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Kat Albrecht, Rachel Brahinsky, Andrew Burns, Laurel Harbridge-Yong, Sarah James, Claire M. Kamp Dush, Kevin T. Leicht, Carla Pezzia, Theda Skocpol, Elizabeth Suhay, and Emily Sydnor are contributors to RSF: The Russell Sage Foundation Journal of the Social Sciences issue, “The Social and Political Impact of the COVID-19 Pandemic,” edited by Beth Redbird (Northwestern University), Laurel Harbridge-Yong (Northwestern University), and Rachel Davis Mersey (University of Texas at Austin). The issue examines how social and political factors shaped the initial responses to the pandemic and how these responses impacted individuals and communities. The interview has been edited for length and clarity.
Kat Albrecht is an assistant professor of criminal justice and criminology at Georgia State University. She is a co-author of the article, “Localized Syndemic Assemblages: COVID-19, Substance Use Disorder, and Overdose Risk in Small-Town America.”
Rachel Brahinsky is an associate professor of urban studies and politics at the University of San Francisco. She is a co-author of the article “‘We Keep Each Other Safe’: San Francisco Bay Area Community-Based Organizations Respond to Enduring Crises in the COVID-19 Era.”
Andrew Burns is a research associate at Louisiana State University. He is a co-author of the article, “Localized Syndemic Assemblages: COVID-19, Substance Use Disorder, and Overdose Risk in Small-Town America.”
Laurel Harbridge-Yong is an associate professor of political science and a faculty fellow at the Institute for Policy Research at Northwestern University. She is a co-editor of this issue of RSF and a co-author of the article, “The Social and Political Impact of the COVID-19 Pandemic: An Introduction.”
Sarah James is an assistant professor of political science at Gonzaga University. She is a co-author of the article, “Institutional Capacities, Partisan Divisions, and Federal Tensions in U.S. Responses to the COVID-19 Pandemic.”
Claire M. Kamp Dush is a professor at the Minnesota Population Center and the Department of Sociology at University of Minnesota. She is a co-author of the article, “Stress and Mental Health: A Focus on COVID-19 and Racial Trauma Stress.”
Kevin T. Leicht is a professor and past chair of the Department of Sociology at University of Illinois Urbana-Champaign. He is a co-author of the article, “The Presentation of Self in Virtual Life: Disinformation Warnings and the Spread of Misinformation Regarding COVID-19.” He is also a contributing author to RSF journal issue, “Status: What It IS and Why It Matters for Inequality.”
Carla Pezzia is an associate professor in biology and Chair of the Human and Social Services Department at University of Dallas. She is a co-author of the article, “Social, Resources, and Institution Disruptions and the Evolving Lives of Economically Vulnerable Older Adults: Implications for Policies and Programs in the New Normal.”
Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard University. She is a co-author of the article, “Institutional Capacities, Partisan Divisions, and Federal Tensions in U.S. Responses to the COVID-19 Pandemic.” She is also a co-editor of RSF volumes Reaching for a New Deal and Inequality and American Democracy, a contributing author to multiple RSF volumes, and an RSF research grant recipient.
Elizabeth Suhay is an associate professor in the Department of Government in the School of Public Affairs at American University. She is a co-author of the article, “Americans’ Trust in Government and Health Behaviors During the COVID-19 Pandemic.” She is also an RSF research grant recipient.
Emily Sydnor is an associate professor of political science at Southwestern University. She is a co-author of the article, “COVID-19 and the Culture of American Federalism.”
Q. The COVID-19 pandemic created a public health crisis. Why is it important to study the social and political impacts of COVID-19? What key points would you like readers to take away from the journal issue?
Harbridge-Yong: At its core, the COVID-19 pandemic was a major health crisis. However, the government and public response to the pandemic was layered atop existing social structures and inequalities further shaping social and political dynamics. For instance, in the U.S., many resources including social supports, health care, and even health and life expectancy are unequal. The pandemic hit many disadvantaged communities like racial minorities, Native American communities, and low-income older adults particularly hard.
