Why Chatham health officials aren’t sharing specifics on positive COVID-19 cases

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As Chatham County’s COVID-19-related death toll elevated from one to six on Wednesday, the county public health department said it would not reveal information on the deaths.

That’s been the standard course for the health department — and many health departments across the state and country — during the COVID-19 pandemic as media and the public pine for more details. But county Public Health Director Layton Long has said from the beginning: that information won’t tell you much.

“The focus on testing, I think, really should in the public’s mind move away from the actual ‘who’s got it, who’s in our community and where is it’ and all these questions to, ‘Let’s just assume that anybody that you approach potentially has it,’” Long told the News + Record last month. “It doesn’t really matter what part of the county that people live in. You need to treat everybody, and it’s not that everybody has it, but practice those social distancing practices that keep you from becoming infected. That is going to apply if the person in front of you is infected, or the person is not affected due to social distancing.”

Reason 1: Not Really Relevant

The N.C. Dept. of Health and Human Services has kept a running update on positive tests and deaths, but even that is inconclusive. The webpage where the ticker resides states that “not all cases of COVID-19 are tested, so this does not represent the total number of people in North Carolina who have or had COVID-19,” and “deaths reflect deaths in persons with laboratory-confirmed COVID-19 reported by local health departments to the NC Department of Health and Human Services.”

As of Wednesday morning, Chatham County had a reported 135 positive COVID-19 tests and six deaths. But Long said at Monday’s Chatham County Board of Commissioners meeting that the reported number didn’t really say much.

“This is not an indicator of the prevalence in the community,” he said. “Usually these are populations that have been prioritized. Case numbers are important, but we are not doing broad-based testing to understand the prevalence in the community.”

The message is that neither the county nor the state have done widespread enough testing to have a scientifically-accurate picture of just how many people in those areas have COVID-19, so even the numbers could be construed as slightly misleading.

That’s the message that Heath Cain, the health director in nearby Lee County, shared Wednesday after Lee announced 16 new cases in the county in one day.

“I recognize that the increase in reported numbers today may cause some alarm in the community,” Cain said in a press release. “Remember, COVID-19 is widespread in the community. This is not a case of knowing where the virus is and avoiding those places to avoid getting sick; the virus is everywhere, there are no safe spots and anytime you leave your home, you risk infection.”

Health departments have been fielding questions about where the positive cases are and if it would be helpful to the public to reveal those spots, even at a zip code level. Officials have pointed to two reasons: the widespread nature of the virus and privacy reasons.

Reason 2: Community Spread

As Cain said, the virus’ status of community spread across North Carolina and in individual communities means that, according to health experts, it doesn’t really matter where the positive cases are or even where they contracted the virus. Officials say it’s hard to know where the virus originated from at this point.

Long said on March 24 that with the “initial cases,” the health department was in contact with the individuals and were conducting contact tracing.

“Because they were the first case, we knew where they were, and we were trying to manage it at that level,” he said. “And that’s what the state was doing initially in the process. And at this point, with community spread, that’s, I guess to use the analogy, the horses out of the gate. We’ve had them in a corral as long as we could contain them, but now they’re out. And so we just need to realize that knowing the individual is really not relevant at this point.”

Reason 3: Privacy

Another reason is privacy. Health officials have pointed to HIPAA — which stands for Health Insurance Portability and Accountability Act — laws, which have the purpose of, according to a U.S. Department of Health and Human Services summary, “assur(ing) that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well being.”

Mike Zelek, the county health department’s director of health promotion and policy, said Wednesday that Chatham officials are following guidance from state officials and lawyers who “specialize in HIPAA and communicable disease law.”

“COVID-19 is a reportable disease, meaning that medical providers are required to notify the public health department of positive tests,” Zelek said. “However, these test results, specific to a person or that person’s place employment, are considered protected health information (not public record) and are protected by law. Therefore, we cannot share information that could potentially lead to individuals being identified, other than completed test totals as reported by the state, which are public record. This includes details like geography and employer.”

Mountaire Farms and The Laurels of Chatham, two places with reported outbreaks, made public statements themselves, which Zelek said gives the health department an option to “discuss some of the public health department’s efforts to respond to some degree, without sharing information specific to the cases beyond what the employer has shared publicly.”

“This is not to protect employers,” he said, “but to protect the individual’s privacy.”

Zelek also pointed to guidance from the UNC School of Government, which regularly provides guidance to local governments on various matters. He shared an April 9 article by Jill Moore which stated that novel coronavirus infections fall under the state’s Communicable Disease Confidentiality Law, which states that “information that identifies an individual who has or may have a reportable communicable disease or condition is strictly confidential.”

“At this time, providing specific health information, like small numbers of positive test results for a reportable disease in combination with the geographic location at the facility level, makes the protected health information of the individuals served by that facility identifiable,” Zelek said.

Reason 4: Testing Limited

Not all counties have followed this procedure. Richmond County, which includes the city of Rockingham and is on the southern border of North Carolina, has revealed the individual ages of those with positive tests, status of those cases and the geographical area of the county where the cases are.

But Long said the Chatham department is not taking that same approach. At Monday’s Chatham County Board of Commissioners meeting, he responded to a question from Commissioner Mike Dasher, who asked if it would be better if people knew the rough locations of the positive tests.

“The testing is only reflective of those specific populations have been tested,” Long said. “We don’t know how many individuals throughout the community have contacted their doctors’ office and said, ‘I don’t feel well, these are my symptoms,’ and the advice is (to) stay home.”

Reporter Zachary Horner can be reached at zhorner@chathamnr.com or on Twitter at @ZachHornerCNR.