On March 12, I picked up my daughters from their respective schools, as they were closing to help reduce the spread of COVID-19. My youngest daughter, Ruby, was disappointed as she didn’t want this to happen – she wanted to be able to finish the charcoal drawing she’d begun in class, and to see her friends as normal.

Five days later, on St. Patrick’s Day, Taoiseach Leo Varadkar addressed the nation stating that, “Never will so many ask so much of so few.” He was referring to the people on the frontline of the response to COVID-19 in Ireland. Ten days later, on March 27 at midnight a ‘Lock-in’, as it has now been dubbed by some, was enacted and further restrictions designed to reduce the spread of the virus came into place. Whilst this is fresh in our minds now, it will not be so apparent to readers later how quickly things changed over the past few weeks in Ireland.

Ana Liffey Drug Project is a ‘Low Threshold - Harm Reduction’ service, working on the streets of Dublin and Limerick, with people who have complex and multiple needs, including problematic drug use, mental health issues, physical health issues, behavioural issues and more. The majority of the people we work with are homeless or at risk of homelessness. Our ‘Low Threshold - Harm Reduction’ ethos and the skills and competencies of our team are well suited to helping with the response to the COVID-19 outbreak amongst this cohort of people.

Led by the HSE (in CHO9 and CHO3), and working alongside our colleagues in Homeless and Addiction services, we have had to quickly adapt how we deliver our services, to help to reduce the spread of the virus and to respond to the increased risks our clients have faced – particularly the increased risk of an overdose.

The group of people who use drugs that we work with are a particularly vulnerable group and are at a higher risk of contracting COVID-19. The sharing of syringes, crack pipes, tooters, etc. is risky and increases the chance of infection, as COVID-19 is transmitted through droplets. So, providing Harm Reduction interventions is going to continue to be essential in the fight to stop the spread of COVID-19 amongst this cohort.

Should they contract the virus, there is a likelihood that they will require hospitalisation as many have underlying health issues which put them at greater risk of complications. For example, smoking crack or heroin can cause and/or exacerbate respiratory conditions. Similarly, someone with HIV or Hep C may have a weakened immune system.

The ‘Lock-in’ has added a layer of complication to an already tough existence. The best way to illustrate this is to tell you a story based upon our experiences.

Imagine a young man addicted to drugs living on the streets during the COVID-19 crisis… one way he gets his money is by sitting down on Henry Street and begging, but now there is practically nobody there to give him money: the crowds have all gone. The little money he has to buy drugs with is now harder to spend as he struggles to find a dealer.

Withdrawing from opiates and feeling really sick, he roams the streets of Dublin. He sees others in the same state as him; and there’s an edginess in the air – a desperation that could bubble over into violence with the wrong word or look. He heads for the day service he’s been using for the past five or six years to speak to the staff he’s built up trust with. Unfortunately, they’ve had to shut down because of COVID-19 and they are providing an outreach service on the streets.

He heads off again. As he comes around a corner four people he knows approach him and demand anything he’s got – money, drugs, whatever. A fight ensues and he comes off the worst: he now has no money and his face has been slashed from lip to nose. He stumbles on through the streets, angry and bleeding. The few people that are on the street look at him with a sense of fear and/or disgust. Then he bumps into two people dressed in matching jackets. They are outreach workers – he knows one but not the other. As he refuses to go to the hospital for his facial wound, the outreach workers call a nurse and arrange for him to be seen.

They ring a GP and arrange for him to be assessed for a methadone and benzodiazepine prescription. They call the Freephone to arrange for emergency accomodation. As he hasn’t eaten, they buy him food and other supplies. They call his friend who heads down to meet him. Most importantly they treat him with dignity and respect.

This is just one scenario – offering a brief insight – into the lived experience of the people we work with on the streets during the COVID-19 crisis.

Suffice to say their lives are made even harder by COVID-19; but it is also true to say that the State and Civil Society are pulling together, working with great pragmatism and flexibility to try to help every single person in this vulnerable cohort.

In that, we can all take great pride.

For more information about Ana Liffey Drug Project, see their website here.