Many people care about the street community and are worried about people’s risks from COVID, but may not fully know what’s been happening. Here’s our perspective.

the more things change, the more they stay the same

Colonialism has been an ongoing health disaster on these lands. From the 1862-1863 smallpox epidemic in ‘victoria’ to the overdose public health emergency declared in April 2016 (still ongoing) and today’s COVID-19 pandemic, colonial governments have responded not with care or respect, but in ways that have actively harmed people that those with power view as disposable. And once again Indigenous people are disproportionately impacted by the racist view that some lives matter more than others.

It’s not news that being poor, criminalized, stigmatized, discriminated against, and subjected to violence makes you more vulnerable to early death. In 2014 a study by Megaphone found that homeless people in ‘bc’ have an average lifespan half that of housed people. That study was before the overdose crisis that has killed people of all income levels, but has had particularly devastating impact in the street community and in Indigenous communities.

It’s also not news that the health care care system doesn’t treat everyone equally and that public health principles go out the window when government is dealing with the street community. We’ve seen it repeatedly in the ways Island Health has in the past supported displacement and amped up fear and hatred of tent cities, rather than using their political power to ensure that people living outside have access to basics like drinking water and bathrooms. While we’d hoped that in a pandemic compassion might trump poor-bashing…nope. We’re seeing the same old patterns play out again in how government responses to the current pandemic have increased homeless people’s risk of COVID, and dramatically worsened people’s lives by cutting off access to survival services and promoting isolation — a deadly combination in an ongoing overdose epidemic.

the current disaster

At the writing of this piece we are more than one month into the provincial government’s declaration of a public health emergency, but no closer than we were on Day 1 to a plan to work with the street community to prevent mass infection and ensure that everyone has access to needed health care. COVID-19 is a highly contagious virus with potentially fatal health impacts for people who are immunocompromised, frail, or have chronic health conditions. This is a serious emergency for the street community, but thus far government actions can be summed up as flailing, failing, and derailing*. While different levels of government with responsibility for housing and health bicker about whose jurisdictional responsibility it is to take action (something long familiar to Indigenous people and the reason for Jordan’s Principle), people who are unhoused, in group shelters, or in housing where their needs aren’t met remain at high risk of COVID transmission.

[* Health and social service agencies funded by government can’t make public statements about the shenanigans that have gone on with funders so there’s nothing for us to link to, but we know from sitting in on some of the meetings that government has been actively interfering with rapid response.]

While COVID-19 prevention is extremely important, government measures undertaken thus far have worsened low-income people’s health and increased COVID transmission risk by cutting off access to hygiene services. People in the street community are facing:

  • The virus itself, which people in the street community are at higher risk for being exposed to (can’t physically distance, no access to handwashing, etc.) and also at higher risk for more severe and potentially fatal consequences of the illness (due to low immunity from lack of nutrition, chronic underlying health conditions, lack of access to medical care / phone to call 911, damaged lungs from lack of access to safe drug supply, etc.).
  • Abrupt service reductions/closures resulting in people having less access to food, hygiene supplies, transportation, communication, information access, and health & social service access. Unhoused people were particularly impacted with severe reductions to accessing shelters, showers, laundry, bathrooms, drinking water, and handwashing facilities.
  • Loss of income from sex work, binning, panhandling, and scavenging (cigarette butts, food, etc) but without the same level of income replacement support as people in the formally recognized economy who have also lost income.
  • More overdoses as a result of extreme fluctuations in drug supply, reduction of overdose prevention services, emphasis on self-isolation and closure of guest access in low-income housing (reducing access to peer witnessing), and increased substance use to cope with stress.
  • Unsupported withdrawal from alcohol and drugs as a result of less reliable drug supply, decreased income, reduction in detox beds, and closure of drop-in health services. Withdrawal from alcohol and benzodiazepines without medical support can result in fatal seizures, and the vomiting and diarrhea of opiate withdrawal can also have significant health impacts particularly when people have reduced access to bathrooms, drinking water, and nutrition.
  • Severe isolation and mental health crisis for people who are inside (very-low-income housing, temporary motels, shelters, etc) without phones/computers or any other way to connect or stay busy. Indigenous homeless women, girls, and 2spirits already at high risk for violence are put more at risk by enforced isolation. As stated by Indigenous women in a neighboring street community: “They say it’s necessary for our survival of COVID to be alone, but being alone is threatening our survival as poor Indigenous people. To survive COVID-19, we have to keep on protecting Indigenous spaces. We have to protect our physical spaces where we can see and care for each other.”

not everyone is equally impacted by coviD

While everyone can get COVID-19, not everyone is equally impacted by the ways government has responded (and failed to respond) to this pandemic. We see this in the cheerful depictions of staying at home as a time when housed people with economic privilege get to take a holiday from the grind of capitalism and social expectations, relishing in the opportunity to catch up on decluttering, learn a new hobby, practice yoga, binge-watch Netflix, try a new gourmet recipe, read a stack of books, go for a walk in the park…

Meanwhile for people in the street community, people with disabilities, and people in jails/prisons — disproportionately Indigenous and Black — this is a life-or-death situation.

