Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

Times like these test our ability and resolve to confront multiple needs seriously and simultaneously. What we used to call the opioid crisis, the scourge that we once featured on front pages and newscasts, has gotten worse in the last year. At the same time, it has disappeared from most news coverage.

The Centers for Disease Control and Prevention says its latest data, covering 12 months from mid-2019 to mid-2020, shows more than 81,000 people died of opioid use. 10 western states reported a 98% increase in opioid deaths.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, tells Kentucky Health News:

“During this pandemic, the epidemic that we were in, of substance use disorder, only worsened,” he said. “2020 will be by far our worst year for fatal drug overdoses. … It’s just been a horrible year for overdoses in general and in overdose deaths as well.”

The CDC adds:

Overdose deaths involving cocaine also increased by 26.5 percent. Based upon earlier research, these deaths are likely linked to co-use or contamination of cocaine with illicitly manufactured fentanyl or heroin. Overdose deaths involving psychostimulants, such as methamphetamine, increased by 34.8 percent. The number of deaths involving psychostimulants now exceeds the number of cocaine-involved deaths.

You will find similar data in Minnesota, Vermont (where 89% of opioid deaths were linked to fentanyl), Louisiana, West Virginia, California and Iowa, just as examples.

The Lancet explains why opioid use and deaths rise in a pandemic:

The COVID-19 pandemic has exacerbated an already difficult situation by reducing access to life-saving treatment, harm reduction, and recovery support services, while increased stress and isolation might increase the risk of addiction and substance use disorders

The Journal of the American Medical Association says:

Stresses related to the COVID-19 pandemic, such as economic strains, as well as COVID-19–related isolation and other factors hindering treatment and support for people with substance use issues, may have contributed to the current rise in overdose deaths.

Other than a small decline in 2018, overdose fatalities have increased dramatically for 3 decades, with a record number of 71,966 estimated deaths in 2019. According to the CDC, opioids — especially synthetic ones (other than methadone) — are currently the chief drivers of drug overdose fatalities.

The Biden administration promises action, and we have heard that before, but The Lancet says there is some hope a new administration will make opioid abuse a priority again. In 2018, the Trump administration sharply increased federal funding targeting opioid abuse. And yet, deaths kept rising. The Lancet says one key to lowering opioid deaths is to make addiction treatment available:

Just one in five people with opioid use disorder in the USA are able to access treatment at the time they need it, and fewer than half of community health centers in the country have the capacity to provide medication-assisted treatment (MAT).

Medicaid expansion through the Affordable Care Act (ACA) has been instrumental in increasing coverage of mental health and SUD services.

Nationally, Medicaid expansion was associated with a 6% reduction in total deaths from opioid overdoses in states that underwent expansion compared to non-expansion states.

In West Virginia, the state with the highest rate of deaths from opioid-involved overdose as of 2018, buprenorphine prescriptions for patients with opioid use disorder increased by an estimated 42% between 2014, when Medicaid was first expanded in the state, and 2016.

Treatments with buprenorphine and methadone were associated with 38% and 59% decreases in opioid-related mortality, respectively, according to one study in Massachusetts; all forms of MAT should be made accessible.

JAMA’s report says America’s opioid addiction arrived in three waves, leading up to the latest wave during the pandemic:

– The first involved prescription opioids (natural and semisynthetic opioids and methadone) beginning in 1999 or earlier, following increased prescribing of opioids in the 1990s.

– A second wave began in 2010, featuring rapid increases in overdose deaths involving heroin, followed by a third wave of significant increases in fatalities starting in 2013 that was fueled by synthetic opioids (especially illicitly manufactured fentanyl).

– The latest rise in fatal drug overdoses may have been boosted by factors related to the COVID-19 pandemic. According to findings from a CDC survey of US adults, 13% of respondents said in late June that they had started or increased substance use to cope with pandemic-related stress or emotions. Groups that were more likely to do so included young adults (nearly a quarter of those aged 18 to 24 years), Hispanic (21.9%) and Black (18.4%) respondents, essential workers (24.7%), and unpaid caregivers for adults (32.9%).

Joe Biden says he will take a different approach to reducing America’s opioid problem. Donald Trump pressed for stronger criminal penalties for dealing and trafficking opioids and proposed the death penalty for drug traffickers.

Biden’s ideas include interrupting drug supplies but focusing more on cutting the over-prescription of opioids, ending incarceration for drug use when that is the only charge, funding drug courts and increasing treatment for addictions.

As part of Poynter’s multi-year effort to help journalists thoughtfully and aggressively cover jails and police reform, I point you to this free webinar featuring Dr. Lipi Roy. Dr. Roy is a nationally recognized expert on addiction medicine and was the chief of addiction medicine at Rikers Island jail in New York. This webinar is a shorter version of the teaching Dr. Roy does with me in our Covering Jails workshops that have trained hundreds of journalists in the last three years.

Will Biden order a national mask mandate?

President-elect Joe Biden puts on his face mask after speaking during an event at The Queen theater, Saturday, Jan. 16, 2021, in Wilmington, Del. (AP Photo/Matt Slocum)

In short, the answer to the headline is “no.” But Biden has made no secret of his plan to make COVID-19 masks mandatory in as many places as he can.

For starters, he says he will mandate all federal workers wear masks and he will order masks be used in all interstate transportation. He says he, himself, will wear a mask in office for at least the first 100 days.

