Covid-19 Information Protection: Between Information Privacy, Health Secrecy and Public Safety

Abstract

To contribute meaningfully to the fight against disease outbreaks, the media should not just funnel predetermined health news to the audience. It should also play the vital role of convincing citizens to protect themselves and to shun rumors, misinformation and conspiracy theories that disfigure reality about infectious diseases. The present study examines alleged Covid-19 information concealment in Nigeria, which is thought to account for citizen uncooperativeness in the fight against the disease. It highlights the distinctions between data privacy and information secrecy. Using Spearman’s rank correlation, Chi-square and linear regression, we analyzed data from 183 statistically selected respondents from two states and the Federal Capital Territory in Nigeria. Data were also generated from qualitative survey of 12 health editors, two public affairs analysts and two government officials. Results indicate negative relationships between compliance with Covid-19 containment measures, citizen opinions on Covid-19 information protection and opinions on Covid-19 controversies. Data from qualitative survey suggest that government’s protection of information forces editors to report stories without “human face.” The study highlights the need for distinctions between physical privacy, information privacy and related concepts in the enforcement of health information privacy. This is to avoid sacrificing the public’s right to know in the guise of health information protection.

Keywords:

• secrecy
• Covid-19
• health
• privacy
• disease

PUBLIC INTEREST STATEMENT

When infectious diseases break out, major information sources must be transparent to convince people to obey health instructions. The study looks at issues about the hiding of important Covid-19 information, which made some people to think that Covid-19 was not real. We asked 183 people in Lagos, Enugu and Abuja what they think about the accusations that government and the media concealed important information about Covid-19. We also asked them how they obeyed health instructions and what they think about some arguments surrounding Covid-19. We asked health editors and social commentators about government’s information protection. We found out that people obeyed the instructions, although they doubted some information because government and the media were not transparent. The editors said they were not allowed to get the kinds of information they wanted. We recommended that government should not endanger society because it wants to protect those who have Covid-19.

1. Introduction

Since 19 December 2019, when the new Covid-19, a severe respiratory syndrome, was first reported in Wuhan, China, the disease has presented confounding attributes in its mutations, transmission process, symptoms and treatment. As a result, responses to Covid-19 have varied considerably, especially in developing countries, where people need to be constantly stimulated to adopt health-promoting behavior. The media have thus stridently alerted people to the deadly nature of the disease. With one of its reports, The New York Times on 24 May 2020, showed how journalism can positively impact the fight against emerging infectious diseases (EIDs), even when the subject matter concerns death. On pages 1 and 12, the newspaper listed the names and addresses of 1,000 out of the nearly 100,000 Covid-19 deaths in the US at the time. “They were not just numbers in our list, they were us,” said The New York Times, which had something to write about each one of the dead. They got names, age and one special attribute about the dead as shown in the following example:

There was a Nigerian, Bassey Offiong, 25, from Michigan who “met the worst in people but brought out the best in them.” Or Frank Gabrin, “an emergency worker who died in husband’s arms.” Fred Grey who “liked his bacon and hash browns crispy,” Dante Flagello who’s greatest achievement was “his accomplishments with his wife.” There were firefighters, storekeepers, people who brought smiles to people, a grandma who sang every school year to his grandchildren, a woman was in her church choir for 42 years.

This type of human-interest reporting has so far been rare in Nigeria, where many people wonder about the factors militating against editors’ efforts to provide vivid images and evidence-based reports on the incidence of Covid-19 (Iredia, 2020; Moshood, 2020). The alleged inadequacy of vivid images has led to a growing concern that some kinds of official protection of information on Covid-19 in Nigeria may be the cause of dwindling citizen responses to disease containment measures, and this poses a big threat to the fight against Covid-19 (Abati, 2020; Iredia, 2020; Moshood, 2020). The World Health Organization (WHO, 2020) recently warned that developing countries face dire threats due to the virus as infections continue to spiral amidst widespread improper behavior towards the disease (Qazi et al., 2020).

In general, studies have reported varying levels of compliance with Covid-19 measures, with developed societies (e.g., the UK, Italy, United States) showing higher levels of compliance than developing societies, e.g., Nigeria and South Africa (Matrajt & Leung, 2020; Nuria et al., 2020; Soo et al., 2020). Some of the factors responsible for the high levels of adherence include fear and government enforcement (Matrajt & Leung, 2020; Soo et al., 2020). In developing countries, factors such as fake news and protection of information on Covid-19 are alleged to be high (Iredia, 2020; Moshood, 2020; OECD, 2020; WHO, 2020). Other attributes such as place of residence, age and sex were also important demographic factors affecting adherence to the measures (Bloom et al., 2017). The present study focuses on the role of information protection on citizen adherence to Covid-19 containment measures. The study uses data from a cross-sectional survey and interviews with health editors, social commentators and government officials. We take note of arguments and regulations on protection of patients and their relatives against stigmatization through confidentiality of health records (Kalra et al., 2006; NBC, 2016; WHO, 2016).

2. Research Questions and Study Hypotheses

Specifically, the objectives of the study were to:

1. ascertain the regularity of compliance to the Covid-19 containment measures by Nigerian citizens

2. evaluate the opinions of Nigerians on Covid-19 information protection

3. appraise citizens’ opinions on Covid-19 controversies

4. ascertain the opinions of media editors and public affairs analysts (health editors, social commentators and government officials) on access to information on Covid-19.

