COVID-19 and people with disabilities in Canada

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Overview

COVID-19 is a respiratory illness that spreads from a person who is infected, to others through respiratory droplets and aerosols. COVID-19 can spread when a person who has contracted the virus, coughs, sneezes, breathes, sings, shouts, or talks. It can also spread by touching an object with the virus on it and then touching your mouth, nose or eyes before washing your hands. A person can become infected with COVID-19 from touching items and surfaces that carry the virus on them.

COVID-19 infections range from asymptomatic (no symptoms) to severe infections that require intensive care and in rare cases death. Some people with disabilities may be at a higher risk of getting severe COVID-19 disease because of their age, vaccination status, the presence of one or more underlying medical conditions and/or from being immunocompromised.

Some known health conditions/syndromes that may put one at greater risk for severe disease or outcomes from COVID-19 include cancer, cerebrovascular disease, chronic kidney disease, COPD, diabetes, Down syndrome, heart conditions, obesity, neurological conditions or a weakened immune system. In addition to the conditions that increase everyone's risks related to COVID-19, the following are additional factors that may increase the risks of a person with a disability:

  1. The nature of some disabilities may put certain individuals at a higher risk of exposure and/or infection. Examples of individuals may include:
    • people who have difficulties washing their own hands
    • people who are low vision, deaf-blind, or are blind and need to physically touch objects or people (tactile interpreters) for support or to obtain information
    • people who may not be able to wear masks/respirators (due to medical or sensory reasons)
    • people for whom physical distancing may be challenging
    • people who have difficulty understanding, performing or maintaining public health guidance or infection prevention and control (IPC) measures
    • persons who are deaf or hard of hearing who need a speaker without a mask to understand what is being said through either lip reading, facial expression, or voice
  2. Individuals with disabilities living in congregate living settings face a higher risk of contracting COVID-19 due to being in close proximity to others, sharing common indoor spaces, or other COVID risks. Examples of congregate living settings may include long-term residential facilities, group homes, foster homes, and assisted living facilities.
  3. Individuals with disabilities interacting with multiple care providers and/or essential supports are at increased risk of contracting COVID-19 due to increased exposures to more people.
  4. Frequent visits to obtain health care may put a person with disabilities at greater risks for exposures.

Those who work with, care for, support, are friends/family, or those who live with people with disabilities, should be aware of the risks posed by COVID-19 for people with disabilities. Primary healthcare providers should be consulted when a person with a disability, or their support persons/friends/family have questions or concerns regarding any health issues, and/or exposures or symptoms of COVID-19.

Protecting people with disabilities from COVID-19

There are things you can do to protect yourself/others from COVID-19 if you are a person with a disability or care for/support or are family/friends/work colleagues with someone who has a disability, including:

To prevent further transmission, immediately notify or have others notify your family/care providers/friends if you or the person you are caring for/supporting becomes ill. If the person with the disability remains within their home environment, please review "How to care for an adult with COVID-19 at home" or "How to care for a child with COVID-19 at home".

The healthcare and social services systems and COVID-19

Special considerations, adaptations and accommodations should be considered and provided for people with disabilities within the healthcare, public health and social service systems, and specifically through an intersectional lens. In this context, intersectionality refers to looking at disability along with race, ethnicity, culture, rural or remote communities, gender, sex, age, socioeconomic status, and other social determinants of health, and how to adapt systems to ensure that unique situations are considered.

In addition, any restrictions imposed within a given space should take into account the needs of people with disabilities, and allow essential support staff, sighted guides, interpreters and/or family members to be present in these settings.

Visitor and support person restrictions in all settings and healthcare facilities should aim to balance the physical, psychological, emotional and spiritual needs of individuals with disabilities with the risk of introduction and transmission of COVID-19, which may vary over time depending on local COVID-19 epidemiology and vaccination coverage within the facilities or community.

It is important that those who are unable to communicate are assessed more often and that essential caregivers or support persons are viewed as important partners in helping to communicate and facilitate the needs of those persons with disabilities. In times when guest visitation is restricted, special consideration should be noted to avoid incorrectly classifying essential caregivers and support persons as guests, especially when they are family members.

The loss of important services and supports provided through community programming, employment, access to therapies, school or day programs can also be detrimental to a person's overall health and well-being, and can lead to regression in positive development for some people with disabilities. Advocate to prevent these losses is essential and strategies to ensure services and supports are not compromised are needed.

