Triage 4.0: On Death Algorithms and Technological Selection. Is Today's Data- Driven Medical System Still Compatible with the Constitution?

Health data bear great promises for a healthier and happier life, but they also make us vulnerable. Making use of millions or billions of data points, Machine Learning (ML) and Artificial Intelligence (AI) are now creating new benefits. For sure, harvesting Big Data can have great potentials for the health system, too. It can support accurate diagnoses, better treatments and greater cost effectiveness. However, it can also have undesirable implications, often in the sense of undesired side effects, which may in fact be terrible. Examples for this, as discussed in this article, are discrimination, the mechanisation of death, and genetic, social, behavioural or technological selection, which may imply eugenic effects or social Darwinism. As many unintended effects become visible only after years, we still lack sufficient criteria, long-term experience and advanced methods to reliably exclude that things may go terribly wrong. Handing over decision-making, responsibility or control to machines, could be dangerous and irresponsible. It would also be in serious conflict with human rights and our constitution.

On some fundamental challenges in monitoring epidemics.

Epidemic models often reflect characteristic features of infectious spreading processes by coupled nonlinear differential equations considering different states of health (such as susceptible, infectious or recovered). This compartmental modelling approach, however, delivers an incomplete picture of the dynamics of epidemics, as it neglects stochastic and network effects, and the role of the measurement process, on which the estimation of epidemiological parameters and incidence values relies. In order to study the related issues, we combine established epidemiological spreading models with a measurement model of the testing process, considering the problems of false positives and false negatives as well as biased sampling. Studying a model-generated ground truth in conjunction with simulated observation processes (virtual measurements) allows one to gain insights into the fundamental limitations of purely data-driven methods when assessing the epidemic situation. We conclude that epidemic monitoring, simulation, and forecasting are wicked problems, as applying a conventional data-driven approach to a complex system with nonlinear dynamics, network effects and uncertainty can be misleading. Nevertheless, some of the errors can be corrected for, using scientific knowledge of the spreading dynamics and the measurement process. We conclude that such corrections should generally be part of epidemic monitoring, modelling and forecasting efforts. This article is part of the theme issue 'Data science approaches to infectious disease surveillance'.

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic.

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.

Give more data, awareness and control to individual citizens, and they will help COVID-19 containment.

The rapid dynamics of COVID-19 calls for quick and effective tracking of virus transmission chains and early detection of outbreaks, especially in the "phase 2" of the pandemic, when lockdown and other restriction measures are progressively withdrawn, in order to avoid or minimize contagion resurgence. For this purpose, contact-tracing apps are being proposed for large scale adoption by many countries. A centralized approach, where data sensed by the app are all sent to a nation-wide server, raises concerns about citizens' privacy and needlessly strong digital surveillance, thus alerting us to the need to minimize personal data collection and avoiding location tracking. We advocate the conceptual advantage of a decentralized approach, where both contact and location data are collected exclusively in individual citizens' "personal data stores", to be shared separately and selectively (e.g., with a backend system, but possibly also with other citizens), voluntarily, only when the citizen has tested positive for COVID-19, and with a privacy preserving level of granularity. This approach better protects the personal sphere of citizens and affords multiple benefits: it allows for detailed information gathering for infected people in a privacy-preserving fashion; and, in turn this enables both contact tracing, and, the early detection of outbreak hotspots on more finely-granulated geographic scale. The decentralized approach is also scalable to large populations, in that only the data of positive patients need be handled at a central level. Our recommendation is two-fold. First to extend existing decentralized architectures with a light touch, in order to manage the collection of location data locally on the device, and allow the user to share spatio-temporal aggregates-if and when they want and for specific aims-with health authorities, for instance. Second, we favour a longer-term pursuit of realizing a Personal Data Store vision, giving users the opportunity to contribute to collective good in the measure they want, enhancing self-awareness, and cultivating collective efforts for rebuilding society.