How tech companies can help combat the pandemic and reshape public health

Karen DeSalvo, the chief health officer at Google, explains the partnership between big tech and public health in slowing the spread of COVID-19 -- and discusses a new contact tracing technology recently rolled out by Google and Apple that aims to ease the burden on health workers and provide scientists critical time to create a vaccine. (This virtual conversation, hosted by current affairs curator Whitney Pennington Rodgers and head of TED Chris Anderson, was recorded on May 27, 2020.)

Whitney Pennington Rodgers:
Before we really dive in

to talking specifically
about Google's work

in the contact tracing space,

let's first set up the relationship
between public health and tech.

You know, I think a lot of people,

they hear "Google," and they think of
this big tech company.

They think of a search engine.

And there may be questions about

why does Google
have a chief health officer?

So could you talk a little bit
about your work

and the work your team does?

Karen DeSalvo: Yeah. Well,
maybe I'm the embodiment

of public health and tech coming together.

My background is, I practiced
medicine for 20 years,

though a part of my work
has always been in public health.

In fact, my first job,
putting myself through college,

was working at the state laboratory
in Massachusetts.

As the story will go with Joia [Mukherjee]
we're reconnected again,

a Massachusetts theme.

And I, across the journey
of the work that I was doing

for my patients

to provide them information

and the right care and meet them
where they were medically,

translated into the work

that I did when I was
the Health Commissioner in New Orleans

and later when I had other roles
in public health practice,

that really is about thinking
of people and community

in the context in which they live
and how we provide the best information,

the best resources,

the best services that are
culturally and linguistically appropriate,

meet them where they are.

And when the opportunity arose
to join the team at Google,

I was really thrilled,

because one of the things
that I have learned across my journey

is that having the right
information at the right time

can make all the difference
in the world.

It can literally save lives.

And billions of people
come to Google every day

asking for information,

and so it is a tremendous opportunity
to have that right information

and those resources to people

so that they can make good choices,

so that they can have
the right information,

so that they can participate
in their own health,

but also, in the context
of this historic pandemic,

be a part of the broader health
of the community,

whether it's to flatten the curve
or keep the curve flat as we go forward.

WPR: And so it sounds like
that there is this connection, then,

between public health
and what Google's work is

in thinking about public education
and providing information.

And so could you talk
a little bit about that link

between public health
and public education and Google?

KD: Definitely.

You know, the essential
public health services

include communication and data,

and these are two areas where
tech in general, but certainly Google,

has an opportunity to partner
with the public health system

and with the public
for their health more broadly.

You know, going back
to the earlier days of this pandemic,

towards the end of January,

Google first leaned in to start
to put information out to the public

about how to find resources
in their local community,

from the CDC or from other
authoritative resources.

So on the search page,
we put up "knowledge panels,"

is the way that we describe it,

and we did develop an SOS alert,

which is something
we've done for other crises,

and in this particular historic crisis,

we wanted to be certain
that when people went on to search,

that there was authoritative information,

which is always there but certainly
very prominently displayed,

and do that in partnership
with public health authorities.

So we began our journey
really very much in an information way

of making certain that people
knew how to get the right information

at the right time to save lives.

I think the journey for us
over the course of the last few months

has been to continue to lean in
on how we provide information

in partnership with
public health authorities in local areas,

directing people in a certain state
to their state's health department,

helping people get
information about testing.

There's also been, though,

a suite of resources that we wanted
to provide to the health care community,

whether that was for health care providers
that may not have access to PPE,

for example,

we did a partnership
with the CDC Foundation.

Though the scale of the company

and the opportunity for us
to partner with public health

around things like helping public health
understand if their blunt policies

around social distancing
to flatten the curve

were actually having an impact
on behavior in the community.

That's our community mobility reports.

We were asked by public health agencies
all across the world,

including some of
my colleagues here in the US,

could we help them have a better
evidence-based way to understand

the policies around social distancing
or shelter in place?

Which I think we'll talk about more later.

In addition to that sort of work,
also been working to support public health

in this really essential work
they're doing for contact tracing,

which is very human-resource intensive,

very complex,

incredibly important
to keep the curve flat

and prevent future outbreaks,

and give time and space for health care
and, importantly, science

to do the work they need to do
to create treatments

and, very importantly, a vaccine.

So that work around providing
an additional set of digital tools,

exposure notification
for the contact tracing community,

is one of the other areas where we've
been supporting the public health.

So we think, as we've thought
about this pandemic,

it's support the users,
which is the consumer.

There's also a health care system
and a scientific community

where we've been partnering.

And then, of course, public health.

