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Overdose reversals during COVID-19 pandemic pose new challenges, fears for the harm reduction community

In the last few years, Roz Pichardo has reversed hundreds of overdoses. But about three weeks ago was one of the first times she felt scared reversing one. 

“I was almost afraid of doing [it],” said Pichardo, the founder of Operation Save Our City. “Usually I wouldn’t be afraid.”

Pichardo’s fears were in response to COVID-19, a highly contagious respiratory virus that is spreading throughout the United States and every Philadelphia ZIP code. The virus was first reported in December in Wuhan, China, and as of Wednesday, there were 395,011 COVID-19 cases and 12,754 deaths in the United States. Pennsylvania is among the top 10 states with the highest number of COVID-19 cases, and Philadelphia County as of Wednesday reported 4,777 total cases and 78 deaths.

In response to the virus, which is transmitted primarily through respiratory droplets, the Centers for Disease Control and Prevention (CDC) recommends that people maintain six feet of “social distance” between themselves and others to lower the risk of transmission. 

But a six-foot distance is impossible to maintain while reversing an overdose, which requires the person responding to administer the opioid overdose reversal medication naloxone as an intranasal spray or an intramuscular injection. Plus, some people give mouth-to-mouth rescue breaths after administering naloxone until the person overdosing regains consciousness or the paramedics arrive.

However, overdoses have not stopped during the COVID-19 outbreak, so harm reduction workers are taking additional precautions — and risks — to continue saving lives.

“Right now, we still lose far more Philadelphians to overdose deaths than we have to COVID-19,” said Brooke Feldman, who manages CleanSlate Centers on Memphis Street near Ontario Street and another location in South Philadelphia.“This is a public health concern, and the chance of someone dying, if you see them experiencing an overdose, is much higher than the chances of most of us dying from contracting COVID-19.”

In 2018, the year for which the most recent data is available, more than 67,000 people died of drug overdoses in the United States, and 1,116 people died of overdoses in Philadelphia. The White House recently estimated that the country could eventually see between 100,000 and 240,000 people die from the COVID-19 virus. However, it’s still unclear how many deaths Philadelphia could see. 

According to James Garrow, the director of communications for the Philadelphia Department of Public Health, how to handle overdose reversals in the time of COVID-19 is included in the city’s latest online overdose training

“The Health Department absolutely recommends that folks continue to be ready to reverse overdoses,” Garrow wrote in an email on April 7. “How to do it safely is something that harm reductionists all over the world have been grappling with.”

Among the city’s safety suggestions for people reversing overdoses is that individuals avoid touching their face and the other person’s face as much as possible. The city also suggests being vigilant about existing precautions like wearing gloves and disposable face shields if giving rescue breaths, Garrow said. 

According to Kate Perch, the housing director at Prevention Point, Prevention Point’s staff is taking extra time to educate people who use drugs about harm reduction practices. The staff is making clear to clients that because of the COVID-19 pandemic, if a person experiences an overdose, there will be fewer people around to help. They’re also offering double the usual dosage of naloxone at their drop-in center in case access to care becomes more limited, Perch said.

“We’re really trying to encourage people to make as informed decisions as they possibly can and to be as safe as they can within that difficult context,” said Perch. “The important thing to remember is that so many of the basic recommendations in a situation like this are things that, for people who are living on the street, or people who use drugs, are not easy or intuitive things to practice.”

To keep their staff as safe as possible, Perch said that Prevention Point is limiting the number of guests who can come inside their drop-in center at each time. They are also distributing medication and supplies at their door, only allowing clients to enter the facility unless absolutely necessary. Additionally, Prevention Point cut down on their walk-in hours during the week and are reducing the number of workers they send out into the field.

“We’re trying as much as possible to educate participants about how they can continue to use as safely as possible while also practicing social distancing to the best of their ability,” she added.

Feldman believes that despite COVID-19 fears, people who are passionate about harm reduction and recovery — especially those who use drugs, who are often on the scene when an overdose occurs — will continue to reverse overdoses. They’ll likely continue to look out for each other, she said. 

However, for people who are not comfortable breaking the six-foot social distancing rule to reverse an overdose, Feldman emphasized the importance to call out for help from others who are nearby and dial 911. 

“It’s important to be practical when we talk about meeting people where they’re at in harm reduction, and we want to meet the general community where they’re at when it comes to willingness to respond to an overdose with COVID-19,” Feldman said. “That may be the best they feel like they can safely offer, and that’s better than turning a blind eye and doing nothing.”

In mid-March, Pichardo’s fears became reality when she developed the hallmark symptoms of COVID-19, including shortness of breath and a dry cough. After the onset of symptoms, she sought testing immediately and quarantined herself for 14 days. While it’s unclear whether she contracted the virus through her outreach, her test came back positive, she said. 

For essential workers who do contract COVID-19, the CDC lists guidelines for how and when they should return to work. The CDC recommends that essential workers wait at least seven days since the onset of a fever, cough, and shortness of breath, and at least three days after recovering from symptoms before returning to work. 

Pichardo followed these guidelines and returned to work last Wednesday. Since then, she has been working alone in a kitchen to cook 300 meals for people experiencing homelessness in the neighborhood, while wearing an N95 face mask. Whenever possible, she adheres to the six-foot “social distance” recommendation from the CDC. 

On Monday, Pichardo used an Ambu bag to resuscitate someone who was overdosing. An Ambu bag is a self-inflating device that can be used to administer rescue breaths to a person who is overdosing, while avoiding mouth-to-mouth contact. Newly prepared with the self-inflating resuscitator and her personal protective equipment, she didn’t feel scared, she said.

“Everybody in the outreach community and harm reduction community is going to try to the best of their ability with the amount of protective gear that we have to still serve the people,” Pichardo said. “Because that’s what we’re called to do.”

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