This is the second of two articles about how COVID-19 is affecting Ontario’s harm-reduction services. Read the first story here.
Every day, staff at St. Stephen’s Community House don masks, gloves, and gowns to guard the entrance to its Kensington Market building.
The Toronto-based social-services agency, which runs an overdose-prevention site, has had to ramp up its screening procedures in the wake of the coronavirus outbreak: clients who were once allowed in with relative freedom are now asked a series of questions about their current health status at the door. They line up outside the tan brick building to have their temperature taken; if they’re found to be fever-less, they’re allowed in one at a time.
But if they’re found to be symptomatic — showing signs of a recurring cough or shortness of breath, for instance — they’re given a mask, escorted in to use their drugs safely, and then quickly walked out and over to a nearby COVID-19 assessment centre. Their escorts are covered head to toe in personal protective equipment, a new measure that St. Stephen’s and countless other safe-consumption sites have implemented to prevent the spread of COVID-19 within their facilities.
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These procedures, however necessary, introduce new barriers to access for a service that is otherwise engineered to be as accessible as possible. They also introduce new requirements for PPE that many sites across Ontario have had difficulty meeting amid global supply shortages.
While most safe-consumption sites typically keep gloves and masks in stock for interacting with or resuscitating patients, the coronavirus outbreak has forced them all to start purchasing such items as gowns, eye coverings, and N95 masks. Most sites had trouble doing so in the first few weeks of lockdown, as global demand had reached an all-time high.
But St. Stephen’s has found itself at a particular disadvantage in accessing PPE: the site no longer receives funding or assistance from the province, as per an April 2019 cost-cutting directive from the Doug Ford government. It’s one of three sites in Ontario that lost provincial funding; resources were reallocated to 15 others (in Guelph, Kingston, Niagara, and beyond). While the latter sites began receiving steady supplies of PPE from the Ontario Ministry of Health once bottlenecking within the global supply chain had cleared, St. Stephen’s has relied solely on private donations to get by.
And, while staff at funded sites have daily conference calls with the ministry during which they provide updates on their inventory levels and current needs, St. Stephen’s has no such regular access. Instead, Barb Panter, manager of housing and drop-in services, says that she and her team have been posting requests for donations on social media and reaching out to family and friends.
“The first couple of weeks, anyway, we were really scrambling,” Panter says. “A lot of my time was spent trying to source PPE; we just sent requests out to everyone, and we got some donations. We got some hand sanitizer from a distillery, for example.”
She estimates that the site now has enough supplies to last a month — factoring in the fact that many staff members are asked to save their surgical masks and reuse them over the course of two shifts. Panter admits that these procedures would “make anyone working in a hospital a little bit horrified” under normal circumstances. “But, by doing that, we'll be able to make our PPE last,” she says.
Staff at Street Health — another non-profit community agency in Toronto that lost provincial funding for its overdose-prevention site in 2019 — have taken similar steps to get the most out of their limited supply of PPE. Six injection-site staff, for instance, share four pairs of goggles that are regularly sterilized. This is “obviously not best practice,” says Kelly White, coordinator of the overdose-prevention site. “But it’s something that we need to do to stay open … We are very much scrambling to make do and keep the doors open with fundraised dollars.”
For White, the stakes couldn’t feel higher. She says that, while the world has turned its attention to the coronavirus outbreak, the supply of drugs circulating through Toronto has quietly become more and more lethal. A growing number of Street Health’s clients have come in with contaminated drugs, she says, and March overdose rates across the city were the worst they’ve been for a year. In March, there were 19 overdose-related deaths in Toronto — seven more than the month prior and three fewer than in the same month in 2019.
Meanwhile, stringent screening procedures have increased wait times, and both White and Panter fear that clients who would otherwise use while supervised are making the choice to use elsewhere on their own. “The barriers to access the spaces have increased a bit,” White says. “It's a lot for some people to deal with.”
Both also say they’re determined to make sure that PPE shortages don’t become an additional barrier to access, forcing cuts to hours or services. The two note that, in the absence of official provincial funding, they’ve found support in the broader harm-reduction community. White’s been invited by other overdose-prevention sites to join the occasional phone call with the ministry, and Panter says that local community-health centres with excess PPE have chipped in and shared gowns and masks with St. Stephen’s. “We're doing a good job at just sort of sharing amongst ourselves,” White says.
But the occasional kindness of fellow health-care workers is no substitute for adequate government support, they argue.
“We continue to be of the opinion that we should be funded,” Panter says. “That's what we're going to keep working towards. And, in the meantime, we're just going to keep it open and keep doing the job that we do.”