36
views
0
recommends
+1 Recommend
2 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      The Covid-19 Pandemic and People with Disability

      editorial
      ,
      Disability and Health Journal
      Published by Elsevier Inc.

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          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.

          Related collections

          Most cited references16

          • Record: found
          • Abstract: found
          • Article: found

          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

            Introduction We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. Methods We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. Results We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41–57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091–0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4–12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35–1.8). Conclusion In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Covid-19: risk factors for severe disease and death

                Bookmark

                Author and article information

                Journal
                Disabil Health J
                Disabil Health J
                Disability and Health Journal
                Published by Elsevier Inc.
                1936-6574
                1876-7583
                28 May 2020
                28 May 2020
                : 100944
                Article
                S1936-6574(20)30069-8 100944
                10.1016/j.dhjo.2020.100944
                7254018
                32475803
                fd9d47e9-1587-4f9a-b9ce-edfabc699793
                © 2020 Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Categories
                Article

                Comments

                Comment on this article