U.S. Representative Steve King asserted on April 7 that publicizing the names, addresses, and medical history of those who test positive for novel coronavirus (COVID-19) would help the country overcome the pandemic by allowing people to “make better decisions.”
King advocated revealing identifying details about COVID-19 patients during his April 3 telephone town hall with residents of Iowa’s fourth Congressional district and discussed the idea at some length during his latest call with constituents on the evening of April 7. An Iowan recorded most of that call (missing the first portion) and provided the audio to Bleeding Heartland. You can listen here:
King returned to the topic several times. His most extended exposition begins a little after the 18:00 mark.
Decades ago, King recalled, local radio used to broadcast a “hospital report.” People could tune in to learn who had been admitted to the hospital because of illness or accident, or to have a baby, and who had been discharged from the hospital. If someone had passed away, the radio station would mention that as well. The hospital report “told us who to pray for, who to go visit, who to cook a casserole for, how to take care of our neighbors and our friends.”
After Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996, “the confidentiality rules were set in,” and the country “shifted pretty significantly away from open access information,” King said. Now “we don’t know enough” about who may be sick in our communities.
If we don’t know who is positive, then how do we know how to help them, pray for them, and how do we know not to visit them, for that matter?
People will say, well, there’s a stigma attached with that today. There may be. But I don’t know why there should be a stigma attached with it. You don’t know where you get it, how you get it. But if you have it, then you need to be staying away from other people and self-quarantining.
And so if we’re going to address this and eradicate this virus, then if, say in our neighborhood we don’t know who has it, we only see that maybe one person in the entire county has tested positive. And then no one knows who that is, or that’s supposed to know, according to the rules we’re living by today. And when that person is now recovered, we don’t know that either.
And–so I don’t think that we can make very good decisions without information. The first thing I would like to have, I’d like to have age, I’d like to have pre-existing conditions. I’d like to know whether they’re male or female, and then on down the line. What town they live in, what their address is, what their name is.
If we had all of that, we could make good decisions.
Medical privacy rules exist for many reasons. Letting the community know who tested positive for COVID-19 could make patients targets for harassment, vandalism, scams, or burglaries. And while it’s important for public health authorities to collect and analyze data on COVID-19 patients (such as their age, gender, race, ethnicity, and underlying conditions), no one should have to fear that their health problems will become a matter of public record.
South Korea releases a lot of information about COVID-19 patients, which has facilitated contact tracing to slow the spread of the virus. But some experts believe the practice could discourage people from getting tested.
Returning to the topic several minutes later, King acknowledged there are good arguments to make on both sides of this issue. Some would say “it violates people’s privacy.” His response wasn’t what I expected to hear from a self-styled constitutional conservative.
I would say our constitutional rights have been suspended, from freedom of assembly, freedom of religion and others. At this point I’m not making an issue of that, because it’s about the safety and security of the American people. So, if constitutional rights can be suspended, so can privacy if it makes us safer.
From King’s perspective, “We can better make our own decisions” if we know exactly who has been infected with coronavirus.
HIPAA makes King’s vision for battling coronavirus impossible. But for what it’s worth, throwing medical privacy out the window is controversial even among his own town hall listeners–a group that skews conservative.
King regularly conducts surveys during his telephone town halls, and his last two calls included a “poll question” on whether names and addresses of those testing positive for COVID-19 should be released. Toward the end of the call, King announced that 50 percent of those who voted during the April 7 event said yes, 40 percent said no, and 10 percent were undecided. When he asked the same question last week, he said, 43 percent of participants said yes and 45 percent no.
P.S.–Around the 3:00-minute mark of the clip posted above, a caller identified as Barbara in Logan (Harrison County) wanted to know “when they’re going to start using the malaria med that the president keeps talking about.” She was referring to hydroxychloroquine, which President Donald Trump has promoted in multiple press briefings, even though it has not been proven effective for treating coronavirus.
King said he’s noticed that “pick up a lot more traction” in the last three or four days, adding that he is “hopeful” the medication will be used more widely, including in New York. “It’s taken a lot of effort to get people to pay attention to this,” he said. “There seem to be very, very few side effects,” suggesting not much of a downside.
In fact, hydroxychloroquine can cause psychiatric and cardiac problems. Side effects from the drug have prompted hospitals in Sweden to stop using it to treat patients with COVID-19. Moreover, Julia Carrie Wong reported for The Guardian on April 7 that the French study claiming to show hydroxychloroquine produced a “100 percent cure rate” for COVID-19 had serious design flaws and excluded some patients with poor outcomes from reported results. This week a French hospital halted a study of the drug because of cardiac side effects.
