The Covid-19 pandemic is changing public health and health care, likely with permanent
consequences. While we have accumulated considerable information through the study
of increasing numbers of people who have been contracted or died from the virus, we
have learned also how much we still don’t know about the virus. Our national surveillance
capability has been inadequate during this pandemic, leaving us with poor appreciation
of the prevalence or death rate from infection. We continue to seek specific knowledge
about positivity, carrier status, transmission, and virus shedding. Reports have associated
older age and multiple chronic conditions, especially hypertension, with increased
morbidity and mortality.
1
A variety of manifestations are being reported in both adults and children.2, 3, 4,
5 Pneumonia and difficulty handling secretions are the focus of management in severe
disease, with a goal of preventing acute respiratory distress syndrome (ARDS). However,
now more complex management includes monitoring cardiac, thrombotic, and vascular
endothelial complications.
3
,
6, 7, 8 Clearly we are learning more details about risk for severity and mortality.
Being older and having multiple co-morbidities continues to be the leading indicator
of poor outcomes from infection with Covid-19. Hypertension, diabetes, cardiovascular
disease, and chronic lung disease have been associated with worse outcomes
1
and obesity, smoking, and male gender have also been implicated.
9
,
10
Besides people of older age and presence of health conditions, population descriptors
identified as more at risk for severe disease include lower socioeconomic status,
homelessness, living in densely populated communities, limited access to food, and
poor sanitation.
11
Racial and ethnic disparities have been suggested, with a call to explore public health
responsive.
12
People with disability belong to a population with a higher prevalence of multiple
chronic conditions, disability often results in lower economic status during the adult
years and it frequently necessitates living in group communities, and disability status
is documented to be associated with disparities in health care. Information about
the effect of Covid-19 on people with disability is now due.
Publishing observations of COVID-19 impact in the disability community are now emerging.
Reseachers and clinicians have highlighted screening and triage difficulties for people
with spinal cord injury (SCI),
13
and differences in symptom manifestation seen in people with SCI challenge that challenge
recognition of COVID-19 infection.
14
They also note the problems people with intellectual and developmental disability
(IDD) face when their routines and support systems are disrupted, resulting in behavioral
changes.
15
Just as health literacy related to risks and protection for the virus is important
for the general population,
16
so too people with IDD are challenged by health literacy gaps related to new routines
and restrictions to activities and changes in the supportive environment.
17
Questions about limiting screening or treatment for people with disability have been
reported.
18
,
19
And for those with new-onset disability or those engaging in outpatient or community-based
rehabilitation, there are interruptions in services with possible increase in recovery
time or preventable loss of function.
20
People with disability are looking for information related to their likely increased
risk for significant Covid-19 morbidity and mortality.
19
Resources for people with disability and those who work with them have been collected
and available from a variety of government, advocacy, service, and health policy organizations
(e.g., Access Living https://www.accessliving.org/our-services/covid-19-resources-for-the-disability-community/
; Administration for Community Living https://acl.gov/COVID-19 ; American Association
on Health and Disability https://www.aahd.us/covid-19/ ; The Arc https://thearc.org/covid/
).
To raise the visibility of people with disability and foster discussion about health
care needs of people with disability, we have included two articles that discuss Covid-19
among people with disability. Boyle et al
21
(Commentary 20-00236) review the U.S. public health response and challenges for people
with disability. Turk et al
22
(Brief Report 20-00237) provide an exploratory view of people with intellectual and
developmental disability related to morbidity and mortality.
While these manuscripts add to the literature about the preparedness, infection rate,
testing, treatment, and mortality for people with disabilities we need to encourage
analyses for many different disability diagnoses coupled with many different underlying
conditions. Analyses need to take into account living situation, since it is already
clear that nursing home populations are at very high risk of spread. There will be
many data sources that can be used to identify testing rates, hospitalization rates,
and death rates, for each subgroup of the disability community. To better grasp the
magnitude of the challenge for people with disability, information about global antigen
and antibody testing within different residential settings and among a few disability
subgroups is needed. We call upon our authors and readership to consider research
approaches to evaluate the ongoing pandemic and to contribute to the understanding
of the effect of Covid-19 on people with disability.