Privacy and patient confidentiality in times of Covid-19

Patients have a right to medical confidentiality. This restricts access to personal and identifiable medical information held by his health care provider which should be kept private and confidential and not normally divulged to the other agencies without consent. We address the issue of privacy and patient confidentiality during the Covid-19 pandemic.

Under s. 7.14 of Professional Conduct, Etiquette and Ethics Regulations, 2002 of Indian Medical Council, a Registered Medical Practitioner should not disclose the patient’s medical information, except in specific circumstances such as on the order of a court of law, where there is a serious and identified risk to a specific person and/or community and in cases of notifiable diseases, etc. ¹ In consequence, a doctor may disclose patient information to appropriate authorities, and such communication is considered privileged. The legislation implies that disclosure of patient information is deemed justified only when made specifically to authorities concerned in the greater interest of society, and not to the general public or lay press. In view of the Covid-19 pandemic, the Ministry of Health and Family Welfare, Government of India issued guidelines for the mandatory notification of information regarding Covid-19 patients by their health care workers to concerned district surveillance units.^2,3

In India, the laws relating to the effective management of epidemics are detailed in the Epidemic Diseases Act, 1897 and National Disaster Management Act, 2005 which allow the government to pass any regulations it might deem necessary to prevent the outbreak or spread of such epidemics.^4,5

Quarantine and social isolation are time-tested instruments for controlling the spread of contagious diseases. To promote the prevalent trend of social distancing, various state governments have tried different quarantine enforcement measures, e.g. stamping the back of the palm of the individuals, pasting posters outside the homes of suspected cases that state ide their names, quarantine period and the number of people in the family asked to remain in isolation, asking quarantined persons to report every hour through ‘selfies’, publicising the names and addresses of people suspected of having Covid-19 through newspapers and social media.^6,7 There is apprehension too about privacy issues with the recommended use of tracking apps. ⁸ These measures taken by the respective states have been criticised as a direct violation of medical ethics and a patient’s right to privacy and confidentiality. ⁶ The very fact that government agencies are employing these strategies for public welfare and in the national interest out-weigh individual concerns of privacy and confidentiality. There is, however, a need to ensure that the interests of affected persons, families and communities are safeguarded, and that they do not face social stigmatisation or discrimination as a result of these revelations.

The government of India mandates medical practitioners to provide the information about Covid-19 cases and suspected cases to specific public authorities but not to the lay press, the media or social platforms. The authorities may take necessary measures to contain the disease which are assisted by information provided by doctors. Although these measures may require revelation of confidential patient information, medical practitioners who provide it cannot be considered a party to such decisions and disclosures directly or indirectly.