UPDATE: King backpedaled a bit on this idea. In a column for publication by news outlets, which his Congressional office released on April 14, he wrote, “please note that I do not include names or addresses in my proposed demographic data.” Instead,
I propose we compile both positive and negative test results, each subject’s actual age by year and month of birth, their height and weight, their full list of preexisting conditions, their sex, their residence by city and neighborhood and an epidemiological estimate of how they contracted the disease. All of this information should be available. It needs to be compiled into a standard form and entered into a public database.
The full text of King’s editorial follows.
Getting Back on Track
by Congressman Steve King
Each of us must be responsible for our own health and accountable for the impacts we have on each other. We can’t rely on government to make each decision for us. Personal responsibility has been fading from our national psyche for more than a generation, but perhaps this COVID-19 menace will show us the way back to our American roots.
Never in modern history has there been such an abrupt shock simultaneously to our healthcare system and our economy. The 1918 Spanish Flu may have been a worse pandemic. The Great Depression may prove to have been a more costly economic hit, but never as suddenly or as astronomically have we thrown so great a portion of our treasure at a crisis this abruptly.
Without arguing the reasons for a near national shutdown or for spending trillions, we all know the path we are on will eventually destroy more lives than it saves; perhaps our nation itself. When then, and under what circumstances shall we “bring ‘er about” and reset our course back to prosperity and harmony?
Americans are quickly learning the means by which this disease is transferred. We will learn a lot more in the next few weeks. We are practicing “social distancing,” hand sanitizing, mask wearing, and self-quarantining effectively. We do so, not only because government tells us to but, especially because we have learned and understand the risks to our health and to others. We Americans are moving towards a solution by taking informed social and personal responsibility.
How then, do we move to the next step? What knowledge or information can we use to determine if we, as individuals, are safe enough to reengage into our economy and society and under what conditions? Some of us know we are high risk and should be some of the last ones to venture out into society. We know advanced age and preexisting conditions significantly reduce survival rates if infected. We know there are a significant number of people who are asymptomatic yet are carriers who infect others.
We don’t know the demographics of asymptomatic carriers. We know, generally county by county, how many have tested positive, how many negative, how many hospitalized, in ICU’s, ventilated, and how many died. Many times, we don’t learn how many have recovered. In none of these cases are the names or addresses of the afflicted released to the public. Even the municipality of residence of those stricken is scrubbed from public record in a misguided hyper compliance with perceived HIPAA statute. There are multiple counties where only one person has tested positive. They may or may not have recovered and they may or may not live next door. They may live an hour away in the opposite corner of your county or they may live right across the road but in a neighboring county.
HIPAA changed our culture to one of medical hyper-privacy. The cost was the loss of access to information that let neighbors look out for neighbors. There once was a time, pre-HIPAA, when we knew who to pray for, who to bake a casserole for, and who to visit in the hospital. Restoring the best parts of that era would serve us all well today.
Regardless, there is demographic data (please note that I do not include names or addresses in my proposed demographic data) that can inform our individual and interactive decisions. I propose we compile both positive and negative test results, each subject’s actual age by year and month of birth, their height and weight, their full list of preexisting conditions, their sex, their residence by city and neighborhood and an epidemiological estimate of how they contracted the disease. All of this information should be available. It needs to be compiled into a standard form and entered into a public database. Why?
If you are a 61 year-old female, in good health, without preexisting conditions, you have a far better survivability probability than an 80 year-old male who has diabetes, is extremely obese, and who has a heart condition. Each of the described subjects are in the same statistical category, and each will want to know their risk of death if they contract COVID-19. Conversely, if you are a 17 year-old and you know that only 17 Iowans who are 17 and younger have been diagnosed with the virus, don’t you want to know if, of the 17, any were actually 17? You are starting to understand my point. If we can all learn what is typical, we can also conclude that which is probable. When each of us are fully informed of the probable, we will then decide where and when we should go back to work, to church, to school, or to the fishing hole or golf course. The data required for us all to make informed decisions is in the hands of government and government needs to compile and publish accurate data in real time.
There is no reason for the data I’ve described to be confidential or hoarded by government for any purpose. The way for government to bring about the best response by the public is to ensure the public is fully informed. Anything less smacks of an attempt to manipulate our decisions and actions.
I propose we plug all the data I’ve described and more into an interactive web site calculator, maintained by the CDC or the private sector. Millions of Americans would immediately go to the site, enter their age, sex, height, weight, and any preexisting conditions to determine their personal survivability factor if they contract the disease. If the calculator concludes they have a 99.9% chance of recovery, they will be more confident to go back to work and resume the rhythm of their lives. If they have only a 50% chance of survival, they will likely decide to self quarantine. But, if their grandchild is in the 99.9% category and exposed, they will likely decide to delay the family reunion until this plague passes.
We have a country to put back on the rails. Let us do so prudently, fully informed and soon.
Congressman Steve King represents Iowa’s 4th Congressional District in the United States House of Representatives.