The past decade has seen significant advancements in improving care for people with disabilities, with the landmark Word Health Organization Disability Action Plan (2014-2021) garnering commitments from member states to remove barriers to health care, improve access to rehabilitation and assistive services, and enhance research on optimizing these services.¹ The COVID-19 pandemic, however, has had a major effect on people with disabilities and dramatically highlighted the disproportionate health care challenges that they encounter and that are exacerbated during public health emergencies, such as a pandemic.²  

The U.S. National Council on Disability (NCD) recently released a report underscoring the myriad ways in which people with disabilities have experienced a negative effect due to COVID-19. They face a baseline increased risk of more severe infection, something not taken into account by many state vaccine allocation programs. Many people with disabilities living in congregate settings furthermore have had limited opportunities to transfer to other locations, and Medicaid Home and Community-Based services have not been sufficient to support community-based care.³  

On a day-to-day basis, the burdens of the COVID-19 pandemic create challenges for those with disabilities that others may face with less frequency. Online communication platforms and telehealth tools are not always compatible with screen-readers and can pose difficulties for those who are blind or visually impaired. Mask-wearing is not only difficult for those who may have trouble breathing, but also creates a communication gulf for those who rely on lip reading, such as those who are deaf or hard of hearing. Mask-wearing has also been shown to exacerbate symptoms related to post-traumatic stress disorder in some cases.⁴  

More broadly, those with mental health disorders have suffered disproportionately from social isolation. A meta-analysis found that people with pre-existing mental illness have significantly higher anxiety and depressive symptoms compared to controls during the pandemic, with reduced use of psychiatric services. Two studies compared subjects’ mental health before and during the pandemic: one study in Canada found that among pregnant women, previous diagnosis of psychiatric disorder predicted elevated distress and psychiatric symptoms during the pandemic. Another study of elderly patients with Mild Cognitive Impairment or Mild Dementia before COVID-19 and five weeks after lockdowns began found a significant increase in neuropsychiatric symptoms such as agitation, apathy and aberrant motor activity.⁵ 

During major surges in case numbers, hospital bed shortages have been shown to exert some of their most devastating effects of people with disabilities, who can be formally and informally triaged out of care by states’ Crisis Standards of Care (CSC) protocols. For example, Colorado’s CSC guidelines bar some cystic fibrosis patients from accessing critical care based on policies derived from 40-year-old mortality data. Washington State’s CSC guidelines rely on assumptions about a patient’s “baseline functional status” under triage circumstances, a measure that requires physicians to decide what care a patient may receive based on subjective and occasionally incomplete conclusions about a disabled patient’s length or quality of life.³ 

Fortunately, the unprecedented nature of the pandemic and spotlights on the the effect of COVID-19 on vulnerable groups have encouraged some positive change for people with disabilities. Though Alabama’s CSC guideline from early 2020 stated that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support,” a disability rights groups filed a formal discrimination complaint with the Department of Health and Human Services (HSS) and successfully had the CSC revised.³  

The HSS has assembled a vast database of resources about federal civil rights projections for individuals with disabilities. Outside the United States, the International Disability Alliance (IDA) is working with under-resourced countries to strengthen the capacity of organizations of people with disabilities to engage with their governments. In February of 2022, the IDA, the government of Norway, and the government of Ghana hosted the second Global Disability Summit, the first of which was held in 2018. This international collaboration aims to generate ambitious, targeted, and concrete commitments on disability inclusion, while supporting stakeholders to achieve them.  

References 

1. World Health Organization Disability and Rehabilitation Team. Global Disability Action Plan 2014-2021. World Health Organization. Published November 30, 2015. https://www.who.int/publications/i/item/who-global-disability-action-plan-2014-2021  

2. World Health Assembly. The Highest Attainable Standard of Health for Persons with Disabilities. World Health Organization. Published May 31, 2021. https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_R8-en.pdf 

3. National Council on Disabilities. The Impact of COVID-19 on People with Disabilities. Published October 29, 2021. https://ncd.gov/sites/default/files/NCD_COVID-19_Progress_Report_508.pdf  

4. COVID-19’s impact on people with disabilities. Massachusetts General Hospital. https://www.massgeneral.org/news/coronavirus/Covid-19s-impact-on-people-with-disabilities  

5. Neelam K, Duddu V, Anyim N, Neelam J, Lewis S. Pandemics and pre-existing mental illness: A systematic review and meta-analysis. Brain Behav Immun Health. 2021;10(100177):100177. doi:10.1016/j.bbih.2020.100177 

6. Global Disability Summit. https://www.globaldisabilitysummit.org/