As the number of hospitalized COVID-19 patients grows in Spokane, it remains unclear if officials have decided to concentrate coronavirus patients in one medical center or if they have some other strategy.

Officials representing local medical centers, as well as the Spokane Regional Health District, have declined to confirm where COVID-19 patients are hospitalized, citing privacy concerns. Requests made for numbers at specific hospitals – without revealing names of patients – have been denied, though federal law permits release of some anonymous data to protect public health.

A state database being consulted by Spokane Health Officer Dr. Bob Lutz includes the number of hospitalizations and emergency room visits, but doesn’t break those statistics down to specific hospitals, he said. The health district is using that information to make public health decisions, including the closure of parks and other measures.

“Those are the two data points that we are following the most,” Lutz told reporters during a news conference Friday morning. “Again, we don’t necessarily break them down by hospitals, but we look at them at the community and county level.”

Representatives of MultiCare and Providence – the health care providers that operate the four main hospitals in Spokane County: Deaconess, Valley, Sacred Heart and Holy Family – said they are trying to balance patient privacy rights with the need to inform the public about the reach of the pandemic in a community. That clash has been playing out as the number of cases locally and nationally continues to rise and residents seek more detailed information about the disease’s spread, adherence to stay-home orders and efforts to treat patients.

“I think that’s a really thoughtful question,” said Dan Getz, medical director at Providence Sacred Heart Medical Center, when asked why hospitals have declined to say how many COVID-19 patients they are treating. “But I guess when I try to distill it down, I don’t really see the purpose to share individual numbers in a hospital. I think what’s more important is to that share we have capacity to care for people in our community.”

Both Getz and David O’Brien, senior vice president and chief executive of the East Region for Multicare, said Friday the response to the coronavirus is coordinated and extends beyond just one hospital or one health care provider. The health district is reporting daily figures including number of tests, positive cases and deaths, as well as the number of hospitalizations.

But those numbers have not included where patients who have tested positive are being treated, information that could show with greater specificity how health providers are handling the sickest patients. Eighteen patients confirmed to have COVID-19 were hospitalized in Spokane County on Friday.

Getz said hospitals needed to consider the privacy rights of patients they treat when sharing information with the public.

“Those numbers, it’s a matter of patient privacy and respect,” he said.

O’Brien added that the health district was the government agency most capable of answering questions about available data, and that hospitalization figures were dynamic.

“This data changes by the hour, so I think that’s probably the best strategy,” he said.

Health care providers are limited from sharing information about a patient that can be used to identify them under a federal law, the Health Insurance Portability and Accountability Act, or HIPAA, that was passed in 1996 and has been amended in recent years.

Exemptions are in place so that providers can give information to public health authorities such as the Spokane Regional Health District in emergencies and to promote public health. Last month the federal Department of Health and Humans Services offered guidance to hospitals that relaxed some of the privacy requirements to promote quicker health care during the pandemic.

That guidance left in place restrictions about information provided to the media, including written authorizations from patients before details about the individual can be released.

But that prohibition does not include aggregated information that could be released to help the public gain a better understanding of the virus’ spread and a community’s response to it, said Al Tompkins, a senior faculty member for online and broadcast journalism at the Poynter Institute for Media Studies in St. Petersburg, Florida.

“It’s vital that we get as much information as possible, so we can understand why it’s important for us to act,” Tompkins said, adding that the release of detailed demographic information about the virus’ spread and testing in places such as Charlotte, North Carolina, and Philadelphia have shown a greater-than-expected number of cases among black residents, prompting questions about the adequacy of treatment for those communities and the availability of testing.

The Spokane Regional Health District has begun posting the number of positive cases by age and gender. Kelli Hawkins, a spokeswoman for the health district, said this week the growing number of local patientsmay be causing a “higher priority” on delivering more detailed data.

Hawkins said health district officials were looking for a way to map where people confirmed to have COVID-19 are living in Spokane County without infringing on their privacy or misleading everyone about where cases contracted the disease.

Specificity in reporting seems to be driven largely by the number of confirmed cases as federal guidelines give local health authorities wide latitude in what they can report to promote public health.

King County, which reported 2,656 positive cases as of Friday, has updated a map showing the number of cases by ZIP code. Early on, the county’s health district also reported where patients were being hospitalized, along with now-standard details that include an age range and gender.

Other locations with large numbers of positive cases, including New York City, also have posted more detailed information about their confirmed cases, including borough location and number of emergency room visits and hospital admissions for people with flu-like symptoms.

Any decision a health care provider or health district will make about releasing data will be informed by decisions about what is legal and what is ethical to release, said Mason Marks, an assistant professor at Gonzaga Law School specializing in health and data privacy law.

“I’d be thinking, in my mind I’m balancing someone’s privacy versus the utility to the public,” he said. “If the utility is so low, why offer it?”

Based on analytical data that news organizations have been collecting, Tompkins said stories about the virus’ spread, whom it’s infecting, and the availability of resources to fight it are among the most demanded information from consumers right now.

“Just by looking at the stories they’re clicking on, people want a few things,” he said. “They want numbers: how big, how bad, how wide and where.”

More concerning, Marks said, is the rise in technology firms collecting data in the name of promoting public health. He pointed to the company Verily, which has provided an online questionnaire for Google users that then directs them to testing centers in California if they’re believed to be at-risk, as evidence of potentially problematic collection of personal health information. Google itself has begun releasing “community mobility reports” based on mobile device data. The reports are intended to show whether people are following stay-home orders.

“The thing that I find most concerning is the fact that across the country and around the world, we are allowing tech companies and government to start collecting information from people,” Marks said.

The Google data is broken down at the county level and indicates that visits to retail stores and transit stops in Spokane County were down more than 40% last Sunday compared to a baseline level from February. By contrast, visits to parks and residences had increased a little less than 10%.

Google says its reports are based on “aggregated, anonymized sets of data” from users who have turned on their accounts’ location history setting, which is turned off by default.