Covid-19 is rightly a national priority, but it is far from the only urgent health issue facing the country. In the pandemic’s shadow, other public health crises are growing. They require urgent action. Three areas that need particular focus are homelessness, mental health, and addiction.
On day one of the new administration, President
signed an executive order extending the current federal ban on rental evictions to March 31. An estimated 13.2 million adults, accounting for one in five renters, are behind on their rent payments, which could result in eviction. Although the eviction moratorium has kicked the can down the road, Congress, state, and local officials must act to prevent a sudden surge in evictions nationwide.
A study published in November about the impact of state eviction moratoriums found that the number of Covid-19 cases and deaths was higher in states that lifted moratoriums early, resulting in an estimated 433,700 additional cases and 10,700 excess deaths. This finding supports public health recommendations to continue eviction moratoriums to reduce the spread of Covid-19. A tidal wave of evictions would disrupt communities devastated by the pandemic and could lead to increased homelessness, further straining the social safety net just as states and local governments face budget cuts.
Without more support from Congress for state and local governments, a new housing crisis will only worsen the virus’s spread. People experiencing housing insecurity are a particularly vulnerable population. And since homelessness services and shelters are frequently delivered in congregate settings, this can exacerbate the risk of viral transmission. Unfortunately, people living in these settings have been excluded from the phased approach to vaccination set by the Centers for Disease Control and Prevention, and the agency has deferred their prioritization to state and local governments. California Gov.
announced last month that, despite their susceptibility, the state would drop homeless residents living in congregate settings from its Covid-19 vaccination distribution prioritization plan.
To correct this, the CDC’s Advisory Committee on Immunization Practices should recommend the inclusion of people in congregate settings into their phased approach, instead of deferring to other levels of government. Following this more immediate policy change, long-term federal efforts to “build back better,” as the Biden administration describes its plan, should prioritize the construction of affordable housing stock and provide developers with incentives to include affordable units in housing developments. Building millions of new, more affordable housing units nationwide would jumpstart an important sector of the economy while making housing more accessible.
Mental health also requires attention. According to a Kaiser Family Foundation tracking poll from December, 51% of adults say pandemic-related worry or stress has harmed their mental health, a level relatively unchanged since July. Drivers of this, aside from the risk of Covid-19, might include employment precarity, school closures, racial injustice, isolation, and political upheaval. Looking to history, the results of inaction are not promising. Census data from the 1918 flu pandemic found that those born following that pandemic experienced reduced educational attainment, higher rates of physical disability, and lower incomes.
To support current and future generations scarred by our current pandemic, the federal government should coordinate with state and local governments to increase access to telehealth and mental health services, particularly for children. Schools (both physically and remotely) should further incorporate mental health services and wellness strategies to be a refuge for children growing up in an uncertain world. To encourage greater uptake of mental health services, substantial efforts, including media and educational campaigns, will be needed to reduce stigma and help connect those in need with vital services. Such campaigns could be modeled after work successfully pioneered in California through the Mental Health Services Act.
Another more heavily stigmatized concern is substance use contributing to the opioid overdose crisis. Overdose deaths have accelerated during the pandemic, according to recently released CDC data. From June 2019 to May 2020, more than 81,000 drug overdose deaths occurred nationwide, the highest number ever recorded in the U.S. Based on previous years, this figure will likely be more than homicides and suicides combined for the same period. Data suggests that the number of overdoses accelerated during the pandemic’s early months, driven primarily by illicitly manufactured fentanyl.
The Covid-19 pandemic has simultaneously disrupted the drug supply, fueled anxiety and fear, and isolated people from their communities and support systems. As drug supplies are disrupted, people who use drugs may be forced to seek out new sources and unfamiliar substances, which could increase their risk of overdose and death. Governments must take a multifaceted approach to address the syndemic of the opioid overdose epidemic within the Covid-19 pandemic.
At the local level, lifesaving naloxone education and distribution must be prioritized. Efforts should also be made to expand access to and awareness of evidence-based treatments like buprenorphine, which is effective for opioid use disorder and has a low potential for misuse. At the federal level, Congress should allow for the creation of supervised injection sites for the illicit use of opioids, as proposed by the likes of Safehouse in Philadelphia. Onerous regulatory requirements on healthcare providers should also be removed, including the buprenorphine X-waiver. These measures promoting harm reduction would simultaneously expand access to treatment and support while ultimately reducing morbidity and mortality.
While Covid-19 dominates the headlines, policymakers and community leaders must consider other public health disasters unfolding just underneath the surface. Rising homelessness, mental health concerns, and overdose deaths warrant robust, coordinated, and comprehensive national strategies. Failure to do so will continue the needless cycle of ignoring problems until they boil over into a crisis. Better to learn from the old saying that an ounce of prevention is worth a pound of cure.
Kyle R. MacDonald is a public health physician and researcher in New York City. He leads a CDC-funded team that provides technical assistance to support local health departments address the opioid overdose crisis nationally.
Friends, this isn’t the time to be complacent. If you are ready to fight for the soul of this nation, you can start by donating to elect Joe Biden and Kamala Harris by clicking the button below.
Thank you so much for supporting Joe Biden’s Presidential campaign.