The study was guided by the following hypotheses:

Hypothesis 1. There is a relationship between compliance with Covid-19 containment measures (CCM), citizen opinions on Covid-19 information protection and level agreement with Covid-19 controversies.

Hypothesis 2. Demographic factors significantly influence citizen opinion on Covid-19 information protection.

3. Covid-19 information protection and controversy in Nigeria

Covid-19, as a pandemic, is itself a child of purported information secrecy. As of 29 May 2020, the US had cut ties with the WHO over its alleged collusion with China to hide important information about the disease, which caused its global spread. As the situation continues to unfold, the global fight against Covid-19 has been increasingly based on data sharing on preventive measures (Palder & Mackinnon, 2020). In Nigeria, by contrast, media images reflect more of untold stories about the disease (Iredia, 2020).

Covid-19ʹs dark alley began on 27 February 2020, when Nigeria’s index case, an Italian, tested positive for the virus. The veiled identity of the Italian and contact tracing related to the index case led to controversies that apparently triggered a credibility crisis about the disease (Bassey, 2020). The controversies revolved around coronavirus vaccines, herbal remedies, infectious disease bill, isolation and treatment of victims (Abati, 2020; Iredia, 2020).

On 28 May 2020, the identity of one Covid-19 victim was published on Facebook by the Abia State government (in southeast Nigeria), the first and only such act in Nigeria. The victim had escaped from an isolation center and his pictures were published to alert the public. Curiously, no media organization used the Facebook picture in their report on the incident (Udeajah, 2020). On 16 October 2020, the media in Nigeria simply reported the infection of 181 pupils in a school in Lagos, Nigeria, without mentioning the name and location of the school.

A Nigerian newspaper once illustrated a Covid-19 story with an internet picture of a functioning isolation center published by The New York Times on 16 April 2020 (Owoseye, 2020; Figure 1).

Figure 1. Functional Covid-19 treatment centre published in Premium Times, 16 March 2020, but culled from The New York Times.

This signified an understanding of the need for such pictures, which unfortunately were hardly published in Nigeria (Figure 2).

Figure 2. A Covid-19 isolation center without humans at the Sani Abacha Stadium in Kano, Nigeria. Photograph: Aminu Abubakar/AFP via Getty Images The Guardian, 28 April 2020.

As noted, the alleged paucity of such pictures may have caused widespread skepticisms towards Covid-19 in Nigeria (Mojeed, 2020; Moshood, 2020; Owoseye, 2020). The Organization for Economic Cooperation and Development (OECD, 2020) recognizes the credibility problem facing Covid-19 in developing countries, and has highlighted the role of communication and media ecosystems in restoring public confidence, integrity and citizen participation. The OECD emphasizes clear, definitive and transparent information as well as consistency in warning about the risks of wrong and blurry information.

4. The tension between health information privacy and public’s right to know

For more than a century of research, privacy has remained a thorny issue mainly due to its multifaceted nature (Margulis, 2003; Smith & Dinev, 2011). The concept of privacy is shaped by the dominant ways in which it is perceived in various fields, e.g., emotional response (psychology), ethical principle (philosophy), a right and a state (law), cost-benefit commodity (economics), ideology and personal control (socio-politics; Dinev et al., 2013).

Privacy generally refers to the collectability, authorization, generation, storage and use of personal information and/or accessibility to a person’s physical space (Smith & Dinev, 2011; Solove, 2006; Westin, 2003). Smith, Dinev and Xu (Smith & Dinev, 2011) distinguish between physical privacy and information privacy. The former refers to the solitude of a person’s occupied space or the desire not to be invaded in a person’s environment. Information privacy refers specifically to protection against unwarranted access to personal information. The authors observe that historically physical privacy appeared in the literature and theory before information privacy, especially because the latter was originally subsumed in physical privacy prior to the 1970s.

With the dramatic rise in information access and use as from the 1970s, people increasingly recognized the danger posed to their personal records by the emerging technologies of information. Consequently, emphasis shifted from physical privacy to information privacy (Smith & Dinev, 2011; Westin, 2003). We argue that Covid-19 heightens the need for such distinctions to better define the goals of health information protection, particularly in the context of infectious diseases. Smith, Dinev and Xu (Smith & Dinev, 2011, p. 991) aptly observe:

We note that the distinction between physical and information privacy is seldom clarified in public debate or, for that matter, in many areas of research. For example, comments about privacy violations in the public media seldom draw a clear distinction between the constructs of physical and information privacy … . The situation is the same with the legal language and the laws in many countries.

This leads to the crucial questions, which studies on privacy have attempted to answer over the years, namely, what is privacy, why is it necessary, how does it differ from related terms (e.g., confidentiality, secrecy, anonymity, security), and to what extent can context define the application of privacy in data collection and use (Bynum, 2008; Pearlson & Saunders, 2009). Due to a diversity of views from various fields, the questions have not received a consensus in answers (Dinev et al., 2013). In the health arena, all the views apparently contribute to the dialectics of privacy (Kalra et al., 2006).

