SWHNPHD to limit release of information on COVID-19 patients

McCOOK, Neb. -- Citing concerns over privacy and just how useful the information would be, the Southwest Nebraska Public Health Department will not issue a list of COVID-19 patients to local first responders, law enforcement and emergency managers.

In a release issued Sunday afternoon, SWNPHD announced the Board of Health, after "quite a robust discussion about the legal and policy issues," had voted to "limit disclosures to those necessary to aid in enforcement of the directed health measures."

Director Myra Stoney said the agency had received several requests to share information with local officials. "We understand the desire to have the information they feel is necessary to protect their health and safety," she said. "The COVID-19 pandemic has caused stress and concern for many residents of the health district, including ourselves."

After receiving requests for addresses and/or names of patients who have tested positive for COVID-19 or are presumed to be positive for COVID-19, Stoney said she gave the requests a great deal of consideration, discussed them with the Nebraska Department of Health and Human Services and other local public health departments around the state, the executive committee of the Board of Health and legal council.

Meeting Thursday, the board reviewed a letter from Dr. Gary Anthone, the chief medical officer for Nebraska, FAQs on disclosure of identifiable health information from the Department of Health and Human Services and Executive Order 20-15, and information about modifications to HIPAA by the federal government, as well input from individuals present at the meeting.

The board ultimately voted to limit disclosures to those necessary to aid in enforcement of the directed health measures.

"The Health Director will respond to direct inquiries from authorized public health partners to confirm a specific individual’s COVID-19 status, after making a good-faith effort to determine if there is a serious or imminent threat to public health or safety."

She also said a committee of board members, staff, and members of the community, is being formed to continue to monitor the COVID-19 situation and make recommendation to the Board of Health regarding information disclosure, personal protective equipment and other related issues."

The release continues:

The conversation during the June 11th meeting showed that the Board had concerns about the following issues, although these are not intended to be an exhaustive list of their concerns.

A list of names and/or addresses would not be as useful to first responders as may expected because:

* Only lab-confirmed positive cases are shared with SWNPHD and tracked by the organization

* Cases in which the individual is solely diagnosed by a medical professional, and not lab-tested, are not shared with SWNPHD or tracked

* There is no timeframe for recovered COVID-19 cases to ‘fall off’ of the list, and these individuals would therefore remain on the list indefinitely

* There are a number of asymptomatic positive cases who wouldn’t be included in the list

* Individuals who are presymptomatic have been shown to shed active virus but wouldn’t be included in the list

* There are individuals who choose to self-quarantine due to symptoms associated with COVID-19, without ever seeking testing or diagnosis, and which would not be shared with SWNPHD or tracked

* Testing in the health district is currently not at a high enough level.

* The possibility of these names or addresses being leaked out to members of the public.

* Currently in some areas of the United States the sharing of personal information has resulted in stigmatization and discrimination by members of the community against those who have tested positive for COVID-19, as has occurred historically with HIV/AIDS.

* Dr. Anthone’s and DHHS’s guidance is that disclosure of protected identifiable health information be shared only when there is “a good faith belief that such use or disclosure would prevent and lessen a serious and imminent threat” to health and safety. Although COVID-19 is certainly a serious threat, it is not necessarily imminent where PPE is available and appropriately utilized by first responders.

* There was no good faith belief that sharing the types of information requested would actually prevent or lessen the threat, due to the fact that with first responders that have been exposed to COVID-19 in other areas of the state, the exposures came from individuals with no known history of COVID-19 diagnosis at the time of exposure.

* The DHHS guidance is that information released be “the minimum information necessary” relevant “to the immediate care of a patient and ensures proper safety precautions for the first responder,” and that “information shall only be shared on a need to know basis,”. The confidentiality and privacy concerns found in Nebraska law were not suspended by executive order, rather it provided a very limited exception to the general rule of non-disclosure.

* There is concern that sharing such information may result in reduced quality of care from insufficient staffing on first responder units if the status of patients as positive for COVID-19 were known.

* The DHHS guidance is that first responders treat every address as a potential COVID-19 positive site.

"It is important to us to all work together to find a balance that allows us to protect the safety and health of the public as well as the individual. We understand the needs of first responders. Therefore, we make the following recommendations for universal PPE to our first responders.:

* Maintain a minimum distance of 6 feet from members of the public whenever possible.

* When not possible, wear PPE when coming into contact with all members of the public, regardless of their COVID-19 status.

* Appropriate PPE for first responders includes mask, disposable gloves, and eye protection. In certain circumstances gowns may also be appropriate, but these are not required or recommended on every call, especially when contact can be limited to 15 minutes or less and where physical distance can be maintained.

SWNPHD has resources that can provide recommendations and guidance on the use of PPE if your agency would like further information.

Information and guidance can be found on the COVID-19 Information pages of SWNPHD’s website www.swhealth.ne.gov. You can also follow SWNPHD on Facebook, Twitter, and Instagram. SWNPHD serves Chase, Dundy, Frontier, Furnas, Hayes, Hitchcock, Keith, Perkins, and Red Willow counties. SWNPHD is located at 404 West 10th St (1 block north of Arby’s) in McCook.