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Due to the absence of a binding body of guidelines, the implementation of policy changes was varied across jurisdictions and varied from one service to the next. However, in Sydney, the overarching restriction was to phase out the use of private rooms, while in other services, only the design and upgrade of rooms was postponed. This paper focuses on the service developments that occurred on the NSW harm reduction service by analysing 8 weeks of weekly data from the syringe exchange database. These data allow us to see the service changes, changes in syringe and drug distribution, and the outbreak’s impact on drug use behaviour.

The paper focuses on the average amplitude and frequency of syringe and drug distribution during the study period, as well as these quantities over the course of the COVID-19 outbreak in these services.

This paper uses a cross-case analysis to identify the impact of the COVID-19 pandemic on the stock and distribution of drugs, and on injecting behaviours in Sydney’s SIF. The case studies reported on are unique in that they provide the first opportunity to link local syringe exchange dynamics to evolving national policy.]

The three main COVID-19 epidemics with documented fatalities in the early stages of the pandemic are: Italy which began in February 2020;[14] South Korea which began in 5th March 2020, and Iran.[13] The most recent country with a reported fatality is the United States.[15]

The Italian government declared the national lockdown on the 22 March and readopted this on the 28 March.[16] During the period of 7 May to 8 June 2020, the Government pursued an aggressive testing strategy. On 14 March 2020, responded to the world’s health system’s acute lack of testing capacity to implement a national testing strategy, and on 23 March closed all non-essential borders, began partial lockdown, and cancelled all gatherings of more than 250 people.[17]

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