And for me, I mean, Whitney,
this is just a wonderful opportunity

for Big Tech to come together
with the public health infrastructure.

Public health, as Joia was
sort of articulating before,

is often an unsung hero.

It saves your life every day,
but you didn't know it.

And it is also a pretty under-resourced
part of our health infrastructure,

globally, but especially in the US.

It's something I worked on a lot
before I came to Google.

And so the opportunity to partner

and do everything
that we can as a company

and, in this case, with contact tracing
in partnership with Apple

to create a very privacy-promoting,
useful, helpful product

that is going to be a part
of the bigger contact tracing

is something that we feel really proud of

and look forward to continuing
to work with public health.

In fact, we were on the phone this morning
with a suite of public health groups

from across the country,

listening again to what would be helpful
questions that they have.

And as we think about
rolling out the system,

this is the way that we've been
for the last many months at Google,

and I'm just really ...

I landed at a place just a few months
ago -- I just started at Google --

where we can have an impact
on what people know

all across the world.

And I'll tell you, as a public
health professional and as a doc,

that is one of the most critical things.

People need to have the right information

so they can help navigate
their health journey,

but also especially in this pandemic
because it's going to save lives.

WPR: That's great. Thank you.

So, to talk more about
this contact tracing system

and the exposure notification app,

we've read so much about this.

Could you describe this,
a little bit about how the app works,

what exactly are users seeing,

what information is being collected?

Just give us sort of a broad sense
of what this app does.

KD: Yeah.

Let me just start
by explaining what it is,

and it's actually not even an app,

it's just an API.

It's a system that allows
a public health agency

to create an app,

and only the API,
this doorway to the phone system,

is available to public health.

So it's not designed for any other purpose

than to support public health
and the work that they're doing

in COVID-19 in contact tracing.

The second piece of this
is that we wanted to build a system

that was privacy-promoting,

that really put the user first,

gave them the opportunity
to opt into the system

and opt out whenever
they wanted to do that,

so they also have some control
over how they're engaging

and using their phone, basically,

as a part of keeping the curve
flat around the world.

The system was developed in response
to requests that we were getting

about how could technology,
particularly smartphones,

be useful in contact tracing?

And as we thought this through
and talked with public health experts

and academics and privacy experts,

it was pretty clear that obviously
contract tracing is a complex endeavor

that does require human resources,

because there's a lot
of very particular things

that you need to do
in having conversations with people

as part of contact tracing.

On the other hand,

there's some opportunity
to better inform the contact investigators

with things like, particularly,
an exposure log.

So one of the things that happens
when the contact tracer calls you

or visits you is they ask,

"Hey, in the last certain number of days,"

and in the case of COVID, it would be
a couple days before symptoms developed,

"Hey, tell us the story of what
you've been involved in doing

so that we can begin to think through
where you might have been,

to the grocery or to church
or what other activities

and with whom you might
have been into contact."

There's some amount of recall bias
in that for all us,

like we forget where we might have been,

and there's also an amount
of anonymous contact.

So there are times when
we're out in the world,

on a bus or in a store,

and we may have come into prolonged
and close contact with someone

and wouldn't know who they were.

And so the augmentation

that the exposure
notification system provides

is designed to fill in those gaps

and to expedite the notification
to public health

of who has a positive test,

because the person would have notified,

they trigger something
that notifies public health,

and then to fill in some of those gaps
in the prior exposure.

What it does not do is it does not use
GPS or location to track people.

So the system actually uses
something different

called Bluetooth Low Energy,

which is privacy-preserving,

it doesn't drain the battery

and it makes it more also interoperable

between both Apple and the Android system

so it's more useful,
not only in the US context,

but globally.

So we built this system
in response to some requests

to help augment
the contact-tracing systems.

We wanted to do it in a way
that was user-controlled

and privacy-preserving

and had technological features

that would allow public health
to augment the exposure log

in a way that would accelerate
the work that they needed to get done

to interrupt transmission --
keep the R naught less than one --

and do that in a way that we would also
be able to partner with public health

to think about risk scoring.

We could talk more about
any of these areas that you want,

but I think maybe

one of the most important things
that I want to say, Whitney,

is how grateful Apple and Google are --

I'll take a moment to speak
for my colleagues at Apple --

to the great partnership
from public health across the world

and to academics and to others

who have helped us think through
how this can be,

how the exposure notification system

fits into the broader
contact tracing portfolio,

and how it does it in a way
that really respects and protects privacy

and also is useful to public health.

We're still on this journey with them,

and I really believe that
we're going to be able to help,

and I'm looking forward
to being a part of the great work

that public health's got to do
on the front lines every day,

been doing, frankly,

but needs to be able to step up.

