Safety measures put in place to curb the spread of the new coronavirus in Vancouver’s Downtown Eastside may have inadvertently increased the risk of overdose in the community and contributed to an uptick in overdose deaths.
Patricia Daly, chief medical health officer and vice-president of public health at Vancouver Coastal Health (VCH), said Tuesday that public messaging about the COVID-19 pandemic, such as recommendations to stay home and practise physical distancing, appear to have led to fewer people using overdose-prevention services.
Several supervised drug-consumption sites either reduced hours or closed every other injection booth to facilitate physical distancing. On any given week, there are roughly 6,000 site visits; in late March and early April, that dropped to around 2,000.
At the same time, Vancouver police reported an increase in suspected overdose deaths. In March, police recorded close to 30 suspected overdose deaths in the city – the highest number since the previous March. In the first 18 days of April, there were about 18 suspected overdose deaths, putting the city on pace for another similar spike this month. The BC Coroners Service has not yet confirmed the cause of deaths.
“There are some early indications of concern that because of fear around COVID-19, people are not making use of life-saving services that they need within the Downtown Eastside,” Dr. Daly told city council during an update on the city’s overdose crisis.
VCH considers the Downtown Eastside community a priority population because of increased risks of virus transmission and severe disease owing to issues such as homelessness and underlying health conditions. As such, health officials have pro-actively tested as many people with mild symptoms as possible, similar to protocols in long-term care facilities.
As a result, the testing rate is more than twice that of the general population in the VCH region: 40.8 tests for every 1,000 people, compared with 15.9 tests for every 1,000 people. (B.C.'s testing rate is 11.6 tests for every 1,000 people.)
Of those tested in the Downtown Eastside, 1.6 per cent are positive. For the general population in the VCH region, it’s 4.2 per cent.
“By far, the greater risk in the Downtown Eastside continues to be the opioid overdose crisis," Dr. Daly said. “We’ve had not a single death from COVID-19 in the Downtown Eastside, very few cases, but we’re continuing to see people die [of overdoses] every week."
In an interview, Dr. Daly said measures such as physical distancing are important in reducing the overall spread of COVID-19 among the general population.
“But it’s not a rule that has to be followed in every circumstance, where it doesn’t make sense, or where life-saving interventions need to be provided,” she said.
Overdose prevention sites that closed every other injection booth have since returned to regular capacity, but visits are still only about half what they usually are.
Dr. Daly said she also advises against no-visitor policies in supportive housing, which can result in people using drugs alone.
Janice Abbott, chief executive officer of Atira Women’s Resource Society, said the society in mid-March restricted its single-room occupancy (SRO) buildings to essential visitors only, such as those who deliver food and medications.
She said while there are typically around 10 overdoses a week across the 2,000 units Atira manages, there were only about a handful in the month after the implementation of the restrictions. The exception was this past week, when there was an influx of money into the neighbourhood from governments’ emergency response benefits.
“Unless you live or work in an SRO, I don’t think you can truly appreciate how much traffic there is in or out, or how it disrupts the quiet enjoyment of so many tenants,” Ms. Abbott said. “Most of our tenants are thrilled. ... Typically, on any given day, in an SRO you have dealers in and out, debt collectors in and out.
“There may be more people overdosing in the community, because they are not in our buildings. But with respect to our tenants, we’ve definitely seen improvements."
In a statement, B.C.'s Ministry of Mental Health and Addictions said visitor policies are based on BC Centre for Disease Control guidelines and that BC Housing meets regularly with VCH “to ensure policies are consistent with evolving health authority advice and direction.”
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