COLUMBIA — South Carolina health officials have doubled down on their decision to shield from first responders detailed information on the location of coronavirus cases, even though a leading federal official urged those disclosures and governments in other states have already enacted them.
The S.C. Department of Health and Environmental Control has also lagged behind other states in reporting several key factors used to track the outbreak, like the number of people sick enough to go to the hospital.
Those numbers are especially important here because South Carolina has reported relatively few test results compared to the rest of the country. The state’s outbreak had swelled to 660 known cases as of Saturday evening, but tests often take a week to complete. The contagion has killed 15 residents.
The state health agency insists it’s doing all it can to alert the public of the virus’ risks. Officials said a low supply of key materials has delayed testing results. And their decisions to share information must fall within federal health privacy laws, they contend.
Yet county officials slammed the state’s decision to withhold information from the people who local government leaders say need it the most — paramedics and other first responders.
Chief among their requests, the counties want DHEC to share addresses of individuals who have tested positive for the virus, The Post and Courier reported Wednesday.
Then, new guidelines surfaced from the U.S. Department of Health and Human Services that counties thought would bolster their case. The guidelines written last week stressed that federal law allows health authorities to share with first responders the names and addresses of individuals known to be carrying the virus.
A director with the federal agency said such disclosures are critical so first responders have “greater access to real time infection information.”
But DHEC officials agreed only to share a breakdown of cases by ZIP code. The agency did grant another request to offer priority status to first responders who seek testing for the virus. By the end of the week, DHEC announced nine of those testing sites statewide.
The measures haven’t satisfied local emergency directors, who continue to decry the lack of information being shared.
In interviews with The Post and Courier over the week, they voiced their concerns from every corner of the state.
In Lee County, officials insist they need the information to help triage their limited supply of special protective gear. Rural areas stressed they must avoid sidelining sick paramedics because they’re only capable of deploying a few to begin with. And in Oconee County, where many commute to North Carolina for work, officials say they've gotten more information about the outbreak in their county from that neighboring state than they have from South Carolina officials.
“We are searching out other ways to get it — and we shouldn’t have to,” said Scott Krein, Oconee’s emergency manager. “We work off whatever we have. No information is always a guess.”
'Hospitalizations don't lie'
In recent days, South Carolina did take some steps toward improving transparency.
In addition to publishing case information by ZIP code, the state is now reporting basic demographics for patients, like their age and gender.
DHEC also gives occasional updates on how many people were tested after becoming sick enough to be hospitalized.
But it only updates that figure once a week, an eternity in a fast-moving outbreak.
Hospitalizations are an especially key measure in South Carolina, because the state has reported relatively few test results — a rate of about 57 people per every 100,000 residents, as of Friday. The national average is roughly three times higher, according to data compiled by the COVID Tracking Project.
Hospital admissions are seen as a clearer measure for tracking the virus because the metric isn’t swayed by differences in how states approach testing.
“Hospitalizations don’t lie,” an Oregon scientist told lawmakers in that state, according to The Oregonian newspaper.
Other states have heeded that call. No fewer than 25 states update the public on COVID-related hospitalizations every day, according to a Post and Courier review of health department data.
South Carolina’s most recent numbers were published last Wednesday. They showed about a quarter of confirmed cases were tested in the hospital.
Some other states, like Colorado, Connecticut and Mississippi, break down the ages of their hospital patients. Iowa, Minnesota and Rhode Island even keep track of when patients are discharged.
The Palmetto State does not. State health officials have stressed that their primary duty is to prevent the outbreak's spread, despite staffing demands.
For Dr. Linda Bell, the state epidemiologist, that means tracking test results, not the outcomes of every patient who may or may not be hospitalized.
“The health department does not follow individuals throughout their hospital course,” Bell said. “We do disease surveillance and we report positive test results.”
No step forward
DHEC faced other criticisms last week when the South Carolina Association of Counties published a letter the group wrote to Gov. Henry McMaster on Tuesday, pleading for assistance.
To protect first responders from infection, the counties requested that the state share with local governments the addresses of those infected with the virus within their communities. The association also asked that first responders get priority access to testing to avoid lengthy quarantines that may be unnecessary.
State health officials did move quickly to address the concerns about testing. The day after the association sent its letter, DHEC announced four sites for expedited testing. By the end of the week, that list had grown to nine sites.
“It is growing every day and that’s our intent,” said Nick Davidson, who is heading the agency’s COVID-19 response.
But DHEC stopped short of releasing the more detailed locations of cases the counties requested.
“It wasn’t even a step forward,” Abbeville County Director David Garner said.
The county of roughly 25,000 has just five ambulances and one other emergency response vehicle. Garner's concerns echoed in rural communities across the state: What if some or all of his paramedics become sick?
That’s what makes it so critical that state health officials share all the information they can, he and others contend.
Last week, the federal government published guidelines intended to address those concerns directly. Under federal health privacy laws, health authorities may disclose identifying information to first responders who are at risk of infection, according to the guidelines. The disclosures are permitted to “prevent or control spread of a disease.”
“This guidance helps ensure first responders will have greater access to real time infection information to help keep them and the public safe,” said Roger Severino, director of the Office for Civil Rights of the U.S. Department of Health and Human Services.
Florence County Emergency Management Director Dusty Owens said he sent the published guidelines to DHEC last Wednesday.
He didn't hear back.
'It all goes back to information'
Some health agencies in other states have heeded the federal government’s go-ahead to release the information.
New York authorities cleared the way for first responders in the hard-hit town of Rockland to get patient addresses, according to The Journal News. And in southwest Ohio, officials went a step further, loading addresses into police dispatch software, the Cincinnati Enquirer reported.
In North Carolina, state officials issued a missive that cleared the way for local health departments to share identifying information of confirmed cases. That was welcome news to first responders in Beaufort County, N.C., said Emergency Director Carnie Hedgepeth.
“We certainly appreciate any heads up we can have,” he said.
Krein, the Oconee emergency manager, said he’s had more luck getting information from North Carolina than his own state health department.
Some Oconee residents work in North Carolina and have been tested for the virus in that state. Krein said out-of-state officials have flagged him to the results of those tests, a measure beyond what DHEC has been willing to offer.
Access to that kind of information is critical so counties can update their emergency dispatches, flagging first responders to any potential risks, Krein and others contend.
Bell, the South Carolina epidemiologist, has suggested those steps aren’t necessary. She noted that county dispatchers had already begun screening emergency callers for coronavirus risks. That gives first responders the information they need, she said.
“We feel that’s the best way for first responders to protect themselves,” Bell said.
But first responders can’t always rely on patients to relay that information, Marlboro County Administrator Ron Munnerlyn said, especially in cases when they may be under medical duress.
“It’s depending on people who may not be straightforward,” he said. “Or, people who are ill and not clearly communicating.”
DHEC has also urged first responders to take necessary precautions to avoid contracting the virus on every call, no matter the known risk.
But that doesn’t square with the practical challenges facing some smaller counties, said Alan Watkins, administrator of Lee County, population 17,000.
His and other counties face a shortage in supply of special gear — known as personal protective equipment — that first responders need to fully cloak themselves from contact with the virus.
The county can’t afford to equip every first responder with the gear on every call. That’s why it’s critical they are flagged to calls with a known risk of the virus, he contends.
“It all goes back to information,” Watkins said. “The more we have, the better we can protect our people, and protect the community.”
Seanna Adcox contributed to this story.