[MUSIC PLAYING] SPEAKER: So case investigations and contact tracing provide a public good. But we always have to balance this with respect for privacy, autonomy, and confidentiality. So let's talk a little bit more about what that balance means, and how it's practiced. Contact tracing programs are a public good, because they're going to reduce the risk for the public from COVID-19. And we must balance this good for society with the rights of people, their private information, confidential information, and their autonomy. So we always have to be sure that we're getting this balance right. Legally, there are often three tests that are used to determine whether a public health intervention is balanced in terms of the public good and individual rights. So in order for the public health intervention to be able to limit the rights of individuals to privacy or autonomy, as contact tracing can sometimes do, it must meet three tests or criteria. And these are, that it must be respectful of individuals and their rights, it must be a benefit to society, that is balanced with the limits on individuals, and three, that intervention must benefit all members of society. So we can see with contact tracing that it does meet all three of these legal tests, because contact tracers are respectful of individuals and their rights. Indeed, they're reaching out to them to provide them with services, make sure they're getting medical care, and make sure that they're doing everything they can to help prevent spread in their communities. It meets the test number two, because it's a benefit to society, and it's balancing the need for information and the limits on individuals with the public health good in mind. Also this intervention will benefit all members of society, because contact tracing will be done anywhere where there's a case identified. So it will meet all three tests. Just as a side note, there is a legal basis for contact tracing in the United States, because there is an authority to conduct public health interventions and individual state constitutions, and the US Constitution. There are clauses that say that states and the US government can act to protect the public welfare. And there are other common law and general principles that apply here as well. You may know that there are other situations where public health interventions are used to protect welfare, and they do place some limits on the rights of individuals. So, for example, we often require children to receive vaccinations to attend to public school, and that's to protect the community's public health and safety. So it's another example of where we're balancing the rights of individuals with public health for the public good. Another example comes from a different disease where we also do contact tracing. So, for example, if you have tuberculosis, which is another infectious disease, it can be highly contagious. So if you have tuberculosis and you refuse to take your medication, which cures you and means you're not infectious anymore, so if you are refusing to take that medication, you could be required to do so by the health department. And, again, that's so you don't infect other people. So they're placing some limits on your autonomy here, or your ability to make your own decisions, because your decisions have a direct impact on other people in society. So health departments will take action to protect health of others. There's a legal basis for this, and we already do it in many other health situations for the public good. Although contact tracers and the contact tracing effort does intrude on people's lives, it should be done only with the utmost respect. And cases and contacts should understand this. So we can assure cases and contacts that the information that they provide will be confidential, so it will only be used for the public health investigation for the purposes of contact tracing, and it's not going to be shared with anyone else who doesn't need to know for the purposes of contact tracing. So this means that the information, again, will only be shared with the people who have to know it for the purposes of contact tracing, isolation, and quarantine. You should also assure cases and contacts that the information will be kept private. So contacts who are identified will be told that they've been exposed to someone who's infectious, but they will not be told who the case is, so you can reassure the case that if they share who their contacts are, you're not going to disclose their name to those contacts. So let's go through an example of when a case might tell you private information and what you should do. Let's say, for example, during an interview with a COVID-19 case, he tells you that his contacts are his wife, his two children, and also his girlfriend who lives in the neighborhood. So two questions for you, should you list his girlfriend as a contact, and should you tell his wife about his girlfriend? So the answer to the first question is, yes. Of course, she's been exposed, and she should be notified and asked to quarantine. Her exact relationship with the case is not important. Remember, everyone should have access to contact tracing services. They should know that they've been exposed, and they should be asked to quarantine. It doesn't matter how they know the case. It doesn't matter in what context that contact occurred. Should you tell his wife about his girlfriend? Well, no. This is private information that the case shared with you. You're not allowed to disclose it to anyone. You can only use it for contact tracing purposes. So you can see here, you're using it for contact tracing purposes because you're going to call the girlfriend. She's a contact. She needs to know that she's exposed and she needs to quarantine. But you can't use the information for anything else, only for contact tracing purposes. So now, let's think of another example that might be tricky to handle, when you hear private information about someone you know. Let's imagine that during an interview with a COVID-19 case, he tells you about the people that he had contact with at a party, and some of those people went to high school with your younger brother. This could happen, because contact tracers are often people who live in the communities that they're helping, so it's possible that you could in the course of your job come into contact with private information about someone you know. So if you heard this, you may be alarmed that there could be people with COVID-19 in your community. So should you warn your younger brother not to have contact with his friends, because they may have had contact with this case? Well, the answer here is, no, because you cannot disclose any private information you learned during contact tracing, even to your family members or friends. What you learn in contact tracing and case investigations has to stay within that realm. It has to stay in your professional life. You can't discuss it with anyone else except for the purposes of contact tracing. Now, let's talk about another scenario that you could encounter as a contact tracer, and that is when the case or a contact is an undocumented worker. So let's say, for example, during an interview with an elderly COVID-19 case, she tells you that one of her close contacts is her helper, who comes to her house three times a week to help clean and cook. So you find that helper. You interview the helper, and she tells you that she provides these services to two other elderly patients each week as well. She also tells you that she is undocumented, and when you ask her to quarantine for the next 14 days, she says that she cannot because if she doesn't work, she doesn't get paid. So two questions for you, how might you try to convince the woman about quarantine, and should you call the immigration or police because she's undocumented? OK, so the answer to the first one, how should you convince her to quarantine? First, you should offer to put her in touch with organizations that might be able to help or get food or other assistance while she stays home, since if she can't work she doesn't get paid. So there may be some support for her there. You should also remind her the people she's caring for are at high risk for death if they get infected from her, so it's really important that she quarantine. In some places, you may also be able to require her to quarantine, and it might be enforced. So if you're in a jurisdiction where that's an option, you may need to tell her this. Now, should you call the immigration or the police because she's undocumented? The answer is, no. The fact that she's an undocumented worker is private information, and it's irrelevant for the contact tracing effort. It's not important for contact tracing effort. What's important is, that she quarantine so she doesn't infect other people. But this has no relationship with whether or not she's an undocumented worker. So, no, you don't have the right to disclose that kind of private information to anyone else. [MUSIC PLAYING]