The system of U.S. government is a federal structure, where many public health and policy decisions are made at the state and local level. This led to a wide diversity of responses to the pandemic since the federal government did not take a particularly active role in many early decisions. So, when decision-making in a federal structure is combined with high levels of polarization, state and local policy decisions – including state home orders, mass mandates, and re-opening plans – became highly partisan. Responses to the pandemic by policymakers and the public also further shaped important social and political dynamics. For instance, differences in elite messaging about masks and vaccines contributed to polarization in the public over this issue, despite it not being something that naturally fell into liberal versus conservative camps or was previously in these kinds of partisan positions. Highly partisan trust in different levels of government also contributed to this pattern. Finally, pandemic responses also had unintended consequences or downstream effects, such as altering responses to the opioid epidemic.
Our introductory chapter tackles the social and political impacts of the COVID-19 pandemic through three core themes, and these themes are part of what we’d like our readers to take away from the journal issue. The first theme is information, the second is inequality, and the third is the government’s response. First, the authors explore a variety of sources of information, including in-person community networks, information spread online, and elected officials, with an eye toward understanding how informational networks, the accuracy of information, and the source of information affected how people dealt with the crisis. Second, the authors examine how the interdependent nature of institutions can exacerbate existing inequalities and create new ones. And third, the authors examined the government response to the COVID-19 pandemic across multiple levels of government and the public’s response. High levels of polarization plus federalism in the U.S. contributed to informational and policy inconsistencies across states, which affected how citizens evaluate the response of their government and how to determine which entities to trust. They also increased the importance of local and community organizations. These challenges also affected the likelihood of an equitable and cooperative policy response to a crisis that affected health, economics, and politics.
Q. Misinformation about COVID-19 is rampant on social media. In an effort to combat the spread of misinformation, some social media platforms began labeling posts as containing misinformation. How do these efforts impact how these posts are shared across social networks?
Leicht: Labeling provides a little, tiny cognitive nudge that gets people out of the habit of simply automatically sharing what they see. It gets them to think about it a little bit, which then reduces the number of posts that they share. Our research shows that to be especially true for Facebook. So, labeling does work, at least to a limited degree, and we think that it works because of this little cognitive nudge.
Q. How did community-based organizations in the San Francisco Bay Area navigate the first year of the COVID-19 pandemic? What can we learn from their response?
Brahinsky: In our article, Alison Cohen, Kathleen Coll, Miranda Dotson, and I traced a year of evolution of Bay Area community-based organizations, or CBOs for short, during the first year of the COVID-19 pandemic. We did 27 interviews with CBO staff, analyzed them, and ultimately, we argue that through diverse approaches, which characterize as a politics of care, Bay Area CBOs actually reshaped their work in ways that could address social and structural determinants of health inequities in the long term; even among CBOs that don't typically think of themselves as health-oriented.
Our analysis also called for a rethinking of the crisis framework around public health challenges like pandemics. Rather than thinking of the pandemic as an exceptional short-term challenge, we saw it as a product of a longer trajectory of structurally produced inequities that are endemic to racial capitalism. This came directly out of the interviews that we did. When the pandemic began to unfold, we began very quickly to track the experience of CBOs across the region. Within a matter of months, CBOs worked to marshal their resources to address pandemic needs. In the absence of full governmental support, we saw groups that focus on a wide array of concerns, from housing and homelessness to immigrant rights, elder care to youth empowerment, begin to engage in what we saw as a transformative politics of care. And in doing so, they seemed to offer a path towards reshaping health equity work in ways that could affirmatively address social and structural determinants of health in the long term. They found the connections between their non-health-related work with social and structural determinants of health.
These findings actually took us by surprise. Although the Bay Area has a reputation as a progressive haven, in recent decades, people have been consumed by questions of how to address the region's extreme and worsening socioeconomic disparities. Whether we're talking about affordable housing crises, access to education, environmental pollution, or even policing, the discourse of the violent impacts of socioeconomic inequity and debates around solutions have literally been constant front page news for a very long time. And for that same amount of time, grassroots efforts have sought to address these complicated issues at many levels. This meant that when they were confronted with the pandemic, local leaders of CBOs knew that on the one hand, the government wasn't prepared to meet community needs. But they also knew that organizing a push for government support was really necessary and could be effective over time. After all, the Bay Area has been an epicenter for several major crises, including the HIV/AIDS crisis and the current housing and homelessness crisis, as well as many other issues, which all link across social issues.
