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Visions Journal

Staying Well in a State of Emergency

Coping and Adapting to the COVID-19 Pandemic

River Chandler, MA

Reprinted from the "COVID-19" issue of Visions Journal, 2020, 16 (2), pp. 5-7

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On March 17, 2020, BC's Provincial Health Officer declared a public health emergency in BC. The next day, Premier John Horgan declared a State of Emergency with the goal of slowing the spread of COVID-19.

Schools, businesses, arts and culture venues, workplaces and social services organizations closed their doors or reduced their hours and capacity. Many people lost their jobs, travel restrictions were imposed and visits to our loved ones in long-term care were cancelled. We were also asked to maintain physical distance from people outside our immediate household.

Thoughtful leadership and widespread public cooperation with public health orders "flattened the curve" over the late spring and early summer—that is, slowed the rate of viral spread—in phases 1 and 2 of BC's Restart Plan. Starting at the end of June, BC moved into phase 3, with travel within the province encouraged, along with planning for and restarting in-person education for kindergarten through Grade 12.

The pandemic and the public health response have been stressful for many of us. Fear and worry about our own health and the health of our loved ones, loss of the support services we count on and a change in our financial situation have been difficult. While public health measures are needed to control the spread of the disease, these actions can leave us feeling isolated and lonely and can impact our sense of well-being.

The effects of the orders are experienced unequally across different groups of people. For some of us, the social and economic impacts are inconvenient. For our most vulnerable citizens, they can be a matter of life and death. People living in poverty and experiencing homelessness, people living with existing mental health and substance use challenges, people living with disabilities and struggling to access necessary care, and adults and children at risk of gender-based violence have experienced additional and serious unintended consequences as a result of measures taken to reduce the transmission of COVID-19.

COVID-19 in the context of other public health emergencies

In BC, the COVID-19 pandemic has compounded the existing opioid overdose emergency. The growing toxicity and unpredictability of street drugs as a result of disruptions to the drug supply chain since late March 2020 is the primary cause of overdoses and deaths. Before COVID-19, people who used substances could reduce the risk of harms by accessing nearby services and social networks. The introduction of COVID-19 response measures has impacted service delivery and disrupted the settings and context of drug use, which has contributed in part to an increase in overdoses. People experience reduced access to overdose prevention, supervised consumption and community drug checking services and, due to physical distancing measures, reduced ability to use the "buddy system" intended to reduce using and overdosing alone. Social and economic situations were compromised, which created additional mental distress and increased substance use due to decreased employment, income and housing security, and increased social isolation.

The BC Coroners Service reported 170, 175 and 176 illicit drug deaths from May to July 2020, respectively, the highest counts of monthly overdose deaths since the opioid emergency was declared. While August and September numbers of overdose deaths were lower at 150 and 127, they still reflect an increase of 110% over September 2019.1

Risks are made worse by poverty, homelessness, unstable housing and the stigma experienced by people who use illegal drugs.

Recent media reports of police violence and reported increases in racism and hate speech in Canada and the US, along with long-standing existing racism experienced by Canada's Indigenous peoples, show us that racism is a third, unofficial, public health emergency. Incidents of racial tension and increased media reporting on the issue—during the already dire circumstances of a global pandemic—has been met with global Black Lives Matter public protests against systemic racism.

First Nations people have a history of suffering adverse impacts of pandemics. As a result of the historical, intergenerational and contemporary trauma that many First Nations people live with, the pandemic can be a trigger for increased mental distress, worry, irritability and other negative impacts. The continued impacts of colonialism and systemic discrimination and racism are also reflected in the disproportionate impacts of the overdose public health emergency on Indigenous peoples in BC. From January to May 2020, 16% of all overdose deaths were of First Nations people. First Nations represent only 3.3% of the province’s population.2

In the past several months, instances of intolerance, stigmatization and acts of violence towards Asian people and communities have taken place. While Asian communities have experienced racism in the context of health crises before (for example, during the SARS epidemic), targeted anti-Asian racism and discriminatory acts have increased in frequency and intensity throughout Asian communities in BC and across Canada during COVID-19.3-7

These trends are worrying. I am concerned about the intersecting effects of racism, sexism and gender-based violence in the context of the dual public health emergencies in BC. I am concerned about the long-term impacts of the spring suspension of in-class learning on children and youth; as a grandparent, I witnessed firsthand the social and educational impact. I am concerned about the long-term impacts of the public health emergencies on our economy and, despite positive job growth in BC and Canada beginning in June,8 the widespread job loss experienced across the province, particularly by women and young people.9,10

I am concerned about our ongoing willingness to observe physical distancing advice. I see in my own family the weariness that comes with following stringent public-health directives over the long term; we have all lost time with loved ones, and we have all curtailed or avoided activities that bring us pleasure and joy. I am also concerned about the failure of US federal leadership to listen to experts and to develop a cohesive approach to reducing the number of COVID-19 cases and deaths, and what this might mean for our health and our economic recovery here in Canada.

