Clusters create confusion

A woman's visit to a hospital for medical tests turned into a nightmare when the receptionist told her she lived in a COVID-19 cluster.

The woman, who asked to remain anonymous, said the receptionist broke the news after learning her postal code.

“Everyone had to wear full PPE (personal protective equipment)... I felt like a pariah.”

The woman's main concern wasn't that health-care providers were taking extra precautions; she is a health-care provider herself.

She's mostly concerned for the patients she interacts with.

“Now I'm afraid to shop or even get a coffee in my area,” she said.

“I've got to keep those people safe.”

Although she's asymptomatic, she made sure to get assessed over the phone after her visit to the hospital and was told she's not at risk of having COVID-19.

The woman is one of several people who were told they lived in a COVID-19 cluster as they were seeking care for NON-COVID related health issues. A few people have recounted their stories on social media sites such as Facebook.

A list of three-digit postal codes identifying COVID-19 clusters in the Nova Scotia Health Authority (NSHA) central zone has also been shared on Facebook. How the list was leaked remains unknown.

RISK ASSESSMENT TOOL

A COVID-19 community cluster is an area designated by a three-digit postal code where public health has identified high rates of COVID-19 spread.

The first three digits of a postal code define a mediumsized geographic area. It can be “a specific rural region, an entire medium-sized city, or a section of a major metropolitan area”, according to the government of Canada website.

During Friday's COVID-19 briefing, Dr. Robert Strang, the province's chief medical officer of health, said the postal codes refer to communities within the NSHA health zones.

Once public health identifies these areas, they set up temporary assessment centres to understand how much the disease has spread in those communities. In some cases, the increased testing has shown there was no significant community spread within those clusters.

The NSHA said in a statement last week that it has been maintaining a list of “community clusters” as part of a “risk assessment tool” to help staff at hospitals, clinics and primary care settings take extra safety precautions when seeing a patient from one of those areas. The extra precautions are necessary because it's possible for someone to spread COVID-19 without having any symptoms or without knowing if they have been exposed. People who live in the identified COVID19 clusters would not be denied care.

“(The list) helps (the NSHA) make decisions on what personal protective equipment a health-care worker would have when interacting with a patient,” said Strang. “It's important we use the personal protective equipment we have in as efficient manner as possible.”

The NSHA updates the list as soon as new information is available from public health.

“Those lists were not meant to go public and they were not meant to help people understand what their own level of risk may be even within their community,” said Strang.

RELEASING THE LIST IS PUBLIC DUTY

Now that the list is circulating online, the woman said she tried to search for it to see if her postal code was on it. It wasn't there.

“I'm just wondering why I live in an area that was flagged as a cluster area and I had no idea. Shouldn't we be informed?” she said.

Wayne Mackay, professor emeritus of law at Dalhousie University, said although the situation doesn't involve imminent danger, there's a public duty to inform people if they live in a COVID cluster.

“It would be better if it were released by the Nova Scotia Health Authority as an official indication of the information rather than having it leak out in various forms, with perhaps inaccuracies or inappropriate context on Facebook or some other online source.”

Releasing the COVID-19 cluster list may have privacy risks, but Mackay said if someone pursued access to this information, the government would have a difficult time not releasing it. One of the exceptions under the Freedom of Information and Protection of Privacy Act (FOIPOP) is the protection of public health and safety.

Mackay said releasing the information would be more consistent with how the government has been handling the COVID-19 pandemic.

“I do think that the best approach to a health crisis like this is to make as much information as possible available to the public.”

PROTECTION SHOULD BE STANDARDIZED

Mary Jane Hampton, who is a health-care consultant, said the list shouldn't be released. She said the real question is what value would releasing this information have.

“We should just be assuming that COVID is everywhere in the community and behaving accordingly. It makes no difference to my behaviuor knowing that one postal code has COVID and another doesn't,” said Hampton, who was once Nova Scotia's commissioner of health reform.

Keeping track of cases and tracing close contacts is an important strategy of managing the pandemic. The COVID-19 cluster list helps public health fulfil that purpose. While the NSHA may need the list for its planning purposes, Hampton said the lists shouldn't inform how health-care workers protect themselves.

“The protection should be standardized,” she said. “It shouldn't matter what community they're working in or what postal code somebody is coming from. The protocols are the protocols. The school of common sense would say that health-care workers should be assuming that we are all at equal risk.”

Hampton is also concerned that releasing the information would harm the communities identified with the postal codes.

“I don't think we should be looking at them as having a red scarlet letter,” she said. “Privacy and confidentiality are important issues that don't get compromised in the time of the pandemic. We should behave more as communities looking out for each other.”