not contaminated. No further action will be required for that student.
When a student tests positive for COVID-19, the blockchain will send them notice to quarantine. The blockchain will also send additional quarantine notices to additional students, based on who the infected student shares living and class relationships with as well as who the infected student has interacted with.
Our blockchain will store keys, relating to each student’s dormitory and classes. This is stored in a way that each individual dormitory or class is given a unique key, however it is possible for multiple students to share the same dormitory/class key. Should a student get contaminated, our system will identify all dormitory and class keys for that student and query the blockchain for each of those keys. All students that commonly share one of the same dormitory or class keys will be sent a quarantine notice as well.