/Privacy a concern for health unit when reporting COVID-19 cases

Privacy a concern for health unit when reporting COVID-19 cases

By Sue Tiffin

With each update of confirmed cases of COVID-19 in the area from the Haliburton, Kawartha, Pine Ridge District health unit, comments from the public regarding their questions and concerns – namely, why isn’t more information given about an individual’s location or their whereabouts leading up to their positive test – follow.

Throughout the year, the Times, has published articles about these concerns, with responses from the health unit explaining their decisions and process – including what contact tracing looks like. Here, the local Medical Officer of Health for the HKPRD health unit weighs in on those topics as Ontario experiences the second wave of the pandemic.
Further information regarding confirmed cases of COVID-19 in Haliburton County, as well as information about best practices including COVID-19 prevention measures during the pandemic can be found at http://www.hkpr.on.ca.

Information reported protects individual’s privacy
Dr. Lynn Noseworthy, local Medical Officer of Health for the HKPRD health unit, said the health unit has received both positive and negative feedback about the way they currently report local COVID-19 data in our region. To date, if someone in Haliburton County, City of Kawartha Lakes, or Northumberland County tests positive for COVID-19, they are listed as a number within their county, rather than a more specific location highlighting the area or municipality in which they live. Numbers are then broken down by gender, age and outbreak setting.

“Our decision to only list local COVID-19 cases by county, not the specific town or township in which a person lives, is largely due to the relatively small populations of these places,” said Noseworthy. “It could be very easy to identify someone who tests positive for COVID-19. We feel our current approach to reporting local COVID-19 cases strikes a balance between privacy and people’s right to know.”
Noseworthy said COVID-19 prevention measures are what will keep people safe.

“The fact is that COVID-19 is circulating everywhere in our community, so a person could potentially be exposed to the virus anyplace and in any space,” she said. “Therefore, continuing with COVID-19 prevention measures is critical to reduce the risk of the virus. No matter where we are in Haliburton County or elsewhere, we need to: stay home if ill, wear a mask when inside public places, practise physical distancing by remaining two metres (six feet) apart from others, wash hands thoroughly and frequently with soap and water and avoid non-essential travel, especially to high-risk areas.”
“This,” said Noseworthy, “is the most important information to use to protect yourself and others.”

Health unit aims to protect personal health information while informing community of potential health risks
Noseworthy said the public health unit is aware that “areas with larger populations or more cases in those highly populated areas may include a break down of cases by municipality in their reporting.”

“Each Ontario health unit, and its respective Medical Officer of Health (MOH), follow provincial protocols and directives around the pandemic response,” she said. “But the nature of Ontario’s public health system also allows for local health units and MOHs to use their own discretion and judgment on public health matters – COVID-19 included – in their own community. We are seeing that in the way COVID-19 restrictions are being tailored to individual areas, not mandated across Ontario. This is a strength of our public health system, in my opinion, to meet the individual and unique needs of the area being served. An approach used in a larger urban centre like Toronto, Ottawa or Hamilton may not be as good a fit in a more rural and remote area like our health unit region, and vice versa.”

“As a medical doctor, it weighs heavily on me how public health agencies like ours can balance privacy with the public’s right to know during COVID-19,” she said. “Privacy does enter the equation, as the health unit has the legal obligation to protect the personal health information of our patients and clients. We also are tasked with informing area residents about potential health risks in their community. We walk a fine line in doing both as we serve the public during the pandemic, and that is why we are taking the approach we are to reporting local COVID-19 data.”

Contact tracing ‘methodical, comprehensive and thorough’
While Noseworthy said the health unit is trying to balance privacy rights and the public’s right to know, she said, “[w]e also want to assure local residents that the health unit takes their concerns seriously about protecting against the spread of COVID-19.”

The health unit will contact anyone who tests positive for COVID-19 in Haliburton County, Northumberland County and the City of Kawartha Lakes, directing that person to self-isolate, not go out, monitor symptoms and take further precautions to limit the spread of the virus. Details are obtained about every place that individual visited or person they were in contact with during their infectious period, with every one of those identified individuals contacted and told to self-isolate and watch for symptoms, with arrangements made for testing if symptoms become apparent.

