An Unequal Response: COVID-19 and Disability
Since the beginning of the COVID-19 pandemic, public health workers have advocated actions we all know now by heart: Wash your hands frequently. Maintain at least 6 feet of physical distance from others.
But for some people with disabilities, those basic strategies don’t apply, says Bonnielin Swenor, PhD ’13, MPH ’09, an expert on disability inclusion and access to care.
Frequent hand washing isn’t always possible for people with disabilities, and physical distancing is almost impossible when people rely on personal aides or caregivers, she says. When people with disabilities live in group homes, these challenges are compounded. SARS-CoV-2, the virus that causes COVID-19, can be transmitted easily among people living in shared spaces, as outbreaks in nursing homes and group homes in multiple states have shown.
Swenor, an associate professor at the School of Medicine with a joint appointment in Epidemiology at the Bloomberg School, points out that more than a quarter of the U.S. population has a disability. And many people with disabilities have chronic conditions—such as diabetes, heart disease, and obesity—that increase their risk of contracting and suffering complications from COVID-19.
Even before the pandemic, people with disabilities often faced challenges “including lack of accessible health care spaces, information, and medical equipment, as well as stigma surrounding disabilities that can affect care,” Swenor says. The current crisis has only exacerbated those longstanding conditions. “COVID-19 has highlighted the gaps in equitable situations for people with disabilities, and that really has to change. That’s part of the reason that there’s a greater risk for people with disabilities in developing COVID-19,” she says.
There are several steps we can take going forward to ensure the safety of people with disabilities in crises like the COVID-19 pandemic, according to Swenor:
- Researchers and clinicians urgently need to collect data on disability. “As an epidemiologist and a public health professional, and also a person that has a disability myself—I have visual impairment—I think we start with data,” Swenor says. “Unlike [data on] race or age, which is systematically collected among patients in health care, [data on] disability is not. Because that information isn’t there, we don’t have the evidence to know where and if gaps exist.”
- Important information about risks needs to be accessible to people with disabilities, including those with vision or hearing loss. Otherwise, they will not be able to stay current with recommendations or engage in those recommended strategies, Swenor says.
- Our public health departments need to ensure that people with disabilities have access to vital goods and services, even during “shutdown” periods.
- People with disabilities must have access to health care—including accessible testing options during the current crisis. “If you’re recommended to go through a drive-through testing site, or you don't have another way to get to care except either mobility services or you don’t drive, there’s a big gap there,” Swenor says.
- We need inclusive response planning. “People with disabilities haven’t been considered or included in emergency and disaster planning,” Swenor says. “That was the case for prior natural disasters and emergencies, and that still holds true today.” One way to ensure inclusive planning? Engage with the disability community.
- Public health professionals need to recognize disability among the factors driving disparities in COVID-19 infection, testing, and outcomes.
The long-term consequences of this pandemic could present further threats to people with disabilities. It’s possible, for example, that health inequities will deepen. “The disruption in health care may disproportionately impact disabled individuals, and the rapid shift to telehealth may leave behind patients with disabilities,” Swenor says.
But she’s optimistic that, this time, we can do better. Not only has the COVID-19 crisis brought more attention to disability inequities, she says, but “the shift to a new normal provides a unique opportunity to rebuild our daily lives with a focus on inclusion and accessibility.”
Melissa Hartman is managing editor of Hopkins Bloomberg Public Health magazine.