Our informants articulated this contradiction around the role of government in a variety of ways. They found some glimmers of hope, even in the midst of the worst depths of the pandemic. One person told us, “When everything falls apart, and then you need to rebuild it, you have a space to rebuild something much more effective and much more beautiful.” And this showed us that long experience with challenges has trained community leaders in the Bay Area to understand that a crisis is part of a longer trajectory of work that they're doing. It wasn't just one moment, it wasn't just one month or one year, or even as we’re seeing now, three years. It's part of a longer pattern that they have been dealing with and will continue to deal with.
Ultimately, there were many lessons from our year of research and a central one was that the pandemic forced a kind of reckoning with long-term inequalities. And Bay Area organizations stepped up to this challenge in a way that could teach us a lot about how to think about structural determinants of health and community care. Though most would not have called themselves public or community health organizations – and still don't – their work around housing, youth issues, and more, became deeply relevant to public health efforts. And we hope that this research is useful for them and for other leaders and researchers working on these issues.
Q. Older adults are most at-risk for health complications, severe illness, and death due to COVID-19. How did efforts to protect low-income seniors from contracting COVID also disadvantage them?
Pezzia: Stay-at-home orders were crucial to controlling the pandemic. They limited everyone's mobility, however, limiting the mobility of older adults can have a more profound effect on both their mental and physical health because it increases their likelihood of health problems and injuries. Further, low-income seniors are often already dealing with multiple health conditions, so this lack of mobility can be problematic because just small amounts of exercise or physical activity can be incredibly beneficial. The seniors we spoke to who usually went to a congregate meal program found the change in mobility particularly difficult since part of the reason they participated in the meal program were the add-on exercise programs, which are geared to older adults to help maintain their physical strength. So, they went from having a fairly active day-to-day to just sitting around and it had a major impact on them. Some participants talked about how they were starting to feel their age more as they lost that primary source of activity. Similarly, restrictions on social gatherings, especially for single residents in senior living communities, meant greater social isolation, as they weren't even able to leave their rooms for any extended period of time. This added to potentially greater deterioration in both mental and physical health.
Limiting mobility also typically means limiting access to goods and services. For low-income seniors, this meant losing direct access to social workers at food pantries and other assistance programs that can help with completing social service applications, including the Supplemental Nutrition Assistance Program, also known as food stamps, health programs, or any other services. This was particularly problematic when many of the application processes went to only online applications. Many low-income seniors have limited internet access and, oftentimes, they only have internet access through their smartphone. And those complex applications with various requirements are difficult to navigate on such a small screen. So, they're also without access to a social worker who could help them work through online applications. Low-income seniors were at a greater disadvantage and experienced increased hardship.
For low-income seniors who receive food assistance, the response of delivering food boxes or converting food pantries into drive-throughs was a wonderful effort to ensure that vulnerable seniors continued to receive some kind of nutrition. But it also limited the types of food that they could receive, and perishable items became a lot less accessible to seniors. Of course, that was also due in part to the higher demand that food pantries were seeing. And many of the canned or processed food items offered often don't meet the standards for certain diets in order to manage various health conditions. Pantry drive-throughs, in particular, were seen as both a blessing and a curse. Many low-income seniors appreciated not having to get out of their cars when getting food. But because of the increase in demand, the lines were often long, and that would be extra challenging for older adults with bladder problems. This was a problem at the vaccine mega sites as well.
Efforts to protect seniors are really important and any other interventions would have also had their strengths and weaknesses. However, should there be a similar public health emergency in the future, we need to make sure that whatever protective efforts that are put into place also address the challenges we now know that low-income seniors faced during the COVID-19 pandemic.
Q. The COVID-19 pandemic unfolded alongside highly publicized accounts of racial trauma. What groups experienced higher levels of stress related to COVID-19 and racial trauma? How was their mental health impacted?
Kamp Dush: The COVID-19 pandemic was incredibly stressful for families. The closing of schools, the loss of jobs, and the general stress of life in a pandemic were overwhelming. At the same time, the murder of George Floyd started a global racial reckoning that was profoundly felt by individuals who held marginalized identities. Asian Americans also dealt with escalated racism and violence due to the politicization of COVID. Even the impact of the pandemic was not equally shared. People who were not white had more severe cases of COVID when contracted and were more likely to die. The same trend held for individuals who were not heterosexual.
