by James A. Bacon
When governments shut down economic and social activity to quell the spread of the COVID-19 virus, Bacon’s Rebellion has frequently warned, they run the risk of engendering unintended consequences. We have predicted negative impacts from job loss and social isolation on mental health, substance abuse, domestic abuse, and suicide. Just because state government doesn’t report those numbers real-time, as it does with COVID-19 cases, doesn’t mean the impacts aren’t real.
Thanks to a study published in the Journal of the American Medical Association, we do have data on opioid overdoses at the Virginia Commonwealth University Medical Center. The surge is dramatic and impossible to ignore.
While overall emergency room visits declined 29% between March and June 2020 compared to the same period the year before, nonfatal opioid overdoses leaped 123%.
(The total number of overdoses was understated because the numbers do not include fatal overdoses, the reporting of which which is delayed to cause-of-death determinations, or cases in which patients did not pass through the emergency room.)
Eighty percent of the opioid patients treated at VCU were for blacks, up from 63% a year ago. In absolute numbers, overdoses among blacks increased from 64 to 181 over the two years, from 29 to 32 among whites, and from four to six among Hispanics. No Asians were reported as experiencing overdoses at VCU.
“Social isolation, job loss, the inaccessibility of community resources — these could all contribute to the overdoses we’re observing,” said Taylor Ochalek, lead author of the study. “Health disparities have been magnified during the pandemic,” he added.
Bacon’s bottom line: There are two ways to look at the racial disparities in this data. One is the Washington Post way, illuminated here, and blame the virus, as if the virus caused the shutdowns. Another is to blame the emergency measures enacted to fight the virus that failed to take into account predictable consequences. There are costs associated with the virus-fighting shutdown orders, and the study suggests that those costs fall disproportionately on African Americans, at least as measured by opioid overdoses. (It would be interesting to know if the increase is seen also in predominantly white Western Virginia where opioid addiction is widespread.)
The VCU emergency room serves mainly residents of the City of Richmond, especially the poor, inner-city neighborhoods. By way of comparison to the 125 increase in opioid overdoses, the city has experienced 413 COVID-related hospitalizations and 58 deaths, according to Virginia Department of Health data. We don’t know yet the number of opioid-related deaths. In all likelihood, coronavirus-related deaths in Richmond outnumber opioid-related deaths by a wide margin. But opioid overdoses are just one negative public health consequence of the shutdown.
For instance, there are reports of the growing severity of child abuse. In an article describing the dramatic decline in child abuse/neglect cases reported by public schools, the Virginia Mercury reported today:
Anecdotally … there have been reports that CPS (child protective services) calls during the pandemic are growing in severity — a trend that some hospitals have also observed. Dr. Robin Foster, a physician at VCU’s Children’s Hospital of Richmond, said Monday that the number of child abuse patients has stabilized but that case presentations have shifted toward an increase in severe physical abuse (“presumptively because we are missing the early warning signs,” she wrote in an email), acute sexual assaults, and ingestions, which she defined as young children taking or being given prescription or recreational drugs.)
“That makes me worry there are children who are in serious situations that we’re not learning about until they’re in the emergency room and something really terrible has happened,” Gilbreath added. Duncan Alonso, the executive director of Virginia Beach’s court appointed special advocates program — a nonprofit that supports victims of child abuse and neglect through legal proceedings — said calls to nationwide to domestic violence hotlines have also increased despite lagging numbers from CPS.
Foster provided no hard data regarding the increase in severity in child abuse cases at VCU. For purposes of comparison to the coronavirus: CPS reported 101 “founded” cases (after investigations) of child abuse and neglect in the City of Richmond in 2019.
Meanwhile, we are still awaiting numbers on alcohol abuse, domestic abuse, and suicides.
