COVID-19, like every epidemic before it, is testing the limits of medical privacy rights. And right now it's first responders — police and paramedics — who say they have a right to know who has the virus.
The question has popped up around the country. Just this week, Chicago's WBEZ reported that the Cook County Board of Commissioners is discussing whether the public health department should give police and fire departments the addresses of people who have COVID-19.
First responders are at great risk of contracting the coronavirus, and many say it would help them if they knew ahead of time when they're about to respond to a call from someone with the disease. They are not asking to have the master list of addresses of people with the virus, but they say they'd like dispatchers to warn them when a call is on that list.
But many public health experts doubt the usefulness of that information. Former CDC director Tom Frieden says it might even be counter-productive.
"There could be a misguided sense of security from that," he says. "You wouldn't want a policeman or fireman to think, 'Well, since that address isn't on the list, it's safe.' With COVID spreading, we have to assume it could be anywhere."
Ideally, first responders should handle every call with proper precautions. But some police and fire agencies say it's not realistic to expect them to wear complete protective gear during every interaction with the public.
"Especially for more rural departments, they're rationing PPE's," says Jeff Potts, chief of police in Bloomington, Minn. and president of the Minnesota Chiefs of Police Association. "They have to pick and choose when to use it, especially when they only have three [surgical] gowns in a department. A little bit more information would be helpful."
In Minnesota, pressure from emergency services chiefs led the governor to order the state's Department of Health to share the addresses of people who'd tested positive. The order was issued two weeks ago, but police say that information isn't reaching them yet.
"They're still testing it," says Chief Potts, referring to a new process for sending addresses of COVID-19-positive people to first responders through computer-aided dispatch systems.
In parts of the state where dispatch calls go out over an open radio system, the governor's order requires the addresses to be shared through more private means, such as a direct phone call to police officers or EMT's.
The extra steps are necessary because medical data privacy laws are especially strict in Minnesota. Generally speaking, it's state laws that determine whether first responders can get these addresses.
"States can impose their own privacy restrictions," says Roger Severino, Director of the Office for Civil Rights of the U.S. Dept. of Health and Human Services. He says the primary federal law governing medical data privacy, the Health Insurance Portability and Accountability Act, or HIPAA, sets a national standard, but he calls it a "floor," not a "ceiling."
"Where state laws require certain disclosures, HIPAA moves to the side," he says. And HIPAA itself allows for the disclosure of medical information under certain conditions.
"The safety of first responders and the people they interact with can be taken into account," Severino says, "in a limited fashion, just for that purpose, to make sure people's safety is protected."
But he cautions that the information should be passed on to first responders as they need it, and not in a broad fashion. Releasing a complete list of all the addresses of COVID-19 patients, for instance, would be going too far.
In practice, some of this is moot. Even if first responders don't get prior warning, they're still free to ask the people they're helping about whether they're infected. Seattle public health officials don't provide addresses of people who've tested positive, but that doesn't mean the first responders have to work in the dark.
"We have worked very hard to educate 9-1-1 dispatch and EMS to screen for potential COVID as a means to assure provider safety while continuing to provide timely and high-quality care," the public health department wrote in an email to NPR. "Based on these questions — if a patient is risk-positive for COVID — the EMS team will don full PPE as part of patient care."