COVID-19 is more than a virus – it’s a systemic threat

From the Beacon, November 2020

Over the past eight months of pandemic pressure and stress, my wife and I have tried to carve out time each weekend to hike and walk on local trails, mostly in municipal conservation lands and nearby state parks. Our explorations have brought unexpected rewards, and our new ritual has helped us experience the beauty of Massachusetts in a rich, close-to-home kind of way. Walking in nature has provided a welcome respite and moments of peaceful quiet.

On a recent autumn afternoon, however, after strolling several miles of trails in a conservation area abutting a cemetery, we were heading back to our car, and our peaceful mood was replaced by an aching sadness. At an open end of the cemetery, we noticed a half-dozen newer headstones, each erected in recent years, and each adorned with flowers, rocks and tokens of remembrance. The names were different, yet the ages of those honored there were remarkably similar. Fifteen years old, 24 years old, 22 years old, 30 years old, 17 years old. All survived by their parents, all leaving broken-hearted friends and family members. All taken by the opioid epidemic.

This led me to reflect on how the coronavirus has eclipsed the opioid crisis as the most urgent and visible public health emergency confronting our communities. Less than 12 months ago, the public health statistics that were top-of-mind were the Department of Public Health reports on opioid-related overdoses and deaths. Between 2015 and 2019, opioid-related overdoses killed 9,936 people in our cities and towns. During that time, communities and agencies mobilized and collaborated to reverse the rising numbers, but the tragic introduction of fentanyl made the challenge even greater, and as of January of this year, deaths had plateaued at about 2,000 per year. That’s 2,000 headstones a year, and more heartache and suffering than can be imagined.

With COVID-19 infecting more than 150,000 Massachusetts residents, taking the lives of nearly 10,000 of our neighbors in just seven months, we can understand why the spotlight has diverted away from the opioid epidemic. But that does not make it right.

A report by the American Medical Association released last month is attempting to reignite the spotlight. The AMA issued the following warning: “[T]he opioid crisis is continuing and may even be accelerating during the pandemic. In addition to the ongoing challenges presented by the COVID-19 global pandemic, the nation’s opioid epidemic has grown into a much more complicated and deadly drug overdose epidemic. [There are] an increasing number of reports from national, state and local media suggesting increases in opioid- and other drug-related mortality – particularly from illicitly manufactured fentanyl and fentanyl analogs. The media reports below cite data from multiple and varied sources, including national, state and local public health agencies, law enforcement, emergency medical services, hospitals, treatment centers, research journals and others. More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder.”

The AMA is calling for the removal of barriers to evidence-based treatment for those with a substance use disorder, as well as for harm reduction services, including sterile needle and syringe services and naloxone. These are vitally important actions that must be taken to save lives. Whether they will occur in time is an open question.

The tragedy is that COVID-19 is eclipsing the opioid crisis, diverting essential health resources away from needed prevention and treatment efforts, and is amplifying our vulnerability to substance use disorders due to increased isolation, separation and mental health impacts.

COVID’s broad reach
But COVID’s impact on the opioid crisis is just the tip of the iceberg. The pandemic’s impact on our lives and society extends far beyond the virus itself. The coronavirus is obscuring and amplifying other social crises and challenges, inevitably delaying and detracting from public policy decisions and investments that must be made to move our communities forward.

With the U.S. and so many countries in the midst of a second or third wave, vital long-term priorities have been obscured and pushed to the side.

Transportation gridlock and crumbling road infrastructure is no longer visible to the naked eye, and with far fewer cars on the road, driving is not as miserable, and public support for immediate action and investment is waning, even though our economic future depends on it.

Global pressure for action on climate change has also waned, as communities and countries deal with the immediate threat of illness, and defer acting on the environmental dangers that will manifest themselves in 20 or 30 years.

The virus has amplified the underlying problems facing our society, too.

Here at home and across the nation, Black and Latinx residents are dying of COVID-19 in disproportionately high numbers, unmasking the health disparities caused by systemic racial inequity.

Here at home and across the nation, a privileged class of workers has been able to transition to remote work and has maintained income status and stability. Meanwhile, millions of lower-paid workers in jobs that require a physical presence must continue to use public transportation and travel to jobs that have higher exposure risks for themselves and their families. The vast majority of lost jobs belonged to the working class.

Here at home and across the nation, our political polarization has widened. Mask wearing and economic shutdowns have ignited violence and separated us further from each other. The pandemic has amplified the rhetoric and locked us in our own corners.

If you spend five minutes making a list of the priorities that have been obscured by the pandemic, and the inequities that have been amplified, you’ll easily come up with a dozen or more.

And so, in the hours after our walk by the cemetery, as I reflected on these things, my perspective on the pandemic changed radically.

The pandemic is much more than a virus that can infect our bodies. It has already infected and attacked our entire system. It has slowed down our response to vital public priorities. It has accelerated deep-seated problems and injustices that were pre-existing conditions. It has created a national political crisis that is undermining federalism and intergovernmental collaboration, making it harder to defeat the epidemic.

I am deeply proud that local and state officials in Massachusetts have recognized the pandemic as a systemic threat, and have cooperated, collaborated and united to confront the crisis head-on.

We need every leader at every level throughout the nation to follow this example – your example – from the White House to all offices in the U.S. Capitol, from every governor’s office to every state legislative chamber, and yes, in every city, town and village hall across the country.

With the national election soon behind us, it’s time to demand unity. Without unity, the attack will continue unabated, and all aspects of our public health and society will struggle.

It’s quite simple: unity against the virus is the only option. Our national leaders need to say this. Now.

The health of our entire American system depends on it.