When Two Public Health Emergencies Collide
April 2016: The overdose crisis is declared a public health emergency in BC.
March 2020: The COVID-19 pandemic is declared a public health emergency.
What happens when two major public health emergencies collide?
One province, two emergencies
In April 2016, BC’s then-Provincial Health Officer (PHO), Dr Perry Kendall, declared a public health emergency in response to an escalation in illicit-drug-related overdose deaths. Since then and despite extensive harm reduction strategies and services, action by government, healthcare and community leaders, and people with lived experience (peers), lives continue to be lost and unintentional drug overdoses continue.
Three years later, Dr Bonnie Henry, BC’s current PHO, wrote a report called ‘Stopping the Harm’. In this report, she outlines how a highly-toxic illicit drug supply and the ongoing criminalization and stigmatization of people who use drugs (PWUD) turns substance use into a criminal and moral issue, instead of what it should be: a health issue.
Fast forward one year and the world finds itself in unknown territory. Another public health emergency is declared, and this one is a global pandemic.
To protect us all from COVID-19, the disease caused by the SARS-CoV-2 virus, we find ourselves facing public health measures we’ve never experienced before, that are necessary but completely at odds with how many of us have functioned our whole lives.
How do you survive two crises at once?
For some, the pandemic creates extra obstacles and increased risk, and many can’t realistically engage in some critically important public health directives like hand washing and physical distancing. How do you wash your hands regularly if you don’t shelter indoors? How do you keep distance from others if you live in a cramped housing facility or shelter?
Further to this, people using substances are encouraged not to use alone, to help prevent overdose deaths. But to stay safe from COVID-19 we have to keep distance from others. These conflicting priorities create a problematic juncture where our loved ones are significantly impacted by these two simultaneous crises. It’s creating compounding barriers and risks, and compromising health outcomes for many in our population.
This is what happens at the intersection of two public health emergencies.
COVID-19 is leading to more dangerous drug use practices, decreased access to safe consumption sites, and an increase in street-level policing, causing more people to use alone. This is leading to increases in overdose deaths: there were 113 suspected illicit drug deaths in March 2020. This is a 61% increase from February. This is the life-or-death problem experts and advocates have been fighting against for years.
Because of COVID-19, some measures have been introduced to protect PWUD and other vulnerable populations:
- The introduction of safe supply guidelines allowing clinicians to prescribe opioid agonist treatments and provide continuity of care for people with opioid use disorder.
- To reduce risk of an outbreak in Vancouver and Victoria’s most vulnerable, government enacted an order to move people from tent-city encampments into indoor spaces, like hotel rooms.
- A group of human rights, drug policy, and legal groups are advocating for the federal government to halt criminal charges for simple drug possession.
- Vulnerable people, such as those experiencing homelessness, are being provided smartphones by social service organizations to enable access to supports and services, improve connectivity with others, and to help people maintain physical distancing.
Yet is this enough? How do we ensure these measures are appropriate and long-lasting?
When the COVID-19 pandemic ends, will the overdose crisis persist?
COVID-19 is shining a spotlight on issues we’ve had in BC for a long time: substance use, homelessness, poverty. It shouldn’t have taken a global pandemic to get people to pay attention. BC’s robust and rapid response to COVID-19 has shown that we’re capable of acting quickly and powerfully to save lives and protect those who are vulnerable. It’s time to apply this level of response to protecting those who are most marginalized and isolated—those who have been living through a public health crisis for over four years, and now have to battle against another.
We need to make these measures, and more, permanent by changing policies, redirecting resources, rallying political will, and ensuring that our most vulnerable do not get pushed back into the cracks of society. What happens when the world looks back on this pandemic? Will we see a snapshot of how we responded in the moment or will we see the beginning of substantial and sustainable change?
In the face of COVID-19, we have seen our provincial and federal governments join forces to protect our population. We call on all levels of government to collaborate on decriminalization, and legal regulation of illicit substances. Dr Henry’s words are being heard and respected in relation to COVID-19. Let’s listen to her words and authority when it comes to ‘stopping the harm’.
We need to act now
This collision of two emergencies is showing us we need to put more effort into improving equity, social justice, and all the determinants of health, for everyone. It is in our control to advocate for those whose voices have been excluded. It is in our control to speak up. It is in our control to show kindness and compassion. It is in our control to improve the health of our population and create a just society. Our individual actions matter and can make a difference.
This is how we Activate Health.
We must ensure we learn from this pandemic and continue to protect everyone even once it has ended. And we can’t lose sight of our other ongoing public health emergency. We must act now to end both.
No matter what, it should be our goal to protect people from harm. Not just at the intersection of two public health emergencies. Always.