Chris DeLine

I’ve been reading through a few long-saved bookmarks the past couple of weeks and one article, Olga Khazan’s “The Opioid Epidemic Might Be Much Worse Than We Thought,” brings to light information that I found incredibly poignant with regard to what’s happening right now. Her article focuses on the findings of a February 2020 report in the Society for the Study of Addiction which stated,

“[W]e found that 71.8% of unclassified drug overdoses in 1999–2016 involved opioids, translating into 99,160 additional opioid‐related deaths, or approximately 28% more than reported. Importantly, there was a striking geographic variation in undercounting of opioid overdoses.”

What can a mammoth discrepancy like this be attributed to? Khazan observes that much of the accuracy relating to causes of death is derived from the faculties utilized by each individual county, which comes down to whether medical examiners or coroners are employed to investigate causes of death. (The importance of this difference was at the heart of the May 2019 edition of Last Week Tonight with John Oliver.)

“Medical examiners are doctors specially trained in pathology and forensics, but coroners can be general practitioners or even laypeople with no medical training. For coroners, ‘in many places, like the state of Pennsylvania, the only requirements are to be a legal adult with no felony convictions who has lived in the county for one year and to complete a basic training course,’ Jordan Kisner wrote this week in The New York Times Magazine. Meanwhile, as Kisner pointed out, the United States has a dire shortage of medical examiners.”

Knowing how widespread an issue such as opioid or substance use disorders are isn’t as big of an issue for me in my current position, as I’m not in the direct business of policy: I work one-on-one with people. But the broader question of how many of those people need help is important when gauging the true nature of the issue, and determining how many resources should be allocated to its aid. Looking at Khazan’s thesis through a broader lens, this same understanding is vital in grasping the reality that we face right now with COVID-19,

“The tragedy of epidemics like opioid abuse is that nothing can be done to help the dead. But the dead can help others—if the things that killed them are accurately reported. Having a better grasp of just how many people are dying from various ailments is crucial for policy makers to help those who are still living.”

Since I last checked the State’s website, just two days ago, there have been seven more deaths attributed to COVID-19. That’s a 5% increase in deaths. In that same timeframe there are 476 more confirmed cases, which represents a 7% increase. Not to take an alarmist’s point of view, but to use the recognized gap in confirmed opioid-related deaths as a comparison, the recorded number of cases and deaths is likely off, and likely higher by a considerable margin. (I’ve attempted to gain access to the journal article, “Using contributing causes of death improves prediction of opioid involvement in unclassified drug overdoses in US death records,” to see how TN counties faired with regard to the assessment, as that might help estimate the gap here. If I gain access to it through my school’s library I’ll add an update speaking to that.)

Reporting for Nashville Public Radio, Damon Mitchell relayed how much of that state-wide increase can be attributed to the growth of cases here in town, “The city currently has 1,903 confirmed cases, an increase of 152 since Sunday. Health officials say while they’ve increased testing by 11% in the past few days, positive cases have increased by 19%.” That’s huge. It’s what makes what happened this weekend all the more concerning.

“Several hundred protesters gathered outside the state Capitol in Nashville on Sunday afternoon in response to the state’s stay-at-home order,” writes Matt Masters for the Nashville Scene, “mirroring similar protests displayed across the nation.”

“In open defiance of both CDC guidelines and state orders promoting social distancing amid the COVID-19 pandemic, crowds gathered on either side of Dr. M.L.K. Jr. Boulevard on a block near Legislative Plaza under gray skies and light rain. The ‘Nashville Freedom Rally’ organized by the #FreeTN Facebook group was specifically in response to Gov. Bill Lee’s recent extension of the state’s stay-at-home order. The order was issued on April 2 and set to expire on April 14, but has now been pushed to the end of the month.”

The organizer of the protest is quoted in the article as saying, “We are all here for one reason, and it’s our rights. […] And I just want to remind us that that doesn’t stop when the shutdown ends. It’s not just the shutdown, it’s the 18 months, the social distancing as a ‘new way of life.’ That’s not my way of life. Is that your way of life?”

This is discouraging for so many reasons, primarily that none of this is fundamentally about a nationwide revocation of freedoms. The situation we’re in is caused by people becoming sick, people dying, and the entire world attempting to curb it spreading to reduce deaths. And to this point, while the responses haven’t been perfect, measures such as Mayor Cooper and Governor Lee’s “Safer at Home” orders have helped reduce spikes in cases, which have also hopefully helped reduce overall deaths and the burden on our hospital system.

What’s also frustrating is that I can empathize with an argument calling for the measures to be relaxed purely so people can get back to work. Nationally, 22 million people are out of work who had jobs four weeks ago. In Tennessee, 9.5% of the workforce has lost their job in this period. Those are real problems that have more to do with people being unable to survive and less to do with an abstract idea of “freedom” or “conspiracy theories involving Bill Gates.”

As of yesterday, Governor Lee confirmed that “he won’t extend his safer-at- home order and will let it expire April 30.” Thus far, Mayor Cooper has not indicated that Nashville will relax the local ordinance.