Invasion of privacy or essential response? Contact tracing is being debated while in use

Nathaniel Cary Kirk Brown
Greenville News

At least four Upstate lawmakers have expressed serious privacy concerns about a practice that public health officials and the governor say is essential to responding to the deadly coronavirus pandemic.

Gov. Henry McMaster said contact tracing is the neighborly thing to do. He said it doesn't infringe on individual rights. The state's public health agency said it's a voluntary but necessary process to find hot spots of infection and prevent full-blown outbreaks when a surge of cases could threaten the gradual reopening of the state's economy.

Several local legislators, however, used descriptions more like "invasion" to describe the practice of identifying the people who've physically interacted with people who've been infected.

The remarks by the Upstate Republicans — which were rebuffed by other Republican lawmakers — highlight a rift between ultra-conservative legislators concerned about what they perceive as an intrusion into privacy and the general guidance of health experts and many of their own Statehouse colleagues who support the program.

Contact tracing is typically performed hundreds of times each year by about 20 DHEC employees to prevent the spread of infectious diseases like hepatitis and tuberculosis, according to DHEC spokesperson Laura Renwick.

Tracers, part of the agency’s epidemiology team, call those who’ve tested positive for an infectious disease and ask them a series of questions about who they’ve had close contact with during the disease’s incubation period, which is 14 days for COVID-19. If there is any action contacts should be warned to take, tracers will then notify the contacts that they may have been exposed and will advise them on what to do next.

With more than 8,000 positive coronavirus cases in South Carolina in two months, DHEC began to train more staff members to perform contact tracing and now has 400 employees able to perform the task, DHEC said last week. The agency has also identified more than 1,400 others to train and enable to work on a contract basis if needed.

What is contact tracing?:Here's how it is being used in SC to respond to the coronavirus

Officials with the state Department of Health and Environmental Control called contact tracing a normal function that's often used to limit the spread of infectious diseases. 

That didn't soothe legislators who balked at use of the practice before approval of a budget measure to provide more emergency funding for DHEC's coronavirus response.

'I’m telling you folks that the setup is bad,' Rep. Jonathon Hill said

“Many people in our districts are concerned,” state Rep. Mike Burns, a Republican from Taylors, said last week at the Statehouse. “There are some states that have taken advantage of this.”

Rep. Stewart Jones, a Republican from Laurens, said he is reluctant to grant “any more power to any part of government in this time.”

“I think we need more freedom,” said Jones who posted a link on his Facebook page to a petition that urged people to “Say no to: the invasion of privacy, contact tracing, forced vaccines and mandatory COVID testing!”

State epidemiologist Linda Bell, right, speaks as South Carolina Gov. Henry McMaster, left, listens during a COVID-19 briefing on Friday, April 3, 2020, in West Columbia, S.C. (AP Photo/Meg Kinnard)

Rep. Jonathon Hill, a Republican from Townville, questioned the “civil liberties implications” of contact-tracing. He said a contact-tracer or a DHEC official might decide that someone who has been exposed to COVID-19 should be placed in quarantine.

“DHEC has the authority to come and impose a mandatory quarantine at a location of their choosing,” Hill said. “I’m telling you folks that the setup is bad. If you care about your constituents’ civil liberties and if you care about your constituents’ health and if you care about your constituents’ livelihoods, you cannot vote for this setup.”

Rep. Josiah Magnuson, a Republican from Campobello, proposed an amendment that he later withdrew that said a person may not be penalized for refusing to be traced.

Other Republican lawmakers said those concerns were overblown. 

“This is not China. No one is coming to kick in your door and drag you out and put you in a cell,” said Rep. Murrell Smith, a Republican from Sumter who is chairman of the House Ways and Means Committee. “I know that is what worries people.”

“There is no law that says you have to cooperate,” he said. “We are not forcing people to quarantine. That is not the role of government in South Carolina or in the United States... We are not putting people in jail for minding their personal liberties, I promise you that.”

More:South Carolina ranks last in the U.S. for its COVID-19 testing

Sen. Thomas Alexander, a Republican from Walhalla, offered a similar assessment.

“It is purely voluntary. It is for information purposes only,” Alexander said. “It is done anonymously, and it’s all done by the phone.”

