Triple jeopardy: disabled people and the COVID-19 pandemic

Abstract

People with disabilities have been differentially affected by COVID-19 because of three factors: the increased risk of poor outcomes from the disease itself, reduced access to routine health care and rehabilitation, and the adverse social impacts of efforts to mitigate the pandemic. 10 years ago, WHO’s World Report on Disability noted that people with disabilities were more likely to be older, poorer, experience comorbidities, and be female. Older age, deprivation, and comorbidities are also associated with increased risk of severe outcomes from COVID-19. Risk of death from COVID-19 between Jan 24 and Nov 30, 2020, in England was 3·1 times greater for men with disabilities and 3·5 times greater for women with disabilities than for men and women without disabilities. People with intellectual disabilities living in congregate residential settings, relevant mainly to high-income settings, had a higher risk of death from COVID-19 than people without disabilities. But even in household settings, people with intellectual disability have an increased risk of COVID-19 death. Worldwide, disasters and emergencies often disproportionately impact the disability community, and this pandemic is no exception. People with disabilities have faced many barriers to inclusion in the COVID-19 response (panel). The lockdown measures societies have taken during the COVID-19 pandemic have meant people with disabilities are worse off and more excluded. If lockdown and curfew are enforced through aggressive actions by security forces, as in some countries in southern Africa, then people with disabilities who may need to access health care or pharmacies are penalised. Cancellation or postponement of regular health care or rehabilitation will differentially impact those with additional health needs. When assistive technology is not prescribed, maintained, or repaired, people with disabilities are rendered dependent. When social care is put on hold, cancelled, or reduced, people with disabilities are thrown back on the support of families if they have them. When it is not possible to attend day centres or voluntary projects, people with disabilities may be left with no one to meet. When individuals are expected to use face masks and physically distance, people with hearing loss who cannot lip read or people with visual impairment who use guide dogs can find it difficult to follow these rules and as a result they might be stigmatised. Additionally, confinement in homes increases the risk of physical or sexual violence and abuse, to which children and adults with disabilities are additionally vulnerable. Inadequate preparedness for the impacts of the COVID-19 pandemic on people with disabilities has been shockingly familiar. People with disabilities have been overlooked or are an afterthought in the education provision for children with special educational needs, the provision of personal protective equipment in social care, or the inclusion of sign language in government announcements. In Uganda, school closures have led to the exclusion of many young people with disabilities since educational materials are not in accessible formats and access to assistive technology, including the internet, has been a challenge. In a public health crisis such as the COVID-19 pandemic, clear information becomes more important than ever. In the UK, messages have been confused or complicated, which has been difficult for people with intellectual disabilities to understand. In other countries, there can be low confidence in public health messaging. Increased isolation and uncertainty or fear about the pandemic have also impacted the mental health of people with disabilities. People with mental illness can find isolation and fear particularly debilitating. People with physical impairments are also disproportionately at risk of mental health conditions. For many people, this pandemic has generally been bad for mental health. Yet in the pandemic there have been some positive developments for people with disabilities. Where they can get internet access, people with disabilities have Published Online March 16, 2021 https://doi.org/10.1016/ S0140-6736(21)00625-5