Health emergency: Freedom trapped

Freedom trapped


This coronavirus will have been the revelation of all possible transgressions. Who would have thought only three months ago that a virus from the end of the world would have been able to lock up half of humanity, stop the economy, empty cities, stores, and rain - in defiance of all established dogmas - thousands of billions to plug what could be plugged? Today, the epidemic is drying up all over the world, but fear, combined with the inability to respond effectively to the threat, is forcing security measures that are shaking up our freedoms. This is the case of these population "tracking" operations presented as a panacea to prevent the spread of the disease. What is the real situation and how do we allow the security trap - in this case health - to close in on freedoms?

He is not an egghead, one of those great professors of medicine that we frequently see, in these times of corona, parading on television channels to deliver the extent of their science as well as their uncertainty. He is not known, he is a general practitioner as there are thousands of them. He shouted out his anger on social networks in a video of two minutes, seen tens of thousands of times. Dr. Kharim Khelfaoui, a doctor in Marseilles, revolts to warn against the violation of medical secrecy". that the government is knowingly organizing ». What is it all about?

Breaking the chains of contamination

The context is that of the law extending the state of health emergency, presented to the Council of Ministers on 2 May, and adopted by the National Assembly on 9 May. Article 6 of this law establishes the creation of an "information system" for " identify infected persons "and to" gather information "on the maximum number of people in contact with them. The latter will be visited by "brigades" of agents, in particular Social Security agents, who will be responsible for questioning, testing and, if necessary, isolating them.  

In essence, to limit the spread of the epidemic, the law organizes a system for identifying cases carrying the virus and the people who may have been in contact with them, the so-called "contact cases". The system takes the form of two files: one, Sidep, will identify all Covid-19 patients; the second, Contact-Covid, will list all contact cases. The objective defended by the Minister of Health during the debate in the Assembly is to "... identify all patients with Covid-19. break the chains of contamination ".

On paper, there is nothing revolting about this measure if we put it in the very particular context of fighting a disease that can, in some cases, prove fatal and against which we have no validated treatment as yet. On the other hand, the way in which this measure is applied and the scope of its consequences raise questions.

Violation of medical confidentiality

The general practitioner from Marseilles talks about the violation of medical confidentiality, the cornerstone of the relationship of trust between a patient and his doctor. The new system in fact requires doctors to enter in a file the identity of patients who consult them and who turn out to be Covid-19 carriers. The government has insisted that the doctor be paid between 2 and 4 euros for this entry in the file. Practitioners are therefore required to declare all cases they diagnose and to forward the information to the public health systems. In doing so, and by accepting payment, they become de facto obligated to the public health administration.

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This practice is not new in principle as it is implemented to report all diseases at epidemic risk. What is new, however, is that the physician's work does not stop with the simple declaration of his or her contagious patients. He will also have to question his patient about all the contacts the latter has had during the 24 or 48 hours preceding his contamination. The doctor will have to enter the names and, if possible, contact details of these people in a file. It should be pointed out that this nominative entry is made not only without the consent but also necessarily without the knowledge of the persons suspected of being contact cases. The doctor is thus called upon to break medical secrecy in order to report information of an intimate nature relating to his patient. Moreover, the doctor is called upon to build up, on the simple declaration of his patient, a database of names and addresses of persons who will then be sought by the services of the Assurance Maladie; if the latter is unable to reach these contact cases, it will seek the assistance of the prefects and municipal services.  

The Marseilles doctor's concern is shared by the Academy of Medicine. In a statement of May 6th, she reminds us that medical confidentiality is " a fundamental element of the doctor-patient relationship of trust ». According to her, such a step is only possible if the patient has the possibility to object to the transmission of data concerning him or her, ". without this choice having any consequence on his own medical care. ".

The medical board has, too, published a statement requesting that the information transmitted by the doctors remain strictly "limited to the sole purpose of controlling the spread of the Covid epidemic19 ». The National Commission for Information Technology and Civil Liberties (CNIL) for its part, ensures want to watch" to limit the number of accesses, to provide for very strict authorisation rules "to prevent abuse of access to these sensitive files.

An armada for massive health data collection

General practitioners are not the only ones who are called upon to feed the databases of patients or case contacts of Covid-19. An army of professionals will be put at the service of this massive collection of data: the army health service, the territorial professional health communities, health, social and medico-social establishments, health centres, health centres, occupational health services, doctors taking care of the people concerned, pharmacists as well as laboratories and services authorised to carry out biological or medical imaging examinations are involved in the implementation of these information systems. says the daily newspaper Le Monde.

In addition, all persons who have undergone a Covid-19 screening test will automatically and by name enter one of the files, in this case the Sidep (Service intégré de dépistage et de prévention). The government is thinking big: every week, 700,000 tests will be carried out to detect the SARS-CoV-2 virus in nasopharyngeal swabs.

So the process does involve collecting health data from millions of French people. The implementing decrees have not yet been published, but sources of press are a document detailing the information that must be included in the Sidep file: name, sex, date of birth, address, telephone number, but also type of residence and activity. Other data, such as the date of appearance of the first symptoms, e-mail address or place of birth, may not be included in the file.

