March 31, 2020

The Honourable John Horgan, Premier of British Columbia

The Honourable Adrian Dix, Minister of Health

The Honourable Judy Darcy, Minister of Mental Health and Addictions

British Columbia Provincial Health Officer, Dr. Bonnie Henry

Vancouver Chief Medical Health Officer, Dr. Patricia Daly

Vancouver Mayor, Kennedy Stewart

Re. Dual crises in the Downtown Eastside and need for urgent actions

Dear provincial and local leaders,

As registered nurses and frontline workers in the Downtown Eastside (DTES) of Vancouver, we write this letter in order to draw your attention to the dual crises unfolding in the DTES and soon to be dire situation faced by the DTES community.  

Every day, we work closely with members of the DTES community who are homeless or precariously housed, living on the streets, in tightly packed shelters, or in buildings with shared bathrooms and limited supplies for hand-washing and cleaning. Many of them rely on public spaces such as libraries, community centres, and drop-ins for safe shelter to access food, clothing, laundry services, and public bathrooms.

Over the past few weeks, these spaces have been forced to close their doors and reduce their capacity in supporting (and safeguarding) the community. Because of this, we have seen large numbers of people being forced back onto the streets with nowhere to go and no way to ensure physical distancing. Staying close to one another is paramount to maintain their safety on the streets and it is unthinkable to ask people in such a precarious situation (and with no additional support) to isolate themselves.    

Registered nurses and frontline workers in the DTES have been responding to a public-health emergency for four years now. We know that the drug supply is poisoned, and for this reason we cannot recommend that people who use substances isolate themselves and use alone. Public-health measures such as physical distancing and isolation put people who use substances at risk of a fatal overdose. Accessing safer consumption services may also put them at greater risk of contracting COVID-19 despite measures currently taken to reduce this risk.

Despite COVID-19, people who have access to or are attempting to access safer opioid-replacement therapies such as methadone/suboxone/iOAT/TiOAT have been required to attend their pharmacies daily or access public spaces, sometimes multiple times a day, to acquire these essential medications. As a result, they have been unable to practice physical distancing and isolation. This is true for people who are unhoused, precariously housed, and those who are housed. It is safe to say that this requirement constitutes a risk in and of itself.   

Every day, registered nurses and frontline workers administer oxygen and provide artificial respirations along with naloxone to treat opioid overdoses. We have been instructed to limit or avoid use of oxygen and artificial respirations because they are aerosol-generating procedures and we do not have the appropriate personal protective equipment (PPE) in our workplaces. Furthermore, we may soon be limited in our lifesaving emergency efforts due to a shortage of PPE. We are terrified that we will witness our community members suffer preventable and treatable deaths due to a shortage of PPE. As limited PPE is prioritized for acute-health-care services, we are concerned that we will be forgotten and not be supported to provide the lifesaving services this community depends on.  

We ask for urgency in addressing the above problems and expediting the following actions:

1. Provide standard and recommended PPE to all frontline and healthcare workers to allow them to do work safely and efficiently—including performing lifesaving, aerosol-generating procedures that are essential to save lives during an overdose crisis.   
2. Prioritize immediate training, support, and supplies to expedite the reopening of Overdose Prevention Sites in order to ensure that staff can safely return to work and clients have a safe place to use.
3. Expand shelter and housing supports in order for people to safely practise physical distancing and isolation. Many community spaces and buildings are vacant and could be used to provide safe shelter in the midst of this dual crisis.
4. Increase access to opioid-replacement therapies and allow people to carry home more than one day’s supply at a time so they can better comply with social distancing and isolation. Rapidly scale up safe supply as per BCCSU guidelines.
5. Provide and distribute food, water, and other essentials to DTES community members who are living on the streets and in our parks.

We appreciate the fact that our local and provincial governments are aware of these issues and are beginning to take action. However, further measures are urgently needed.  Every hour that goes by puts the lives of our most vulnerable community members at risk and contributes to the preventable spread of COVID-19.  Please hear our message and act immediately.  

With urgency,

Concerned registered nurses and frontline workers of the DTES