Critics question Sonoma County’s secrecy over workplace outbreaks of COVID-19

Almost every night for the past six months, public health officials have released a new batch of data documenting the unrelenting spread of the coronavirus pandemic in Sonoma County.

The statistics, aggregated in ways intended to prevent anyone from divining the identities of individuals infected with the disease, provide the public with broad categories of information about the 80 new cases now being detected daily, on average, in Sonoma County. They include the age ranges, gender and ethnicity of patients, the percentage who end up in the hospital and the geographical areas in which they reside.

But the county conceals information about a main driver of the continued rise in cases: workplace outbreaks.

Critics say the county’s decision to withhold the locations of infections in the workplace, based on a common interpretation of health privacy rules, gives corporations the power to choose whether and how to inform their workers and customers about potential exposures to the virus.

Health Officer Dr. Sundari Mase said she sees no value in providing public information about the specific locations of outbreaks of the disease, saying that people should be extremely cautious wherever they go.

But the public demand for more details about where the virus has spread is testing the bounds of health officials’ deference to patient privacy. The issue came to the forefront last week at Santa Rosa Memorial Hospital, which reported an outbreak in one of its departments, fueling calls for the county to tell the public whether the virus has penetrated the places where people work, shop and go for medical care.

“It really seems like the county is protecting these private corporations,” said Steven Batson, an operating room anesthesia technician at Memorial Hospital. “They’re protecting special interests rather than the public — who needs to know. When it comes to hospitals, patients have a right to know if there’s an outbreak at a hospital.”

Santa Rosa Memorial Hospital officials waited roughly three weeks to inform staff after they first discovered COVID-19 was spreading among employees and patients. So far, 21 employees have tested positive for COVID-19 since the outbreak was detected in early August, hospital officials said Saturday. Fewer than five patients are presumed to have been exposed to the disease by staff, according to the hospital.

Dr. Chad Krilich, chief medical officer for Providence St. Joseph Health, operator of Santa Rosa Memorial, said he understands why the public and hospital employees would want more information sooner, but hospital officials had to weigh their obligations to patient and employee privacy.

“Given the information that we had, and the work we’ve done, I think we’ve followed an appropriate timeline” for providing information, Krilich said.

Krilich said that although the hospital has not yet completely quashed the virus, he believes “we have a handle on it.”

“I really want to help, as best I can, the hospital and its caregivers and the community through a difficult process,” Krilich said. “We know we have a population of caregivers testing positive and a population of patients who have tested positive. We want to reassure the community that we continue to provide safe care.”

Sal Rosselli, president of the National Union of Healthcare Workers, the union representing about 740 of the hospital’s employees, criticized the hospital’s delay and said he believes there should be ”total transparency“ when it comes to outbreaks. If private companies won’t do it, then health departments must step in.

“The public should have all the information when there are COVID-19 outbreaks,” Roselli said. “People need to play a role in protecting not only themselves but also their family and fellow citizens. That’s why wearing masks is so important.”

Mase said details about outbreaks are “on a need to know basis” — and the health department’s contact tracing teams are the ones who must be told. She views outbreak information as less crucial for the general public because of patient confidentiality concerns and suggested publishing outbreak data might make businesses less forthcoming with public health workers.

“The objective here is to encourage safety and to stop the spread and not to stigmatize or or discourage people from being involved with our health efforts,” Mase said.

County leaders are torn. All five members of the Board of Supervisors expressed a commitment to transparency, but three deferred to county lawyers’ interpretation of the privacy rules while two said the county is not providing enough information.

Supervisor Susan Gorin, chair of the board, said she believes privacy must trump the public release of outbreak information.

“We don’t want to get in the business of public shaming when in fact that might not be the fault of any business or employee. It’s just a sign of the times we have community transmission,” Gorin said.

Supervisor James Gore said he believes in “brutal transparency” and thinks the county should publish data on specific workplace outbreaks to satisfy its mission to protect the public during a pandemic.

“Outbreaks are going to happen even under the best controls and mitigation measures,” Gore said. “It’s better to just communicate that to the public and work with companies to get through it.”

Supervisor Lynda Hopkins said she’s a believer in transparency but put the onus on private companies to provide information on COVID-19 outbreaks. She also suggested employees bear some responsibility, as well, in where they choose to work.

“I think that an employer has a responsibility to inform employees what’s going on, quite frankly, even more than the government,” Hopkins said. “How can you work for a company that you don’t feel is taking adequate care of you?”

Supervisor David Rabbitt said he is normally “in favor of putting everything out there and letting adults be adults and make their own decisions” but said he also questions the value of releasing data on workplace outbreaks.

“We can’t really give people assurance that one place is safe and another place is not,” Rabbitt said.

Supervisor Shirlee Zane said she believes the county cannot leave it up to private corporations to publish timely information during a pandemic that has caused the deaths of 93 local residents, mostly over the age of 65, so far.