WPR: That's great, and thank you
for that really detailed explanation.

And you know, we actually have Chris here
with some questions from our community,

so why don't we turn there really quickly.

Chris Anderson: Yep.
Questions pouring in, Karen.

Here's one from Vishal Gurbuxani.

Uh ... Gurbu --

I've pronounced that horribly wrong,
but make up your own mind.

Vishal, we'll connect later
and you can tell me how to say that.

KD: Fabulous last name. I love that.
That's a Scrabble word.

CA: "Given where we are today,

how should employees think about
returning to work,

with so many conflicting messages?"

KD: This has been an important part
of my work for the last few months.

I joined Google in December,
and all this started happening.

The pandemic in the world
first began in November

but it got very hot
in many parts of the world

in the last few months,

and we've been thinking a lot
about how to protect Googlers

but also protect the community.

I've been talking a lot about
what we've done externally.

You know, internally,
Google made a decision

to go to work-from-home pretty early.

We believed that we could.

We believed that in all the places
across the world where we have offices,

that the more we could not only model

but frankly just be
a part of flattening the curve,

that we would be good citizens.

So we have been fairly ...

I don't know if the right word
is conservative or assertive, about it,

because we really wanted to make sure
that we were doing everything we could

just to get people to shelter in place
and socially distance.

A lot of other companies
have been doing the same,

and I think the choices
that people are making

are going to be predicated
on a whole array of factors:

the rates of local transmission;

governmental expectations;

the ability to work from home;

the individual characteristics
of the workers themselves,

how much risk they might have
or how much risk it would be

for them to bring that back
into their household

if they have people
living in their household

who would be at increased risk
from morbidity, mortality,

from suffering and death, from COVID.

So these are individual
and local considerations.

I think for us as a company, we want
to, as we've talked about publicly,

we want to continue to be a part
of the public health solution

around social distancing,

and so that for us means
continuing to encourage work-from-home

for our employees

and really only be in if it's essential
that people are in the workplace.

And we've said publicly that we're going
to be doing that for many months to come.

Now, here's one thing I do want to say,

which is,

working from home
has definite benefits,

not only for the pandemic,

but for some people,
time for commute, etc.

I think we're already learning
there are some downsides,

and there are generic downsides,

even just not from work-from-home
but school-from-home

and just being at home,

which is: social isolation is real.

It causes depression.

It has physical impacts
on people's bodies;

there's science around this.

So as the world is weighing,

even beyond the pandemic,

when we've achieved herd immunity

because we've been able
to vaccinate the world

with a functioning vaccine
that creates immunity,

I think probably a lot of workplaces

are going to want
to encourage work-from-home.

But I just want us also to remember
that part of humanity is community,

and so we'll have to be thinking through
how we balance those activities.

CA: And, of course, there are
huge swathes of the economy

that can't work from home.

We're a lucky few who can.

And speaking of which,
here's a question from Otho Kerr.

"Vulnerable communities
seem to be receiving

a disproportionate amount
of misinformation.

What is Google doing

to help make sure these communities
are receiving accurate news

rather than fake news?"

KD: You know, vulnerable communities
is where I have spent

most of my career focused.

I think with many things
that we've learned as a society

in this pandemic

were things that we,
frankly, should have known.

And before I get to the information,
I'll just talk about access to services,

which is to say, and to brag, I guess,
on my hometown of New Orleans.

One of the early things
that New Orleans learned,

or remembered or whatever,

was that drive-through testing
only works if you have a car.

So you need walk-up testing,
and it needs to be in the neighborhood.

We need to meet people where they are,

and it's thematic of all the work that we
did after Hurricane Katrina in New Orleans

was to build back a health care
and public health infrastructure

that was community-oriented,
built with community not for community.

Of all the many things that I really
do hope last from this pandemic,

one of them, though, is that
we're being much more conscious

of building with especially
vulnerable communities

and building out policies and processes

that are as inclusive as possible.

For Google information,
we start with,

on the search platform, for example,

adding up knowledge panels,

that we spend time making sure are
linguistically and culturally appropriate.

We tend to start globally,

with global authoritative groups
like the World Health Organization

or the National Health Service or CDC,

and then we begin to build down
to more focused jurisdictions.

On other platforms
that we have like YouTube,

we've built out special channels

where we do, because
it's a platform and we can host content,

we've partnered with creatives --

we call them, I don't know,
that's a new thing for me

because I'm a doctor --

but we've partnered
with creatives and influencers

whose reach resonates with communities.

