Impact of COVID-19 on the daily life of people with disabilities

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THE COVID-19 pandemic has had a greater impact on the lives of people with disabilities compared to the general population (here, here and here). Compared to the general population, higher rates of infection and death have been reported in people with intellectual disabilities in studies conducted in the United States (here and here), the United Kingdom (here, here and here) and in Canada (here and here). The magnitude and consistency of reported relative risks require notification and action.

The Australian landscape

Some researchers have argued that there are no comprehensive sources of data on COVID-19 infections for people with disabilities in Australia (here and here). While this is largely true, the National Disability Insurance Scheme (NDIS) Quality and Safeguards Commission and the National Disability Insurance Agency (NDIA) publish figures on the number of active cases. and deaths among NDIS participants by jurisdiction.

Within the limits of what can be gleaned from these data, compared to the general Australian population, NDIS participants appear to have contracted COVID-19 at a much lower rate, but when infected with SARS -CoV-2), their risk of death is about five times greater.

Australia has up-to-date information on vaccination rates for people with disabilities. These data show that more than 95% of people aged 16 and over are fully vaccinated, while only 85.7% of NDIS participants of the same age are fully vaccinated. Vaccination is the most effective way to reduce the impact of COVID-19, and the lower vaccination rate among NDIS participants is likely to increase the risk of adverse effects.

People with disabilities are more interested in information about COVID-19 than people without disabilities (here and here). People with disabilities as a whole use social media more for information related to COVID-19 and report seeing more types of information about COVID-19 than people without disabilities. The only disability type for which this was not the case was cognitive impairment.

The pandemic has shown that where people with disabilities can access the internet, they have been able to participate in society like never before, as physical and communication barriers have largely disappeared, as education, work, shopping and many leisure activities have moved online.

Vaccination hesitancy

Published data suggests that similar proportions of people with and without disabilities are hesitant to receive a COVID-19 vaccine. Concerns about safety and potential side effects, and not feeling at risk of contracting COVID‐19 are primary considerations for vaccine hesitant people.

Certain groups of individuals may be more reluctant to receive a vaccine because they are more concerned about vaccine safety than COVID-19 infection. Public health messages that emphasize the risks of vaccines versus the risks of COVID-19 could reduce hesitancy and increase uptake of vaccination. Information should also be suitable for specific disabilities (i.e. physical, mental, sensory), written in plain language and made available in an accessible manner.

Many people with disabilities have a negative experience of the healthcare system. Considerable work is needed to ensure that health professionals and health services are responsive and appropriate (here and here). Health services with dedicated pathways and environments can have a positive impact.

Immunization should be a priority for all people with disabilities, regardless of their household setting, to overcome their increased vulnerability to the physical, mental and social effects of the pandemic and participate and contribute to socio-economic life within the remaining limits. of the pandemic (here, here and here).

boosters

A third dose of vaccine has significant advantages over the second dose, but evidence is emerging that a third dose becomes less effective after 4 months. Vaccines may also be less effective against different variants of SARS-CoV-2, and there is no timeline for a universal vaccine yet. People aged 16 and over who received their second dose 3 months or more ago should receive their third dose. Workers in key sectors, including disability, must receive their third dose before being allowed to work on site.

People most at risk of severe illness from COVID-19 can receive their fourth (winter) dose 4 months after receiving their third dose. This includes:

  • anyone aged 65 and over;
  • people who live in aged care facilities or accommodation for the disabled;
  • people aged 16 and over who have been found to be severely immunocompromised; and
  • Aboriginal and Torres Strait Islander people aged 50 and over.

Workforce

The closure of international borders during the pandemic has impacted the workforce with disabilities, which depended on immigration for growth (here and here). Fortunately, the reopening of the borders will improve the situation, but difficulties remain. Since varying rates of COVID-19 infections have become part of everyday life, a number of employees will still be unable to work as the number of cases rises and falls. NDIS vendors face the challenge of balancing close contact isolation with workforce availability.

Due to the high proportion of casual workers within the workforce with disabilities, the risk of COVID-19 infection is higher. Several factors contribute to this, including the large number of workers who move from one place of residence to another; workers are only paid for the work they do, which discourages self-isolation; and a loosely tied workforce with no central registry, making it more difficult to communicate new information to all workers.

Employers face the complexity of juggling many workforce issues, including attracting new employees, retaining existing employees, ensuring the workforce has the right skills and abilities at the over time, being able to respond to sudden changes in demand and looking after the well-being, mental health and mental health of employees. risk of burnout. All of these issues are affected by salary and conditions.

COVID-19 has impacted all of these areas and this situation is further complicated by the thousands of vacancies in the sector and the need for 83,000 additional NDIS workers by 2024.

The “new normal”

The pandemic has caused loss and hardship for people with disabilities and those who support them. As COVID-19 has become part of everyday life, it is important to apply the lessons learned so far and take a holistic view of quality of life. We must consider the impact of COVID-19 in the context of overall morbidity and mortality and access to health care.

Rapid deployment of mobile high-efficiency particulate (HEPA) filters, when used with other best practices, including social distancing and mask-wearing, can reduce the potential for airborne transmission of COVID-19 to the inside.

The mental health toll of the extended lockdowns has been significant, especially for people with disabilities living with their families (here and here). The telehealth experience provided a clear lesson: some people may have experienced increased independence and connection to the community when specialist group programs were shut down. Video calls and home automation, for example, will be improved.

Now is the time to prepare for COVID-19 to become a regular part of life in Australia. People with chronic illness, disability, and weakened immune systems are likely to remain at high risk. We need to identify and close data gaps on COVID-19 infections and outcomes for people with disabilities in Australia.

Conclusion

NDIS providers must invest in their leadership, planning, and disaster management capability to respond quickly and predictably to future surges and the next pandemic. We need to close the immunization coverage gap between people with disabilities and the general population.

This depends on a clear understanding of why people are hesitant to get vaccinated and giving people with disabilities priority access to current doses and future boosters, including access to a trained workforce for administer.

Consideration should be given to modifying the fourth recommended dose to include all persons with disabilities, regardless of their place of residence. All decisions and recommendations must be consistent with the best available reliable evidence using reputable sources such as the National COVID-19 Clinical Evidence Task Force.

The voices of NDIS providers and people with disabilities must be heard to ensure that major policy decisions are reasonable and can be implemented. Providers should advocate for the working group to have a panel specifically for people with disabilities and other vulnerable groups. People with disabilities should have priority access to antivirals, including more explicit inclusion of people with disabilities in eligibility for subsidized antiviral treatments under the Pharmaceutical Benefits Scheme.

We cannot become complacent about COVID-19 within vulnerable groups themselves or in efforts to protect vulnerable groups within the wider community.

Professor Erwin Loh is Group Physician and Chief Executive of the Clinical Governance Group at St Vincent’s Health Australia.

Dr. Paul Ireland is Director – Policy, Compliance and Research at Yooralla.

Terry Symonds is CEO of Yooralla.

Statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of WADA, the MJA Where Preview+ unless otherwise stated.

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