How much you learn about COVID-19 cases in the St. Louis region depends on where you live

Mar. 30--ST. LOUIS -- A gas station employee. A postal worker. Nursing home residents. If you live in St. Charles County, public health officials have provided some details about the cases where people have tested positive for COVID-19.

The city of St. Louis and St. Louis County, by contrast, have offered the public very little information about the growing number of cases -- other than a daily tally.

And that's a serious problem in the midst of a pandemic when the public welfare depends on detailed and accurate information, say proponents of government transparency.

"People need to know who's getting sick and where, for all kinds of reasons. If you just report 'one person got sick,' people will probably assume it's a frail elderly person, so disclosing the breadth of who's coming down with the virus helps make the threat more realistic," said Frank LoMonte, director of the Brechner Center for Freedom of Information at the University of Florida. "It's a bad public health practice to keep people in the dark."

Dave Roland, director of litigation for the Freedom Center of Missouri, agreed.

"Transparency is absolutely critical, especially in a situation where the government has not imposed lockdown requirements," Roland said. "In order for people, of their own initiative, to act responsibly, they do have to be informed."

Federal and state officials have not issued directives to local health agencies on what information to release about cases of COVID-19. In St. Louis, for example, that has meant the bare minimum: total number of confirmed illnesses.

The Missouri Department of Health and Senior Services has told local public health agencies to make the determination based on what level of information could potentially identify a patient, said Lisa Cox, DHSS spokeswoman.

In the city, that meant not confirming that Jazmond Dixon, 31, worked at the American Red Cross and had no known health conditions, according to family members, before she contracted the virus and died March 21.

The city also did not alert the public that an outbreak of coronavirus has sickened four residents and two employees at Life Care Center nursing home at 3520 Chouteau Avenue.

Verification of both cases came from the Red Cross and the nursing home operator, not the city.

St. Louis Department of Health spokesman Harold Bailey in an email cited the federal law governing the privacy of medical records -- the Health Insurance Portability and Accountability Act -- to explain the city's stance.

"The HIPAA Privacy Rule outlines why we are not releasing information on individuals related (to) COVID-19," Bailey said.

Bailey has not responded to follow-up questions about how a person's workplace or preexisting conditions contain personally identifiable health information.

The federal privacy rule cited by St. Louis officials prevents public health agencies from disclosing what's known as personally identifiable information. It includes demographic data that relates to the person's medical history, health care plan or payments for health care. It does not include basic information such as age or gender.

"Medical privacy is a lot narrower than many people in authority seem to think it is," LoMonte said. "That definitely doesn't mean counties or states or hospitals should be withholding statistics. Even Sherlock Holmes couldn't reverse-engineer the name of a particular patient by knowing that a certain hospital or nursing home or county has one case or two cases or ten cases."

When dealing with outbreaks of other communicable diseases, such as hepatitis A, health agencies often tell the public where the illness occurred. For example, in September, the state alerted the public that an employee at Ruby Garden restaurant in Ava {a style="font-size: 1.5rem;" href="https://health.mo.gov/news/newsitem/uuid/80b0f743-8035-4e3a-b8ff-f464f95c1d06" target="_blank"}tested positive{/a} for the disease. The employee was not identified, but health officials advised anyone who dined at the restaurant on Aug. 30 or 31 to be vaccinated as a precaution.

The contrast in how the public is being informed about COVID-19 was underscored this weekend by the way the city and county handled disclosure that police officers had tested positive.

On Saturday, a police union official told the Post-Dispatch that 15 to 20 officers of the traffic division had been placed under quarantine after one of their colleagues had tested positive for COVID-19 and a second had been hospitalized and was awaiting test results. Spokesmen for both Mayor Lyda Krewson and the St. Louis Police Department declined to confirm that information, saying they would not discuss the health of city employees.

Later Saturday, the St. Louis County Police Department confirmed one of its officers had tested positive and was currently in isolation and that other steps had been taken to protect other department employees and the public. The officer was not identified.

After the county made its disclosure, the city's health director, Fredrick Echols, issued a statement that said two city employees tested positive, but did not say where those employees work. He said he released the information "because there is evidence of community spread and some employees have been exposed."

Private sector in charge?

The first person to die of COVID-19 in St. Louis County was a nurse, Judy Wilson-Griffin. Confirmation of her occupation came from her employer, SSM Health, not the government. All that St. Louis County health officials would acknowledge was the death of "a woman, 60-69 years of age, with underlying health conditions."

St. Charles County health officials also deferred to the private sector when they disclosed information, including telling the public on Wednesday that an employee at the Circle K at 3700 Elm St. had tested positive for COVID-19.

"When a business already has told the public or the media that there is a positive case at their store or facility, then we can verify that information and add messages that will further protect the community," said Mary Enger, director of communications for St. Charles County.

Enger also said it was important to release the age and gender of COVID-19 patients "so that people know that it can happen to anybody."

On Tuesday, St. Louis County stopped providing the age range for each case and whether it was travel-related, saying on its website, "Due to the volume of results now available, the ability to provide data on each positive case has diminished." On Sunday, it launched a dashboard with an age range of cases.

But in New York City, which has nearly 33,500 cases, online data tables give details about age, sex and borough of residence. Many other counties including Dallas County in Texas also release the city of residence to help identify the spread of the virus.

Chris Prener, a sociologist at St. Louis University, said public health officials need to strike a balance on disclosure. Releasing too much information could discourage some people from being tested -- and that could pose a bigger risk to the public.

At the same time, too much information could also give the public a false sense of security -- thinking that if their paths didn't cross with an infected person, they were safe.

"Should you be changing your patterns because of a confirmed case at a gas station?" he said. "No. You should treat every public place as if it is filled with positive cases."

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