The Inequities of Epidemic Management

The COVID-19 pandemic has transformed our lives, and how physicians deliver healthcare. This pandemic is an unprecedented event, but it’s important to remember that BC has other healthcare crises that are far more established.

The May 2020 report from the Coroner’s office on Illicit Drug Toxicity Deaths in the first half of 2020 brought into sharp definition our first, as yet unresolved, epidemic in BC. The highest yet recorded monthly number of deaths related to suspected overdose, a 93% increase over May 2019 and a 44% increase over April 2020. This equates to 5.5 lost lives every day, 70% of them between the ages of 19 and 49. Our future.

There have been many proposed etiologies for the overdose spike, but no one cause rises above the others. While we have not been in full “lockdown” related to COVID-19, the necessary public health restrictions we put in place have played a role - the amplification of many long-standing social factors that have contributed to this tragic outcome.

Our Provincial Health Officer, Dr Bonnie Henry, has often repeated “We are all in this together” in her daily press conferences. This simple phrase has encouraged us to support each other as we navigate this strange timeline. Besides a few incidences of hygiene supply hoarding, our communities have largely responded to this call. We stay home and keep our circles tight. We understand the difficulty maintaining our usual mental health state following the loss of our social circles, physical activities, and travel opportunities. We feel the absence of the family and religious celebrations we looked forward to over the years.

While British Columbians made sacrifices to bend the curve, a dark horse seized the opportunity to pull ahead. Not all epidemics are so easily spotted, or well-managed. The long line-ups at our local liquor stores were testament to a greater secret in the first weeks of COVID-19. Liquor sales increased as lockdowns began. Anxiety, depression, and addiction were quietly ramping up behind closed doors. As humans, we are a social species. Uncertainty surrounding our circumstances, and isolation are drivers of substance use at the best of times. Add to this the chronic, poorly-addressed social determinants of health in our society, and we have an uptick in related devastating overdose outcomes. 

A recent CBC report suggested that relatively easy access to CERB dollars is a driver of increased drug use. Alongside increasingly toxic drug compositions due to drug supply chain disruptions, and increased unsupervised use due to social distancing, the risks escalate. I agree that these are major contributors, and that striving for a safe supply under the guidance of medical practitioners will help those in crisis now. In the long term, the opioid crisis will require our governing bodies and society to pull together in the same way we did to flatten our COVID-19 curve.

We should mimic the processes our government has applied to support Canadians left unemployed, struggling with businesses, or experiencing limited access to medical care. We can increase funding and support for public health in a way that also addresses the social determinants of health driving our opioid crisis: education; employment insecurity; income insecurity; food insecurity; lack of housing; early childhood development; social exclusion or discrimination; and equitable access to healthcare and mental health services. We can name - and eliminate - the stigma that persists around addiction, and mental health conditions limiting our response.

Canadians have demonstrated that we can pull together to address a threat to our survival. Let’s pull together with that same spirit and determination to help our most vulnerable British Columbians and put an end to the epidemic claiming our future.

- Dr Kathleen Ross