Without doubt, health information privacy protects the sick from undue publicity, and studies have reported its benefits in drug development, human relations and treatment protocols (Carey et al., 2020; Dinev et al., 2013; Kalra et al., 2006). However, the thorny issue often is how to handle privacy when the disclosure of personal health information may stigmatize the sick/information volunteers, while data protection may endanger the wellbeing of the non-sick (Institute of Medicine, 2009; Kalra et al., 2006). Researchers are concerned that data protection can harm medical practice as well as the safety of society when misleading information replaces accurate, but protected information (BBC, 2020; Carey et al., 2020; Hammerstein, 2012; Moshood, 2020). Studies show that many disease outbreaks were aggravated by fake information and conspiracy theories, e.g., the Ebola outbreak in West Africa, Zika outbreak in Brazil, and not least the Covid-19 pandemic (BBC, 2020; Carey et al., 2020).

In Westin’s theory of general privacy, the individual is responsible for ensuring their own anonymity, solitude, reserve and intimacy (Westin, 2003). Similarly, Altman (Altman, 1977, p. 24) proposes a theory of general privacy, based on “the selective control of access to the self.” Other scholars have corroborated this view by pointing out the centrality of the individual in making core decisions about access to their occupied space and to their personal details (Laufer & Wolfe, 1977; Margulis, 1977; Schoeman, 1984). The central issue in the theory of general privacy is “an individual’s right to be left alone” (Smith & Dinev, 2011; Solove, 2006).

Scholars have however also pointed out the part to be played by society in regulating an individual’s privacy rights, namely, that specific laws should mandate individuals to release personal health details to researchers, healthcare providers, marketers, and drug developers (Dinev et al., 2013). This is based on the research finding that environmental and interpersonal elements mediate privacy (Dinev & Hart, 2007; Institute of Medicine, 2009). Smith, Dinev and Xu (Smith & Dinev, 2011, p. 985) observe that privacy must imply “a continuum of states of privacy from absolute to minimal.” Cate (1997) argues therefore that general privacy reflects the struggle for control between society and the individual. As such, it is difficult to defend a definition of privacy that gives sick individuals absolute right to solitude when that could critically endanger others (Solove, 2006). Scholars have considered the multifaceted nature of privacy and have stressed that the value of privacy lies in the context of its application. Context helps to resolve the conceptual crisis facing privacy in its multifaceted nature as a goal, behaviour, process, attitude and state (Aquisti, 2004; Margulis, 2003; Sheehan, 2002).

Apart from the role of context, there is also a need to distinguish between privacy and related terms (confidentiality, security, anonymity), some of which can be the specific goal of privacy, instead of being equated with it (Carey et al., 2020; Hammerstein, 2012; Qian & Scott, 2007; Smith & Dinev, 2011). Confidentiality refers more to efforts to ensure that health information obtained from consenting individuals in a defined relationship such as doctor-patient communication is not illegally disclosed to a third party (Kalra et al., 2006). Publication of health records may not necessarily negate confidentiality. It can preserve anonymity without sacrificing publicity, thereby helping to separate physical privacy from information privacy (Bassey, 2020). Anonymity relates to concealing the identity of a person and their occupied space or personal information about a person, while publicizing details about their health. Television stations, for instance, close-off the faces of Covid-19 victims or use long shots while showing the efforts of government and health workers on the frontline to save society (Bassey, 2020; Moshood, 2020).

When anonymity is equated with privacy, it may lead to secrecy, false and misleading information. Secrecy is a deliberate and total concealment of information, which often masquerades as confidentiality (Qian & Scott, 2007; Zwick & Dholakia, 2004). Smith, Dinev and Xu (Smith & Dinev, 2011, p. 996) note that “although secrecy is easily distinguishable from privacy, they are often mistaken and confused with each other.” Citing Bok (Bok, 1989, p. 11), they further state that “privacy need not hide; and secrecy hides far more than what is private.” As a result, secrecy is more akin to manipulation and is more likely to cause citizen incredulity towards health information (Bassey, 2020; Iredia, 2020).

Furthermore, security of data refers to evidence of effort made to ensure that unauthorized parties do not have access to confidential health information (Goldman & Choy, 2006; Kalra et al., 2006). In a case of data leak, security measures are assessed to determine liability. Government is expected to protect health data in terms of security and confidentiality, but disclosure is still possible if it would guarantee public safety, and it can be done without identifying patients’ occupied space or exposing them to stigmatization (Moshood, 2020).

The present study focuses on respondents’ opinions on Covid-19 information protection and level agreement with containment measures. Opinions on Covid-19 information protection refers to people’s views about whether or not there were attempts by government and/or the media to conceal information on Covid-19. It is used to test the views of respondents on how they see government’s efforts to protect information about Covid-19 victims.

5. Methods

The study involves a cross-sectional quantitative survey, qualitative survey and unstructured personal interviews. Ethical approval for the study was granted by the Faculty of Arts Research Ethics Committee, University of Nigeria, Nsukka, Enugu State (form number UN/FA/FAREC/02392020). The human research participants also granted personal consent before completing the questionnaire.

5.1. Cross-sectional survey

The quantitative survey compared relationships among three groups of variables, namely, compliance with Covid-19 containment measures (CCM), citizen opinions on Covid-19 information protection (OCIP) and opinions on Covid-19 controversies (OCC). Two states in Nigeria (Lagos and Enugu), and the Federal Capital Territory (FCT) were sources of data for the quantitative survey. As of 5 December 2020, Nigeria had 68,627 confirmed cases. Of these, Lagos had the highest incidence at with 23,660 (34.47%) cases. The FCT had the second highest incidence with 7,101 (10.34%) cases, while Enugu, the 12th most affected state, had 1,332 (1.94%) cases. The capitals (Ikeja, Enugu and Abuja Municipal Area Council, AMAC) were purposively chosen due to the limitations imposed by the pandemic in going to sub-urban areas.