Using the National Couples' Health and Time Study – the first large population-representative study of same and different-gender couples in the United States – we examined COVID stress and racial trauma from September 2020 to April 2021. We found that compared to non-Latine White individuals, individuals who were Asian reported more COVID-19 stress. We also found that Black and multiracial individuals reported more racial trauma stress than non-Latine White individuals. Individuals who held multiple sexual identities or a different sexual identity than heterosexual, such as gay, lesbian, or bisexual, reported higher COVID-19 stress and racial trauma stress than heterosexual individuals. Individuals who are bisexual also reported higher racial trauma stress than heterosexual individuals.
Overall, individuals who had higher COVID stress and higher racial trauma stress had elevated depression, anxiety, and feelings of loneliness, and felt more overwhelmed than those who have less COVID stress and less racial trauma stress. Our results suggest that the stress of these shared traumas had serious implications for mental health and stress overload. Without further dismantling structural racism and the rising anti-LGBT discrimination in the United States, these disparities will continue.
Q. The COVID-19 pandemic and responses to COVID-19 are highly politicized in the U.S. How did political polarization impact state-level response in the early stages of the pandemic?
James: The first thing to keep in mind before we dive into the exact answer to your question is just a reminder that we live in a federal system. So, states and localities can have a lot of power and autonomy over policy responses. Traditionally, we have often had nationally coordinated responses in response to nationwide crises, which is what COVID was. What was unique about the COVID crisis is that by and large, the national government, led by Donald Trump, abdicated their power and left responses to COVID up to the states. So, the response was very federated. For the most part, states got to decide how they were responding and what mitigation tactics they were using, such as if they were having stay-at-home orders. Because states were allowed to make these decisions, we can really observe evidence of polarization in responses. There were 50-plus different responses to the pandemic – even more if you take into account responses at the local level.
Skocpol: I would add that public health has always had a pretty important component of state and local response because that's where some of the agencies are.
James: What we were trying to understand was if there were different responses, then how and why they varied. So, we looked into Theda's point about agencies and the extent to which states collected and published data about the pandemic early on. In the first six months, it seems like whether or not a state had a robust set of public health and data-oriented agencies is more relevant to whether or not data got collected and published than any sort of partisan control of state government.
But where the partisanship really came through was when we started to look at actual mitigation strategies – the rules and restrictions that states were putting into place that limited the options for their residents to move around and engage in daily life. We saw partisan patterns in the differences in whether Democrats and Republicans governors implemented mask mandates. And when Republicans did implement mask mandates, they were likely to be significantly shorter than those in Democrat-led states. One of the findings in our paper is that by July 2020 Republican-led states had mask mandates that were 88 days shorter than mask mandates in Democrat-led states. That’s almost three months; that’s not insignificant. We see similar patterns regarding stay-at-home orders, with Republican-led states having shorter stay-at-home orders than Democrat-led states.
What I think what may be the most interesting contribution that we make is that we not only see partisan patterns, so patterns between differences between Democrats and Republicans, but also differences among different types of Republicans. We went through our data and said, “Well, in American politics in 2020, all Republicans are not the same.” We grouped Republicans into three groups: there were Republicans who were the old guard who were skeptical of Trump and his handling of the pandemic; there were Republicans like Ron DeSantis and Greg Abbott, who were very celebratory of Trump and his approach to the pandemic and who really kind of were vocal in their approval of his handling of the pandemic; and then there were people in the middle, who call ostrich Republicans, who weren’t celebrating Trump but also weren’t speaking out against him.
And we see substantial differences within the Republican Party among governors who belong to these different groups. And interestingly, the Trump skeptics, or the governors who are Republican but who openly question Trump, are not significantly different from Democrats in terms of the mitigation strategies they implemented. Whereas the other groups of Republicans – the pro-Trump and the ostrich Republicans – had mandates and stay-at home-orders that were multiple months shorter than their Republican counterparts who are more vocally opposed to Trump.
Skocpol: I think that was key in our analysis. Because a lot of times in political science, people who study partisan effects just say Democrats versus Republicans. And where that used to be roughly okay, once you get to the 2000s that distinction really breaks down. And certainly in this COVID period, we're seeing very different brands of Republican Party orientations, even if you take out the obvious kind of outlier Republican governors like Massachusetts and Maryland. If you want, you can look at someone like Governor DeWine in Ohio, who had to straddle a lot of different factions in the Republican Party. But he ultimately tended to approximate a moderate democratic approach to COVID issues.
