For those of us connected to technology, it’s hard to imagine not having continual information about the novel coronavirus pandemic. It’s everywhere—Facebook updates on daily struggles and sacrifices, tweeted news stories and viral threads from healthcare workers begging for people to stay home, horrifying TikTok challenges where foolish teens boast about licking toilet seats and coughing on produce. News feeds teem with global infection rates, political squabbles over relief funds and the latest conspiracy theories. Although the way the coronavirus has hijacked all our attention is unique, the atmosphere is symptomatic of our era, when information and misinformation merge into chaotic overload.
Yet it’s easy to overlook the fact that economically disenfranchised people have far less access to technology and the information surplus it grants. According to a 2019 Pew Research report, 10 percent of US adults don’t have internet access—rising to 18 percent for households with an income below $30,00 a year. Without a device and a consistent WiFi connection, or the comfort of a safe place to sit and scroll, some of the most vulnerable among us are left confused, skeptical or scared.
According to the frontline workers who interact with marginalized populations daily, many are simply being forgotten.
“One of my patients had no idea what social distancing was and thinks everyone is overreacting.”
“It’s incredibly chaotic,” said Kimberly Sue, medical director of the Harm Reduction Coalition, which is headquartered in the heart of New York City. “Everyone’s kind of got their own understanding of the situation. One of my patients had no idea what social distancing was and … thinks everyone is overreacting, and doesn’t understand the barrage of information coming in.”
It’s hard for anyone to keep up with the data and recommendations, which are constantly updated in response to the rapidly evolving pandemic. Every morning the world seems to have shifted on its axis, with disjointed and sometimes conflicting messages from various health and political authorities challenging even the best informed. For those who rely on free resources to access the internet like public libraries, many of which are now closed, their main news source now might very well be word-of-mouth.
“It’s complicated how people are able to synthesize and understand a lot of information right now,” Sue told Filter. “Nobody is talking to anybody in a coordinated fashion. People are being overwhelmed by information. There’s also a lot of people who have anxiety and fear already, and COVID is another thing on top of a lot of chronic anxiety, stress and/or trauma.”
Many crisis support centers have been forced to close their doors in the last two weeks, in order to comply with ordinances against gatherings. With very few alternative options, these closures have left the people they serve without access to information or support in coping with their new reality. But these are populations for whom accurate information and support is crucial.
A disproportionately high number of people experiencing homelessness and people who use drugs have chronic conditions that put them at heightened risk for developing severe symptoms of COVID-19. The likelihood of infection is also heightened for rough sleepers and those living in group shelters, or who have to go out regularly and interact with multiple people in order to procure illicit drugs and stay out of withdrawal.
“We deal with a large population of people experiencing homelessness that intersect with drug use, and we are finding many have co-occurring medical conditions. I see a lot of people with compromised immune systems, or respiratory disease,” said Chris Schaffner, program manager for the JOLT Foundation, a harm reduction provider in Central Illinois. His organization recently had to close the doors of its drop-in center in response to the pandemic, though they are still offering safe supply services, one person at a time.
This double vulnerability—being at heightened risk for contracting and transmitting the virus, and heightened risk of its most severe outcomes—makes it imperative that marginalized populations receive current, accurate information. But with limited access to credible news sources, and cut off from support systems, this often isn’t happening.
“There is this sense of helplessness: ‘Even if I were to become sick or infected, there’s nothing to do.’”
“How do they know what’s a symptom of their preexisting condition versus a new onset of symptoms from the coronavirus? They can’t just bumrush the emergency room because we’ve been instructed not to do that,” Schaffner told Filter. “A lot of them struggle with healthcare literacy, understanding the healthcare system and their own health. A lot of them don’t have access to 24-hour news cycles. I can’t tell you how many times I’ve had to talk about … the symptoms of COVID because they don’t know.”
He cited the example of an elderly Black man who is unhoused and actively injecting drugs. “We instructed him, ‘If you have symptoms [of COVID-19], seek medical care.’ The CDC is recommending people call their primary healthcare provider, but he doesn’t have a primary health provider. The hospital is his primary healthcare, where he’s not supposed to go. There is this sense of helplessness: ‘Even if I were to become sick or infected, there’s nothing to do.’”