Within the street community there are people especially impacted by COVID. Below are links to sections of this page about specific issues. They are not mutually exclusive, e.g., someone who uses substances may also be a sex worker, or an Indigenous person in prison may have disabilities.

black and indigenous people

As Black health leaders have pointed out, in a racist society how you are racialized is a determinant of health and structural and systemic inequalities are amplified in this pandemic. Data from the ‘usa’ are devastating in showing how anti-Black racism has resulted in vastly disproportionate numbers of Black people dying from COVID-19 compared to non-Black people also diagnosed with COVID-19. While ‘canada’ doesn’t track racialization in the same ways, it is well established that Indigenous people are, in every ‘canadian’ public health crisis, disproportionately affected (including the overdose crisis).

Prior to European invasion of these lands, 100% of people here were Indigenous. That’s obvious but it bears repeating when talking about pandemics, homelessness, and colonialism as the three are so entwined here. Currently approximately 5% of people in the ‘greater victoria’ area are Indigenous, but a limited point-in-time count done here in 2018 concluded that 33% of people who are unhoused are Indigenous. And that statistic doesn’t reflect the numbers of Indigenous people who have been dislocated from home — including relationships to land, water, place, family, kin, each other, animals, cultures, languages and identities.

Indigenous people in the street community have been particularly impacted by COVID-19. A lot has been triggered for Indigenous people by this crisis given longstanding mistreatment of Indigenous people in the health system, including isolation and abuse experienced by Indigenous people with TB who were stolen from their families/communities and confined in “Indian hospitals”. This pandemic also evokes settlers’ deliberate use of smallpox and other contagious illness as a weapon of genocide, and worry about Elders passing with resulting loss of language and traditional knowledge. Travel restrictions mean many displaced low-income Indigenous people are cut off from home communities and culture. Loss of phone/computer access means low-income Indigenous people can’t check in with loved ones, further increasing stress.

People who use substances

The explosion of COVID comes at the same time as another devastating epidemic. Overdose isn’t new, but rates of opiate overdose spiked intensely with the widespread introduction of fentanyl and other highly concentrated opiates into the street drug supply. On April 14, 2016 the provincial government declared a Public Health Emergency and since then over 3,600 people have died in ‘bc’.

If someone overdoses, they need someone who can get help, give naloxone, and do rescue breathing. The message of “self-isolation” helps prevent COVID transmission but it makes things much worse for people at risk of overdose. Ensuring a safe drug supply so people can dose reliably and know what they’re taking is a basic measure that would greatly reduce risk of overdose. For many years people who use drugs have been calling for access to safer supply, but governments have stubbornly refused to decriminalize drug use and professional associations have pressured doctors and nurses not to ‘enable addiction’ by prescribing alternatives to street drugs.

With COVID and the recognition of serious risk of increased overdose there have been some victories around prescription alternatives to street drugs. Under the new guidelines it is now at least theoretically possible. But access relies on having a prescriber who understands and supports these measures, and most people don’t have a doctor or nurse willing to do this. This particularly impacts people who routinely experience harm from the health care system (including Indigenous people, Black people, psychiatric survivors, and sex workers) who may have even less access to health care, less power to navigate asking a prescriber for drugs, and more to risk in making that ask.

Additionally the revised guidelines are of little use to people who rely on alcohol but don’t have access to a Managed Alcohol Program (i.e., pretty much everyone everywhere in ‘bc’ other than ‘vancouver’). Reduced access to alcohol and to supported detox has put low-income people who rely on alcohol at risk of dangerous withdrawal including seizures and death, and this especially impacts Indigenous people who are already highly stigmatized and stereotyped around alcohol consumption.

sex workers

Low-income sex workers (who because of intersections of poverty, racism, ableism, and transmisogyny are disproportionately Indigenous, Black, 2spirit / transfeminine, disabled) have also been particularly impacted by COVID. While some indoor workers have been able to switch to camming or other no-contact work, if you don’t have a home or other access to private space, phone, or computer, that’s not possible to do so for some sex workers there’s a big drop in income. If you’re on welfare you don’t qualify for the same level of support as other people who work, and to file for government benefits available to other workers you need access to a computer, have filed tax papers, and have declared at least $5,000 in income — all totally inaccessible to people who make money outside the mainstream economy.

people with disabilities

Many people in the street community have disabilities. Employment & housing discrimination, normie standards that don’t work for diverse bodies, structural barriers like stairs or insistence on verbal communication, and inadequate government benefits mean that people with chronic illness / disability are often living with very low incomes and unable to find workable housing. Poverty is a social determinant of health, and not being able to access nutritious food or safe housing can cause or worsen health problems. And while substance use isn’t necessarily inherently disabling (although there are health impacts of putting anything into our bodies, including substances), the war on people who use substances in non-normie ways and the resulting lack of access to safe supply, stigma, shaming, isolation, and discrimination means that people who are visibly poor and also use alcohol or illicit drugs often experience profound physical and mental health impacts.

COVID is impacting people with disabilities in intense ways.

