In response to: “Health unit bureaucracy” Letter to the editor in the January 6 edition of the Fort Frances Times.
It is imperative that COVID-19 case numbers consider the balance between respecting privacy and ensuring that the public is informed in order to protect themselves. Unfortunately the recent letter to the editor titled “Health unit bureaucracy” submitted by Diana Coulombe failed to consider the complex nuances related to communications of case numbers.
All health units in the province are legally bound by the Personal Health Information Protection Act. To ensure consistency with the legislation and the De-identification Guidelines for Structured Data from the Information and Privacy Commissioner of Ontario, we determined that cases had to be announced for the four regions in the catchment area of NWHU. We also reviewed how case information is released by other local public health agencies and noted that our current approach is similar or provides even more detailed information than others.
For every case announced, there is also a release of case details provincially that include age range, gender, date that symptoms started, date of testing, date of reporting and possible source of the infection. When case numbers are small (as is the current situation for most communities), the provincial information can be matched with location information from the health unit, increasing the risk that the individual can be identified.
The Personal Health Information Protection Act is a powerful piece of legislation and recognizes the social importance of privacy. Although we have repeatedly promoted kindness and support for people diagnosed with COVID-19, we have been informed that some have suffered unnecessary hardship from being ostracized or made to feel unsafe. Such harms could be more substantial and long lasting for young children or those who hold more vulnerable positions in society. Considering this risk of harm, it is even more paramount that we make efforts to protect the privacy of these individuals.
Threats to privacy can threaten all of us. Negative stigma combined with unreliable privacy would be a disincentive to come forward for testing. If individuals avoid getting tested, cases are less likely to be found and COVID-19 becomes more challenging to control.
We do and will continue to release information that is useful to the public. If there was an increasing number of cases that suggest that there is a higher risk or possibility of community transmission, we will identify the area at a smaller geographic level. If there is a situation where there was a public event or a public location where many people had a significant level of exposure, then we will identify that event or location. Currently, multiple communities in the Rainy River district are affected by the increase in case numbers. All people across the district are at an elevated risk.
Releasing the actual number for each community is not useful and does not change the level of risk. A community with zero cases does not mean that there is zero risk. Some people with COVID-19 do not show symptoms, some may not get tested, and people are infectious before symptoms start. Also, many people travel regularly from their small community to larger centres like Kenora, Dryden, Fort Frances or Sioux Lookout to work, go to school, shop for groceries, or access other services.
Waiting for a known test result is too late for prevention, which is why NWHU has said to assume that COVID-19 is in your community and take the appropriate precautions at all times. It is not meant to induce fear; it is meant to promote and encourage safety. Information about the location of a case will not protect you. However, there are proven methods to prevent COVID-19 – including frequent hand washing, physical distancing, and wearing a mask while in enclosed public spaces. We are well aware of messaging fatigue, but the reason we keep repeating them is because these practices remain the best way to prevent COVID-19.
Dr. Kit Young Hoon
Medical Officer of Health
Northwestern Health Unit