James: We have another point that I think is worth really highlighting here, though it may not be directly related to polarization. One of the conservative arguments for federalism is that there's real value in allowing sub-national units, like states or localities, to have autonomy or control over their own policies and decision-making so that they can tailor what they're doing to their context and to the needs of their residents. So, on the one hand, you could see this devolution to the states to respond to COVID as an example. Like, let's let Texas do what Texas needs to do because the rates in Texas are different from what they are in Massachusetts or California. But we also find that this kind of support for federalism and local control was not even. Republican governors were more likely to tie the hands of local authorities than Democratic governors. So, Republican governors didn't want the federal government coming in and telling them how to respond to COVID, but then they were going into their cities and townships and counties and saying, “No, actually, you're not going to be able to put in a mask mandate.”
Skocpol: Like Texas did to Austin.
James: That's right. It's normally a red-state-to-blue city phenomenon, but that is something that we saw across the states as well.
Skocpol: And that reflects the fact that the major axis of polarization now is, yes, Democrats versus Republicans, especially more right-wing Republicans, but it's also big cities and their near suburbs versus the exurbs and the smaller towns. And so almost all the big, more powerful Republican-led states like Florida and Texas have cities that want to go another way and whose realities are different, but they're not allowing that. That's one of the dividing lines between Trump Republicans and other Republicans – whether they actually do believe this devolution thing goes all the way down or if they don't see it that way.
Q. What factors impacted whether Americans trusted information about COVID-19 from different levels of government? And how did these factors influence the level of government individuals trusted?
Sydnor: We focused on how partisanship, ideology, and identity impacted Americans' trust in government, more specifically their trust in information from the government about COVID-19. We looked at identity with both the states – so, how much you think of yourself as like a Texan or a Californian or New Yorker – and identity with the nation – so, how strongly you associate strongly with an American identity. And what we see is that all four of these factors impact the extent to which people trust information from federal and state governments and the people within those governments, like the governor or the CDC.
At the national level, we focused on trust in specific federal responders: President Trump, the CDC, and Anthony Fauci. And we examined the extent to which Americans trusted them to share pandemic-related information. Partisanship, perhaps not surprisingly, played a key role here, especially in explaining the trust in the president and the information he shared. Republicans were more likely to trust information coming from President Trump and Democrats were more trusting of information from the CDC or Fauci. You see the same split across ideologies. Again, conservatives trust information from the president more than liberals and liberals trust information from Fauci more.
In terms of identity, people who identify strongly as Americans are more likely to trust information from all federal responders – it didn't matter if it was the president or someone else. At the state level, we see something a little different. So here, we didn't disaggregate, we just asked about the extent to which the participants in the survey trusted information from the state government writ large. We assumed that when thinking about the role of partisanship, trust in information would be dependent on which party held power and the COVID mitigation policies being implemented within that state. And sure enough, this turned out to be the case. Once again, partisanship, ideology, and state identity all mattered for trust and information from the state government. But while Republicans and conservatives were reasonably trusting of state government information, regardless of who was in power and the policies they put in place, Democrats’ and liberals’ trust varied dramatically based on where the information was coming from. If the state government was run by a Democratic governor, then they were most trusting of that information. If the state was run by a Republican governor, but one who had implemented mask mandates, they trusted that information more than if they were in a state where if they in a state with a Republican governor who had done little mitigation, particularly in the context of these mask mandates.
We think that these findings help us understand ways in which the federalist system that we use in the United States has helped us get information about COVID-19 that we might not have had in a sort of unitary state where there's not national, state, and local governments doing all of this work to try to communicate with us. But at the same time, there are ways in which that response failed in getting information out to us that we trusted during a serious public health crisis.
Q. Why is trust in the government important during crises like the COVID-19 pandemic? How did trust in the government change during the first year of the pandemic? How did trust in federal, state, and local government impact protective health behaviors?
Suhay: Scholars generally argue that trust in government is critical to a nation's well-being, and it is especially crucial in public health emergencies. Past studies have found that trust in government increases the likelihood that citizens will follow government recommendations and mandates during a public health crisis. All this said, as we think about trusting the government in the U.S. context, it's important to remember how complex U.S. government is. We have government officials at the national, state, and local level. This turned out to be especially important during the COVID-19 pandemic, as the federal government led by President Trump decided to devolve responsibility for handling the pandemic to the states and localities. This meant it was primarily state and local officials who provided health guidance to Americans. Thus, if you want to study trust in the US government during COVID, you need to look at Americans' trust in state and local governments too.
