Last week, on 2 April, Bhubaneswar Municipal Corporation revealed the identity of Odisha’s fifth COVID-19 patient. A day later, it was reported that Begusarai Police in Bihar has filed an FIR against three people for revealing the identity of a COVID-19 patient on social media.
These two incidents reflect the varying ways in which India is handling the crucial question on whether the identity of a patient infected with COVID-19 should be revealed or not. And underlying this question are also issues of privacy, the stigma of being seen as a COVID-19 patient, and the urgency of response to a fast-spreading communicable disease.
What Is India’s Policy?
The Ministry of Health and Family Welfare has issued an advisory to the citizens, asking them to not “spread names or identity of those affected or under quarantine or their locality on the social media.” But what is the stance taken by the governments — both at the Centre and at the state-level — on the issue?
Dr Rajni Kant, Head of Research Management, Policy, Planning and Coordination at Indian Council of Medical Research (ICMR), explains to The Quint that India’s policy is to not reveal the identity of the patient. He says,
“We are not revealing the identity of the patient. This is the stance the ICMR has taken. We do not disclose the name, age and in fact, anything about the patients.”
So what explains state governments in Odisha, Uttar Pradesh, and Gujarat arguing in favour of not keeping the patients’ identities anonymous?
The fact that health is a state subject. Dr Kant expands on this point, saying, “We don’t know about the states adopting their own policy. Because health is a state subject, so we cannot say anything about the state governments.”
This means that even though ICMR has a policy on not revealing the identity of COVID-19 patients, state governments can formulate their own policies based on the situation in their states.
Revealing Identity Leads to Easier Contact-Tracing?
When the Odisha government revealed the identity of the fifth COVID-19 patient in the state, it broke its own norms about not doing so. In fact, on 1 April, the state police had arrested three people for revealing the identity of a 29-year-old COVID-19 patient in Bhadrak.
However, an exception was made for this case by Bhubaneswar Municipal Commission since the patient had no previous travel history. Cited in the Hindustan Times, Bhubaneswar Municipal Commissioner Prem Chandra Chaudhury said, “The man is mentally retarded, and for the last three months he has not gone anywhere except to some local hospitals for treatment... He has no records of travel. As there is no other known way of finding out how he contacted the virus, we have issued an appeal to people to inform us and go on quarantine.”
Easier contact-tracing – this is the reasoning put forth by states which have taken the decision to reveal the identity of COVID-19 patients.
Like in Gujarat where Deputy Chief Minister Nitinbhai Patel has said the state government has decided to officially declare the names of COVID-19 positive patients in the state. Speaking to reporters on 23 March, he justified the decision by saying that revealing the identity of the COVID-19 patients would mean that “their neighbours, business associates, or those who came in contact with them can get themselves checked.”
Similarly, in Uttar Pradesh, Chief Medical Officer of Lucknow Dr Narendra Aggarwal has told COVID-19 patients to reveal their identity themselves. Speaking to The Times of India, he said, “Self-identification by patients will alert others who were in contact with them and they can take steps to not infect more people. They must get themselves isolated/tested.”
But does revealing the identity of a COVID-19 patient lead to better and more comprehensive contact-tracing?
Speaking to The Quint, Dr Anant Bhan, an independent researcher of global health, bioethics and health policy, explains that this may not always be the case. The important factor is the question of “value-add.”
He says,
“I don’t think a public identity reveal is a good idea, because you see all these cases of stigmatisation, unless there’s a value-add in revealing the identity of the patient. Ideally, if identity of a COVID-19 patient has to be revealed, it should only be done with the consent of the person, and for some specific purpose. A lot can be accomplished to a large extent, including contact-tracing, using de-identified details.”
Stigma of Being Identified As a COVID-19 Patient
In India, the stigma associated with contracting COVID-19 is a crucial issue – evidenced by reports of quarantine posters stuck outside people’s homes, the eviction of doctors and nurses from their rented homes for fear of ‘infection,’ spraying disinfectant on migrant workers, et al.
In Lucknow, the family of a COVID-19 patient was harassed with abusive phone calls blaming them for “bringing the virus to Lucknow” after the personal details of the patient and his family members were leaked.
In fact, the stigma of being a COVID-19 patient, and the fear of social boycott, is preventing people from coming forward. For instance, eleven people suspected of coronavirus, with a travel history to Dubai, reportedly fled from a hospital in Maharashtra's Navi Mumbai in March due to fear of social stigma.
Dr Bhan explains how revealing the identity of a COVID-19 patient in public could cause stigmatisation, and consequently, jeopardise efforts to control the spread of the virus. He says, “Revealing the identity of the patient could lead to stigmatisation. It could also lead to potential harm to the individual, and implications for the family members, and their loved ones.”
Most states in India have a strict policy similar to that of ICMR – of not revealing the identity of COVID-19 patients. And in cases where the identity is revealed, people have faced consequences. For example,
- In Maharashtra’s Pune, authorities have warned of strict action against those who reveal the identity of COVID-19 positive patients on social media.
- The police in Mangaluru in Karnataka announced that stringent action will be taken against those who reveal the identity of COVID-19 positive patients on social media.
- In Jammu, a medical superintendent was suspended after disclosing the identity of a suspected COVID-19 patient in Rajouri district of Jammu and Kashmir. His actions allegedly violated doctor-patient confidentiality.
Maintaining the anonymity of COVID-19 patients is also how the US is dealing with the outbreak. Jeffrey Kahn, director of Johns Hopkins Berman Institute of Bioethics in Maryland, put it simply in a report in USA Today. He says, “Doctors don’t out people. Whether it’s HIV, syphilis, coronavirus or anything else, people simply won’t show up to their doctor if they feel they might be outed for a condition.”
As the number of COVID-19 cases rise, an increasingly difficult choice presents itself to state governments. To combat stigma and respect the COVID-19 patient’s privacy by not revealing their identity? Or will a public health emergency with a communicable disease at its centre compel it to take a different stance?
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