“If you’re walking into a workplace and there have been 8 people out of 50 that have been identified with COVID-19, you should have the right to know that ASAP,” Zane said. “Public health is just that — public. Things become public for a reason.”

Critics of strict interpretations of privacy rules say workers — especially the most vulnerable essential employees — have the most to lose when the county Department of Health Services chooses its relationship with companies over giving the public information.

Dr. Jenny Fish, a local family medicine physician who helped found the local health care advocacy group called H-PEACE, or Health Professionals for Equality and Community Empowerment, said she has heard patients say they were not told by their employers about an outbreak until after they had contracted the disease. She’s also heard from patients who were told by their employers to keep their diagnoses secret.

“If the Department of Public Health isn’t releasing information about where outbreaks are happening, then employers get away with a lot,” Fish said.

Fish said she believes it’s especially critical that county health departments take a leading role in providing information about outbreaks at health care facilities, where both workers and patients carry an outsized risk compared to other places of transmission in the community.

“To be honest, we can’t necessarily trust the health systems to make the right decisions,” Fish said.

In a statement, Memorial Hospital said it is responsible for reporting an outbreak of the disease to employees and patients, not the Department of Health Services.

“The public deserves to know when and where outbreaks occur,” the hospital said in a statement provided by a spokesman.

But it is "the duty of those who provide that service“ to notify the people impacted, adding “we have aimed to do so by notifying our caregivers and patients where indicated, while adhering to privacy laws and partnering with public health.”

Sonoma County’s interpretation, which Gorin said was decided by county counsel and health department lawyers, is common across the country, with some exceptions where local officials have decided to provide detailed information on outbreaks.

One such outlier is Los Angeles County. The county has published the addresses of places with three or more cases at businesses, child care facilities, skilled nursing facilities, residential care homes, educational settings and homeless shelters. The business listings include anything from a pharmacy where four employees have contracted COVID-19 and a car wash with three detected cases to the county sheriff’s academy, with 55 reported cases.

Dr. Paul Simon, chief science officer for the Los Angeles County Department of Public Health, said his department started identifying worksite outbreaks early in the pandemic.

The unprecedented nature of the global health crisis called for significant actions by county health officials, said Simon, who oversees the department’s data-related work, including research, disease tracking and public health surveillance.

Simon said public health workers began noticing a correlation between worksite cases and unsafe work environments. Listing business locations where outbreaks have occurred puts pressure on employers to be more accountable, he said.

“It’s a stronger incentive to adhere to guidelines that we put,” he said.

Simon said he understands why some counties may be reluctant to publish worksite outbreaks for fear that employers may choose not to report outbreaks. In such cases, public health workers would have to do more detective work to figure out if new cases are tied to a particular worksite.

Nicole Martinez-Martin, an assistant professor of bioethics at Stanford University, said officials must balance the “trade-offs” between a legal duty to protect individual privacy with urgent public health concerns.

Privacy laws, including the often-cited HIPAA or Health Insurance Portability and Accountability Act, have clear allowances for the public release of health data when there are public health benefits, but Martinez-Martin said the bar is high.

“Does it seem highly likely that releasing information, with an eye toward releasing the minimum information, might save lives?” Martinez-Martin said.

Asked whether the general public benefits from knowing when and where workplace outbreaks of COVID-19 take place, Martinez-Martin said “it depends.”

In the case of skilled nursing facilities, which have been hot spots for the disease nationwide with devastating results for older residents, there has been a clear benefit to transparency, she said.

“With nursing homes, one could say there was value knowing that it was happening at specific nursing homes, but also in a wider sense that this was a general problem,” Martinez-Martin said.

But knowing whether, for example, a cluster of grocery store workers had been diagnosed with the disease may "be of questionable value,“ according to Martinez-Martin.

Public health officials must bar against undue stigma that disease information can levy upon certain communities or demographic groups, she said.

Zane said she believes publishing workplace outbreak details might provide an incentive for businesses to take greater lengths to protect employees and customers if they know any outbreak would be reported publicly.

“Would I go to Home Depot if I read there were 15 cases among employees? Probably not,” Zane said, speaking hypothetically. “There are different levels of risk but you can’t protect yourself if you don’t know. I think that’s a good idea to put out workplace information. It gives an extra incentive to employers to enforce the rules.”

Rabbitt said his position is partly based in how hard the pandemic-driven economic shutdown has been on local businesses. He believes the county must weigh the value of the information with unintended consequences, like business closures.

He also pointed out that some information about virus cases at businesses may not actually be that informative, and it depends on details like whether the outbreak is current or in the past.

“There are going to be little dots on addresses all around town, but what does that tell you other than it’s everywhere,” Rabbitt said.

Santa Rosa Memorial Hospital officials said any current or former patients with questions about the outbreak can call 707-547-4647.

Staff Writer Martin Espinoza contributed to this story. You can reach Staff Writer Julie Johnson at 707-521-5220 or julie.johnson@pressdemocrat.com. On Twitter @jjpressdem.