The first question we address in our study is how Americans' trust in government changed in the first year of the pandemic. Prior studies of the subject in other countries have come to mixed conclusions, with trust decreasing in some countries and increasing in others. We find that trust in all levels of U.S. government fell during the first year of the pandemic, and these declines were especially steep in the pandemic's early months. This said, Americans differentiate among government institutions. Their trust in the federal government declined the most during our period of study and their trust in local government declined the least. This pattern of findings makes a great deal of sense in our view. COVID sickness and deaths in the United States during the first year of the pandemic were quite high compared to other developed nations. Additionally, Trump's response to the pandemic was widely acknowledged to be inadequate. At the same time, the fact that he passed the buck to state and local governments meant that they inevitably received blowback from the public as well.
The second question we address in our study is whether trust in government increased Americans' likelihood of engaging in expert-recommended health behaviors such as wearing a mask and social distancing. It turns out that our results are highly contingent on who exactly citizens trusted. Americans with a lot of trust in their state and local governments were more likely than others to engage in these health behaviors. However, Americans with a lot of trust in the federal government led by Trump were less likely than others to wear masks and social distance. We also found that Republicans who trusted Democratic state governments were more likely than their counterparts to engage in healthy behaviors and Democrats who trusted Republican state governments were less likely to do so. The upshot of these analyses is that trust in government is not an unmitigated good. To our knowledge, our study is the first to show that trust in government actors providing low-quality health advice to citizens may be a threat to public health.
Q. The U.S. was struggling with a substance use and overdose crisis prior to the emergence of COVID-19. How do these simultaneous public health crises impact one another?
Albrecht: Prior to the COVID-19 pandemic, overdose death rates in the United States doubled between 1999 and 2010. They continued to increase until about 2018 when rates seemed to plateau. But after COVID-19 forced a global shutdown and caused dramatic changes in people's lives, routines, and financial stability, the U.S. saw its largest single-year increase in overdose death rates. Many states experienced their highest historical overdose death rates in April and May of that year. In our article, we study exactly how COVID-19 and the opioid crisis overlapped and interacted. To do this, we used a combination of data from institutional sources and then we actually talked to people. We used information that we obtained from police reports and overdose calls in combination with interviews of residents from Sandusky, Ohio to understand a variety of perspectives on exactly how simultaneous public health crises affected everyday life in a small town.
Burns: The shift in daily life impacted everyone. For many that meant a loss of access to services they relied on to begin or maintain recovery from substance use issues. This meant that many who had prior substance use found it difficult to maintain the recovery and experienced some form of relapse. Police reports showed that prior to COVID-19, emergency calls for overdoses in progress often ended with officers successfully reversing overdoses after a witness called 911. Due to social distancing requirements during the early months of the pandemic, however, many people who were actively using substances with overdose potential were at increased risk. This is because the use of overdose-reversing drugs such as Naloxone cannot be self-administered, and one of the key tenants of harm reduction – to never use alone – could not be adhered to. The dramatic shift in daily life brought uncertainty and confusion to everyone, but for someone trying to deal with active addiction, problematic substance use, mental and emotional stressors, ongoing or past trauma, or any combination of these factors, the confusion and loss of stability placed them at increased risk.
With the coincidence of these two major health crises, the overdose epidemic and a global pandemic, emergency medical systems struggled to keep up with either. While first responders were among the first to receive COVID-19 vaccines, these vaccinations were not available until the end of 2020. Prior to the proliferation of the vaccine, EMTs, doctors, and nurses regularly contracted or were exposed to the virus, causing staffing shortages that hindered the capacity to respond to overdose calls and placed intensive strain on those medical professionals who provide life-saving assistance to people experiencing an overdose.
So far, we've focused on how the COVID-19 pandemic impacted the overdose epidemic, but we could also discuss how the massive influx of fatal and non-fatal overdoses affected the capacity to reduce the spread of COVID-19. For emergency medical technicians, every emergency served as a potential exposure to the virus. This is the same for firefighters, police, and other first responders responding to an emergency at any time. But in the context of an unprecedented number of overdoses, many of which were successfully reversed, these incidents comprise direct effects on COVID-19 response efficacy. Of course, we may also note that people engaged in illegal drug consumption and trafficking may not necessarily have adhered to social distancing as strictly as was recommended, so that too factors into COVID-19 exposure for first responders and overdose calls for service.