I know masks have become a partisan issue — but it’s a patriotic act. Experts say wearing a mask from now until April will save more than 50,000 lives.

— Joe Biden (@JoeBiden) January 17, 2021

“On the first day I’m inaugurated, I’m going to ask the public for 100 days to mask. Just 100 days to mask — not forever, just 100 days. And I think we’ll see a significant reduction” in the virus, Biden said in December.

Forbes points out that masks will not be optional in Congress, either:

$500. That’s how much lawmakers will reportedly be fined for refusing to wear masks on the House floor under a new rule proposed by House Speaker Nancy Pelosi, with a $2,500 fine for a second offense.

The mask mandate on federal property is just one of a range of executive orders the new president will sign, according to his team. The other orders include:

• Extending pandemic-related limits on evictions and student loan payments
• Rescinding the travel ban on several predominantly Muslim countries
• Rejoining the Paris climate accord
• Ordering agencies to figure out how to reunite children separated from families after crossing the border

The scary Norwegian vaccine headlines don’t tell the whole story

Earlier this week, Bloomberg (and other news organizations) ran some headlines:

Norway has registered more deaths among people over the age of 75 who had their first Covid-19 vaccination shot https://t.co/DaMtT3krKj

— Bloomberg (@business) January 16, 2021

29 elderly people died in Norway after receiving their Covid-19 vaccination. Here’s what you need to know about the shot https://t.co/rqkoe2ZrMz

— Bloomberg (@business) January 18, 2021

Then, they toned it down:

LATEST: Health officials in Norway say there’s no evidence of a direct link between the recent string of deaths among elderly people and Covid vaccines https://t.co/DNlODd40mN

— Bloomberg (@business) January 18, 2021

The story behind the headlines is that 33 people in Norway over age 75, who all had terminal illnesses or “serious underlying health disorders,” died sometime after being vaccinated. The Norwegian Medicines Agency has warned that when you vaccinate “the oldest and sickest,” deaths will occur, just as deaths will occur without a vaccine. There is no proven link or causal relationship between the shots and the deaths. An average of 400 people die each week in nursing homes and long-term care facilities, according to the Norwegian Medicines Agency.

Bloomberg’s own story explains:

The findings have prompted Norway to suggest that Covid-19 vaccines may be too risky for the very old and terminally ill, the most cautious statement yet from a European health authority.

The Norwegian Institute of Public Health judges that “for those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences. For those who have a very short remaining life span anyway, the benefit of the vaccine may be marginal or irrelevant.

In Germany, investigators looked at seven deaths involving elderly patients and found that the deaths were probably due to the patients’ underlying diseases, including carcinomas, kidney deficiencies and Alzheimer’s, not the inoculation.

In short: Come on, journalists. Knock it off with the headlines that even imply there could be deaths associated with the vaccines unless you have the goods to say such a thing. Otherwise, it is clickbait of the worst sort.

Building COVID-19 vaccine trust among Black, Latino and Native American communities

Biden said his administration will launch a massive public education campaign aimed directly at reluctant audiences. He said nonwhite patients were being infected at four times the rate of white patients and dying more often, too.

(The COVID Tracking Project)

You can search (most) states’ data for race and COVID-19 deaths.

This is Kaiser Health’s COVID-19 tracker, which also sorts data by states and race.

Journalists, it would be useful for you to explore why people of color are so skeptical of vaccines. Recently, I read this summary of racial discrimination during the polio epidemic. A national polio center where President Franklin Roosevelt was treated only accepted white patients (half of the workers there were Black). And some “medical experts” publicly claimed that Black people were not susceptible to polio.

Last year, the drug companies who were testing their COVID-19 vaccines struggled to recruit Black participants. Polling by Kaiser and The Undefeated surfaced historical concerns that go back 90 years to the Tuskegee Syphilis Study. That study went on for decades. Time explains:

The study enrolled 600 Black men, including 399 who had syphilis, according to the CDC. The participants were tricked into believing they were receiving free medical care but were instead just observed for a study of untreated syphilis. The men were told they were being treated for “bad blood,” and did not receive any treatment for their illness — not even after penicillin was found to cure syphilis in the mid-1940s. Dozens died as a result. The study did not end until it was exposed to the press in 1972 and has gone down as one of the nation’s most egregious examples of medical racism.

But just focusing on historical wrongdoings ignores the lived experience of today.

A Department of Health and Human Services study just two years ago found that Black patients are treated differently from white patients. 40% of the measures that the government uses to assess health care quality were worse for Black Americans. Some reluctance over vaccines may not just be distrust as much as a lack of confidence.

In an op-ed for StatNews, Dr. Julian L. Watkins, a physician with the New York City Department of Health and Mental Hygiene, writes:

Health and health care disparities are crushing communities of color in this country. Health care systems and their practitioners play a significant part in this. Relative to white people, Black people are less likely to have their pain adequately treated. Black and Indigenous women are three to four times more likely to die in childbirth than white women, regardless of education or socioeconomic factors.

To create equitable vaccine programs, we must go beyond addressing historical trauma and account for the traumas people experience in the here and now. Racial trauma is like other forms of trauma: Its impact is widespread, it is intergenerational, and it can have severe social, physical, and psychological consequences. We already have proven public health frameworks, such as trauma-informed care, to address trauma. It’s time to broaden their application.

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