COVID-19: Disclosing contacts to contacts

The novel coronavirus – 2019 has affected the world in many ways. Subsequently, the World Health Organization (WHO) and the leaders of affected countries have accepted working guidelines and containment protocols to slow down the spread of the disease as well as enhance early detection and management of the disease. Among these protocols are self-quarantining, mandatory quarantines, lockdowns, mass testing, enhanced contact tracing, social distance, and the use of face masks. Key amongst these protocols is the need for contact tracing.

According to the Centres for Disease Control and Prevention (CDC), contact tracing encapsulates efforts by public health workers to assist a patient to recall all those they might have come into close contact with during a specified timeline while they may have been infectious. Thus, contact tracing targets both suspected and confirmed cases of a disease to see whether they have been in close contact with others. Obviously, contact tracing has been around for a long time and are mainly used in tracing infectious and communicable disease including Tuberculosis, meningitis, Ebola,^{1, 2} and now COVID-19.

In contact tracing, the new contacts are educated on the particular disease and ways to prevent or protect themselves from it should they be tested negative. Hence, contact tracing is quintessential to the early detection, diagnosing and treatment of cases. In the course of contact tracing, the public health worker is not supposed to disclose the identity of a contact to another contact but rather inform the new contact that they may have been exposed to a patient with the infection. Theoretically, this seems to be very easy and simple because there is the need to protect the privacy and confidentiality of suspected and confirmed cases. However, in the real situation, it is quite difficult.

Laying emphasis on the COVID-19, enhanced contact tracing has been very instrumental in the detection of confirmed cases, particularly asymptomatic cases within the population. In fact, cases from enhanced contact tracing constitute the majority of the confirmed cases particularly in sub-Saharan Africa. For instance, as at May 13, 2020, Ghana had a total confirmed case of 5,530. From this number, a total of 3,787 confirmed cases, constituting 68.5% of the total confirmed cases accrued from enhanced contact tracing.³ This clearly shows the critical role contact tracing plays in the fight against the COVID-19 pandemic.

In the course of conducting contact tracing, public health workers face a number of challenges including wrong or non-disclosure of information by contacts; difficulty in locating residence of contacts; natural interference (example: during heavy rainfall). Another challenge that they face on the field is being faced with the dilemma to disclose or not disclose the identity of a contact to another contact. As stated earlier, the rule is that in order to protect the privacy and confidentiality of a contact, the identity of contacts must be kept anonymous. However, in the real situation, every rational contact will want to know why you think he/she has been exposed to a confirmed or suspected case. Hence, for that matter, in order for them to agree that they may have actually been exposed and therefore, warranting a sample collection for testing, the contact may demand to know the identity of the one from whom they were traced from.

This demand by contacts to know who their primary contacts are is not out of context at all. Rationally, it is expected that this will happen. Besides, providing them with such information may actually help them to know whether that primary contact had access to other contacts of the secondary contact. Therefore, it may also facilitate early detection of more cases. Hence, refusing to disclose the identity of a primary contact to a secondary contact may reinforce denial in the secondary contact and probably deter them from agreeing to be tested as well as complying to self-quarantine protocols.

On the flip side, disclosing the identity of primary contact to their secondary contacts is an outright disregard and breach of the public health principles of privacy, anonymity and confidentiality. This may have serious legal implications should the primary contact take the case on. Also, given the high stigma that has been associated with the COVID-19, disclosure of the identity of a primary contact to their secondary contacts will perpetuate and exacerbate more stigma and hate. Particularly, in situations where the secondary contact tests negative for the disease, they are likely to stigmatize the primary contact who had tested positive. Hence, it can deter infected individuals who test positive at their physicians’ offices from reporting results to their employers, families and friends. This can even affect future contact tracing as contacts will lose their trust in the system and in public health workers.

Although confidentiality can be breached in situations where it is deemed to be beneficial to the greater good of the public, I believe that no exceptionalism should be given to breaching confidentiality and anonymity of contacts. Essentially, what I am driving at is that under no circumstance should the autonomy of an individual to know the status a contact for personal reasons surpass the public good of strictly adhering to privacy, confidentiality and anonymity. This will be helpful in building the trust of contacts and the general population in the health care system as well as prevent needless confrontations and stigmatization from the society, friends and family. The best that can be done to also meet the desire of secondary contacts is to encourage primary contacts to voluntarily make public disclosure of their status to their loved ones and close contacts. Also, the use of information technology can be significant in reducing the tendency to disclose anonymity of cases. By adopting contracting tracing app, all contacts of the case can be interviewed remotely and anonymously.

References

1. Grzybowski S, Barnett GD, Styblo K. Contacts of cases of active pulmonary tuberculosis. Bull Int Union Tuberc. 1975;50(1):90–106
2. World Health Organization. Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries. Geneva: World Health Organization; 2012
3. Ghana Health Service. Situation Update, Covid-19 Outbreak in Ghana as at 12 May 2020. 2020. Retrieved from: https://www.ghanahealthservice.org/covid19/archive.php