(TNS) — It hasn’t yet been possible to see how many people are infected with the coronavirus in the city of Grand Rapids, or in outlying towns like Sparta or Lowell.
That’s about to change. Kent County officials plan to join a growing number of Michigan counties disclosing COVID-19 cases and deaths at the zip-code or municipality level.
“We’re going to be presenting more granular data at that government unit level,” said Adam London, Kent County health officer. “I think we have a large enough number of positive COVID-19 cases now.”
As the climbing count of Michiganders stricken with the deadly COVID-19 disease continues to taper, data on where those people are located is getting better. In southeast Michigan, where most of the state’s people and cases are located, Wayne, Macomb, Oakland, St. Clair and Livingston counties, as well as the city of Detroit, are reporting cases and/or deaths at either the municipality or zip code level.
Nearby Washtenaw, Genesee and Monroe counties are now also reporting zip code totals.
But the transparency is not uniform. Location data becomes inconsistent outside of metro Detroit. Many counties still only report the number of infections or deaths within county borders. That also holds true for Michigan state government, which thus far only separates out the city of Detroit when reporting cumulative totals.
Saginaw County is reporting case count ranges by municipality. But the Central Michigan District Health Department, which covers Osceola, Isabella, Clare, Roscommon, Arenac and Gladwin counties, is publishing only a basic case and death count. Officials there say, among other concerns, they lack the resources to offer more details. They are not alone.
“We do not have a staff epidemiologist to pull this data together,” said Rashmi Travis, health officer for Jackson County, which only releases data at the county level.
Public health and legal experts, and some officials, say the piecemeal approach reflects both a lack of resources at public health agencies and worries they might run afoul of personal privacy protection laws by disclosing information that could somehow be traced back to a particular patient.
Michigan isn’t the only state juggling the issue. On April 1, South Carolina’s Republican governor ordered (by tweet) the state’s health department to begin disclosing cases by zip code. Oklahoma began disclosing cases by city this week. Nevada began reporting cases by zip code last week. Illinois is now disclosing statewide cases by zip code, but only for those with five or more cases.
Officials in Michigan say they’ve been fielding regular calls for more detailed data on where the coronavirus has been found and whom the disease is affecting. More demographic data has generally been disclosed as a result, as well as some numbers on recovered patients. In some counties, previously reluctant officials are now disclosing more location data.
But others question the utility of releasing sub-county level data amid the ongoing crisis. They argue the information could have negative consequences and may undermine Gov. Gretchen Whitmer’s stay-home order by giving people in areas with a low number of confirmed cases a false sense of security when, in fact, the danger has not passed.
One of the largest concerns about data release in Michigan has been focused on the overall dearth of testing, which likely means cases are undercounted in most areas. National evidence has also been mounting about “stealth cases” of infected people who show no symptoms.
Lynn Sutfin, spokesperson for the Michigan Department of Health and Human Services, said the state is not reporting zip-code or municipal level data “because it does not provide any additional actionable information for residents.”
“Just because someone lives in one area doesn’t mean they didn’t get infected or spread the virus in another jurisdiction,” Sutfin said. “At this time, Michiganders should assume COVID-19 is in their community and take the appropriate precautions.”
Some counties are following the state’s lead.
“This virus knows no boundaries. It does not adhere to zip code borders,” said Lyndi Warner, spokesperson for the Kalamazoo County Health Department, which recorded 185 cases and nine deaths as of April 20. “The best practice for the public is to follow the governor’s orders, maintain six feet from others and wear a cloth face covering when in public, wash your hands, and disinfect surface areas regularly.”
Kalamazoo County’s case count is roughly comparable to Ottawa County in basic totals. The two counties have released identically worded public statements at different points to justify their decision to withhold zip code level data. But Ottawa officials began reporting a list of cases by zip codes on March 27 and began mapping that information on April 10.
Why? “Our case count has increased,” said Kristina Wieghmink, spokesperson for the Ottawa County Department of Public Health.
Like many Michigan counties, Ottawa has large rural areas with lower population density. Wieghmink said there was concern that demographic data such as age, race and gender could provide enough information for someone to make an educated guess about a COVID-19 patient’s identity in a lower population zip code. This concern was magnified by people’s usage of social media. Today, in zip codes with fewer than ten confirmed cases, Ottawa’s map simply indicates “less than 10.”
Denise Bryan, health officer at District Health Department No. 2, has a similar population-based privacy concerns in her jurisdiction, which covers Iosco, Alcona, Ogemaw and Oscoda counties in northeast Michigan. The case counts up north are lower — the highest in her jurisdiction is 14 cases and two deaths so far in Iosco — but she worries about community spread that hasn’t been detected due to a lack of testing.
Despite privacy concerns, Bryan said she’s working with an epidemiologist on a case heatmap of some sort — although, frankly, she’d prefer the state do it for “centralized consistency.”
However, the state has similar privacy concerns.
“When you have a limited geography, any identifiers can lead to identification of an individual,” Sutfin said. “That’s why we report out on cases only as counts down to the county level.
Greg Gulick, a Michigan State University professor who specializes in regulatory compliance with health care laws, thinks some of the privacy concerns may be overblown.
National laws like the Health Insurance Portability and Accountability Act (HIPAA), which restrict the release of health information that can be tied to a specific person, nonetheless allow public health agencies to exercise some discretion, he said. One of the purposes of state and local health departments is to educate the public during an emergency.
“A lot of times HIPAA is used as a default position,” Gulick said. “If they don’t want to share information; don’t want to make it public, they fall back on that.”
While some populations and case counts could be small enough to pose a legitimate privacy concern, Gulick thinks those situations are in the minority. “I’m failing to see how disclosing one case in a zip code of 3,000 people is going to be able to be tied back to a specific person.”
Oakland County was among the first in Michigan to disclose zip code level data. Bill Mullan, spokesperson for the county executive, said Oakland is trying to deliver the same public health messaging around social distancing and staying home, but with more transparency.
“The more information you can give your residents about how the disease is progressing in the community, the more likely they are to take and follow proper measures,” Mullan said. “By being transparent, it’s the facts backing up what you’re asking the public to do.”
Kayte Spector-Bagdady, a lawyer and bioethics researcher at the University of Michigan, quibbled with that, suggesting empirical study is needed to determine whether providing more detailed location data actually affects behavior.
Spector-Bagdady said that, until there’s a vaccine developed, releasing case data by zip code could open the door to employer discrimination against people who come from zip codes with high case and death rates once restrictions on business and travel lift.
Brian J. Zikmund-Fisher, a decision scientist and risk communication professor at the University of Michigan, said tracking cases by zip code would help researchers correlate the coronavirus outbreak impacts with environmental factors like air pollution, which new research indicates is likely to increase the risk of someone dying from or having severe COVID-19 symptoms.
Zikmund-Fisher said there are legitimate concerns about people drawing the wrong conclusion from zip code data that might indicate a low number of cases in their area, but there are also legitimate benefits to consider, such as bolstering trust in public institutions by releasing case incidence data in an effort to fortify the argument for staying home.
“Providing that kind of data both increases transparency and confidence in the public health or government agencies releasing it,” Zikmund-Fisher said. “That confidence and trust is essential at a moment like this, when we’re having the government very explicitly issue orders about what is safe or not safe to so.”
“It’s also true that some of the ways in which people interpret it will be accurate and helpful, and some of the ways, absent help, may be problematic,” he said.
“The heart of the problem is not that one side is right, and one side is wrong. They are both right.”
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