The COVID-19 response must be disability inclusive
Authors: Richard Armitage, Laura B Nellums
Journal: The Lancet Public Health (2020)

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).1Kuper H Heydt P The mission billion: access to health services for 1 billion people with disabilities. London School of Hygiene & Tropical Medicine, 2019https://www.lshtm.ac.uk/TheMissingBillionDate accessed: March 22, 2020Google Scholar 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.2UN NewsPreventing discrimination against people with disabilities in COVID-19 response.UN News. March 19, 2020; https://news.un.org/en/story/2020/03/1059762Date accessed: March 22, 2020Google Scholar 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.3The LancetPrioritising disability in universal health coverage.Lancet. 2019; 394: 187Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 4Global Health Security Indexhttps://www.ghsindex.orgDate: 2019Date accessed: March 22, 2020Google Scholar 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.2UN NewsPreventing discrimination against people with disabilities in COVID-19 response.UN News. March 19, 2020; https://news.un.org/en/story/2020/03/1059762Date accessed: March 22, 2020Google Scholar 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,"5Human Rights WatchHuman rights dimensions of COVID-19 response.Human Rights Watch. March 19, 2020; https://www.hrw.org/news/2020/03/19/human-rights-dimensions-covid-19-response#_Toc35446586Date accessed: March 22, 2020Google Scholar 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. We declare no competing interests. Disability and COVID-19: who counts depends on who is countedRecent publications have highlighted how people with disabilities could be at increased risk from COVID-19, and have made calls for a disability-inclusive pandemic response.1,2 However, little attention has been given to a crucial underlying factor that precludes movement towards addressing inequities: the scarcity of disability data. Without data, the impact of COVID-19 on people with disabilities remains unknown. Full-Text PDF Open AccessCOVID-19 puts societies to the testAs of April 21, the coronavirus outbreak has infected more than 2·3 million people and taken 162 956 lives—35 884 in the USA, 24 114 in Italy, 20 852 in Spain, 20 233 in France, 16 509 in the UK, 5209 in Iran, 4642 in China—all underestimates most probably. Beyond these numbers are people, families, communities, societies that have been affected in unprecedented ways. The coronavirus pandemic puts societies to the test: it is a test of political leadership, of national health systems, of social care services, of solidarity, of the social contract—a test of our very own fabric. Full-Text PDF Open Access