For years, Medellín’s elite have inured themselves to security and surveillance measures that might make citizens of other cities uneasy. Entry into commercial and residential buildings usually requires an ID and sometimes a fingerprint. Closed-circuit cameras are common on street corners. By and large, the residents of Colombia’s second largest city welcome the extra security — it’s a small price to pay for peace in a place still healing from decades of violence.
But over the past few months, citizens of Medellín have been introduced to a new kind of surveillance: mobility passports. A nationwide app, CoronApp, and a city-run website, Medellín Me Cuida (Medellín Takes Care of Me), produce QR codes that allow people to travel to work, doctor’s appointments, schools, and shopping malls. Users enter their personal information, including address, contact details, and family members’ names. When they want to go, they can log on and answer a series of simple questions: Do you have a fever? Do you have a cough? Have you come in contact with someone who is showing symptoms? The app then produces a QR code.
“If it’s green, you can go out; if it’s red, you cannot,” says Juliana Velásquez, an attorney in Medellín who uses the apps. Her firm is one of 139,000 workplaces the city has approved to provide QR codes to some 1.5 million employees for travel to work. Should a police officer catch someone outside with a red QR code, that person is given a hefty fine. With people scanning QR codes at subways, shopping malls, and workplaces, contact tracers have been able to track the steps of people who tested positive and identify the shoppers, family members, subway riders, and co-workers they may have put at risk.
“Every time we confirm a positive case, Medellín Me Cuida helps us to know who lives there, who lives around, where they work, how many cases of the virus have been confirmed in the company in the last 15 days. And all of this is synchronized automatically for testing,” the city’s 39-year-old mayor, Daniel Quintero, told El País in June.
The QR codes are part of a larger COVID-19 response that began as a massive data-collection effort to get food and money to those hit hardest by restrictions on travel; that effort succeeded in getting benefits to more than 700,000 families. Now, Medellín Me Cuida has expanded to collect information on workplaces, shopping centers, schools, health-care facilities, emergency calls, and public transit. All of that data can be cross-referenced to generate COVID-19 heat maps, which have been used to implement neighborhood quarantines.
“Medellín Me Cuida is not just a technology; it’s a strategy,” says Juan Sebastián González, Medellín’s secretary of technology. That strategy has been hailed as a “medical marvel” for its efficiency in keeping the coronavirus under control. In early June, when much of Latin America was beginning to feel the full impact of the pandemic, Medellín, a city of 2.5 million, had only 741 confirmed cases and just ten patients in ICUs.
But over the past two weeks, Colombia’s case rate has skyrocketed, and while Medellín’s overall case rate is still low compared with other major cities in the region, the city has also seen a sharp increase. The rise is likely due to the country’s relaxation of distancing measures over the past month. Colombia’s economy contracted 20 percent in April, and in an effort to stanch an economic crisis that could set the country’s poorest back decades, the largest cities allowed many businesses to reopen. On June 19, President Iván Duque declared a national tax holiday that triggered a countrywide “COVID Friday” shopping spree. Now, the country’s National Institute of Health is reporting a sharp rise in cases, raising new questions about the role technology can play in combating outbreaks.
“At the beginning, the apps were very useful. But now, even if the app gives us an alert, the response is very delayed,” says Dr. Yessica Giraldo, a clinical epidemiologist advising contact-tracing field teams in Medellín. According to Giraldo, the technology was helpful in mapping clusters at first, but the sheer volume of cases over the past two weeks has overwhelmed contact tracers on the ground. “In general, people no longer ‘fear’ the disease or believe in the severity of the disease,” she says. “The problem is people’s behavior, and the technology cannot correct that.”
Medellín is often called the Silicon Valley of Colombia, and Mayor Quintero has made no secret of his faith in technology to navigate the pandemic. “Out of every three meetings I have about the virus, one is about methods with technology to make coronavirus care more efficient,” he said last month. (Before he was mayor, Quintero was Colombia’s minister of technology and had previously founded a software-development company.) Fighting COVID-19 successfully “can only be achieved if one has enough information to anticipate the escalation of the cases,” Quintero said. “Without data, it is very difficult to save lives.”
Colombia is not alone in its dependence on technology to fight the coronavirus. New apps have been flooding the international market since February. Some of those supplement the work of human contact tracers, while others, like the system used in China, hoover up personal information, including GPS data and recent payment histories. In the U.S., digital contact-tracing development has been fractured. Apple and Google worked together to develop a software that can issue “exposure notifications” and help local public-health authorities with contact tracing, but it’s unclear how many states have put the technology to use. In North Dakota, Bison Tracker, an app developed to track North Dakota State University football fans, was the basis for Care19, one of two contact-tracing apps being used in the state.
Colombia had moved swiftly to control the spread of COVID-19. President Duque declared a national health emergency on March 6. Three days later, when Colombia had only one confirmed case, the country launched the first version of CoronApp, a nationwide app similar to Medellín Me Cuida. It has been through a number of revisions — including failed partnerships with Apple and Google — and today it has four functions: to provide localized information, to allow citizens to report symptoms, to provide mobility passports, and to perform contract tracing with BlueTrace, a technology developed in Singapore in March. It remains unclear whether the Colombian government has activated BlueTrace to aid its contact-tracing efforts, raising privacy concerns in a country already wracked by data-privacy scandals.
“What I can tell you is that we’ve followed the permissions in CoronApp, and it has the capability to access everything: GPS, Wi-Fi, and Bluetooth,” says Carolina Botero, director of the Karisma Foundation, a technology and human-rights watchdog group based in Bogotá. “We know that the app has all of these capacities, but we don’t know how it works. There is no public information.”
Those privacy concerns extend to all the data being harvested by Medellín Me Cuida. Publicly, Quintero has mostly brushed off those fears. “We cannot face a global pandemic with 19th-century technologies,” he tweeted last month. “Many are willing to give their information to private companies to make it rich, while refusing to give it to the state to save lives.” He has managed to convince plenty of Medellín residents. Some 3.5 million people — 90 percent of Medellín’s metro area — have entered their information into Medellín Me Cuida, and as of June, more than 9 million Colombians had downloaded CoronApp.
“I know there is a lot of opposition to the app in Bogotá because of privacy, but here in Medellín, we see it as a way to protect ourselves,” says Velásquez, the attorney. “We have confidence that our institutions are not going to use the information in a harmful way. It’s a matter of trust.”
Botero conceded that the data CoronApp and Medellín Me Cuida collect may be helpful, but she believes the technology has received outsize credit for the city’s low infection rate. Medellín and Antioquia, the state where Medellín is located, have large contact-tracing teams with experience managing outbreaks of dengue, chikungunya, and zika. “This is not some great technology making a difference,” Botero says. “It’s people filling out surveys and cross-referencing data. The mayor would say that the technology has great contact-tracing capabilities, but it’s manual contact tracing that has worked.”
Both technological and manual contact tracers are being tested as cases surge in Colombia. Over the past week, Duque and Quintero have walked back plans to reopen. Last week, Quintero announced a new strategy to rotate quarantines by neighborhood, allowing most people to work Monday through Thursday and placing tight restrictions on weekends and holidays. “We declare Medellín in a State of Total Care,” Quintero tweeted. “We enter the most dangerous stage of the virus; the next 20 days will be the most challenging.”
