Public health experts say it can be difficult to strike the right balance between informing the public and maintaining patient privacy.
When the novel coronavirus first arrived in Northern Nevada in early March, a bevy of health and communications officials gathered on a conference call to discuss how to properly “message” to the community that Washoe County had its first case.
Because the man in his 60s had a grandchild at Huffaker Elementary School, the officials made the extraordinary decision to close the school. Still, they didn’t want to actually acknowledge it was the coronavirus forcing the closure. Instead, they said students there had been exhibiting “flu-like symptoms.”
In fact, Washoe District Health Officer Kevin Dick refused to publicly address the presence of the coronavirus until his hand was forced by a county commissioner who confirmed for the Reno Gazette Journal that Washoe County had its first case on March 5.
Since then, the district has been slow to release specific details about where coronavirus infections are occurring, initially pushing back against releasing zip code specific data before relenting on Tuesday, and outright refusing to comment on outbreaks in health care facilities.
Public health experts say it can be difficult to strike the right balance among the competing priorities of keeping the community informed, protecting individual privacy and inciting the public to take necessary actions to stay safe.
The bottom line, however, is keeping the public’s trust.
“If the government and public health agency loses the trust of the community because it’s perceived to be hiding information, that can undermine their other efforts to try to control the transmission in the population,” said Craig Hedberg, a public health professor at the University of Minnesota.
“One of the main things about public disclosure of events like this is the need for our government agencies to be transparent and accountable.”
Available for press briefings, but details are scarce
Washoe District Health Officer Kevin Dick hasn’t been inaccessible.
He conducts regular press conferences, during which he releases information such as the number of infections and deaths in the community and what his department is doing to address testing needs.
But when pressed for additional information, he often resorts to “no comment,” or “I don’t have that data in front of me.”
Other examples of the district being slow to release information include:
- Dick initially declined to release the number of cases by zip code until coming under pressure to do so. The district released a new map on Tuesday. That map finally answered questions residents of Incline Village had been asking for weeks and showed the Pyramid Lake Paiute Reservation has the highest density of cases in the county.
- The district has refused to answer questions about COVID-19 cases at specific locations, such as work sites or the explosive outbreaks at a children’s mental health hospital and a nursing home in Reno. Outbreaks at those two locations have accounted for 110 of the county’s 710 total infections. Fourteen people have died in those clusters.
- Dick also argued against a new state regulation that would allow first responders to be notified of where people were being quarantined for potential exposure to the coronavirus. The Nevada Board of Health did not agree with Dick’s argument and passed the regulation anyway.
- Earlier this month, when he learned that information he had given to local leaders had been leaked to the press, Dick refused to participate in his normal daily briefing to emergency officials. He resumed the briefings a day later.
Meanwhile, elected leaders such as Mayor Hillary Schieve and Gov. Steve Sisolak have imposed new social distancing restrictions based, in part, on such things as photographs of people congregating on golf courses or not wearing masks in grocery stores and not necessarily on where infections are actually occurring.
Schieve has often been frustrated by the amount of information coming from the Washoe County Health District.
“It’s hard to know what info they have and what they share,” Schieve said Tuesday. “That’s been the frustration, especially on clusters.”
It’s not just the public that isn’t getting information on coronavirus clusters in Washoe County. Neither is the Incident Management Team in charge of the region’s emergency response to the pandemic.
“The Incident Management Team is not aware specifically of where deaths or exposures occur,” public information officer Adam Mayberry said when asked for details on the outbreak at Lakeside Health & Wellness nursing home. “From the IMT, we are not privy to the potential outbreak in local care facilities.”
Dick and his public information officer Scott Oxarart routinely decline to comment on whether cases are occurring at specific locations. Oxarart cites “medical privacy requirements” as his reason for declining information.
State and federal law is clear that health authorities can’t release any personal identifying information about those who contract the coronavirus. Those laws, however, allow the health district to release data on infections as long as it has determined the data can’t be used to identify specific individuals.
In this case, the Washoe County Health District has determined anything beyond the zip code level shouldn’t be released. Oxarart wouldn’t explain why when pressed by the Reno Gazette Journal.
“We made that determination to release what we’ve released,” Oxarart said.
Hedberg said local health districts often are given wide latitude to decide what should be public.
“The first order is don’t disclose anything that could identify an individual,” Hedberg said. “But what level of information constitutes identifying information is something that is open to judgment and is going to vary depending on the setting.”
Transparency lacking across the state
Indeed, the interpretation of that rule has been interpreted differently across the state. Nye County, for example, names the home town of each person with a positive test. Clark County was the first to begin reporting cases by zip code.
It’s also been difficult to get information from other jurisdictions across the state.
For example, until it came under pressure from state and national reporters, Sisolak’s administration declined to provide data on the number of nursing home infections. The Clark County School District has released only obscure details about cases within its jurisdiction. And the coroner’s offices in both Washoe and Clark counties are refusing to release information about those who have died from the virus.
That has caught the attention of the Nevada Open Government Coalition, which released a statement urging governments to maintain transparency through the pandemic.
“Nevadans need more transparency, not less, when access to accurate and complete information can mean the difference between life and death,” the coalition said in a statement sent to local and state government agencies this week.
More details made available in 2015 measles outbreak
In the past, health officials have released far more detail about infectious disease outbreaks.
For example, in 2015 when a measles outbreak hit 14 states, Washoe County released the name of the school attended by someone suspected of having the virus. That same month, state health officials listed all of the places a family with a toddler showing symptoms of the illness had visited, and when.
Hedberg said the sheer number of coronavirus cases makes it more difficult to provide that level of detail. And he added that measles is much more contagious, perhaps better justifying the detailed release.
“Measles is the most infectious viral agent that is commonly dealt with,” he said. “Being able to say to people if you were at this grocery store at this date and time and there’s a likelihood you could have been exposed, that’s important information.”
County says it’s facing massive workload
In an interview Monday, Dick said his decision not to release more detailed information about where infections are occurring comes down to several factors.
One, his department is drowning under the coronavirus workload, which has his staff so busy they haven’t been able to conduct even routine food establishment inspections. And information on new infections is constantly changing, making it difficult to provide accurate data.
Dick also said he doesn’t want to harm an individual business by acknowledging whether it has had any coronavirus cases. But he said he is exploring ways to release information on how many cases are occurring in particular industries, but not specific businesses.
His primary reason for keeping infection details from the public is because he believes that to prevent further spread of the virus, everyone needs to stay home regardless of their proximity to a cluster.
“The reality is it’s coming from everywhere,” Dick said. “The best scenario is if people consider everywhere to be a hot spot. They are safe when they are staying at home and are at risk when they go out.”
Anjeanette Damon is the government watchdog reporter for the RGJ. You can reach her at email@example.com or follow her on Twitter @AnjeanetteDamon. If you care about shining a bright light on decisions made by your elected officials, please consider subscribing to the Reno Gazette Journal.
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