We have had particular programming,
for example, for seniors,

African-Americans,

so "vulnerable" takes on
a lot of meaning for us

globally and in the US context.

Our work is not done,

and we certainly every day are thinking
about how we can do more

to see that the information is accessible,

accurate

and also, frankly, interesting
so that people want to engage.

CA: Yeah.

Alright, thank you Karen.

I'll be back in a bit
with some other questions.

WPR: Thank you, Chris.

And you know, and this is really
wonderful talking about

more broadly, where you see
tech and public health going,

and specifically, talking about
these vulnerable communities.

And I think one thing,
even just beyond Google,

it would be interesting
to sort of hear your thoughts

on where you see tech in general
better serving public health,

if there are spaces that you think,

no matter which tech company
we're talking about,

we could all sort of come together
to better serve the community.

Do you have any thoughts on that?

KD: I could spend several hours
talking to you about that,

but maybe I'll just start by saying

that I came to tech

through the pathway
of direct patient care

and public health service
in local community,

and I ended up in a role
in the federal government

as the National Coordinator for Health IT,

which, for my background,
felt unusual to me,

I'm just being honest.

And I thought, well,
I'm not really a tech person,

but the secretary at the time said,

"That's exactly why we need you,
because we need to apply tech."

And she had had the unfortunate experience
of hearing me chirp about

how public health needed more timely data
to make better evidence-based policy

on behalf of community and with community.

This was a source of frustration for me
as a local public health officer,

that sometimes the data
I was working on, though great,

was stale by the time
I needed to make decisions

about chronic disease interventions,
or mental health or even violence

or intimate partner violence issues

in my community.

And so the desire to make data
useful and accessible

to support people in communities

is something that's been
burning in me for a long time,

and what I have learned
since I have been out in Silicon Valley

is that that desire burns
in the bellies of many people

who work at Google and Apple
and other companies,

and it's been really wonderful to see,

during this horrible time of the pandemic,

the incredibly brilliant
engineering and programming

and other minds at a company like Google

turn their attention on
how can we partner with consumers

and with public health
to do the right thing,

to bring the resources
that we have to bear.

And I said I could talk all day about it
because I have many examples

from the work that we have done at Google.

Maybe I'll just point out a couple.

One is to say that

we very early on wanted to find
a crisp way to help people understand

what they could do to protect
themselves and their community,

to flatten the curve,
get the R naught less than one,

and this "Do the Five" work
that our teams, largely in marketing

but then a lot of other people weighed in.

It required massive amounts of talent

to make that available
on our landing page, on search,

and then fold it out more broadly.

We did that in partnership
with the World Health Organization,

then the CDC, then with countries
all across the world

to get simple messaging
about staying home if you can

and coughing into your elbow,
washing your hands.

These are basic public health messages

that public health has been,
frankly, even in flu season

trying to get the word out,

but it became,

the resources at a company like a Google,

and the reach to billions,

it's a platform and a set of talents

that aren't even the technical,
computer vision kind of stuff

that you would typically think about.

Many other companies in Silicon Valley
have weighed in in the same way.

I think similarly,
we've been thinking through

how we can use tools like
the community mobility reports.

This is something,

a business backer
like we have for restaurants.

The engineers and scientists said,

what if we applied that to retail
and grocery stores and transportation

to get a snapshot in a community

of whether people
were using those areas less,

whether people were adhering
to local public health expectations

and sheltering in place,

and give that information
not only to public health

but to the public

to help inspire them
to do more for their community

as well as for themselves.

So there has been, I think
what I'm trying to say, Whitney,

is I think there's a natural marriage,

and COVID has been an accelerant use case
to demonstrate how that can work,

and it is my expectation
that companies like Google

who, certainly for us it's in our DNA
to be involved in health,

will want to continue
working on this going forward,

because it's really not just good for what
we need to get done in this pandemic,

but public health and prevention

are part and parcel
of how we create opportunity

and equity in all communities
across the world.

So I'm passionate about
the work of public health

and very passionate about partnership.

Can I just say one more thing?

WPR: Absolutely.

KD: Which is to say

that one of the first things that I did
before the pandemic started,

I had just started in December,

and then in January, I did
a listening session with consumers

about what they wanted,

and they said something
kind of similar to what you said,

which I just want to call out,

and that is,

they wanted partnership,
they wanted transparency

and they really felt like
there was quite a lot

that tech in general could do

to help them on their health journey.

But their ask was that we did it
in a transparent way

and we did it in a partnered
way with them.

And so as we move out of the pandemic,
and we're thinking more about consumers,

I want to carry some of this spirit also

of prevention and helpfulness

and transparency

into the work that we're going to continue
to do for people every day.