The man had been revived by paramedics, and Cox leads a team with a mission of finding every overdose survivor to save them from the next one.

The Centers for Disease Control and Prevention estimates that more than 88,000 people died of drug overdoses in the 12 months ending in August 2020 — the latest figures available.

That is the highest number of overdose deaths ever recorded in a year.

The devastation is an indictment of the public health infrastructure, which failed to fight the dueling crises of COVID-19 and addiction, said Dr.

Simultaneously, Kilkenny said, disruptions in health care exacerbated the collateral consequences of injection drug use — HIV, hepatitis C, deadly bacterial infections that chew flesh to the bone and cause people in their 20s to have amputations and open-heart surgeries.

There were 38 HIV infections tied to injection drug use last year in this county of fewer than 100,000 people — more than in 2019 in New York City.

The county’s overdose rate plummeted.

On this day, five overdose reports had arrived on Cox’s desk — a daily tally similar to the height of their crisis.

The last year has been particularly brutal.

His cousin died from an overdose in somebody’s backyard.

It’s like I’ve got two devils on one shoulder and an angel on the other,” he said.

The Quick Response Team was born amid a horrific crescendo of America’s addiction epidemic: On the afternoon of August 15, 2016, 28 people overdosed in four hours in Huntington.

“Our day of reckoning,” she calls it.

Almost everyone who overdosed that afternoon was saved, but no one was offered help navigating the bewildering treatment system.

One of them, a 21-year-old woman, overdosed again 41 days later.

That time she died.

The crisis was raging not just in Huntington but across America, killing by the tens of thousands a year.

Life expectancy began tumbling, year after year, for the first time in a century — driven largely by what researchers call “deaths of despair,” from alcohol, suicide and drugs.

Some businesses changed out their bathroom light bulbs to blue — to make it harder for drug users to find a vein.

They track down people who overdosed in abandoned houses and tent encampments on the river, in rural stretches outside of town, at half-million-dollar homes on the golf course.

“You’re not in trouble,” she always says first, then offers them the overdose reversal medication naloxone.

People like her for it, and that makes it easier.

After two years, the county’s overdose calls dropped by more than 50 percent.

The first couple months of the pandemic were quiet, said Priddy, who coordinates the team and tracks their data.

The 911 calls started and seemed like they wouldn’t stop — 142 in a single month, nearly as many as in the worst of their crisis.

“It was almost like a horrible human experiment,” Priddy said.

By the end of 2020, Cabell County’s EMS calls for overdoses had increased 14% over the year before.

“That makes us sick,” Priddy said, but she’s heard from colleagues in other counties that their spikes were twice as high.

The overdose tally captures just a fraction of the desperation, Priddy said.

In Cabell County, ambulance calls for dead-on-arrival suicides increased five-fold in the first two months of the pandemic compared to the year before.

Carter had overdosed dozens of times.

In early 2018, HIV started quietly spreading among injection drug users in Huntington.

By the time they realized what was happening, dozens had been infected, said Kilkenny with the county health department.

They ramped up testing, treatment and the needle exchange program that offers clean syringes to drug users, recommended by the CDC.

As Huntington tries to beat back the damage the pandemic has done, Priddy said it feels like their own state is working against them.

However, the CDC describes syringe programs as “safe, effective, and cost-saving,” — they do not increase drug use or crime, studies have found, and they dramatically cut the spread of Hepatitis C and HIV.

It brings him comfort to think she died from complications from her surgeries, and not that she relapsed and overdosed.

A 39-year-old who went into treatment and was healthy and hopeful for weeks, then relapsed last month and died in his kitchen.

She overdosed many times, and like Carter developed infections.

She fears COVID-19 turned all this death and addiction around her into what seems like a national afterthought.

But this year has been her worst.

She leaves home before dawn each day to ride two buses to her job answering calls from people trying to find COVID-19 vaccines