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      COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic

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          Abstract

          During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa’s Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are ‘worth’ saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.

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          Fair Allocation of Scarce Medical Resources in the Time of Covid-19

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            A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

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              The COVID-19 response must be disability inclusive

              There are more than 1 billion people living with disabilities (PLWD) worldwide. The coronavirus disease 2019 (COVID-19) pandemic is likely to disproportionately affect these individuals, putting them at risk of increased morbidity and mortality, underscoring the urgent need to improve provision of health care for this group and maintain the global health commitment to achieving Universal Health Coverage (UHC). 1 PLWD, including physical, mental, intellectual, or sensory disabilities, are less likely to access health services, and more likely to experience greater health needs, worse outcomes, and discriminatory laws and stigma. 2 COVID-19 threatens to exacerbate these disparities, particularly in low-income and middle-income countries, where 80% of PLWD reside, and capacity to respond to COVID-19 is limited.3, 4 Preparedness and response planning must be inclusive of and accessible to PLWD, recognising and addressing three key barriers. First, PLWD might have inequities in access to public health messaging. All communication should be disseminated in plain language and across accessible formats, through mass and digital media channels. Additionally, strategies for vital in-person communication must be safe and accessible, such as sign language interpreters and wearing of transparent masks by health-care providers to allow lip reading. Second, measures such as physical distancing or self-isolation might disrupt service provision for PLWD, who often rely on assistance for delivery of food, medication, and personal care. Mitigation strategies should not lead to the segregation or institutionalisation of these individuals. Instead, protective measures should be prioritised for these communities, so care workers and family members can continue to safely support PLWD, who should also be enabled to meet their daily living, health care, and transport needs, and maintain their employment and educational commitments. Third, PLWD might be at increased risk of severe acute respiratory syndrome coronavirus 2 infection or severe disease because of existing comorbidities, and might face additional barriers to health care during the pandemic. 2 Health-care staff should be provided with rapid awareness training on the rights and diverse needs of this group to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision. COVID-19 mitigation strategies must be inclusive of PLWD to ensure they maintain respect for “dignity, human rights and fundamental freedoms,” 5 and avoid widening existing disparities. This necessitates accelerating efforts to include these groups in preparedness and response planning, and requires diligence, creativity, and innovative thinking, to preserve our commitment to UHC, and ensure people living with disabilities are not forgotten.
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                Author and article information

                Journal
                Afr J Disabil
                Afr J Disabil
                AJOD
                African Journal of Disability
                AOSIS
                2223-9170
                2226-7220
                18 August 2020
                2020
                : 9
                : 766
                Affiliations
                [1 ]Interdisciplinary Centre for Sports Science and Development, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
                [2 ]Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
                [3 ]Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
                Author notes
                Corresponding author: Emma McKinney, emma@ 123456disabilityincluded.co.za
                Author information
                https://orcid.org/0000-0001-7483-5463
                https://orcid.org/0000-0003-1067-8934
                https://orcid.org/0000-0003-1741-5897
                Article
                AJOD-9-766
                10.4102/ajod.v9i0.766
                7479422
                32934920
                04da49e0-484a-4feb-824c-7b977c2de912
                © 2020. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 08 June 2020
                : 09 July 2020
                Categories
                Opinion Paper

                covid-19,disabled people,triage policies,ventilators,icu admission,ethics of care,accessibility,south africa

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