“This case and contact management is very methodical, comprehensive and thorough … and a critical part to controlling the spread of COVID-19 in our communities,” said Noseworthy.
“It’s been our health unit’s experience that people who test positive for COVID-19 are very open and honest about their interactions with others and do their best to provide the needed information to track down potential contacts.”

Reporting workplace outbreaks
While workplace outbreaks are reported by the media if the information can be verified, or by workplaces themselves, the health unit does not immediately report this information if it determines there is no risk to the public.

“The health unit will not routinely share the location of workplace outbreaks, but is including the number of local workplace outbreaks in our daily COVID-19 case reporting,” said Noseworthy. “Having said that, if there is a workplace outbreak in which there is a risk to the public, and we are unable to determine all the close contacts, we would notify the public. That is what happened in one previous incident when there was a workplace outbreak [in the region] with a potential risk to the public.”

“In another previous situation [in the region], we also released the name of a large workplace with COVID-19 cases,” said Noseworthy. “This was done in consultation with the workplace, which was issuing its own public statement. In these types of scenarios, the health unit may also share information about a workplace if the workplace requests public notification – even if there is no risk to the public.”

Contact tracing is essential to prevent the spread of COVID-19, said Noseworthy, and said restaurants and eateries are required to keep contact information for customers who dine in. Under the province’s COVID-19 framework, in the higher colour categories, including yellow, which the HKPRD health unit region is currently under, additional businesses like gyms and fitness centres must also keep contact information for customers and patrons.
“The idea is that this information could be provided to public health if there is a positive COVID-19 test and people need to be traced/contacted,” said Noseworthy.

Noseworthy said the information about workplace outbreaks differs from the information the public is able to access in the case of restaurant, personal services and recreational water facilities health inspections, which are mandated to share their inspection reports and because “the reporting of health inspections at restaurants does not involve personal health information, but information about whether or not the restaurant complies with regulatory requirements.”

Reporting of confirmed cases in schools and long-term care homes
“Just as we do for area workplaces and businesses, the health unit’s focus is working and supporting efforts to prevent and limit the spread of COVID-19 in all public settings,” said Noseworthy. “In the case of schools and long-term care homes, we work closely with our partners in these sectors to keep learning environments and care settings safe for everyone.”
School outbreaks are reported online by the province at www.ontario.ca/page/covid-19-cases-schools-and-child-care-centres and not by the health unit, which said to avoid duplication, they instead include that information in the cumulative total that is posted on their website.

“When it comes to schools, there are protocols in place with educators to inform school communities about potential COVID-19 cases,” said Noseworthy. “Similar measures are also in place for the health unit to support long-term care homes in the management, control and response to COVID-19 outbreaks.”
“When it comes to long-term care homes and hospitals experiencing COVID-19 outbreaks in our region, this information is included in our daily COVID-19 data reporting,” said Noseworthy. Information on COVID-19 cases for residents and staff living or working in Ontario’s long-term care homes can also be found here: https://covid-19.ontario.ca/data/long-term-care-homes.

Results return to health unit of primary residence  
When a person tests positive for COVID-19 in Haliburton County, their test results return to the public health unit of their primary residence – that means someone testing positive in Haliburton County who primarily lives in Toronto will have their result returned there, while someone from Haliburton County testing positive in Toronto will have their result returned here.
“Currently, people can get tested for COVID-19 anywhere in Ontario – regardless of where they live in the province,” said Noseworthy. “If a confirmed positive COVID-19 test result comes back, the findings are reported to health authorities in the region where the individual lives.”

In this case, the appropriate health unit/health department will then do follow-up with the person who tested positive, said Noseworthy, and includes the same direction as anyone else who tests positive to self-isolate, not go out, and contact trace based on details of where the individual visited or people they might have been in contact with.

“The bottom line is that regardless of where someone lives or is tested for COVID-19 in Ontario, the provincial case and contact management system will follow up with the person to ensure they self-isolate and reduce the spread of the virus to others,” said Noseworthy.