Clus­ters cre­ate con­fu­sion

The Chronicle Herald (Provincial) - - FRONT PAGE - NEBAL SNAN nebal.snan@her­ald.ca @nebaljourn­o

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.”

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