A tale of Two Public Health Crises
Sydney Grad, Print Editor
August 10, 2020
Months ago, no one could have fathomed our infrastructure and public services being faced by a critical public health emergency like SARS-CoV-2, more commonly known as Coronavirus or COVID-19. As countries around the world mobilised, the ensuing crisis from the spread of COVID-19 has simply taken over and masked the deep rooted problem of the opioid epidemic in North America, which has raged for years. Originally the focus of public health agencies in the United States and Canada, COVID-19 has refocused public health spending and caused service diversions while, in essence, nothing changed in the fight against opioids. The crisis continues even as our media and attention has moved on and it is only to be expected that our failure to strengthen progress and continue combating the local epidemic will only leave us farther behind once the pandemic is over.
Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain. Beginning in the 1990s, the medical community began prescribing opioids to treat moderate-to-severe pain and often prescribed them following surgery or injury, or for health conditions such as cancer. However, the dangers of prescription misuse, opioid addiction, and overdoses have been a growing difficulty for many communities, and has become one of the worst public-health problems in North America. Since 1999, more than 750,000 people have died from a drug overdose. The crisis became worse and overdoses more frequent with the introduction of fentanyl, a synthetic opioid that is 80-100 times stronger than morphine. Many users purchase heroin, unaware that when combined with fentanyl, increases the possibility of overdose deaths. Public health agencies and the CDC, in their response to the opioid epidemic, have outlined a multi-pronged approach to preventing opioid overdose deaths, including “improved opioid prescribing, treatment of patients with opioid use disorders, expanding access to naloxone to reverse overdoses, and providing educational resources to medical professionals and the general public to increase awareness of the problem and outlining strategies to combat it.”
While the opioid epidemic was in full force and public health focused on improving their response, the WHO China Office was informed of cases of pneumonia of unknown etiology detected in Wuhan City, the capital city of Hubei Province in China on December 31, 2019. The outbreak began in a seafood and poultry wet market in Wuhan, spreading quickly in the city of 11 million in central China. Like SARS and MERS-CoV, the newly detected coronavirus has a zoonotic source, meaning that the disease came from an animal carrier to an intermediate host species, which then transmitted the virus to humans. On March 11, 2020 the WHO declared COVID-19 viral disease a pandemic.
COVID-19 is transmittable from one person to another. The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks. People can catch COVID-19 if they breathe in these droplets from a person infected with the virus, hence the importance of maintaining a distance of six feet from others. In response to this knowledge, large-scale global efforts have been taken to contain the spread through the closing of international travel, social distancing and to divert resources to first responders and medical care. Despite the global response and call to action there have been, as of August 9th, 2020 over 19.7 million worldwide confirmed cases of COVID-19 according to data from Johns Hopkins University.
Governments across the world have reacted with urgency, passing spending bills to try and fight COVID-19. The magnitude of government spending has been unprecedented, all done in an effort to keep the economy going and support workers forced to stay home. The United States alone has pumped over six trillion dollars into their economy with many countries similarly introducing new programs, services and cash handouts.
Given that viral pandemics such as COVID-19 disproportionately affect marginalised groups with medical and psychiatric conditions, many in the health community are concerned that COVID-19 will increase already catastrophic opioid overdose rates. Besides the threat of infection, there is a serious risk that access to medication, critical research, and community resources will be lost due to the all-encompassing focus placed on the COVID-19 response. Harm reduction workers battling Ontario's opioid crisis say COVID-19 is making the situation worse, as police and public health officials in Toronto report a spike in overdoses and drug-related deaths since the start of the pandemic. Additionally, Toronto Public Health said data from the city's paramedic service for March and preliminary figures for April show a spike in suspected overdoses and deaths. In March, there were 345 suspected opioid overdose calls and 19 deaths. The preliminary figures between April 1 and 26 show there were 300 suspected overdose calls and 20 deaths. On March 31 alone, Toronto paramedic service said it responded to 25 overdose calls.
The dovetailing of the opioid epidemic with the wider COVID-19 pandemic have exacerbated the public health emergency gripping the marginalised communities in North America. With so much funding and energy going towards fighting the coronavirus, attention and resources have shifted away from the ongoing opioid epidemic. While states/provinces push for stay at home regulations and the cancelling of in-person meetings, those experiencing addiction and their communities are being left behind. As lockdowns continue, access to in-person medical care is unavailable, support groups cancelled, and rehab centres closed, the opioid epidemic is slowly growing behind the curtain of coronavirus. This failure to fight both crises will have devastating impacts on vulnerable communities and all the work accomplished in the last few years will be undone by the lack of funding and services being provided at a critical point of time of isolation and fear. While we might currently fear and focus on finding a vaccine to the coronavirus the opioid epidemic will not be so easy or single focused to solve. It will take a holistic approach of coordinated action, laws being passed and structural support for numerous communities all of which has been set to pause and put aside while the world is singularly focused on what it believes to be the most pressing public health issue.