For six weeks, the Virginia Department of Health has been allowing local health districts to release the names and addresses of individuals with COVID-19 to 911 dispatch centers.
The policy — first ordered by Health Commissioner Dr. Norman Oliver, according to internal emails from VDH — was introduced at a time when shortages of personal protective equipment were creating anxiety among first responders.
“The whole issue of PPE, for everyone, was an issue,” said Bob Hicks, the department’s deputy commissioner for community health services, in a phone interview on Monday. “And certainly, for first responders, there was a lot of concern that they might not be informed [of COVID-19 cases] or have the PPE to safely do their jobs.”
In an email released to the Mercury as part of a Freedom of Information Act request, Hicks sent the new guidance to district directors and VDH leaders, including State Epidemiologist Lilian Peake and Laurie Forlano, deputy commissioner for population health, on March 29.
It allows local health departments to distribute the names, addresses and telephone numbers of residents with lab-confirmed cases of COVID-19 to a “single local government point of contact” — often a city manager or chief administrative officer, Hicks said Monday. That contact is then responsible for passing the information to local 911 dispatch centers, where operators can provide the information to first responders.
In his original email, Hicks cited a section of Virginia code that allows the state’s health commissioner to disclose the identity of patients or medical practitioners “if pertinent to an investigation, research or study.” The release of patient information to first responders is also compatible with federal patient privacy laws, which allow the release of personal health information if those workers are at risk of infection, said Sara Blose, the director of health advocacy for the Central Virginia Legal Aid Society.
But at the same time Oliver was allowing wide dissemination of personal health information to first responders, he was relying on the same section of code to justify his decision not to release information on COVID-19 infections at long-term care facilities. During the first several weeks of the pandemic, he and other state health officials also said Virginia’s patient privacy laws prevented them from releasing information on cases below the health district level.
That policy was reversed at the start of the month when Oliver announced that VDH would begin releasing case numbers by ZIP code.
And despite repeated requests from nursing homes, Oliver didn’t authorize local health departments to release information on outbreaks, even between facilities, until late April. Virginians still don’t have public access to the information — a policy that’s led to growing bipartisan criticism.
Oliver said Monday that there was a “contradiction” between the two policies that encouraged him to authorize the release of information between long-term care facilities. But he also defended the department’s continued interpretation of state code to prohibit the public identification of long-term care facilities with outbreaks of COVID-19.
“I think releasing that information within the sphere of people who are providing direct care to those patients is a lot different than releasing information to the public at large,” he said.
Hicks said that the guidance on dispatch centers emerged after multiple requests from emergency responders across Virginia, including in the Peninsula Health District — a region with one of the first confirmed outbreaks of COVID-19 in the state.
“Ideally, first responders would have the correct equipment for every call,” he said. “But again — at that particular time, PPE was a big, big problem. And we thought this would be helpful for them.”
According to the March 29 email, individuals who test positive for COVID-19 through the state laboratory in Richmond are asked to voluntarily notify their local 911 dispatch centers of their status if they request emergency services.
But Hicks said that residents have not been explicitly informed that their information is being shared with dispatchers or first responders. Nor do health departments track how that data is disseminated after it’s released to local health departments.
“What people outside my organization do, I can’t control,” Dr. Colin Greene, the director of the Lord Fairfax Health District, said in a phone interview on Monday.
“My local health emergency coordinator sends the information to the local government, who sees to it that the 911 dispatcher has it,” he added later. “And they don’t work for me. You were asking me questions about what happens in the 911 office, and the honest answer is, I don’t know.”
At the time the policy was released, Greene was one of several local health directors with concerns over its ramifications. In late March, Virginia was only three weeks past its first confirmed case of COVID-19. With known cases of the disease still relatively rare, many worried that a list of residents would provide first responders with a false sense of security, or discourage the uniform use of personal protective equipment.
Greene, though, appeared more concerned over patient privacy.
“How do we ensure that the receiving person, and their local government, play by the rules,” he responded in an email to Hicks and other health leaders on March 30.“I.e. to make the list available only to the local 911 dispatcher, rather than just posting it in the precinct, firehouse, or EMS station?”
“I’m putting together [a standard operation procedure] for my district right now, but I’m uneasy about controlling this process once it’s turned on,” he added.
One of his biggest concerns at the time was how residents would be removed from the list, which Greene said is still delivered daily to the five counties — and the city of Winchester — that make up his health district.
The removal policy can vary between local health districts, Hicks added on Monday. Lord Fairfax removes residents 21 days after their last known positive test — the full incubation period for the virus plus a week, Greene said.
Other districts stick to 14 days, but Hicks said he’s heard of some local departments who include names for up to a month and a half after a positive test.
“On a broader sense, nationally, we really don’t have nearly as good a definition of who’s recovered as we probably should,” Greene added. “We lack the general availability of a good test to find antibodies. And that’s what would really be a good way to check for recovery from the illness.”