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The ethics of Covid-19 status disclosure: To tell or not to tell?

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As the Covid-19 pandemic rages on, contact tracing has become an important element in the strategy for returning to some degree of normalcy. But the disclosure of test results to contacts is a key area of ethical concern. To what extent should an individual’s results be made public or kept private? When is the line crossed between too much or too little information? 

During the Asian phase of the outbreak, countries such South Korea and Hong Kong provided more detailed information on Covid-19 positive cases compared with Japan. Beyond status disclosure, other novel ethical issues that may dominate the post-Covid era include the issuance of “immunity passports” and forced vaccination.

In Nigeria, proponents of Covid-19 status disclosure opine that public interest overrides any issues of individual privacy. Although section 44 of the Nigerian medical ethics code states that “the disclosure of information on the patient by the doctor can only be made following informed consent of the patient preferably in writing”, there is a caveat excluding “situations in which a discretionary breach of confidentiality is necessary to protect the patient or the community from danger”. Indeed, proper contact tracing can only be successful when an index case is fully identified. Contacts can subsequently be tested so that the chain of community transmission can be promptly halted. 

The United States Department for Health and Human Services recently released guidelines to regulate disclosure of information of those with Covid-19.

A case in point was recently demonstrated in the United Kingdom when Prime Minister Boris Johnson fell ill with Covid-19. The public was promptly informed and continuously updated even when he required intensive care. It is commendable when popular figures and celebrities willingly disclose their Covid-19 status as this not only encourages others to do the same but provides a powerful re-enforcement to messages of prevention. 

Several Nigerian political figures have publicly announced their Covid-19 status during this pandemic. Although this has had a positive effect of demonstrating the reality of the disease, it has also had the unwanted effect of misleading the public to believe Covid-19 is a disease of the rich that spares the poor. In a similar vein, people of lower socioeconomic status find it more difficult to get tested. Thankfully, this scenario is changing with scaling up of testing by the Nigerian Centre for Disease Control.

Opposing views exist. Some have argued that infected individuals have a right to confidentiality. After a high-ranking Nigerian presidential aide took ill with Covid-19, there was scant public information regarding his treatment and eventual death. The government cited the need for privacy.

Stigmatisation also discourages testing and contact tracing. A Covid-19 positive person can be stigmatised by family members, friends, colleagues, and even broader society. With the possibility of continued viral shedding post-recovery, the fear of contamination increases the chances of stigmatisation. A resident of a building may find that he or she must change accommodation because neighbours are worried about getting infected.

There is certainly a need to balance individual privacy and public safety regarding disclosure of Covid-19 status. Public office holders, healthcare workers and others whose line of duty involves contact with many members of the public should be encouraged to disclose their status if infected. This will promote overall public safety.

There must also be internal mechanisms to protect the individual and their jobs. Massive public health education will be needed to ensure effective contact tracing and prevent stigmatisation after successful treatment. 

Every nation must create up-to-date ethical guidelines regarding test status disclosure in the context of Covid-19. 

To tell or not to tell is a difficult choice which we must all think about.

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Ido Aniekan
Ido Aniekan is a member of the Nigerian Bar Association
Akpabio Akpabio
Dr Akpabio Akpabio is a rheumatologist and internal medicine physician at the University of Uyo teaching hospital in Nigeria. He is certified by the European League Against Rheumatism and volunteers with the Global Image Foundation
Utibe Effiong
Dr Utibe Effiong is an internal medicine physician with MidMichigan Health and a clinical assistant professor of medicine at Central Michigan University. He is also a senior fellow of global health and development at the Aspen Institute

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