Philly’s HIV, hepatitis, and nonfatal overdose counts may be artificially low because of COVID-19 shutdowns

Even as the city hit nearly a record last year for overdose deaths, a new report from the Philadelphia health department shows fewer cases of HIV and hepatitis C -- as well as emergency-room visits for nonfatal overdoses -- in 2020. But that doesn’t mean fewer people overdosed or contracted diseases through injection drug use.

Instead, city health officials say, the COVID-19 pandemic temporarily shuttered many health services, meaning that testing data that reflect drug use and related medical conditions in Philadelphia are probably inaccurate.

“The decreases in HIV numbers and hepatitis C numbers are probably false,” said Dana Higgins, an epidemiology manager and supervisor in the city health department. “Especially when it comes to the outbreak in people who use drugs -- it’s probably not a true decline. It speaks to services being shut down.”

Testing for HIV, hepatitis B, and hepatitis C -- which can all spread through sharing needles -- dropped in the first months of the COVID-19 pandemic, between March and October 2020, according to the report.

And while reported cases of HIV have been increasing since 2016, just 36 new diagnoses of HIV were reported among injection drug users in 2020 -- down from 90 reported diagnoses in 2019. Similarly, reported hepatitis B and C cases declined in 2020 after years of increases.

So did visits to emergency departments for drug overdoses and requests for addiction treatment. Like many others, people who struggle with addiction likely avoided hospitals during the pandemic -- ER visits for any medical condition decreased by about 23% in the city. Addiction treatment outreach workers have spoken of clients who wouldn’t visit hospitals for fear of contracting the virus, even when they desperately needed care.

“When hospitalizations are down, the true burden of disease and overdoses can’t be represented as much as we would like,” Higgins said.

But in some cases, people were too ill to avoid the hospital. Admissions for overdoses that required care beyond the ER and for serious conditions related to injection drug use such as sepsis and other infections did increase.

Fatal overdoses in 2020 increased by just over 5%, to 1,214 -- Philadelphia’s second-highest death toll on record, surpassed only by the 1,217 overdose deaths recorded in 2017. Health officials have said overdose deaths were likely also exacerbated by the stress and isolation of the pandemic, and have noted with alarm a demographic shift in such deaths.

For years, overdose deaths occurred among mostly white Philadelphians. In 2020, fatal overdoses decreased among white Philadelphians and rose among Black and Hispanic Philadelphians, with the spike particularly pronounced in the Black community. It was another devastating blow to a community already hard hit by the COVID-19 pandemic.

The health department’s latest report was released as the CDC announced more than 100,000 people had died of drug overdoses nationwide between May 2020 and April 2021. The new figures represent a 30% jump in the latest year and were likely affected by the coronavirus crisis and the increasing presence of fentanyl in the drug supply.

In Philadelphia, fentanyl has been part of the drug supply for years, and that may be one reason the death toll here did not jump as dramatically, Higgins said.

“Philadelphia’s placement when it comes to our drug supply, and how fentanyl came in, might speak to how we saw these huge increases [in fatal overdoses] very early on,” she said. Existing city services for people with addiction, built up over the years as overdoses skyrocketed, also could have kept the toll from climbing even higher.

With most HIV and hepatitis testing operations back up and running, Higgins said, the health department expects that it will get a more accurate picture of how the pandemic affected the spread of other diseases.

“We’ll continue to advocate for resources,” she said. “Surveillance information is always limited, both in Philadelphia and nationally. That’s something the pandemic has also shed light on. Health departments tend to lack resources for surveillance. We need to be able to better standardize our access to this information. The public health infrastructure in our country continues to need more support.”