People with disabilities may face unique barriers to accessing COVID-19 public communication information, which impacts their response and engagement with services and programs. These barriers to information access may be further exacerbated by social and economic conditions in which the individual is living; for example, using an intersectionality lens and looking at how disability status intersects with race/ethnicity/culture, rural/remote communities, gender, sex, age socioeconomic status, and other social determinates of health, can help address some of these inequities and barriers to access. Assistance in navigating community supports may be needed, along with frequent communication strategies to communicate new information. All information must be communicated using a variety of ways, and be made available and accessible through various mediums and platforms.

Within most care settings (i.e. acute care, long-term care, home care, ambulatory/outpatient care, public health centres, testing and immunizations centres), considerations and accommodations need to be in place for people with disabilities. These considerations and accommodations should include:

Vaccination for people with disabilities

Everyone eligible should receive all doses of the COVID-19 vaccine that are recommended for them.

Some populations may face challenges accessing immunization services, and special efforts to reach these populations are needed throughout all stages of COVID-19 vaccine roll-out.

Efforts should be made to increase access to immunization services to reduce health inequities without further increasing stigma or discrimination, and to engage people with disabilities in immunization program planning.

Special considerations for essential support persons

Essential support persons can include care providers, support workers, persons supporting communications, sighted guides, interpreters, friends, and/or family members.

Within the policies, procedures, and directives of any organizations that provide COVID-19 and non-COVID healthcare and supportive services to people with disabilities, permission should be provided within the directives that allows accompaniment of essential support persons at all stages of care and support. Essential support persons should be permitted to accompany a person with a disability to their vaccination appointment.

Protective measure considerations for people with disabilities

a. Guidance on the use of masks among individuals who are deaf or hard-of-hearing:

In the community, there are masks designed for people who are deaf or hard-of-hearing. These masks have transparent windows and can be used:

If a non-medical mask with a transparent window is not available:

b. Masks/Respirators:

Individuals that provide care and support to people with disabilities should wear masks/respirators and perform physical distancing as much as reasonably possible, especially in the case when the person with a disability is not able to wear a mask/respirator.

c. Transparent physical barriers and the blind or visually impaired and others with disabilities:

Transparent physical barriers (e.g., Plexiglas) are clear and therefore difficult to see, so people who are blind or visually impaired and others with disabilities may not be able to visually identify them. Facilities should consider that all transparent physical barriers have high contrast and bright tape applied around the edges, especially around the bottom opening. If a person must pass any documents/payment/identification through the bottom opening of the transparent physical barrier, staff should plan to explain this process. Staff should also inform the person where the opening of the transparent barrier is and what is on the other side.

All staff should be trained on how to properly provide assistance and sighted guide assistance. The "Sighted Guide Technique" is the best method to provide assistance in a safe and respectful way to guide someone who is blind or visually impaired. Others may require assistance as well since processes of entry, exit and interactions during COVID may be different from previous visits.

d. Guide dogs: Physical distancing and COVID-19

Guide dogs are used for a variety of reasons. Examples include: guide dogs for people who are blind or visually impaired, people who are deaf, people with autism, people with mental health conditions, people who have reduced mobility. Guide dogs do not understand physical distancing. Guide dogs do not understand the changes in physical distancing and therefore those around them need to practice physical distancing should the dog and its owner get too close.

Guide dogs are not trained to follow arrows on the floor. If you see someone with a guide dog who is not following the arrows on the floor you may offer assistance. If the person is blind or visually impaired the above referenced "sighted guide technique" can be used and is a respectful way to offer assistance.

g. Cleaning and disinfection:

Ongoing cleaning and disinfection should be performed with particular attention to high-touch areas or surfaces such as:

Educational materials

All organizations that serve and support persons with disabilities need to ensure their information is provided to meet the needs of the individuals they serve. Information should be made available in diverse, accessible, multi-lingual, and culturally and functionally appropriate formats.

Acknowledgments

This document was prepared by: Dr. Marianna Ofner, Dr. Marina Salvadori, Yung-En Chung, Aoife Pucchio, Thomas Atkins, Dr. Laura Orlando, Alexandra Erhardt and Eliza McClelland

The authors gratefully acknowledge the review and contributions of:

COVID-19 Disability Advisory Group: Krista Carr, Bill Adair, Neil Belanger, Diane Bergeron, Bonnie Brayton, Ellen Cohen, Maureen Haan, Hélène Hébert, Dr. Heidi Janz, Rabia Khedr, Dr. Michael Prince & Josh Vander Vies

PHAC contributors: Nicolas De Guzman Chorny, Rachel Field, Shainoor Ismail, Marnie Johnstone, Jennifer Rooney, Matthew Tunis, Kelsey Young & Shamiram Zendo

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