Afterward, McMaster’s spokesperson, Brian Symmes, entreated upon state residents' sense of neighborliness.

“We believe that South Carolinians want to help their communities and loved ones by participating in this process,” Symmes said. “In no way whatsoever does it infringe upon any citizen’s rights."

SC is considering use of a smartphone app from Apple and Google

Much of the concern among privacy-rights experts centers on the use of technology, especially smartphone applications, that could track movements of those who download and use an app.

If a person tests positive for COVID-19, the app would use Bluetooth technology to alert those also using the app who've been in close contact with the individual — to warn of exposure to the virus — according to Apple, which has partnered with rival Google to develop an app being made available to public health agencies.

The state of South Carolina isn't currently using an app, but DHEC told The Greenville News that it is reviewing its options. 

More:Hundreds in Greenville nursing homes deemed vulnerable as COVID-19 testing increases

More than half of Americans polled in a Pew Research Center survey conducted April 7-April 12, 54%, said it would be somewhat or very unacceptable for the government to track those who may have had contact with someone who tested positive for COVID-19.

As for tracking just those who have tested positive and not their contacts, 52% found it acceptable.

More:81 Upstate first responders, medical workers tested positive for coronavirus

Early in the virus' arrival in the state, DHEC had performed contact tracing in an attempt to limit community spread, but as it became clear the virus had spread more widely, DHEC moved into a phase to mitigate the infection and warned citizens they should assume anyone they come into contact with had been infected.

Health officials “wanted to make sure people were taking lots of precautions,” said Nick Davidson, DHEC’s director of community health services and the incident commander of the agency’s pandemic response team.

Now, as McMaster has rolled back many of the restrictions on activity, leaving in place guidance on social distancing and asking residents to wear masks when in close contact with others, Davidson said contact tracing will help limit the virus’ spread and, along with an increase in diagnostic testing, will help health officials track infection hot spots before they become full outbreaks.

To do that, public health officials need cooperation in contact tracing. DHEC says it is a voluntary process performed by people who've been vetted by DHEC and trained in patient confidentiality.

“We are always encouraging those who are sick to work with us and help answer our questions and take the advice that we’re giving in terms of what we need them to do to keep themselves and others healthy, but we do not force them to speak to us for COVID-19 if they are not willing to,” Davidson said.

This is how contact tracing works in South Carolina

The work of a contact tracer begins when they receive a positive case report. In a typical day, a contact tracer will reach out to 10-15 cases to begin investigating possible close contacts, Davidson said.

A close contact for COVID-19 is anyone who has been within six feet of a COVID-positive individual for a prolonged period of time, generally 10 minutes, or has been sneezed or coughed on by that individual, said Dr. Brannon Traxler, a DHEC physician.  

Tracers first contact the COVID-positive person if that person can talk or a family member if they can’t, Traxler said. Tracers are trained to be empathetic and seek information on where the person has gone and who they may have had close contact with in the past 14 days.

For instance, if a person had gone to an event, tracers can maintain confidentiality of a person but still reach out to the event organizer and ask them to notify people that someone at the event had tested positive, Traxler said.

“That’s pretty much standard for what we do for all diseases when we’re doing this contact tracing,” she said.

The key in notifying a workplace, an event or locations the individual may have gone to is whether there is enough information to recommend any actions be taken, she said.

The health agency’s core epidemiology team, its full-time contact tracers, have handled calls to those who are COVID-positive, Davidson said. They conduct an interview with the individual to explain the need to self-isolate and follow up to monitor their symptoms and connect them with health services, according to DHEC.

Once they’ve conducted those interviews and found leads to likely close contacts, other tracers reach out to the contacts, Davidson said.

They may ask close contacts to self-isolate and will follow up to monitor them for symptoms.

“It’s a lot of phone calls. It’s a lot of paperwork. It’s a lot of, sometimes, dead ends, but they’re reporting back to our permanent (epidemiology) team staff with their results and completing the loop,” Davidson said.

As the virus is found and traced, and impacted people isolated, the infection won’t be able to find new victims, and will die out, public health officials have said.

But to accomplish that, the state needs more testing, which it now plans to perform, and health officials need to know who to isolate to kill off the infection.

“We’re doing everything we can to increase testing, which will mean more positives,” Davidson said, “which will mean more contacts.”