Wear masks. Social distancing. Stay home in case of illness. To get vaccinated. Have it tested.
Hawaii Governor David Ige, Department of Health Director Libby Char and other officials have been telling us for many months now how to best guard against Covid-19. They say it is about taking personal responsibility and also being responsible to your fellow citizens.
So why doesn’t the state give us more details on where Covid is occurring, especially when there is a cluster that we could have been close to? This would allow us to take personal responsibility and go for testing if we think we could have been in the same place at the same time a known outbreak was occurring.
Name the church, restaurant, retirement home, beach gathering. Give us the details. We deserve it and we can help the state and help ourselves.
Tim Brown, an epidemiologist at the East-West Center, is sensitive to the extreme pressure exerted by the DOH to deal with Covid. But he thinks the agency should have been much more transparent from the start.
“The challenge from day one was a real reluctance on the part of Sarah Park and Bruce Anderson” – the former state epidemiologist and director of DOH – “to discuss things and give the public the information they needed. to ensure his safety, “he said. .
“The vast majority of data doesn’t give you any idea of the context, and it’s the information people need to make decisions. People need to understand where the risks are. More meat on DOH cluster reports would be very helpful. “
Brown cites the example of Singapore, which he says publishes full details on the clusters.
“And I see value in it,” he says. “If you’ve been to a place that has had an outbreak, you know to get tested. The reluctance here is our litigious society.
In Taiwan, meanwhile, each Covid case is assigned a number and posted on Twitter every day. Public data on each case includes gender, age, how the person is thought to have been infected (travel, household, etc.), and even diagrams showing specific spread from one individual to another.
In the United States, there are many examples for the DOH to follow. The National Governors Association, with support from the Robert Wood Johnson Foundation and the State Health Access Data Assistance Center, determined whether and how states report Data on epidemics linked to Covid.
In a January report, the NGA singled out several states for “clear presentation” of epidemic data. It includes Kansas, a state of just under 3 million people, which publishes the names of places that have at least five cases of Covid with dates of onset of symptoms in the past 14 days.
A website check for the Kansas Department of Health and Education earlier this week listed dozens of such sites in his Cluster Summary tab including Tabor College in Hillsboro, Country Place Senior Living in Hoisington, and fuel appliance maker Great Plains Industries in Wichita. The database is searchable by county.
North Carolina Department of Health and Human Services lists on its website the names and locations of collective living quarters suffering from epidemics in a state of more than 10 million people. A recent check found that a nursing home, the Black Mountain Neuro-Medical Treatment Center in Buncombe County, reported a total of 35 cases of Covid, and The Kid’s Corner Daycare in Franklin County last week reported 10 cases in total.
And in Louisiana, a state of 4.6 million people, the Department of Health is monitoring Covid cases in state colleges and universities. Delgado Community College, for example, recorded 105 cases last week among students living or attending classes on campus. LSU and A&M College have reported 622 cases.
This is useful information that alerts people who might want to get tested after learning about the problematic places. Compare that to the generic cluster reports released by the Hawaii Department of Health, which offer descriptions that ensure we never know where the cluster actually happened: a karaoke bar, a large restaurant, a small restaurant. , a marriage.
“A cluster from a Honolulu County transportation department and another from an industrial work environment in Maui County were investigated,” the DOH cluster report said. for September 30.
Sarah Kemble, the state epidemiologist, tried to explain to Civil Beat the reasons for this vague report. State contact tracers need cooperation when investigating Covid clusters, she says, and if establishments are afraid of being named, they can get stuck.
The state says it doesn’t want to risk stigmatizing establishments, doesn’t want to risk unnecessary panic and – especially with the rapidly changing delta variant – doesn’t want to draw attention to a site where the danger of dying exhibition has come and gone.
But this is clearly a double standard when it comes to other health department practices. The DOH has no problem naming the restaurants that violated food safety rules. Why not name those who have Covid outbreaks?
“I understand the anonymity arguments, but we are in a public health emergency,” Brown said. “We need detail and depth to understand the context in which Covid was contracted. We need to give people enough information so that they can act on it. “
Brown would like the DOH to produce an aggregated and comprehensive report that tracks all cluster data for the past six months and details the conditions under which the transmission occurred.
The legislature must intervene
Improvements in greater transparency of public health data can occur in Hawaii, but it takes more political will than the DOH and Ige are prepared to muster.
The legislature has shown it is capable of moving beyond vague and unproven claims of invasion of privacy or social injustice when it comes to keeping the public informed about Covid. Earlier this year, lawmakers insisted that Covid outbreaks in public schools had to be disclosed and they even overrode the governor’s veto to make sure that happened.
The Education Department, citing confidentiality and fears of stigma, had refused to release data on positive Covid cases in individual schools. Senate Bill 811 was introduced in this year’s legislature to force the DOE to do so. The DOE and DOH have testified against the bill, but the Hawaii State Teachers Association and others have testified in favor of it.
“I understand the anonymity arguments, but we are in a public health emergency.” – Epidemiologist Tim Brown
With SB 811 now law, anyone can find out exactly how many cases are occurring in schools across the state. Likewise, the State Public Security Department regularly reports tests and the number of cases for penitentiaries.
Since the start of the pandemic in Hawaii, we’ve struggled to get a full picture of the spread of the coronavirus. State officials often cite the Health Insurance Portability and Liability Act 1996, which protects patient health information from disclosure without their consent or knowledge.
But we’re not asking the state to release information about individual patients, just where they get sick.
As DeWolfe Miller, Emeritus Professor of Epidemiology at the University of Hawaii, says, “Knowledge is power.
Miller is also frustrated with the lack of information from DOH and other state officials.
“Privacy laws have made epidemiology impossible in the United States,” he says. “Right now all I can think of is a way to brake the transmission. Having information is the key to interrupting the transmission.
Daily Covid cases appear to be trending down, hospitals are seeing fewer patients crammed into intensive care units, vaccination rates hover around 70% and the governor is relaxing some assembly restrictions. Now is exactly the time to bring in the audience as a true partner.
It is also much easier to get tested now. You do not need a medical certificate to check if you have contracted the virus. Rapid home antigen testing is offered free of charge to anyone who signs up on the state’s website. You can buy them at local stores or online for a few dollars.
It is high time to listen more carefully to public health experts like Brown and Miller. The DOH must err in giving us more detail, not less.
It is not difficult to do. The data is there. He just needs to be released.