On Tuesday, public health officials in Arizona and Sonora each announced a positive case of COVID-19 in the local border area.
The amount of information they provided about the people who tested positive in each case differed widely, however.
Those differences illustrate the sharp contrast in approaches to the disclosure of patient information in the United States and Mexico, and also highlight an ongoing debate about whether U.S. officials are erring too far on the side of privacy in a time of emergency.
In the Sonoran case, state Health Secretary Enrique Clausen Iberri said during a videoconference Tuesday evening that a 65-year-old woman from a town approximately 45 miles southwest of Nogales, Sonora, had tested positive for COVID-19.
He said the woman had gone to Arizona and returned home on March 16. Six days later, she began experiencing fever, cough, headache and overall malaise. When she began having trouble breathing, she was hospitalized in Nogales, Sonora on March 28.
Clausen said the woman was in “very serious” condition at the Hospital General in Nogales, Sonora, where she was breathing with the help of a ventilator.
The woman had four “direct” contacts, Clausen said, none of whom were currently showing symptoms, and authorities were continuing to investigate other contacts.
He also said the patient had a history of high blood pressure.
In the Arizona case, the Santa Cruz County Health Services Department announced Tuesday morning via news release that a person from Santa Cruz County had tested positive for COVID-19, and that an investigation determined that the person had traveled “to an area where community transmission is present.”
The person was “recovering well at home,” the department said in its news release. It did not provide specific details about the person’s age, gender, community of residence, where they had traveled to, when they traveled there, or if they had any underlying health conditions.
The difference in the details revealed in each case caught the attention of people reading the Nogales International’s online coverage of the announcements, a number of whom lashed out at the NI on social media, assuming that the newspaper was withholding information about the Santa Cruz County case.
But as Jeff Terrell, the county’s health services director, explained, officials are sharing information with the public as allowed by the federal Health Insurance Portability and Accountability Act (HIPAA) and Arizona state laws.
“As you know, living in a smaller community, it is hard to balance both the patient’s privacy and the public wanting to know,” Terrell said.
County Attorney George Silva agreed, saying it’s been a challenge trying to find a balance between protecting a patient’s identity and being transparent enough so the public can take necessary precautions.
In small communities like those within Santa Cruz County, he said, people can easily identify individuals based on general information such as their community of residence and places of travel.
“Let’s say we said that the person traveled to South Africa. The reality is that very few people from Santa Cruz County would travel to South Africa,” Silva said. “So if there’s one person who traveled there, the neighbor would know… All of a sudden, the person is identified.”
While the Santa Cruz County health department remains tight-lipped about what it will say about specific people who test positive, it has begun to publish limited aggregate information about local cases on the county government website.
For example, following Tuesday’s announcement, the website included data showing that there had been three total cases reported in the county. Of those, two patients were women and one was a man. One person was in the 18-to-40 age range, one was between 41 and 65, and the third was 66 or older.
“We started to provide more information to try and be consistent with the state and other counties,” Terrell told the NI. Silva added that disclosing age groups allowed the county to share more details with the public while still maintaining anonymity.
In regard to the amount of detail the Sonora health director had provided about the woman at the Nogales, Sonora hospital who tested positive, Silva said he wasn’t aware of the relevant laws in Mexico. Still, he said:
“If you’re applying what they said to the standards here in the U.S., then definitely, it would be inappropriate because I think you’re identifying the person,” he said. “If we’re talking about a town that’s inhabited by 100 people, they’re all going to know who traveled to Arizona and returned and is now in the hospital or sick. That definitely identifies the person.”
The question of how much information about patients should be shared with the American public during a pandemic is not unique to the local area. In a column published by The New York Times last Saturday titled “How Much Should the Public Know About Who Has the Coronavirus?” writer Thomas Fuller examined the reporting practices of state and county officials in California, Connecticut, Florida and New York. He found varying degrees of transparency, though nothing that approached the disclosure offered by health officials in Sonora, Mexico.
Fuller noted the public’s desire to know if the virus has been detected in their communities so they can take appropriate preventative steps, and demands from researchers for specific data to help them better study the pandemic.
He also noted health officials’ concerns that the release of detailed information about COVID-19 patients could heighten discrimination against communities with disease clusters and expose individuals to stigma and discrimination.
Ultimately, he concluded: “In the perennial tug-of-war between privacy and transparency in the United States, privacy appears to be winning in the coronavirus pandemic.”