VIRUS: TEST, TRACE AND ISOLATE

By Bill Heaney

How will the contact tracing process that is currently being piloted by the government in an attempt to kill off coronavirus balance patient confidentiality and the need to alert people of public health threats?

This was the question Willie Rennie, leader of the LibDems in the Scottish Parliament, asked Cabinet Secretary for Health and Sport, Jeane Freeman, citing the failure to trace guests at a conference in Edinburgh who contracted the virus in March.

Ms Freeman said: “Contact tracing involves the person who has the disease identifying people with whom they have had close contact while they may have been infectious.

“Outbreaks are investigated by means of a risk assessment, which takes into account patient confidentiality, public health needs and individual consent issues.

“To protect patient confidentiality, only close contacts are informed that they may have been exposed, so that they can be given relevant health information and, in the case of Covid-19, know how to self-isolate in order to interrupt chains of transmission.

“The index case is always asked for permission to disclose their personal details. The use of information about patients is subject to data protection legislation and all personal health information is held under strict ethical and legal obligations of confidentiality.

“In circumstances such as this pandemic, there are difficult balancing discussions between the importance of patient confidentiality and the importance of information to the public.

“As we move to the scaled-up use of test, trace, isolate and support in the next phase of our response, we are giving active consideration to how that balance should be struck.”

Mr Rennie said the issue had moved on – “In addition to the Lloyds staff, the kilt shop and the digital agency, we now know that the Nike delegates were taken on a walking tour of the old town by tour guides, none of whom were contact traced by the incident management team.

“The issue is confidence in the contact tracing system. The First Minister said yesterday that the process was rigorous, but if that is the case, why were those people not contacted?”

Ms Freeman replied: “I believe that the process that was undertaken at the outset and subsequently in contact tracing that we have carried out elsewhere—probably most recently and notably in and around the Home Farm care home in Skye—is rigorous.

“It is a clinically led process that is governed by Health Protection Scotland, which uses risk and specific infection science.

“The member mentioned other contacts. Those will be contacts that the contact tracers were not aware of from their conversation with the index case, which led to the tracing of eight individuals in Scotland and, from memory, 25 individuals globally, and involved other countries and their health protection teams.

“I consider the process to be rigorous, and I think that it is the right process. However, a difficult balance has to be struck. Patient confidentiality is an important ethical part of how our clinicians and health service work and it is important that people have confidence that their information is being held confidentially, unless they agree to circumstances in which it should be released.

“Public health is important, too. Therefore, a difficult balance has to be struck between individual patient confidentiality and public health and the need for the public to understand the situation that they are facing. I therefore understand the concern.

“As we look to move into the next phase in our response to the pandemic, we are giving careful consideration to what that balance ought to be. We are taking views not only from members and others but from Health Protection Scotland and our clinical teams, including our Caldicott guardians, about what would be the best balance to strike in any given circumstance.”

Willie Rennie persisted with his question: “The tracing process is an important part of keeping us safe as we ease out of the lockdown, and the public must have confidence in it.

“If we are meant to be treating the public as adults, should the incident team not have put the information into the public domain? If that had been done, anyone at the hotel, or anyone who was in contact with the Nike delegates, would have been able to take precautions.

“I want to protect patient confidentiality, but alerting people about an event, or about a building, does not breach that. In hindsight, should the incident have been made public? Looking forward, is there ever a circumstance in which the knowledge of an outbreak would be put into the media?

But Jeane Freeman told MSPs: “All of us have the benefit of hindsight. With the information that we had at the time, I believe that we took the right decision. However, I recognise the competing calls on protecting patient confidentiality and letting the public know, particularly in relation to this virus or any other virus that causes widespread harm. This is a pandemic. Therefore, we are giving that situation—the balance between the judgments that need to be struck—careful consideration as we move to the test, trace, isolate and support strategy, and at the scale at which we will need to do that.”

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