Pandemics Layered on Epidemics

Our society’s current method to get rid of the drug epidemic is to chastise Sunshines’ behavior rather than acknowledging the histories of inequality and inequity that contributed to it. This society-wide moral shaming, and framing Sunshines as the scapegoat for the violence inflicted by the pharmaceutical industry, is not the only way structural violence is operating; we can see the hands of structural violence in the push and pull battle between the Philadelphia government and nonprofits.

The historical lack of governmental programs to aid Kensington residents has fostered an embodiment of distrust. Many nonprofits, such as Prevention Point Philadelphia, Safehouse, and Roz’s Operation Save Our City, have risen to fill the community’s unmet needs. Nonprofit organizations understand the local needs through community collaboration. This is a higher level of understanding than the government can achieve through surveys and data collection. Structural violence in Philadelphia is currently acting to undermine the efforts of nonprofits; our legislature and health system’s ties to neoliberalism are preventing nonprofits from meeting the specific, local needs of residents because the government claims that their goals and actions violate federal law. Claims of legal violation result in the stagnation of action, which yields an increase in overdose deaths both in Philadelphia and nationwide.

The Data Narratives of Two Epidemics

The COVID19 pandemic is a force that has revealed cracks in the support structure for the communities suffering from the opioid epidemic. Society-wide loss is the predominant narrative, as emphasized by the evening news tributes of those, integral to communities in the United States, who have lost their lives to COVID19. As I am pursuing an ethnographic account of absence, and its links to structural violence and health, I realized that the opioid and heroin epidemics have been a disregarded narrative in the time of COVID19. There has been a substantial increase in the number of individuals who have died from a drug overdose in 2020 as compared to 2019. While I could not obtain the drug overdose data from the Philadelphia Health Department for 2020 (it is currently March of 2021), this graphic from an initial report from the National Center for Health Statistics depicts a significant increase in overdose deaths during 2020 compared to previous, non-pandemic years. 

Rossen, Lauren M, Holly Hedegaard, and Farida B Ahmad. “Early Provisional Estimates of Drug Overdose, Suicide, and Transportation-Related Deaths: Nowcasting Methods to Account for Reporting Lags,” n.d., 21.

The chart describing overdose deaths is often rendered “less significant” than the “death tally” of the COVID19 pandemic. I visualized the pandemic outline in Philadelphia in the chart below to provide the “height” of a COVID19 line graph as a comparison to the NCHS graph.

However, the outline of the pandemic in Philadelphia (as articulated by a graph of new, positive COVID19 cases per day) only represents COVID19 cases proven positive by a test. These graphs articulate only the presence of data, not the absence of data. The “real” narrative or graph of the pandemic in Philadelphia is arguably a very different shape due to the very possible undercounting of Philadelphia’s most vulnerable neighborhoods.

A quick key for the graph’s colored arrows (McDaniel and Orso 2020):

On March 11th, the WHO declared COVID19 as a pandemic; on March 16th, Philadelphia halts all non-essential activities and jobs.
By March 20th, there is a significant personal protective equipment shortage in the United States, and specifically in Philadelphia.
By April 9th, 100 individuals have died of COVID19 in Philadelphia; Pennsylvania Governor Wolf orders all schools to close for the remaining school year.
By May 14th, 1000 individuals have died of COVID19 in Philadelphia.
On June 26th, Pennsylvania institutes a public mask mandate. 
On July 26th, the city of Philadelphia made a pledge to increase testing for communities of color in Philadelphia. 


Discussions articulating the overlapping of the COVID19 pandemic with the drug epidemic reveal not only how there is a hierarchy in our society of “worthy” (COVID19) versus “unworthy” (drug abuse disorder) health problems, but additionally a hierarchy of socially acceptable death. This hierarchy is currently reinforced and seen through narratives on news channels: an individual who is experiencing significant COVID19 disease, who is often depicting laying in a hospital bed, will make a plea to their audience (through the camera lens) that COVID19 is indeed “real” and “significant.” These narratives also reference that while the individual did not heed the “warnings,” mask-wearing, or social distancing measures seriously, they urge everyone else to abide by them to avoid their same fate.

There are some significant similarities and differences between these narratives and the narratives of Sunshines. They are similar because the individual is not adhering to society’s socially constructed notion of health, but different in that the end of the narrative results in severe stigmatization for Sunshines. It is not death that is significant in our society, but what causes an individual’s death.

Discussing Public Health Measures: Social Distancing

Roz taught me, both through narrative and definition, that harm reduction is not only intentional action but meaningful action. he COVID19 pandemic has made some harm reduction practices more difficult, namely through social distancing. While social distancing is imperative to minimize aerosolization spread of COVID19 viral particles, it also mitigates potential sources of intervention in the case of a drug overdose. As Roz told me when discussing her cousin Louis in Kensington,

I always tell him he needs a buddy system with that in case someone falls out.

Roz’s suggestion of a buddy system emphasizes “safety in numbers” for Sunshines. Sunshines need to employ different safety measures than other residents in Philadelphia, as their lives are at risk if an individual uses a batch of drugs laced with too much fentanyl. Trace amounts of fentanyl, as illustrated in the DEA’s image below, can cause overdoses.

Caption: photo illustration of 2 milligrams of Fentanyl, a lethal dose in most people.

In a situation of an overdose, another individual would be able to administer Narcan or find another source of help (such as Roz’s Community Kit). However, social distancing has severed human relationships through a fear of contamination. This has left Sunshines at a greater risk of losing their lives.

I am not arguing against social distancing measures, as it has helped to mitigate the communal spread of COVID19; instead, I think that public health measures need to consider all populations, not just those of the dominant societal narrative. If a public health measure hinders one population, then infrastructure should be in place to reduce that disparity.

Nonprofits like Safehouse could reduce these disparities if the United States was willing to alter its social construction of health to allow nonprofits to operate in neighborhoods like Kensington. A supervised injection facility like Safehouse could be set up to adhere to the required six-foot social distancing measures while also providing a built-in buddy system. It is a simple solution to save the lives depicted in the National Center for Health Statistics chart above.

Some Closing Thoughts

The comparisons and contextualizations of the pandemic and epidemic on this page are structured to provoke questions such as why one epidemic/pandemic garners more societal support than another? Why is dying of one cause more valid than another?

To meet the needs of individuals in society, including Sunshines and those subject to the daily manifestations of structural violence, we need to value human bodies to the extent that it doesn’t matter the “cause” of injury or disease. The only thing that should matter is that there are infrastructure and societal support to ensure that all individuals can survive and thrive.