The majority of deaths in ‘bc’ have been in long-term care facilities. People in the street community who are in residential care are at high risk of COVID transmission and complications. So are people with pre-existing conditions like diabetes, asthma, kidney disease, and heart problems (which because of connection to all of these with poverty & racism means disproportionately Indigenous people).

Many people with disabilities have had traumatic experiences in the health care system, including discrimination related to racism, substance use, mental illness, or cognitive disability, leading to fear of hospitalization. Some governments have openly called for decisions about resource allocation to take into account whose life has more “quality” with open bias against people with disabilities.

Information about COVID isn’t being made accessible to people with intellectual disabilities. And the closure of in-person services means that most government resources relating to COVID are available only by phone or online, already inaccessible to people with very low incomes but even more so if you are Deaf or hard of hearing. Masks and face shields worn by health care workers make it even harder hear and understand what someone is saying.

Closure and reduction of local services, including bathrooms and buses, has huge impact on people with mobility disabilities who now have an even harder time getting to the few places services are still open, and may have to stand for long periods of time in lineups. Health care access has also been reduced which has huge impacts for people with chronic illness.

people in prison

Approximately 40,000 people are in prison across ‘canada’ — disproportionately Indigenous and Black. On April 7 CTV news reported there were 1,805 people in ‘bc’ prisons/jails, with 617 people convicted and serving sentences, 1,138 awaiting trial/court hearings, and 50 being held on immigration issues.

People in jails and prisons are often living in overcrowded conditions with no way to physically distance or directly access cleaning products, creating the perfect conditions for mass COVID transmission. People in prison are also at higher risk of complications and death from COVID. In federal prisons, more than 25% of those incarcerated are over age 50. As a result of limited access to health care and often lifetimes in poverty, people in prison have higher rates of poorly treated respiratory illness, heart conditions, diabetes, HIV, and cancer.

When the COVID crisis began, courtrooms largely shut down and legal processes were frozen / suspended. People awaiting trial or hearings (approx. 2/3 of people in ‘bc’ prisons) have been denied their legal right to due process at the same time as being held in lockdown conditions with no visits with loved ones, limited access to legal counsel, and no clarity about how long the situation might last.

The same service closures/reductions that happened on the outside world to promote physical distancing also happened in prisons. People have been in conditions similar to solitary confinement or penned up with a cellmate under near-constant lockdown, with little or no access to showers, time outside, phones, legal assistance, food, a way to get exercise, or access to mental or physical health care.

At the same time people in prison reported that guards and other personnel were denying prisoners access to hand sanitizer and other basic protective measures; refusing access to medical care; and keeping sick prisoners cleaning common areas. Whistleblower guards have reported management denying them access to masks and testing, insufficient cleaning protocols, improper application of physical distancing in kitchens, and an inadequate period off-work for self-isolation when symptomatic (i.e., sick guards being pressured to return to work while still contagious).

Prisoners’ and families’ worst fears were realized on April 2 when the first case of COVID-in-prison was confirmed at a provincial prison in ‘bc’. Since then one person in a ‘bc’ prison has died and the disease has exploded throughout across the country. On April 20 it was confirmed that COVID is now rampant throughout federal prisons, where overall 33% of those tested have been confirmed as having the virus — and in the worst hit facilities, more than 70% of those tested have COVID. According to Indigenous organizations, almost 40% of the confirmed cases of at Mission Institution in ‘bc’ (the worst hit facility) are Indigenous.

Decarceration was recognized early on as the only viable strategy to prevent mass outbreaks in prison. It has happened in other countries, including (unevenly) the ‘usa’, ‘australia’, England, Italy, Germany, Poland, and Iran. But it has been slow in ‘canada’, with only a few hundred of 14,000 federal prisoners reported released as of Apr 20 and 600 more who were already eligible for parole under consideration by the Parole Board. The ‘bc’ government temporarily released 442 people between March 15 – April 6 for COVID-related reasons, primarily people serving intermittent or weekend sentences and stating that only the courts can release the vast majority who are in prison awaiting a hearing/trial. Indigenous activists have pointed out that in the context of a colonial and racist system, criteria for assessing eligibility for release are inherently discriminatory.

links to external info

Learning is super-important but we know from our own experience that learning isn’t head-only, it also comes from doing things. Particularly in these times when it’s easy to get lost in information overload, internet learning (reading, podcasts, etc.) needs to be balanced with action. But for folks who are wanting some more information, here are a few more links to resources that we’ve found helpful.

Crackdown is a podcast about drugs, drug policy and the drug war led by drug user activists. Produced by Cited Media Productions on the territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and sel̓íl̓witulh (Tsleil-waututh) Nations. Includes two episodes on COVID, Emergency Measures and Apocalypse Prescribing.

Some sensationalist language, but these three articles explain what is happening around the government failure to address COVID prevention with the street community:

For wisdom from people who are most impacted and also highly experienced with organizing and doing healing justice work in times of being constrained by illness and societal bullshit, check out Social Justice Resources for COVID-19 Responses which includes podcasts (with transcripts) and online circles, including the recent episode #ShareMyCheck: Redistributing Stimulus Money for Justice & Mutual Aid.