Don’t Repeat the Mistakes of 1918

Originally published on April 15, 2020 in The Boston Globe. Written by Robert Greenwald and Carol Rose. 

During the 1918 influenza pandemic, local governments in the United States placed special placards on the doors of homes where sick people were subject to quarantine. The measure was an attempt to contain the spread of a virus that ultimately killed nearly 700,000 people in the United States alone. Sadly, this well-intentioned move backfired: Many doctors chose not to report cases in order to prevent homes from being quarantined. Families of sick people sought to evade the stigma of a placard on their homes by not seeking medical attention.In light of today’s coronavirus crisis, it’s useful to recall this history and to avoid repeating the mistakes of the past. Yet in an executive order dated March 18, the administration of Governor Charlie Baker directed local boards of health to submit to first responders the home addresses of people who have tested positive for the virus. The idea is that police, fire services, and EMTs should know which homes have COVID-19 cases so that responders can adequately protect themselves.

Protecting the health of first responders is certainly an important priority that the state needs to address; however, some public health experts have noted that disclosing addresses does not ensure a first responder would be safe from exposure from asymptomatic people or from those who are infected but remain untested. It may seem counterintuitive, but this order could indeed do more harm than good.

This truth is that we do not know — and at this point cannot know— who has COVID-19 and who does not. Recent estimates are that as many as 1 in 4 cases may be asymptomatic. Thousands of people who have fallen sick and who may have the virus have been unable to obtain a test, and so won’t appear on any list of homes provided to responders. Providing the addresses to first responders of people who have tested positive thus makes no sense — from either a public health or patient privacy perspective. To protect public health, we cannot create lists that give our responders a false sense of security and instead they must treat everyone as a potential carrier of the virus.

First responders deserve the best equipment, and the best policies, to ensure their safety. But the harsh reality is that our first responders continue to lack sufficient personal protective equipment and, system-wide, we don’t have enough COVID-19 tests. Emergency medical technicians, paramedics, firefighters, and police officers — like our doctors, nurses, and other front-line essential workers — are being asked to continue to do their jobs amid acute conditions, without the equipment they need to keep themselves safe.

Thankfully, government officials in Massachusetts are taking important steps to address the lack of PPE and tests for front-line workers. The Baker administration and Mayor Marty Walsh of Boston announced plans to set up additional testing sites that give priority to first responders. These sites should be open to all workers who are putting themselves at risk, whether they are first responders or grocery store workers.

Ultimately, we must listen to public health consensus during public health emergencies. And the public health experts are clear: The twin threats of community-level transmission and a lack of wide-scale testing make the use of home addresses dangerously ineffective. Worse, since screening is critical to slowing the spread of the disease, disclosing addresses of confirmed cases will undermine public health efforts by deterring some people from seeking testing and treatment — just like during the 1918 influenza.

Sometimes public health needs overtake our normal expectations of privacy or other civil liberties. But disclosing the home addresses of people who have tested positive is not one of those cases. First responders, like all of us, should treat every person they interact with as a possible COVID-19 patient. Relying on the training of our first responders, not the home addresses of those stricken by the virus, is the best way to ensure public health and safety for everyone.Carol Rose is the executive director of the ACLU of Massachusetts.

Robert Greenwald is a clinical professor of law at Harvard Law School and the faculty director of the Law School’s Center for Health Law and Policy Innovation.