Technological solutions to this problem are inherently limited. Justine Waldman, medical director for REACH, a harm reduction-centered health hub in Ithaca, New York, described to TalkPoverty that her patients typically have very little income, and have been marginalized in multiple ways, including by the healthcare system. When she offered them the opportunity to engage in services through telehealth, many declined, citing that they didn’t have the proper technology or enough cell phone minutes.
“Sometimes this is where they go to get things they don’t always otherwise have, like a snack or internet access,” Waldman explained. “I am worried that if a lot of my patients start getting sick [with COVID-19], they might end up coming here, even though we’re not equipped for that, because it’s where they know to go, where they feel safe.”
Even for those who can get online, misinformation can also cause major harm to those who don’t have the luxury of vetting data sources, and who might be looking for easy remedies to their anxieties right now.
“The fear [caused by the pandemic] has created so much misinformation,” said Sue. She cited a viral social media post falsely claiming to be from Stanford, which stated that you could tell whether or not you were infected with the coronavirus by how long you were able to hold your breath. Fortunately, that one was publicly debunked by Mother Jones, but that doesn’t mean everyone who saw the post knows that. Because the internet favors the succinct and sensational, it’s easier to make a meme with an easy fix go viral than an evidence-based article.
“I am very afraid that the messaging around overdose is not accurate,” Sue added, referring to another morsel of coronavirus misinformation aimed at the very population with the least resources for recognizing false claims that appear credible at a surface-level. Several high-profile and likely well-meaning harm reduction and treatment entities shared a statement on social media that the novel coronavirus heightens the risk of overdose in people who use sedatives, because it attacks the respiratory system.
“That is medically not known…[COVID-19] is a totally new scientific entity. This virus has not been studied so … to say it heightens the risk of overdose is simply inaccurate,” said Sue, clarifying that the rumor was derived from research on the impact of other viruses on people with respiratory conditions like asthma. “You can’t take scientific papers from another context to apply to COVID … I just don’t want people freaking out. If you have a cold, naloxone, [the opioid overdose reversal drug], works for you. If you have coronavirus, naloxone works.”
In order to combat misinformation for marginalized people, the Harm Reduction Coalition published an online list of resources related to COVID-19 and people who use drugs, engage in sex work, have HIV or hepatitis C, and other related vulnerabilities. The organization offers online support groups and clinic hours, and is still seeing people in person who cannot utilize the online services.
Other harm reduction and treatment groups are making similar efforts to keep marginalized people safe and supported. CleanSlate Outpatient Addiction Medicine, an evidence-based treatment provider in Philadelphia, jumped on the recently relaxed telehealth regulations by sending representatives to do street outreach, chatting with people on the streets (while utilizing social distancing measures) and offering immediate telehealth appointments from phones or complimentary Lyft rides to the clinic. Harm reduction organizations in Baltimore and many other places are similarly sharing physical resources and conducting COVID-adapted in-person work.
“Ultimately [misinformation] could harm people, psychically or mentally, or people could die if the information is not good.”
Devin Reaves, executive director of the Pennsylvania Harm Reduction Coalition, is working on getting 6,000 cases of naloxone distributed throughout the state, with a focus on partnering with detention facilities to get them in the hands of people being released right now. His organization also plans to have a mail distribution operation running within the next 10 days, to include naloxone and pamphlets that detail facts about COVID-19.
Yet accurate information is frequently drowned out. The White House has offered us several examples of the effects of bad information coupled with an inability to appropriately interpret it. During several recent press conferences, Donald Trump touted the anti-malaria drug hydroxychloroquine as a cure for the novel coronavirus. Within days, a man was dead after attempting to inoculate himself against the virus by ingesting choloroquine phosphate, an ingredient in an aquarium product which is different from the pharmaceutical drug.
“Harm reduction is about providing people the most accurate, evidence-based information possible so [people] can make the best decision for themselves,” said Sue. “Ultimately [misinformation] could harm people, psychically or mentally, or people could die if the information is not good.”