The Greek covid-19 miracle and a fax machine
If you want to read this story in Greek you can do it here
Greek government has decided to ban the use of the fax machine in the public sector, with the new Digital Governance Code. Even so, it is amazing and puzzling that the National Public Health Organization (EODY) is still using today a single fax machine to receive the reports on covid-19 positive tests by doctors from all over the country.
In fact, in the beginning of the pandemic, this single fax machine was the only way the private sector labs and practitioners could report to the administration the positive results of the coronavirus tests as well as personal details of the people tested. It was not until April the 3rd that EODY made available to them an excel form, that could be encrypted and sent back by email only to authorised personnel. By that time, the number of covid positive tests have gone beyond 1600 and people had died of coronavirus in several areas of the country, Thessaloniki, Athens, Ilia and Achaia in Peloponnese, Zakynthos, Kastoria and Kozani, Pella, Xanthi, Evros and Crete.
At that same date, EODY has asked all private laboratories performing molecular testing for COVID-19 (RT-PCR) to send retrospective information on all the tests performed and positive results they had since the beginning of the pandemic. Why was there a need for collective data? According to biopathologists, especially during the first week private laboratories started to test patients for COVID-19, they had to keep trying to get through the fax line in order to send their report. Many doctors and lab personnel were confused as to whether they had to report only on the positive tests or on negatives too, while up until the end of March there was no penalty by law if a doctor failed to report on a COVID-19 case.
According to the organisation, the form «Mandatory Declaration of Infectious Disease Case of New Corona 2019-nCoV» is only one of the ways they are using, in order for all the doctors, nurses and others involved in the management of the disease outbreak to declare the event. According to the information on the form, it is «to be filled in either by the treating physician and the lab doctor or by either one of them» and to be sent in a specific fax number. We asked EODY to specify whether this procedure was in fact the only one available for all private sector testing up until the beginning of April. The organisation simply referred us for the procedure to their website.
After we received complaints by private biopathologists that the fax line was often busy, especially at the beginning of the COVID pandemic and well into March, on the 28th of April we called the phone number provided for information on the form. We asked whether, instead of the fax, we could send the form by email. «No, it should be sent by fax whenever you can», we were told. «The line is busy because there is one fax in the room and it takes calls from all Report Centers (of the disease), labs… There is nothing I can do about it».
The same employee verified that there are no more fax lines for this purpose, adding: «The fax is next to me, I can see it’s constantly busy. So it’s working. It’s just too much coming in».
One could only wonder why, in the midst of such a crucial time, EODY continues to use a fax machine with a single line. This was apparently an old procedure, used many years now to report cases of infectious diseases and to summon epidemiologic data. With the outbreak of COVID-19, the needs to report on the disease multiplied. So, on the end of March, a bill was passed for the creation of a National Database of Patients with COVID-19. A few days later, on April the 3rd, all private laboratories were called upon to inform the system with all data collected previously and all positive results. Ever since, private laboratories use the new excel form for daily updates. Yet the fax remains in use, probably as a backup. At least it seems that in the public sector, a more organised method of reporting the disease cases was adopted sooner. According to information from the Microbiology Lab of Patras University in the General University Hospital of Patras (which is one of the Report Centres of the disease), the lab started reporting their results to EODY via the coded excel form since March 13.
«During the first days there was a difficulty, things were not well organised and we were not properly informed» says biopathologist Panagiotis Makridis, president of the board of Laboratory Doctors Cooperative MEDISYN, which has 550 biopathologists as members all over the country. Their members can send viral samples for more explicit tests, such as molecular control of COVID-19, to any of the four laboratories of the Cooperative in Greece. «The problem was gradually restored, and we have now reached the point where we should be at the beginning. A link with which all doctors who perform tests can connect and directly inform the system, without the need of anyone’s involvement. Without obsolete methods like a fax, without a telephone, or anything else».
Biopathologist Maria Kalamari, S.G. of MEDISYN and member of the board of the Medical Association of Piraeus, who is a private practitioner performing tests for COVID-19 on the lab of the Cooperative, said that in order to send a fax for a positive sample, she had to wait on the fax machine for 45 minutes. A few weeks later, waiting was even worse. The line was constantly busy, and doctors were not sure whether they had to report on all the tests they performed. In fact, most only did send the positives, this resulting to a lack of backdrop data.
Finally, on March 27th, EODY issued «Instructions of Epidemiologic Surveillance of Covid-19 infection», where it was clarified (and highlighted with a red margin and an “Attention” signal) that one had to send the report form with the fax only for positive test results.
Beyond confusion and inconvenience, could there be positive tests missing from the final counting? This depends on the work done by EODY on cross-checking the results gathered. According to information, at least one lab certified for the method PR-PCR was only summoned to hand in the full data of previous tests only by mid-April. Also, there seems not to be yet in EODY a full list of all private sector labs that perform the test on COVID-19 patients.
THE FAX MACHINE AND… GOOD OLD GREEK PUBLIC SECTOR
Still we may wonder why «the fax machine»? When EODY was established in 2019 (Law 4633/2019, article 10), it was stated that every public or private agent has to report disease by «every means available and, especially, by digital means». It is the same law that provides for no penalty if a case fails to be reported, leaving in other words a loophole for any laboratory or other doctor that might neglect to fax a COVID incident. Especially since the fax was busy.
On March 27, EODY changed at least the telephone number “for information” provided on the coronavirus report form. At first, it was a general line on the Operation Centre of the organisation. This was consequently replaced with a phone line in the office with the fax machine.
We called the initial phone number on the form- the one on the Operation Centre- and asked if there was another way to report a COVID case. The employee, who was obviously unsure of the procedure, said we could also email the test results and provided us with the email address of the Centre of Operations. But, he added, you must also send it by fax, at some point. We insisted on the procedure and were told to contact another line on the office «upstairs». Doctor Maria Kalamari called on the line and asked for specifications. The answer was clearer, this time, though somehow puzzling! «Only with fax you should send it, since there are personal data involved»!
WHAT ABOUT PERSONAL DATA?
«Not only is the fax not suitable, but in fact it is forbidden for the protection of personal data» explains Mrs Aggeliki Mitropoulou, lawyer and data protection officer of GAGDPR Consulting. «Especially when we don’t know where this fax is located. Do you know where this fax is? Is it at least in a secluded office, do other people have a key, or is it not locked at all and everyone can access it? Then there is no protection of personal data, on the contrary there is a breach of personal data».
Can the fax be considered safer than an email? «Of course not, on the contrary. An email can be rendered totally unreadable to someone who is not authorised», explains Mrs Mitropoulou. She believes the data protection issue is wider. Despite the fact that Hellenic Data Protection Authority has issued guidelines for the processing of personal data during the management of COVID-19, neither EODY, nor any public hospital, as she states, is in line with the regulation on the protection of data.
NATIONAL PATIENT REGISTRY
On March 30, a National Registry for coronavirus patients was established. A move that actually recognises the need for a more complete recording of the COVID-19 cases. Also, for the first time, punitive measures were established for failure to report a case. In particular, a temporary six-month suspension of license (and a revoke of license in case of recurrence) for legal entities under private law. For private physicians, this is a disciplinary offence to be punished by the president or the disciplinary board of the Medical Association.
For the time being, the National Registry is still in a pilot phase. As we were informed by IDIKA (Social Security E-Government), «the National Registry of Patients with COVID-19 has been put in productive operation on the first phase, during which it is informed on already registered cases».
This story was concluded with the support of Reporters United.