SAN FRANCISCO — In this California epicenter of the coronavirus outbreak, officials say they are trying to be as transparent as possible. They’re keeping a cruise ship out at sea, updating citizens on new cases and providing emergency resources to battle the epidemic.
But on one matter there remains absolute silence: the names of those who have died after being exposed to COVID-19, which so far nationwide involves one Californian and at least 13 Seattle-area residents.
That’s because experts in public health and bioethics say that far from helping society, a decision to reveal the identities of those — dead or alive — who have contracted coronavirus would be a disaster with far-reaching ramifications.
“Doctors don’t out people,” says Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics in Maryland, which focuses on the ethical implications of scientific advancement. “Whether it’s HIV, syphilis, coronavirus or anything else, people simply won’t show up to their doctor if they feel they might be outed for a condition.”
Kahn pointed to the Hippocratic Oath, which explicitly states that a physician will “respect the privacy of my patients, for their problems are not disclosed to me that the world may know.”
What’s more, laws laid down in 1996 by the Health Insurance Portability and Accountability Act (HIPAA) ensure that an individual’s health records remain undisclosed to the general public long after their death. That means releasing names of anyone with COVID-19 would violate HIPAA. So far, there are 51 confirmed COVID-19 cases in California.
“Just wanting to know something like who died from coronavirus doesn’t entitle you to know,” says David Magnus, director of Stanford University’s Center for Biomedical Ethics in California.
“There are far more deadly diseases that doctors see and don’t report publicly,” says Magnus. “Then it’s up to public health officials to step in, but they won’t tell people who you are.”
Coronavirus cases trigger ‘tracing’
What officials are duty-bound to do in any sort of infectious case — whether it’s a sexually transmitted disease or tuberculosis — is referred to as “contact tracing” investigation. This piece of detective work involves finding out anyone who has been in contact with the infected patient and advising them of best next steps.
With at least 14 U.S. deaths from COVID-19 to date — compared with 3,400 worldwide, the vast majority in China and 148 in Italy — it remains fairly easy for U.S. health officials to perform contact tracing investigations to try and keep people healthy.
In one California county, that is exactly what is happening. While calls Thursday to Seattle-area health officials were not returned, Placer County Health and Human Services spokesperson Katie Combs Prichard was candid about protocol.
“HIPAA requires us to protect confidentiality and we are only releasing as much information as is necessary to protect public health,” says Combs Prichard, adding that officials did disclose that the one COVID-19 victim in the county — described as an “older adult with underlying conditions” — hailed from the city of Rocklin.
“We are absolutely 100% doing a thorough contact investigation, that’s why we don’t feel there is a public health reason to release more identifying information,” she says. “We’ve been able to develop a thorough list of close contacts and are contacting them directly and placing them in quarantine.”
Health officials walk ‘a fine line’
Placer County’s approach represents “a constant discussion in public health, as we’re walking a fine line between causing harm and getting people unnecessarily frightened versus making sure they adopt the right precautions,” says Claire Wheeler, professor of Public Health at Portland State University.
Wheeler points out that while medical officials may be following protocol by not releasing the names of COVID-19 victims or those currently with the virus, that doesn’t stop those contacted by health workers from sharing details, including a name, with friends or through social media.
Should such personal information be leaked to the media or online, “it could be very bad for those individuals,” says Wheeler. “What if they lost their jobs? In these situations, people become hysterical. That’s the most dangerous piece of this.”
Worrying about the specific identities of those affected by COVID-19 may soon be moot, says Stephen Latham, director of Yale University’s Interdisciplinary Center for Bioethics in Connecticut.
With experts predicting that the number of people carrying the virus is bound to increase exponentially in the coming days and weeks, we may start reacting to coronavirus reports in much the same way we react to the seasonal flu, which this year has infected 32 million Americans and killed 18,000.
We’ll focus more on protecting ourselves — with rituals ranging from frequent hand washing to avoid large crowds — and care much less about the specific names or ethnicities of those with COVID-19, Latham predicts.
“In this first days of coronavirus, Chinese people and even Chinese food were stigmatized, but now we know this has nothing to do with going to a Chinese restaurant, it’s more about bumping into anyone of any ethnicity who might have this disease,” he says. “It’s everyone.”
Contributing: Lindsay Schnell, USA TODAY