5.2. Procedure

The study adopted a multi-stage sampling technique owing to the heterogeneous nature of the population (Babbie, 2013). First, the state capitals were stratified according to existing local government areas. AMAC was considered as a cluster of residential areas since it does not have local governments. Eight local government areas (four for each state) were selected by simple random technique. A sample size of 384 was statistically computed based on the populations of the eight local governments and AMAC. Thereafter, we created a sampling frame composed of residential areas in the (eight) local governments and AMAC. From the residential areas, five streets each were selected through the simple random technique. Using the systematic technique with an initial random selection, 384 individual households were selected from each of the five streets. Number of households visited in each study area was proportionally allotted according to the residential differences as follows: Ikeja (151), Enugu (111) and AMAC (122).

Journalists were recruited as research assistants, because they were thought to be better suited to generate data in the mood of the pandemic. One of the authors is a practicing journalist. The journalists used their personal protective equipment in addition to enjoying some privilege because of their identity as journalists. The study began on 7 May 2020, two days after government began a phased end to the lockdown, which began on 30 March 2020. After granting consent, residents 18 years and above were requested to complete the questionnaire. A total of 212 copies of the questionnaire was retrieved, while 183 were used in the final analysis. This included 94 male and 89 female respondents.

5.3. Measures

Data were collected with a self-developed, 27-item, structured questionnaire. The sections include demographic attributes (age, economic status, sex, educational level, occupation and state of residence), compliance with CCM (i.e. regularity of adherence to preventive measures), opinions on Covid-19 controversies (i.e. viewpoints about trending controversies, e.g., debates surrounding coronavirus vaccines, herbal remedies, infectious disease bill, isolation and treatment of victims), and respondent opinion on Covid-19 information protection (level of agreement with information concealment). Variables were measured on a 5-point Likert scale. The instrument was validated by three senior lecturers drawn from the department of psychology at the University of Nigeria, Nsukka. Using the Cronbach alpha method, reliability co-efficiencies of 0.78, 0.67 and 0.84 were calculated based on three self-developed scales (CCM, OCC and OCIP). Spearman rank correlation, Chi-square test of influence and linear regression were used for data analysis in SPSS, version 23.

5.4. Qualitative survey of health editors

Formal participation requests were sent by e-mail to all 28 national newspapers in Nigeria and four television stations. While all the newspapers are privately owned (there is no government-owned national newspaper in Nigeria), television stations were purposively selected from government-owned and private television stations. Health editors in newspapers and television stations were used for the study because they have first-hand experience of issues arising from access to information. With a journalist as part of the present study, access to fellow journalists and the interviewees was facilitated through established contacts. Ten health editors from eight newspapers participated in the study (Daily Sun, The Guardian—two editors, Nation, This Day, Punch, Daily Trust, Premium Times and Vanguard −2 editors). Two health editors came from two television stations, one each from a government owned medium (The Nigerian Television Authority, NTA) and a privately-owned station (Africa Independent Television, AIT).

The editors helped in deconstructing the text of their own responses to suggest themes. They also read the results of the study to offer final guides. This was done to validate data and to eschew bias. An editor is a person who schedules reporters for reportorial activities and may also edit and package news reports for publication. The editors completed a 10-item unstructured questionnaire. Some of the questions are:

1. Can you describe how you have covered the pandemic: type of media writing used (e.g., news), images shown, areas visited for reporting, and ways of sourcing information?

2. What were your sources of information on Covid-19?

3. What are some of the factors that affected your coverage of covid-19?

4. In what ways did government support your efforts?

5. What government actions or directives affected the professional and ethical discharge of your duties towards the pandemic?

6. What do you think people wanted in your reports which you did not report?

7. Kindly describe people’s attitudes to Covid-19 in Nigeria from your experience as a member of society and from audience responses to your reports, e.g., on your social media platforms.

8. Describe the scenes in the isolation centres covered by your medium (name them if you can)

In addition, two public affairs analysts and two government officials were interviewed by telephone due to expected issues that may arise from editors’ reference to audience interests and government’s handling of Covid-19 information. The respondents granted permission before the instrument was administered to them. A public affairs analyst is a commentator on current issues in society. The interviewees were asked about government policy or tendency not to reveal the situation in the isolation centers and the apparent secrecy surrounding Covid-19 in Nigeria. They answered six unstructured questions each, after significant prodding to proffer information.

5.5. Coding

With the help of the editors, we developed the final themes after initial coding. These include: (1) information sources (2) restrictions to isolation centers and using images of Covid-19 patients (3) reasons for limitation of access to information (4) consequences of constraints to information gathering. For the purpose of reference, the study uses the code Res, attached to a serial number (1–12), to identify the health editors. The interviewees were given the code -Pub, attached to a serial number as follows: Pub 1 (government official), Pub 2: (NCDC official), Pub 3: (public affairs analyst 1) Pub 4 (public affairs analyst 2).

