Wear masks. Socially distance. Stay home when sick. Get vaccinated. Get tested.

Hawaii Gov. David Ige, Department of Health Director Libby Char and other officials have been telling us for many months now how best to guard against Covid-19. They say it’s about taking personal responsibility and also about being responsible toward fellow citizens.

So why won’t the state give us more details on where Covid is occurring, especially when there’s a cluster we might have been close to? That would let us take personal responsibility and go get tested if we think we might have been in the same place at the same time a known outbreak was happening.

Name the church, the restaurant, the nursing home, the beach gathering. Give us the specifics. We deserve it and we can help the state and help ourselves.

Tim Brown, an epidemiologist with the East-West Center, is sympathetic to the extreme pressure the DOH is under to handle Covid. But he believes the agency should have been far more transparent from the outset.

“The challenge from day one was a real reluctance on the part of Sarah Park and Bruce Anderson” — the former state epidemiologist and DOH director — “to discuss things and to give the public the information they needed to keep themselves safe,” he says.

“The vast majority of data give you no idea of context, and that’s information people need to make decisions. People have to understand where the risks are. More meat on the DOH cluster reports would be very helpful.”

Brown points to the example of Singapore, which he says publishes complete detail on clusters.

“And I see value in that,” he says. “If you went to a place that had an outbreak, you know to get tested. The reluctance here is our litigious society.”

In Taiwan, in the meantime, every case of Covid is assigned a number and posted on Twitter every day. Public data on each case includes gender, age, how the person is believed to have been infected (travel, household, etc.), even diagrams illustrating specific spread from individual to individual.

Problematic Places

There’s plenty of examples in the U.S. for DOH to follow. The National Governors Association, with support from the Robert Wood Johnson Foundation and the State Health Access Data Assistance Center, has identified whether and how states report Covid-related outbreak data.

In a January report the NGA singled out several states for “clear presentation” of outbreak data. It includes Kansas, a state of just under 3 million people, that publishes the names of locations that have five or more Covid cases with symptom onset dates in the past 14 days.

A check of the website for the Kansas Department of Health and Education earlier this week listed dozens of such sites in its Cluster Summary tab including Tabor College in Hillsboro, Country Place Senior Living in Hoisington and fuel device manufacturer Great Plains Industries in Wichita. The database is searchable by county.

The North Carolina Department of Health and Human Services lists on its website the names and locations of congregate living settings undergoing outbreaks in a state of more than 10 million people. A recent check revealed a nursing home, the Black Mountain Neuro-Medical Treatment Center in Buncombe County, reported a total of 35 Covid cases, and The Kid’s Corner Daycare in Franklin County last week reported 10 cases total.

And in Louisiana, a state of 4.6 million people, the Department of Health keeps track of Covid cases at the state’s colleges and universities. Delgado Community College, for instance, recorded 105 cases last week among students living or attending classes on campus. LSU and A&M College reported 622 cases.

That’s helpful information that alerts people who might want to get tested after learning about problematic places. Contrast that to the generic cluster reports put out by the Hawaii Department of Health, which offer descriptions that ensure we never know where the cluster actually occurred: a karaoke bar, a large restaurant, a small restaurant, a wedding.

“One cluster from a Honolulu County transportation service and one from a Maui County industrial work setting were investigated,” says the DOH’s cluster report for Sept. 30.

Sarah Kemble, the state’s epidemiologist, tried to explain to Civil Beat the reasons for the vague  reporting. The state’s contact tracers need cooperation when investigating Covid clusters, she says, and if establishments are afraid of being named they may clam up.

The state says it doesn’t want to risk stigmatizing establishments, doesn’t want to risk creating panic unnecessarily and — especially with the fast-moving delta variant — doesn’t want to draw attention to a site where the danger of exposure has come and gone.

But that’s a clear double standard when it comes to other health department practices. The DOH has no problem naming restaurants that have breached food safety rules. Why not name those with Covid outbreaks?

“I understand the arguments about anonymity, but we’re in a public health emergency,” says Brown. “We need detail and depth to understand the context in which Covid was contracted. We need to give people enough information so they can act on it.”

Contact Key Leaders

Hawaii Gov. David Ige
governor.hawaii.gov
808-586-0034
DOH Director Elizabeth Char
webmail@doh.hawaii.gov
808-586-4410

Brown would like to see DOH produce an aggregated, comprehensive report that tracks all cluster data for the last six months and details the conditions under which transmission occurred.

Legislature Needs To Step In

Improvements in greater transparency of public health data can happen in Hawaii, but it takes more political will than the DOH and Ige are willing to muster.

The Legislature has shown it’s capable of rising above vague and unproven claims of some harm to privacy or social injustice when it comes to keeping the public informed about Covid. Earlier this year lawmakers insisted that Covid outbreaks in public schools needed to be disclosed and they even overrode the governor’s veto to make sure it happened.

The Department of Education, citing privacy and fears of stigma, had refused to release data about Covid-positive cases in individual schools. Senate Bill 811 was introduced in this year’s Legislature to force the DOE to do so. The DOE and DOH testified against the bill, but the Hawaii State Teachers Association and others testified in favor of it.

“I understand the arguments about anonymity, but we’re in a public health emergency.” — Epidemiologist Tim Brown

With SB 811 now law, anyone can find out exactly how many cases are occurring at schools across the state. Similarly, the state Department of Public Safety regularly reports testing and case counts for correctional facilities.

Since the start of the pandemic in Hawaii we have struggled to get a comprehensive picture of the spread of the coronavirus. State officials often cite the federal Health Insurance Portability and Accountability Act of 1996, which protects patient health information from being disclosed without consent or knowledge.

But we’re not asking the state to release information on individual patients, just on the places where they are getting sick.

As DeWolfe Miller, University of Hawaii emeritus professor in epidemiology, says, “Knowledge is power.”

Miller is also frustrated by the lack of information coming from DOH and other state officials.

“Privacy laws have made epidemiology impossible in the United States,” he says. “Right now all I can think about is some way to curb transmission. Having information is key to interrupting transmission.”

Daily Covid cases appear to be trending downward, hospitals are seeing fewer patients crowding ICUs, vaccination rates are hovering around 70% and the governor is easing some gathering restrictions. This is exactly the time to bring the public in as a true partner.

It’s also much easier to get tested now. You don’t need a doctor’s note to check to see if you might have picked up the virus. Home-use rapid antigen tests are being offered for free to anyone who signs up on the state’s website. You can buy them at local stores or online for a few dollars.

It’s long past time to listen more closely to public health experts like Brown and Miller. The DOH must err on the side of giving us more detail, not less.

It’s not hard to do. The data is there. It just needs to be released.