Drawing on our strengths as we move forward

Despite these concerns, I am hopeful. We have strong public health and political leadership in our province and country. There is increased awareness and focus on addressing systemic racism, insufficient mental health supports, gender-based violence and other issues that have significant impacts on the physical and mental well-being of individuals and communities. We have made thoughtful and creative adaptations to service delivery across the province. Overall, there is a continued willingness on the part of British Columbians to do what it takes.

A number of resources have been created or expanded to support our health care systems, including the publication of extensive, easily accessible information about COVID-19, provision of increased mental health supports, adaptation of service delivery and other innovative initiatives. One of these initiatives includes the March 2020 release of the BC Centre on Substance Use's prescribing guidelines, intended to reduce risks for people who use drugs, while supporting them to maintain physical distancing and self-isolation,11 while the more recent public health order authorizing nurses to prescribe pharmaceutical alternatives to the poisoned drug supply will help save lives and provide opportunities for care, treatment and support.

Extensive planning, additional funding, enhanced safety measures and new resources have enabled a safe return to school for BC's K-12 students, supporting their emotional and mental well-being and ability to socialize and learn, ensuring that children needing additional resources receive supports and enabling parents to return to work. These innovations illustrate how flexibility and adaptability will enable us to safeguard the health and well-being of all people in BC, while ensuring that those of us who are most vulnerable receive the supports, care and protection we need.

About the author

River is Director, COVID-19 Response, with the BC Office of the Provincial Health Officer, where she leads work to identify, monitor and report on the unintended consequences of the public health response to COVID-19. River's public health policy experience spans mental health, substance use and gambling. Previously a community-based social worker with a focus on children and families, River is also Artistic Director of TheatreWorks, using arts-based approaches for community and school engagement, dialogue and education

Footnotes:
  1. BC Coroners Service. (2020). Illicit drug toxicity deaths in BC January 1, 2010 – September 30, 2020. www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-
    and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf
    .
  2. First Nations Health Authority. (2020). COVID-19 pandemic sparks surge in overdose deaths this year. (July 6). https://www.fnha.ca/about/news-and-events/news/covid-19-pandemic.
  3. Vancouver Police Department. (2020). VPD says hate incidents still prevalent throughout the city. (Media release, July 17). mediareleases.vpd.ca/2020/07/17
    /vpd-says-hate-incidents-still-prevalent-throughout-the-city
    .
  4. CBC News. (2020). Vancouver police launch task force to address spike in hate crime. (July 17). www.cbc.ca/news/canada/british-columbia/vpd-hate-crimes-still-on-rise-1.5653564.
  5. Angus Reid Institute. (2020). Blame, bullying and disrespect: Chinese Canadians reveal their experiences with racism during COVID-19. (June 22). angusreid.org/racism-chinese-canadians-covid19.
  6. Heidinger, L. & Cotter, A. (2020). Perceptions of personal safety among population groups designated as visible minorities in Canada during the COVID-19 pandemic (StatCan COVID-19: Data to insights for a better Canada, Catalogue no. 45280001, July 8). Ottawa, ON: Statistics Canada. https://www150.statcan.gc.ca/n1/en/catalogue/45280001202000100046.
  7. Rowe, D.J. (2020). Anti-Asian racism on the rise in Canada’s biggest cities amid COVID-19 crisis: poll. CTV (August 10). montreal.ctvnews.ca/anti-asian-racism-
    on-the-rise-in-canada-s-biggest-cities-amid-covid-19-crisis-poll-1.4913957
    .
  8. WorkBC. (2020). Labour market snapshots. www.workbc.ca/labour-market-industry/b-c-s-economy/
    labour-market-snapshots.aspx?month=September&year=2020
    .
  9. Alini, E. (2020). Welcome to the “she-session.” Why this recession is different. Global News (May 9). globalnews.ca/news/6907589/canada-coronavirus-she-session.
  10. Gupta, A. (2020). Why some women call this recession a ‘shecession’. The New York Times. (May 9). www.nytimes.com/2020/05/09/us/unemployment-coronavirus-women.html.
  11. BC Centre on Substance Use (BCCSU). (2020). Risk mitigation in the context of dual public health emergencies. www.bccsu.ca/wp-content/uploads/2020/04
    /Risk-Mitigation-in-the-Context-of-Dual-Public-Health-Emergencies-v1.5.pdf
    .
  12. Statistics Canada. (2020). Canadians’ mental health during the COVID-19 pandemic. (May 27). www150.statcan.gc.ca/n1/daily-quotidien/200527/dq200527b-eng.htm.
  13. Angus Reid Institute. (2020). Second wave angst: COVID-19 concern levels rebound to April highs as Canadians brace for worse to come. (September 30). angusreid.org/covid-second-wave-september.

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