6. Results

Table 1: Compliance with Covid-19 Containment Measures

Table 1. Below indicates respondents’ compliance with Covid-19 containment measures CCM

Compliance with CCM	Very regularly (%)	Regularly (%)	Rarely (%)	Very rarely (%)	Never (%)
Exposure to information about the risk factors of Covid-19	76(41.5)	79(43.1)	13(7.1)	8(4.3)	7(3.8)
Appropriate use of face masks	46(25.1)	82(59.4)	27(14.7)	14(7.6)	14(7.6)
I observed personal hygiene	79(43.1)	75(40.9)	12(6.5)	10(5.4)	7(3.8)
I paid attention to information on preventive messages	28(15.3)	70(38.2)	43(23.4)	16(8.7)	26(14.2)
I observed social distancing rules	46(25.1)	89(48.6)	32(17.4)	12(6.5)	4(2.1)
I made avoidable trips out of my state n = 178	1(0.5)	12(6.7)	16(8.9)	22(12.3)	135(75.8)
I corrected those not complying with containment measures n = 181	32(17.6)	56(30.9)	32(17.6)	18(9.9)	43(23.4)

Results from Table 1 indicate a high level of compliance with CCM. The majority of the respondents indicated that they had exposure to information on the risk factors of Covid-19 and adherence to safety protocols such as the use of face masks. The percentage of those who attempted regularly or very regularly to correct non-compliant people (48.5%) also points to commendable efforts towards compliance with the safety measures. Information on respondents’ opinions on secrecy of information on Covid-19 is shown on Table 2.

Table 2. Citizens’ Opinions on Covid-19 Information Protection

Perception of Media Messages	Don’t know	Strongly disagree	Disagree	Agree	Strongly agree
My inability to see cases negatively affected my belief in the existence of the disease	20.2	17.9	13.9	27.2	20.8
I think there were fewer cases than revealed	38.2	16.3	16.3	19.8	9.0
Fake news thrived due to curiosity for accurate information	18.5	11.8	19.7	37.1	12.9
My inability to see cases affected my faith in the existence of the disease	4.5	13.5	17.4	43.8	20.8
I would not blame anyone who suspects foul play with the disease	41.4	14.9	6.4	28.7	8.6
Government is not secretive with information about Covid-19	25.7	20.4	19.8	25.1	9.0

Data from Table 2 indicate that nearly half of the respondents think that their inability to see cases of victims negatively affected their belief in the existence of Covid-19. Among the 52% who did not agree with the opinion, one-third of them (20.2%) still indicated the option “don’t know”. This implies that most of the respondents did not directly disagree that the paucity of images of victims affected their belief in Covid-19. This was bolstered by another 65% who did not at least disagree that government was not hiding Covid-19 information from the public. The majority of the respondents also support the opinion that protection of information on Covid-19 victims fuelled fake news about the disease.

Despite the majority agreement that government protected information about Covid-19 victims, most of the respondents believe that Covid-19 was actually in Nigeria (Table 3).

Table 3. Opinions on Covid-19 Controversies

Covid-19 Controversies	Strongly agree (%)	Agree (%)	Disagree (%)	Strongly disagree (%)	Can’t say(%)
Covid-19 was not actually in Nigeria n = 183	4(2.1)	16(8.7)	56(30.6)	71(38.7)	36(19.6)
Compliance with CCM can’t prevent Covid-19 n = 179	12(6.7)	25(13.6)	79(44.1)	43(24.0)	20(11.1)
Government shared palliatives n = 179	36(20.1)	46(25.6)	24(13.4)	49(27.3)	24(13.4)
We only need divine protection	9(4.9)	20(10.9)	41(22.4)	9(4.9)	25(13.6)
Covid-19 figures from NCDC were contrived n = 177	12(6.7)	45(25.4)	40(22.5)	53(29.9)	27(15.2)
Nigerians do not fall ill from Covid-19 n = 177	7(3.9)	39(22.0)	50(28.2)	53(29.9)	28(15.8)
Govt. helped foreigners import Covid-19 n = 179	13(7.2)	42(23.4)	38(21.2)	37(20.6)	49(27.3)
Vaccines are for ulterior motives n = 178	27(15.1)	23(12.9)	35(19.6)	20(11.2)	73(41.0)

The respondents also corroborated their high adherence to CCM with the indication by the majority that compliance with CCM prevents the spread of the disease. Responses to the questions on disease susceptibility, complicity of foreigners in importing the disease into Nigeria and ulterior motive behind the vaccines show that the majority of the respondents do not agree with the notions. This implies that the majority of the respondents agree with the opinion that there was high official protection of information. They also acknowledged its negative impact on their belief in Covid-19, though the impact tended more towards doubt than total unbelief.

The level of relationships between compliance with CCM, OCC and OCIP were analyzed using Spearman’s rank correlation statistics while the specific changes in compliance with CCM due to OCC and OCIP were measured using linear regression analysis. The data for the correlation and regression analyses were transformed by obtaining the average of responses on the items for CCM, OCC and OCIP for each respondent. The transformed data were used to obtain relationships between the three factors (CCM, OCC and OCIP) and the results presented in Table 4. The results reveal a significant negative relationship between compliance with CCM and OCC and CCM and OCIP. These indicate that OCC and OCIP have significant negative influences on compliance with CCM. Also, there are significant regression coefficients of −0.031 and −0.173, respectively, for OCIP and OCC. Therefore, for every OCC, there is a 0.173 negative influence on the respondents’ compliance with CCM and for every OCIP, there is a 0.031 negative influence on compliance with CCM.

