By Bacchus Pang and Dr Wong Bak
A totalitarian regime has only one yardstick: what benefits itself. While an open society calls for concerted efforts from different professions and academics to illuminate what is best for its people, a totalitarian regime has but one aim: total control. No other professional standard is allowed.
The Health Code scheme is a new export product from mainland China – a technology not proposed by the medical profession, but stemming from the Chinese Social Credit system. According to the Sing Tao Newspaper on August 14, there are plans to import it to Hong Kong by the government, which is widely known as Beijing’s puppet.
In March this year, in the midst of the Covid-19 pandemic, Chinese authorities piloted the “health code” scheme in the city of Hangzhou.
The Code App collects citizens’ identities, addresses, contact numbers and details of recent entries. It then automatically generates colour codes: green, yellow, or red. If you are green, you can go anywhere you like, enjoy life, and make a living. If you are yellow, you must isolate yourself for seven days; if red, 14 days.
The code must be shown when entering a public place. If you don’t, you are barred from restaurants, malls, public transport or workplaces. It is no exaggeration to say one cannot leave his or her home without a code. When the Health Code scheme goes into effect, it amounts to a curfew for anyone who doesn’t comply.
If one cooperates and downloads the app, as the regime requests, his home immediately turns into his prison cell, unless he can prove himself to be “healthy”. But no one knows how the code is made up. Initium on March 3 reported a case in Hubei, who was sure he was 100 per cent healthy. However, he was forced into isolation as long as his code remained at red and no one could help. After a month, he tried to have his code reviewed by the authorities. Or at least someone could tell him what to do to make himself ‘healthy’. But the only reply he got was: believe in the code system, the A.I. algorithm – you can only wait for it to turn green.
A Financial Times journalist reported on May 7 that he received a code yellow after travelling from Wuhan to Beijing. After staying in a hotel for more than 14 days — the incubation period of Covid-19 believed to be adequate quarantine — the code persisted. He was asked to stay isolated, without any work. “I found myself in digital purgatory,” he said.
Should one see a doctor? Alas, he may help diagnose you if you are sick, but can’t prove you are healthy.
Because this is not a health issue. In China, the Health Code system was found to be connected with its police information server, without telling its users. Where you went, what you ate and bought, was known to the government. With AI, your social patterns and even your political inclinations are known to the police. Every single move is monitored. And police brutality can befall anyone, in the name of health.
Not medical, not ethical
I cannot stress enough that such a scheme is a blatant assault on human rights. It also has fundamental contradictions with medical concepts and ethics, despite its name.
Even with the best intentions, even if the code system is solely intended to combat Covid-19, and data use is restricted, it is doomed to fail in Hong Kong.
For the Health Code to be implemented, one must practise territory-wide Covid-19 screening tests. As there will not be enough manpower to do the work, people will have to save specimens by themselves, which will result in extremely high false negative rates.
Plus, it is common knowledge that the test is likely to be negative during the incubation period, when the viral load is low. For reference, the Hong Kong government provided voluntary screening and distributed sputum bottles to asymptomatic residents of Wong Tai Sin, Kwun Tong, Tuen Mun, Yau Tsim Mong and Shatin. According to Standnews on August 14, 31,000 specimens were collected in over a month, but only one carrier of the disease was identified.
At the time of writing, everyday there are dozens of new cases being identified, and transmission links are still hidden in Hong Kong. Carrying a code that gives false reassurance to continue high-risk activities, such as gatherings and banquets, is the most stupid and irresponsible thing to do. It’s squandering money and manpower for no cause.
Further, we seriously doubt if any medical practitioner participating in the scheme — taking specimen from healthy subjects, and uploading subjects’ information — can still comply with professional ethics. One of us may not be a medical ethicist, but ethics is something built into our profession, and analysis is a reflex. Below are some reasons why the scheme violates medical ethics.
Autonomy: it is the patient’s choice to disclose if he is sick. It is also a choice whether to provide a specimen. Doctors cannot force him into telling his history. Nor could anyone force him into expectorating sputum just to prove his state of health. However, the Health Codes system assume that all people are contagious and thus have no right to go anywhere but stay home, their prison cells, unless they download the Code App and provide a specimen. Providing specimens under such circumstances is definitely not an act of valid consent, but akin to coercion.
