When I spoke with Dr. David Persse of the Houston Health Department recently, I was frustrated and anxious.
I was trying to puzzle my way through the information gap facing Houston’s would-be diners and bargoers and takeout customers, who have no official way of knowing which establishments have COVID-19-positive employees. Neither the state, the county nor the city steps in to close a restaurant down temporarily or, at the very least, to let the public know there’s a problem.
It’s all voluntary. We must depend on the ethics of individual owners, who are between a rock and a very hard economic place.
Why, I wanted to know, did the city have an elaborate and very public restaurant inspection system to inform the public of sanitation and health concerns, when during a once-in-a-century health emergency like this pandemic, it isn’t set up to alert restaurantgoers to possible problems?
Why was contagious disease different from a pan of meat left out at improper temperatures? Why did the public have to depend on the social media, the rumor mill and information uncovered by the media to guide their behavior?
Persse, the department’s designated health authority, keyed into my frustration right away. “My wife complains to me about this every night,” he said. “I hear you. I hear you more than you know.”
In our discussion, Persse broke down for me the reporting and tracing difficulties imposed by federal HIPAA law, which mandates patient privacy — especially with regard to a patient’s employer — once a food-service staffer tests positive and is reported to the city or county health departments.
I emerged less confused but still frustrated by the regulatory snarl that no government entity has managed to cut through during this particular emergency.
And I was struck by some of Persse’s observations and personal precautions as he moves through his day at his downtown office.
What follows is a conversation lightly edited for clarity.
Q: Can the federal government adjust HIPAA regulations to respond to this particular emergency?
A: It would have to be Congress, and they have not done that.
The other thing is that to some degree, it almost doesn’t matter. People who get sick and are having symptoms are infected with something, whether it’s COVID or not, and they shouldn’t be at work in a public-facing position.
But with this virus, the biggest challenge is that some who are infected show no symptoms. They tend not to get tested, and those are the people who are spreading it, to an extent.
Even if HIPAA was changed by Congress tomorrow, and if we relied on saying ‘X restaurant has three employees who are COVID positive, it still wouldn’t address the other four or five coworkers, some of whom are probably infected and asymptomatic. And there’s a decent chance they caught it at work because the two most likely sources of infection are family members and coworkers.
So it’s not about whether this or that restaurant has an employee who has tested positive. It’s about whether we (as consumers) are willing to go out in public without a mask or social distancing. If we get to the door and look inside, are people spaced out and wearing masks?
Q: People are using social media to assess risk, too. I have a friend who checks Facebook, Twitter and Instagram feeds routinely.
A: I saw a photo of a place in Galveston recently, and even though they were complying with occupancy limits, the manager had put people all in one section. I thought, “Are people just not getting it?”
Q: What are the limitations of contact tracing once a food-service employee tests positive and that information is in the city or county health system?
A: Say Bob the Waiter at Dave’s Restaurant tests positive. Unfortunately, we can’t tell Dave. We can tell Bob, and he might follow advice and self-isolate. We can get a hold of his coworkers, but we can’t name Bob, we can just advise them to self-quarantine.
HIPAA law was well intentioned, but it’s often over-interpreted. Years ago, even if Bob got so sick he had to be hospitalized, hospitals would refuse to share information with us. Now hospitals can share with local health departments, but nowhere in HIPAA is there anything that can be interpreted that the information can be shared with an employer.
Q: So what can the public rely on in deciding which places are safe to patronize?
A: We need to rely on three things.
First, we need the individual who’s infected or exposed to do the right thing (in terms of informing close contacts and self-isolating for the recommended period).
Second, we need bosses not to pressure people to do anything different (from health departmend advice), to allow isolation or quarantine at no penalty.
And third — and I really hope your readers take this to heart — we need the individual restaurantgoer to do a little reconnaissance. Even if it’s a door check to see whether customers are spaced out and whether employees are wearing masks.
Q: Yes, you mentioned doing your own reconnaissance right at the door. What are you seeing?
A: I work downtown near the federal building. I’m not going to restaurants (for dine-in). There are maybe three places around the office where I order and leave.
I’m seeing a lot of waitstaff wearing masks, and that’s a good thing. But none of the younger people I see downtown are wearing masks.
Q: Any parting thoughts?
A: What we’ve seen so far, that was a ripple. This is our wave.
alison.cook@chron.com