Table 4. Relationship between compliance with CCM, OCIP and OCC

Variable		Regression		Correlation
		Coefficient	t (p-value)	Coefficient (p-value)
Opinions on Covid-19 controversies (OCC)		−0.031	5.039 (0.00)	−0.230 (0.003)
Citizen opinions on Covid-19 information protection (OCIP)		−0.173	−4.211(0.00)	−0.335 (0.00)

Dependent variable = CCM, Regression ANOVA = 5.215, P-value = 0.001, R-square = 0.561

The influence of demographic factors on respondents’ opinions on Covid-19 information protection (OCIP) was analyzed using Chi-square measure of association. The results are displayed in Table 5 where significant Chi-square values are flagged.

Table 5. Chi-Square Test of Influence of Demographic Factors on OCIP

Opinion on Information Protection	Demographic Factors
	Age	Sex	Economic Status	Marital Status	Occupation	State	Education
My inability to see cases affected my faith in the existence of the disease	52.31*	21.94*	30.76*	19.25*	30.36*	27.72*	16.37*
There were fewer cases than revealed	33.65*	12.14*	44.13*	13.95*	34.45*	31.66*	11.82
Fake news thrived due to curiosity for accurate information	36.45*	6.50	20.29	11.79	20.53*	15.52	18.44*
Showing images of victims is necessary despite fears about stigmatizing them	24.28	11.30*	37.58*	8.71	29.90*	23.09*	24.43
I would not blame anyone who suspects foul play with the disease	20.37	13.46*	25.43	10.90	22.99*	13.23	15.16
Government is not secretive with information about Covid-19	26.11	16.38*	27.68*	14.18	9.97	25.29*	17.25*

Sex and occupation have the most significant influence on all the options for OCIP, except the option that ‘government is not secretive with information on Covid-19 (for occupation) and “fake news thrived due to curiosity for accurate information” (for sex). A significant number of respondents who indicated that their inability to see cases affected their belief in the existence of the disease were within the age range of 18–33. A significant number who made the same choice of option also came from the poor and middle-income earners, the male gender, the never married, students and employees, Enugu State residents and those with tertiary education. Sex and occupation were the only factors that significantly influenced choice of the option: “I would not blame anyone who suspects foul play with the disease.”

6.1. Results from qualitative data

Results are presented based on the themes developed from questions presented to the respondents. The code “Q” represents a question, and the numbers attached to the code “Q” represent the numerical order of questions. Q1, therefore, represents question 1. As earlier indicated, the study uses the code Res, attached to a serial number (1–12), to identify the health editors. The interviewees were given the code -Pub, attached to a serial number as follows: Pub 1 (government official), Pub 2: (NCDC official), Pub 3: (public affairs analyst 1) Pub 4 (public affairs analyst 2).

Source of information on Covid-19

The editors reported that they sourced information mainly from government sources, which often involved press briefings and news releases. They however noted that their personal efforts to contact news sources to verify or to investigate issues often met with refusal to grant interviews or unanswered calls.

Q1 [Res 1] I have covered the Covid-19 pandemic using all forms of media, news, features and of course images were used. I visited IDH [an isolation centre], attended a training and conferences both online and offline. That’s how I source for my stories.

Q1 [Res 4] My coverage of the Covid-19 pandemic has been basically by telephone and online interviews as well as literature reviews. Regular visits to the websites of WHO, NCDC, UNAIDS and many other relevant organizations as well as press statements were handy. I only visited the isolation center at Lagos University Teaching Hospital (LUTH) Idi-Araba once during the inauguration by the Presidential Task Force.

Q1 [Res 6] We used agency-sourced images of patients in the isolation centres in some of our videos, but we did not show their faces.

Restrictions to isolation centers and using images of Covid-19 patients

The editors indicated generally that access to the centers was highly restricted although some said that they had access at some points without meeting the patients. The editors noted that there was a clear indication that journalists were not permitted to visit the centers. After an influential Nigerian and media owner survived the disease, he relayed his experience to his broadcast station, which aired it. Res 12, a journalist in the station, who also participated in the present study, said:

Q2 [Res 12] xxxx was taken to the isolation centre after he was said to have tested positive for Covid-19. He came back and talked about his experience, saying that he doesn’t know the difference between Covid-19 and malaria because he wasn’t treated like a Covid patient. He was given just malaria drugs and paracetamol. After this was broadcast, NBC sent a warning note to the company few days later accusing xyz of airing information that threatens national security. We all know what that meant.

Q2 [Res 2] Sometimes the authorities were not quite clear on true nature of facilities in the isolation centres as not much access is allowed to centres. Sometimes govt. media teams film and bring images of the isolation centres. So difficult to access the true nature of facilities there and how patients cope there. Again we only hear of new cases without access to the patients and the facilities where they are kept (though perhaps peculiar to Delta State).

Q2 [Res 4] LUTH [Lagos State Teaching Hospital] dedicated one of its wards as an isolation center. The area was condoned with danger instructions all over the place warning people not to get near. All the health workers were fully kitted with the Personal Protective Equipment (PPE).

Q6 [Res 7] Getting real experts to interview; availability of fund to purchase airtime to hook up with numerous virtual conferences, interviews and WhatsApp chats, etc.; how much information the PTF are willing to disclose; what aspect of the pandemic my editors are interested in.

Reasons for limitation of access to isolation centers

The implication of lack of access to isolation centers was that images of patients were largely absent from stories. However, the reason given by government officials (protection of victims against stigmatization) seemed to be the reason that the media did not even source such images elsewhere. For instance, why did newspapers still refuse to publish the image of a Covid-19 patient who had absconded from an isolation center as published on Facebook by the Abia State government? Yet, one of the public affairs analysts noted that there was no law or ethics mandating the media not to show images of the patients.