The new basis for sanitary S files

These data, real sanitary "S files", will be stored in the Sidep and Contact-Covid databases, which will serve as the basis for a "". new information system "related to health. It was inaugurated by then Health Minister Agnès Buzyn in December 2019, just before the start of the pandemic and originally unrelated to it.

It's a new platform, christened in English by the French government " Health Data Hub "which has the function of centralizing the health data of the French. The new platform replaces the National Health Data System (SNDS) and meets the objective of "improving the quality of health data in France. promote the use and increase the possibilities of exploiting health data, both in clinical research and in terms of new uses, particularly those linked to the development of artificial intelligence methods ".

Big data and technosciences at the service of health; this platform is in line with the liberal inspiration of the health law voted in July 2019. Its vocation is to become a one-stop shop for private and public players, research laboratories, industries and startups, and to support research in artificial intelligence. A fundamental tool in the digital transformation of the health system, carried out at a forced march by the government.  

The fundamental idea of this platform is to extend as far as possible the data collected by the Health Insurance; these are already numerous, France being one of the rare countries to centralize all the data on the care pathway of 99 % of the population. In the initial project, all the data present in the university hospitals will be added to this data, as well as those collected by local doctors and pharmacies. A wealth of information conceived without taking into account the opportunity that the Covid-19 epidemic would represent.

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Problematic data hosting

These billions of data represent a huge amount of information that needs to be hosted on powerful servers and managed as efficiently as possible. Officially " to move fast "The government's choice was cloud services from Microsoft, the US IT giant. A choice made through a limited call for tenders procedurally to a candidate. This choice of an American service to manage the personal data of millions of French people did not fail to cause controversy. France is, for example, fortunate to have a very high quality operator, OVH, which could have claimed to fill the service as well as Microsoft. This was not the case, and some, like Professor Israel Nisand, did not hesitate to describe this decision as "... a very good decision...". high treason "at the European Bioethics Forum held last February.

A controversy justified by precedent. Google is the operator of health data for millions of Americans and British citizens; Facebookis not to be outdone and is looking at the health data of its billions of users. With the Covid-19 outbreak, the GAFA has sensed a seam. Alphabet, Google's parent company, set up an interface to make it easier to qualify for testing; Amazon offered the British government its logistics for implementing large-scale tests; Jack Dorsey, the boss of Tweeter, put a billion dollars on the table to discover the first treatment for coronavirus. Beyond the "historic" GAFA, it is Alibaba that provides the QR health codes, which are indispensable for the Chinese to circulate in times of pandemic. Finally, it is Palantir, the massive data processing company, created by Peter Thiel, the founder of Paypal, who offers to France its algorithms for analyzing French health databases, hosted by Microsoft.

A capture that undermines a country's sovereignty over its sensitive data, and poses a risk to their use and commodification. Because, through Microsoft, any certified health hosting company demonstrating a simple interest in medical research could claim access to health data, whether or not it is linked to Covid-19; this is already the case for Amazon or Google. The Microsoft platform could thus be the gateway to a data circuit between various players connected in the same cloud. Finally, the American company is subject to the Cloud Act set up by the Trump administration: it obliges all American data hosting companies to provide the administration or the justice system of their country with all the data they have at their disposal. This regulation allows unilateral access by the U.S. government to data from a third country, without having to provide details about the nature of the recovered content.

Admittedly, the French authorities swear that safeguards and privacy protections will be scrupulously respected. The data will be encrypted if not anonymized, access to it will be drastically restricted, we promise. In order to circumscribe any concerns, the Senate has obtained the creation of a "Covid-19 Control and Liaison Committee" to assess the relevance of the digital devices put in place. For its part, the Assembly's Law Commission has provided that a report and an opinion from the CNIL will be regularly transmitted to Parliament. It is not certain that this will be sufficient in view of the appetites of many players in the field of sensitive data.

Fear and freedom

In the fight against the coronavirus, faced with the unexpected, with shortcomings in the organization of health care systems in the face of a formidable enemy, governments have had to act urgently. The first reflexes were to protect by isolating as much as possible each individual from the others, so that they would not be contaminated. This implied adopting unprecedented measures in times of peace of constraint and coercion. Containment measures were thus put in place and adopted fairly easily by the population because the threat of the announced risk was immense.

Fear has led to more distortions of liberties than we ever imagined. Then, as the epidemic waves dried up, it was necessary to avoid a resumption of the epidemic but, at the same time, to revive the economic activity that had been put on hold during this period. A new discourse emerged based on the assumption of responsibility by everyone: we are a little freer to come and go, but everyone must be vigilant and take responsibility.

The epidemic, we are told, is less violent, but it still exists, it is there, in our immediate environment, and could circulate at low noise. Tracing" measures are thus added to those of social distancing. It is necessary to know the relational circuits of each infected person in order to avoid the spread. This seems common sense. But such a measure necessarily undermines the protection, which we have established as an intangible principle, of our personal data and privacy.

This situation requires time-limited measures that are controlled in great detail to avoid slippage and to confine their use to a very specific field. These limits are part of the promises made by the authorities. But the methods of implementation, the technical choices made, the appropriateness of certain provisions raise questions and oblige each citizen to be extremely vigilant.


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