Toilet-tattling? Trump COVID adviser criticizes 'smart toilet' proposal for COVID testing

With the CDC reportedly withholding the vast majority of its collected data on COVID-19, Stanford University radiology and urology faculty are proposing a futuristic — some might argue dystopian — mechanism for state and local governments to fill in the gap.

Because SARS-CoV-2 RNA "can be found in faecal matter," they propose a "smart toilet platform" that can passively monitor COVID surges, "enabling earlier detection of infected individuals and promoting public health."

Published on Wednesday in the Nature journal npj Digital Medicine, the five researchers pitch the toilet-tattling as a response to the "psychological fatigue" experienced by populations repeatedly being subject to swab tests for two years. They note China's practice of anal swabs has not caught on "due to its intrusive and unpleasant nature."

While the researchers acknowledge the proposal "will require serious considerations on the ethics and privacy front," they emphasize that their "Coronavirus: Integrated Diagnostic (COV-ID) toilet" system would provide "more granular estimations" of virus prevalence than wastewater analysis. The Centers for Disease Control and Prevention just started publishing state-submitted wastewater data in February.

Individuals who test positive would be given "information to determine quarantine protocols and further confirmatory testing," while the aggregated network data could provide "more real-time information to guide decisions about travel," the paper states. It contemplates the process of "continually testing an entire community" to preempt outbreaks. 

Just the News asked President Trump's COVID adviser, Scott Atlas, a former chief of neuroradiology at Stanford and a senior fellow at its Hoover Institution, what he made of the paper.

"It is a sad and even frightening result of obsessive concern for this virus, given its very low risk for the vast majority of people and the clear pathway to protect those most vulnerable, that intrusive monitoring policies are being considered," he wrote in an email.

"As members of societies built on freedom and rational, objective analysis of information, we as individuals need to carefully re-evaluate the role of scientists and other so-called experts before we once again permit a misallocation of resources and a perversion of priorities by elites in power, especially since they already failed terribly in their policies," said Atlas, as the U.S and other countries emerge from two-plus years of COVID restrictions.

Stanford medical professor Jay Bhattacharya told Just the News that the "technical problems of designing and maintaining such systems in real-world settings ... are likely to be considerable."

Atlas and Bhattacharya are founding fellows of Hillsdale College's Academy for Science and Freedom, which hosted its first conference last month.

"This is an interesting idea but it's overkill," Jon Callas, director of technology projects for the Electronic Frontier Foundation, a digital civil liberties group, told Just the News. The practical advantage over wastewater testing appears "minimal."

He said smart toilets fit two categories of privacy concern to EFF: "intimate devices" that collect extremely personal data such as virtual reality headsets that track eye movements, a potential gold mine for advertisers, and "public goods" such as red light cameras.

Callas said the most relevant Supreme Court decision related to smart toilets would be 2014's unanimous Riley ruling, which struck down warrantless search and seizure of data on a cell phone as unconstitutional. Chief Justice John Roberts said the devices contain "the privacies of life."

The COV-ID system would not require mass installation of new toilets but just "mountable bidet-style attachment[s]" that can be installed in "highly trafficked, public areas ranging from shopping malls and sporting arenas to schools and hospitals," the paper states, suggesting tax credits and public funding to deploy them widely.

Defecating individuals could scan a QR code on the toilet to consent to COVID testing and receive test results to their smartphone "if desired." (The paper suggests using Bluetooth contact-tracing systems available on Apple and Google devices.) The system must be fully automated to ensure "high user compliance."

Individual results would be de-identified and reported to an "anonymized tracing system," the researchers propose. Embedded sensors could also measure markers of infection such as body temperature and "oxygen saturation," and the toilets could be programmed to look for other infectious diseases such as norovirus.

"If the results are used to support invasive contact tracing, quarantining, and isolation protocols, many people may respond by avoiding or disabling the toilets or refusing to provide the QR codes the toilet requests," Stanford's Bhattacharya wrote in an email.

He said cooperation with contract tracing programs is "spotty" and did little to reduce COVID transmission "during seasonal waves. There is no reason to think that smart toilets would alter that fact, which is caused by the public’s loss of trust in public health authorities."

The researchers acknowledge their proposal could lead to less-than-voluntary participation. 

Military settings are "virtually guaranteed" to require inhabitants to use the COV-ID system, "but consent is likely required for individualised testing," the paper states. It doesn't discuss compulsory installation of smart toilets in personal homes.

The researchers emphasize smart toilets could also be popular with well-to-do defecators. They conducted a survey two years ago that found "smart home users are more acceptable toward smart toilets," which could be incorporated into the infrastructure of so-called smart cities that already use "internet of things" technology.

A person who enters a friend's house with an Amazon Alexa device may tacitly consent to being recorded, but it's questionable whether a person can really "consent" to using a smart toilet when nature calls, EFF's Callas told Just the News.

Even if an airport didn't use smart toilets to rat out individual COVID infectees, "it's still kind of creepy," he said. 

The paper's corresponding author, Seung-min Park, didn't respond to Just the News queries asking for her response to science and civil liberties concerns and whether the researchers are providing a roadmap for intrusive monitoring to governments, military and corporations.