Q2 [Pub 1]: It is against the ethics of the medical profession to reveal the medical records of patient except on the consent of the person in question.

Q3 [Res 5] We do not show patients in the isolation centres as a matter of policy so as to respect their dignity and break the chain of stigmatization.

Q3 [Pub 2] Revealing the identity of patients amounts to exposing them to stigma and at the same time discouraging others who might be infected not to come out openly for possible testing and treatment.

Q3 [Pub 4] Apart from the confidentiality of a medical patient, there is no express law that prohibits the media from revealing the faces of Covid-19 patients. This issue can be resolved if the media outfit can approach the patient and if such a patient gives permission for the media house to do an interview. The biggest problem is that the NCDC has made it a policy for the media not to have access to the patients. This has constrained the media from having access to patents and denying them useful information.

Q4 [Pub 1] Countries of Europe and the US have suffered heavy casualties in terms of death tolls as a result of the pandemic. At least pictures of patience on treatment beds and ventilators could be seen while saddening pictures of dead ones are made open. Unfortunately, Nigeria’s curve is still on the rise while those of the above mentioned countries except Brazil and South Africa of recent are flattening on daily basis.

Constraints to reporting Covid-19 and their consequences to information gathering

Limited access to the isolation centers, virtual dependence on government for crucial information and lack of resources to pursue stories (transport fares, internet subscription, personal protective equipment) were major constraints to reporting the disease. The consequences, according to the editors, were incomplete stories, audience skepticisms, and feeling of professional inferiority for not being treated as essential workers or being estranged by information sources. While the public affairs analysts joined the health editors to bemoan the constraints, government officials however asked journalists to make their own effort to meet Covid-19 patients elsewhere and to get their (patients’) consent to publish information about their health status.

Q4 [Res 7] People were far from the reality of the disease, and that is why they show limited compliance with protective measures.

Q5 [Res 3] I was most affected by incomplete information, which did not answer key questions I wanted to resolve in their stories.

Q5 [Res 1] Movement restrictions affected my coverage of the pandemic. Also funds to foot my expenses also affected my coverage. Then, fear of the pandemic also comes to the fore.

Q4 [Pub 4] It is very sad and unfortunate that some Nigerians still doubt the existence of Covid-19. The virus and pandemic is real and continues to portend great fatal danger to humanity. The doubt in the minds of Nigeria is engendered by the secrecy of the Nigerian Government towards the handling of the pandemic. Firstly, there was scaremongering then the elites, especially, Government Officials, flouted the very rules on social protocol of Covid-19. Again, the utter secrecy in the treatment of the disease by doctors at designated govt. hospitals made it impossible for other health practitioners to take a cue from. So since the treatment was not made public the masses believed that there is no Covid-19.

Q5 [Pub 2] Instead of pressuring government to go against its policy, journalists should seek out those who have survived the disease or those who lost loved ones and collect information from them with their consent. Some of the casualties such as politicians, celebrities, business moguls among others, willingly disclosed their status, so it is left for anyone to freely give information about himself or herself.

7. Discussion

The study examines information protection surrounding Covid-19 in Nigeria. It makes comparisons between health information privacy and secrecy. Results from quantitative survey show a high compliance with CCM. Generally, respondents complied with containment measures significantly, although the majority indicated that government was secretive with Covid-19 information, and this negatively affected compliance with CCM and opinions on Covid-19 controversies (OCC). By implication, compliance with CCM could have been higher without the negative effects of OCC and OCIP. Studies have found high levels of compliance with Covid-19 messages and its positive influence on the spread of the disease (Matrajt & Leung, 2020; Nuria et al., 2020; Soo et al., 2020). However, reported high compliance with CCM in the present study may be explained by a high exposure to (possibly panic-prone) media messages. The majority of the respondents may have also found adherence easy because government enforced them. This aligns with findings indicating relationship between citizen cooperation with disease protective measures and ease of self-protection (Chen et al., 2013; Matrajt & Leung, 2020; Soo et al., 2020). This also points more to the cost-benefit and commodity perspective to privacy used in the economic and market arenas (Campbell & Carlson, 2002; Davies, 1997; Garfinkel, 2000).

In the present study, sex and occupation had a significant influence on citizen opinions on Covid-19 information protection. Also, the younger respondents, the poor and middle-income earners, the male gender, the never married, students and employees, and those with tertiary education were more likely to express doubt on Covid-19 messages due to the paucity of images of Covid-19 patients. Studies have also shown the importance of demographic attributes on attitudes to disease outbreaks (Bloom et al., 2017). This may have implications for the spread of controversies and fake information since younger people are likely to engage more in debates than older adults.

In view of the responses from the health editors and the public affairs analysts, the absence of media images of Covid-19 victims stems from government policy. Moreover, inadequate resources to pursue stories mortgaged media rights as gatekeepers, leaving government as major Covid-19 information brokers (Iredia, 2020). Responses from the government officials reflected a concern for ethics and protection against stigmatization of the sick and the need for journalists to personally obtain consent from Covid-19 patients to interview them. This, according to government sources, is in line with national and international laws and ethics of crisis reporting (Nigerian Broadcasting Code, NBC, 2016; WHO, 2016). However, referring to Sections 3.6 (Morality and Social Values), 4.6 (Privacy), and 5.4 (coverage of crisis and emergencies) of the NBC Code (NBC, 2016), the public affairs analysts in the present study insisted that the Code did not prohibit either government or the media from publishing images in a way that conveys public-interest messages. For instance, Section 4.6, subsection 4.6.1, articles “a, b & d” read:

A Broadcaster shall: a. respect the right of everyone to privacy; b. protect the sources of information in line with the Code of ethics for journalism; c. ensure that a person inadvertently appearing in a scene is not portrayed in a manner to cause him or her embarrassment.