Benevolence: As said, there are no medical grounds for the Health Code scheme. One can only conclude that the Code has been introduced for meticulous state monitoring and policing. It is thus inferred that, under the scheme, when a health care worker takes a specimen from a healthy subject — which may involve provoking sputum or scratching the nasal pharynx — he or she is not doing so for the sake of the person’s health.
Medically speaking, these are unnecessary procedures and they are not without risks. The healthy person may gag, vomit, or bleed. The author has seen cases where the swab stick has broken inside a patient’s nasal cavity, and an ENT surgeon had to take it out. Legally speaking, doctors may face charges under the Offences Against the Person Ordinance for practising unnecessary medical procedures.
Confidentiality: this is not only a principle in medical ethics, to possess secrets is a human right. Even with good intentions, the system disproportionately absorbs users’ data. Details of the scheme are lacking, but we can look to the mainland Chinese experience. The Hong Kong government claims that the app would send its individual or institutional user a signal when a Covid-19 case is confirmed and is recorded to have had contact with them or to have entered their premises by its AI algorithm.
Alternatively speaking, once this system is set up and checkpoints are erected in every restaurant, store, building, train and bus, uploading one’s GPS or code would mean disclosing one’s identifiable details to every institution involved in the system.
A health care worker’s behaviour is governed by the above principles so that people trust the white coats. Such mutual trust forms the basis of professional duty. It is only when the above ethical “ABC”s are ensured that medical professionals can call themselves guardians of health.
The Health Code scheme, despite its guise, is not medically sound. Instead, it completely contradicts medical ethics. Any healthcare workers taking part in a totalitarian act that infringes human rights are not acting professionally. They are not independent parties equipped with the knowledge and skills to promote values and safeguard people’s health, but accomplices of an oppressive regime.
What should be done
One may argue the above procedure is only what a public health officer or a doctor practises for an epidemiological search. As a matter of fact, the Australian government has also issued an app “COVIDsafe” to assist in epidemiological tracing. But there are important differences. It registers rather restricted data: a pseudonym, age range, mobile number, postcode. That’s all. Location or GPS signal are not recorded. Rather, it only records people who have come in close range as detected via Bluetooth, and only those who also have the app installed on their phones.
Territory-wide mandatory screening as above described is not practised. One goes to a doctor and gets tested, as we did when we had a cough or a fever before the Covid-19 pandemic. It is only after one becomes ill and tests positive for the disease that COVIDsafe will ask for the owner’s consent to upload contact data. Then, a message is sent to close contacts to suggest screening, at their own choice.
The principle of proportionality is at stake here. Compared to the proposed Chinese Health Codes, the COVIDsafe app minimises breaches of confidentiality. Most importantly, one has full autonomy at every step of data collection and sharing. Tests are only performed when a person is sick and has agreed to be tested.
Admittedly, at some point in the fight against the pandemic, we need to surrender a certain degree of autonomy, such as in cases of mandatory quarantine and isolation. When the policy is targeted and medically grounded, it can be ethical, appropriate and answerable to the public. However, the Health Code infringes most people’s rights in order to identify only a tiny fraction of coronavirus carriers. This is not proportional.
While the Health Code scheme will likely involve unethical actions by healthcare workers, it opens up a problem of a different category than just medical ethics. It aims to take hold of the whole city, changing the landscape and the souls dwelling in it. When the scheme becomes a ubiquitous obstacle, citizens not only lose autonomy and privacy, they face the total loss of normal living. That is a tangible threat to the free world. Should there be a public health specialist in the government, he or she should seriously take the people’s interests and fundamental rights in consideration.
As Beijing tries to export the Health Code scheme to Hong Kong, it is sending a Trojan horse disguised as health policy. Hong Kong is an open society with robust professional bodies and a developed medical system forged through its SARS experience. It has no place for an ineffective and unethical app such as the one suggested under the Health Code scheme. Our low mortality rate and flattening Covid-19 case number curve are proof. The only reason to export the scheme to Hong Kong is to crush professional ethics, break trust, and place a once free people under total state surveillance.
Parts of this article were published in Cantonese on the authors’ blogs and Standnews. Bacchus Pang is a Hong Kong freelance writer and journalist. He runs his page on philosophy and current affairs @makeinterestingreadings. Dr Wong Bak is a doctor working in a Hong Kong public hospital – he was granted a pseudonym to protect his job.
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