How can you do harm reduction from six feet away?

Health-care workers provide life-saving support to Ontario’s most vulnerable — but physical distancing is creating new challenges
By Audrey Carleton - Published on May 05, 2020
This February, Ontario saw its highest rates of opioid-related deaths in nearly a year. (Paul Chiasson/CP)



This is the first of two stories about how COVID-19 is affecting Ontario’s harm-reduction services. Read the second story here.

Meghan O’Leary sees the numbers. 

The director of clinical services at the Kingston Community Health Centres reads the monthly dispatches from the Ontario Ministry of Health tallying drug-related overdoses. She knows that, in the middle of a global pandemic, the province’s opioid crisis has quietly gotten worse and worse: this February, Ontario saw its highest rates of opioid-related deaths in nearly a year. 

Despite the obvious risk the spread of COVID-19 poses for staff at KCHC, the idea of cutting hours or shutting the centre down “wasn’t really even in the discussion,” O’Leary says, adding that the site’s role in the broader health-care system is now, in some ways, more important than ever: as hospitals struggle to serve growing numbers of coronavirus patients, KCHC is working to divert overdose cases away from already-overwhelmed emergency rooms. 

But guidelines around physical distancing are creating new challenges. 

On paper, KCHC was prepared to handle everything that COVID-19 has thrown at it, O’Leary says. The site had a pandemic plan in place well before the coronavirus hit Canada’s radar, so as the province went into lockdown in March, she and her team knew what to do. A group of 12 KCHC staff began meeting every two days to discuss the best ways to adjust their procedures to protect staff and clients from the virus. They inventoried their personal protective equipment levels, identified priority areas and potential pain points, and braced for impact.  “We kind of quickly identified priority areas that we needed to keep an eye on,”she says, “and then put a plan together and then have been touching base every two days.”

Even the most rigorous of plans, though, could not have prepared KCHC staff for how difficult it would be to provide lifesaving support to Ontario’s most vulnerable populations from six feet away.  

Ontario’s harm-reduction services offer more than protection from overdose, O’Leary says: they also provide a sense of social structure and support. Clients who opt to use drugs in a safe environment can chat with social workers, access resources, and see familiar faces. “That's such an important piece in some people's lives,” O’Leary says. “To have that place where people say hi to them, and they know their face, and they're welcomed in.” 

Now, though, clients of the Kingston community-health centre have to line up at the door to be screened for symptoms of COVID-19. “We're screening people at the door, and they can't come in, but they have nowhere to go to the bathroom or get drinking water,” O’Leary says. Clients who do make it in the doors are permitted to spend only a limited amount of time inside.

“The guidelines are specific that you're supposed to come in to use, and then you're monitored, and then you leave,” O’Leary says, noting that the shift toward new procedures has been a jarring one for many. “What's hard during this time is, you know, having to turn people away at the door [by saying], ‘You're not coming in to use — this is not a social-gathering place.’” 

Kingston’s CHC is far from the only site grappling with the realities of social distancing. Glen Walker, executive director at Positive Living Niagara, says that increased PPE requirements threaten the rapport most staff have worked hard to build with their clients: it’s hard to maintain a relationship with someone who’s hardly recognizable beneath head-to-toe PPE, Walker explains. “It's very antiseptic,” he says. “It takes away from that personal type of touch that we normally would have.” 

Walker notes that his staff also struggle to offer directives to clients about best practices for drug use. “How do you get that balance there in terms of, you know, you got to stay away from each other, but, at the same time, don't use alone?” Walker asks. “Those two messages don't go too well together.”  

Amber Bramer, manager of marketing and communications at Ottawa’s Shepherds of Good Hope, says the site has rejigged some of its services in response to the new realities: rather than serving daily meals in-house, for example, it’s handing out bagged lunches for takeaway; clients who want to eat together can use one of the physically distanced picnic tables outside. 

Virtual care can offer at least a partial solution to the shutdown of group-based social supports, says Raechelle Devereaux, executive director of the Guelph CHC. The site has moved a number of its early-childhood-development programs, such as sing-alongs and garden tours, online. And staff check in weekly with their regular adult clients by phone, offering grocery delivery for those who need it. “There's been some really great innovation that has connected families and vulnerable and marginalized populations during this time,” Devereaux says. “It's really brought health equity to the doorsteps of many of the people that we serve.” 

In a time defined by uncertainty, Devereaux adds, there’s one thing she knows to be true: the services her staff offer are vital. “Our nurses and peers in these sites, who have truly adapted to how their jobs have changed … are walking into the fire of this pandemic in the name of health equity and support for our most vulnerable citizens,” she says. “I just think they need to be honoured in this.” 

Correction: An earlier version of this article misidentified the executive director of the Guelph Community Health Centre. regrets the error.

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