Thursday, August 6, 2020

Patient confidentiality places Batswana at higher risk of COVID-19 infection

The government’s refusal to disclose the identity of COVD-19 patients may be putting the public at a higher risk of contracting the virus. Botswana’s decision to shroud the identity of confirmed COVID-19 victims with a cloak of secrecy means Batswana remain sitting ducks, helplessly looking to the heavens for exemption from possible infection.While confidentiality remains central to a doctor, patient relationship it may not always remain an absolute obligation where public health is concerned.This week (Thursday April 16,2020) the Minister of Health Dr. Lemogang Kwape announced two new infections, bringing to 15 the total number of recorded  Coronavirus cases in Botswana.

The announcement came with what is now becoming a worrying trend for both the government and the public at large; local transmissions.Kwape announced yet another case of local transmission which brings the total to three. The latest local transmission is the second by the same undisclosed Molepolole 27 year old patient. The first victim is a partner to the gentleman, who had returned home from the UK mid-March.Addressing the nation on television recently President Mokgweetsi Masisi said the government was working to trace at least 46 people who are believed to have had contact with the Molepolole patient, currently recovering at Sir Ketumile Masire Hospital.The third involves a nurse who had been screening suspected case at one of the designated health facilities. While the government is working tirelessly to trace contacts of all people with a positive COVID-19 diagnosis, those who unknowingly had contact with such people remain clueless while possibly spreading the virus.

The Health Minister told Sunday Standard this week that their hands are tied in relation to disclosing the identities of those patients.“It’s an ethical dilemma and we in the health profession have taken an oath,” Kwape has said. By keeping the identity of the positive cases away from the nation the government may be inadvertently fueling the spread of the Coronavirus among the public. While Botswana has enforced a nationwide lockdown and undertaken a rigorous ‘Extreme Social Distancing’ campaign to curb the spread of the virus, the blind adherence to ethics guiding the handling of patient information remains likely to endanger many other innocent residents.

Although the National Health Act makes it an offence to divulge information about health service users without the user’s consent, there may be permissible exceptions when the law requires disclosure, or if non-disclosure would represent a serious threat to public health. The COVID-19 pandemic may be a case in point.In its implementation of the mandatory quarantine of suspected and confirmed cases of COVID-19 the government has already, in line with the relevant legislation,  limited people’s movement in the interest of public health as reasonable and justifiable in an open and democratic society. Those against confidentiality have argued that in the same manner, providing a means for disclosure of COVID-19 infected individuals’ status may also be reasonably and justifiably in the best interests of public health. That while protection of privacy is important, if such protection becomes the means for public harm, the magnitude of such an impact should be considered.

Experts have argued that unlike other diseases, infection with COVID-19 carries no inherent social or cultural stigma. Knowing the name, location and mobility network of these cases, they have said, can make an invaluable difference in curbing the spread of the virus. Granted, countries worldwide continue to adhere to the confidentiality practice with those in support raising concerns that suspecting COVID-19 victims may be discouraged from coming forward for fear of victimization, making it difficult for governments to record such cases and contain the virus. Governments across the world have introduced stringent legislation guiding conduct during the COVID-19 crisis. Botswana has introduced COVID-19 specific regulations some of which aim to prevent disclosure of information regarding COVID-19 cases.“Any person who relays any information to the public about COVID-19 from a source other than the Director of Health Services, and the WHO commits an offence is liable to a fine not exceeding P100 000 or to imprisonment for a term not exceeding five years,” reads some of the regulations.

“A person who intentionally exposes another person to COVID-19 commits an offence and is liable to a fine not exceeding P100 000 or to imprisonment for a term not exceeding five years, or to both. A person who publishes any statement, through any medium, including social media, with the intention to deceive any other person about —(a) COVID-19 infection status of any person; any measure taken by the Government to address COVID-19,commits an offence and is liable to a fine not exceeding P100 000 or to imprisonment for a term not exceeding five years, or to both.”

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Sunday Standard August 2 – 8

Digital copy of Sunday Standard issue of August 2 - 8, 2020.