THE COVID-19 pandemic has had a larger impact on the lives of people with disability compared with the population as a whole (here, here and here). Relative to the general population, higher rates of infection and death have been reported among people with intellectual disabilities in studies from the US (here and here), the UK (here, here and here) and Canada (here and here). The size and consistency of the reported relative risks demand notice and action.
The Australian landscape
Some researchers have argued that there are no comprehensive sources of data on COVID-19 infections for people with disability in Australia (here and here). Although this is largely true, the National Disability Insurance Scheme (NDIS) Quality and Safeguards Commission and the National Disability Insurance Agency (NDIA) do make figures available on the number of active cases and deaths among NDIS participants by jurisdiction.
Within the limits of what can be gleaned from these data, relative 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 does have up-to-date information about vaccination rates among people with disability. These data show that over 95% of people aged 16 years 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 rate of vaccination in NDIS participants is likely to increase the risk of harmful outcomes.
People with disability are more engaged with information about COVID-19 than those without disability (here and here). People with disability as a whole use social media for COVID-19-related information more and report seeing more kinds of information about COVID-19 than those without disability. The only type of disability for which this was not the case was cognitive impairment.
The pandemic has shown that where people with disability can get internet access, they have been able to participate in society as never before because physical and communication barriers have largely disappeared, as education, work, shopping, and many leisure activities moved online.
Published data suggest that similar proportions of people with and without disability are hesitant about receiving a COVID-19 vaccine. Concerns about safety and potential side effects, and not feeling at risk of getting COVID‐19 are the main considerations of people who are hesitant about having a vaccine.
Some groups of individuals may be more hesitant about receiving a vaccine because they are more concerned about vaccine safety than COVID-19 infection. Public health messages that focus on the risks of vaccines relative to the risks of COVID-19 could reduce hesitancy and increase vaccination uptake. Information should also be tailored to specific disabilities (ie, physical, mental, sensory), written in plain language, and made available in accessible ways.
Many people with disability have a negative experience of the health care system. Considerable work is needed to ensure that health professionals and health services are sensitive and appropriate (here and here). Health services with dedicated pathways and settings can have a positive impact.
Vaccination must be a priority for all people with disability, regardless of their household setting, to rise above their increased vulnerability to the physical, mental and social effects of the pandemic and participate and contribute to socio-economic life within the remaining restrictions of the pandemic (here, here and here).
A third vaccine dose has significant benefits 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 time frame yet for a universal vaccine. People aged 16 years and over who had their second dose 3 or more months ago are due for their third dose. Workers in key sectors, including disability, are required to get their third dose before being permitted to work onsite.
People at greatest 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 years and older;
- people who live in aged care facilities or disability support accommodation;
- people aged 16 years and over who have been deemed severely immunocompromised; and
- Aboriginal and Torres Strait Islander people aged 50 years and older.
The closure of international borders through the pandemic had an impact on the disability workforce, which had been reliant on immigration to achieve growth (here and here). Fortunately, the reopening of borders will improve the situation, but difficulties remain. Because varying rates of COVID-19 infections are now an ongoing part of day-to-day life, a certain number of employees will always be unable to work as case numbers rise and fall. NDIS providers face the challenge of balancing isolation for close contacts against workforce availability.
Due to the high proportion of casual employees within the disability workforce, there is a higher risk of COVID-19 infections. Several factors contribute to this, including the large numbers of workers moving between homes; workers being paid only for the work they perform, which is a disincentive for self-isolating; and a loosely linked workforce without a central registry, which makes 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 over time, being able to respond to sudden changes in demand, and addressing employee wellbeing, mental health and the risk of burnout. All of these issues are affected by pay and conditions.
COVID-19 has had an impact on all of these areas and this situation is further complicated by the thousands of unfilled vacancies across the sector and the need for an additional 83 000 NDIS workers by 2024.
The “new normal”
The pandemic has caused loss and hardship for people with disability and those who support them. As COVID-19 becomes part of everyday life, it is important to apply the lessons that have been learned so far and take a holistic view of quality of life. We need to view 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 air (HEPA) filters, when used along with other best practices including social distancing and mask-wearing, can reduce the potential for airborne transmission of COVID-19 indoors.
The toll on mental health of extended lockdowns has been significant, especially for people with disability living with their families (here and here). The experience with telehealth has provided a clear lesson: some people may have experienced increased independence and connection to the community when specialised group programs were closed. Video calling and home automation, for example, will be enhanced.
Now is the time to prepare for COVID-19 becoming an ongoing part of life in Australia. People with chronic disease, disability, and a compromised immune system are likely to remain at high risk. We need to identify and address data gaps on COVID-19 infections and outcomes for people with disability in Australia.
NDIS providers must invest in their leadership, disaster planning and management capability to rapidly and predictably respond to future surges and to the next pandemic. We must bridge the vaccination coverage gap between people with disability and the general population.
This depends on having a clear understanding of why people are hesitant to get vaccinated and giving people with a disability priority access to current doses and future boosters, including access to a trained workforce to administer them.
Consideration should be given to changing the fourth dose recommendation to include any person with disability regardless of their residential setting. All decisions and recommendations should be in line with the best available reliable evidence using trusted sources such as the National COVID-19 Clinical Evidence Taskforce.
The voices of NDIS providers and people with disability need to be heard to make sure big policy decisions are reasonable and can be implemented. Providers should advocate for the Taskforce to have a panel specifically for people with disability and other vulnerable groups. People with disability should have priority access to antivirals, including more explicit inclusion of people with disability within eligibility for subsidised antiviral treatments under the Pharmaceutical Benefits Scheme.
We cannot become complacent about COVID-19 within vulnerable groups themselves or in efforts aimed at protecting vulnerable groups within the broader community.
Professor Erwin Loh is Group Medical Officer and Group General Manager of Clinical Governance at St Vincent’s Health Australia.
Dr Paul Ireland is Director – Policy, Compliance & Research of Yooralla.
Terry Symonds is CEO of Yooralla.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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