Section 5.4 says that a broadcaster shall (a) “present news and commentary on a crisis or emergency in a professional manner, and, (b) at all times ensure the coverage of a disaster or crisis is aimed at overall public safety.” Accordingly, Moshood (2020) argues that the aforementioned report by The New York Times (2020) did not have information that could lead to any form of stigmatization, yet it portrayed indelibly instructive images to the audience. He insists that the world has since passed the stage of using the guise of Hippocratic Oath (vow by doctors to protect patients) to endanger the safety of people, adding therefore that the way the disease control agency has managed Covid-19 in Nigeria does not have human face. While government efforts in limiting access to images of Covid-19 patients may be in line with the uncertainties associated with emerging infectious diseases (Bloom et al., 2017; Kalra et al., 2006), concerns about public safety can intermittently override fears about stigmatization of the sick (Hammerstein, 2012; Center for Infectious Diseases, 2009; Carey, (Carey et al., 2020); (Margulis, 2003); Laufer & Wolfe, 1977).

It is therefore important to be concerned about the dangers of insisting on privacy as an absolute right or an issue of personal control during disease pandemics (Cate, 1997; Smith & Dinev, 2011; Solove, 2006). The theoretical perspectives on striking a balance between an individual’s privacy rights and social needs to temper such rights come into play (Aquisti, 2004; Sheehan, 2002). Government’s claim of protecting the sick against stigmatization and its action in rebuking the media for reporting isolation centers raise questions about the motive for insisting on data protection (Carey et al., 2020; Cate, 1997; Hammerstein, 2012). The distinctions made between information privacy and related terms show that attempt at information privacy should not be a subterfuge for secrecy (Carey et al., 2020; Hammerstein, 2012; Qian & Scott, 2007; Smith & Dinev, 2011).

Even when it comes to publishing information directly obtained from patients, the media, as earlier shown, seem to be applying a lot of caution. It was remarkable that no media firm published the image of the Covid-19 victim which was explicably published on Facebook by the Abia State government (Udeajah, 2020). Accordingly, one of the public affairs analysts noted that hiding information about victims of the disease could encourage community spread since the non-infected may not be able to shun areas where there were cases. For instance, the media simply reported the infection of 181 pupils in a school in Lagos, Nigeria on 16 October 2020, without mentioning the name and location of the school. In effect, many may have been in fear, confusion and doubts, which are progenies of rumors and misleading information (Carey et al., 2020). As Iredia (Iredia, 2020, para 4) puts it: “Nigerians who probably believe the pandemic exists also have ample doubts.” Unfortunately, the media that should clarify audience’s doubts are facing dire resource-related problems, which deny them the right and privilege of Covid-19 information gate-keeping.

Government should institute a crisis communication structure and invest in the training of health workers in government health institutions on how to work with the media during emergencies. The structure should consist of media firms, government institutions and health agencies. Professional media associations (e.g., the Nigeria Union of Journalists) can create groups of health reporters with identified journalists to link up with government and health institutions. This can become a body entirely under the Nigeria Union of Journalists or the Broadcasting Association of Nigeria. It can be called “communication emergency response team” because it can be used in any other social emergency such as an environmental disaster. Such a synergy will preserve government’s role as a major frontier for health information during emergencies, without sacrificing journalists’ right to access information.

8. Conclusion

The study found relatively high compliance with CCM, although this was negatively affected by level agreement with OCC and OCIP. Government attempt at information privacy does not apparently distinguish between physical privacy and information privacy. It also hardly reflects a distinction between privacy and related terms, which should be the goal of privacy. The formal quarantine on health data is the direct cause of the said Covid-19 reporting without “human face”. This has made government the main frontier for health information. The media appears not to be ready for reporting emergencies given the way they talked about travel restrictions and finance as constraints. By scheduling stories to track possible social emergencies before they occur, the media can help to boost government emergency readiness, and in effect lessen secrecy. The media should track emergencies by keeping schedules for updates about former disease outbreaks.

Given the limited population of the present study, its findings cannot be generalized to the whole country, especially given the relatively small sample size. Future studies can extend to other areas of the country, with bigger sample sizes when restrictions imposed on information generation by the Covid-19 mood eases.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Michael O. Ukonu

The present study is undertaken by Michael O. Ukonu, Edith U. Ohaja and others, all senior academics at the department of mass communication, University of Nigeria, Nsukka. The authors’ research interests are in health communication and media analysis, with over 25 published journal articles. The study is one of the three done by the present group to address the communication questions posed by the Covid-19 health information system in Nigeria. Having looked at the predictors of compliance to Covid-19 protocols, and a content analysis of newspaper coverage of Covid-19, we saw a gap in the area of the contexts of media coverage of the pandemic. In light of government’s role as a major Covid-19 information broker, we noticed some dire implications to the gatekeeping role of the media. We attempted to show the necessary demarcations between information protection and information secrecy vis á vis media role during health emergencies.