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Preventing a covid-19 pandemic

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m810 (Published 28 February 2020) Cite this as: BMJ 2020;368:m810

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COVID-19 and disabled people: issues to be considered

Dear Editor

Shortly after reports on an unknown viral pneumonia in December 2019 and detection of COVID-19 on January 6, 2020, it has become a major global health concern as a pandemic.[1] Health officials worldwide have focused on adopting strategies such as quarantine, limitation of contacts, travel restrictions, promoting proper personal hygiene to control this fast-moving outbreak by lowering its transmission rate.[2 3] As in any crisis, people with disability/impairment must be regarded as a vulnerable population. About 15 out of every 100 people in the world experience some form of disability and between 2 and 4 people out of every 100 have really severe disabilities.4Inattention to certain needs and specific limitations of these people impede effective planning and in time actions.

According to WHO, globally about 39 million people are blind and rely more on their sense of touch as a substitute for impaired vision.[5] As one of the major routes of the virus transmission is believed to be via contact, this group is at a higher potential risk of getting the COVID-19. Although it is better to minimize the unnecessary public presence of these individuals, while requiring assistance, they may be left unassisted in fear of virus transmission by touching them. Providing usable and valid informative materials (Braille, audio, and electronic formats) regarding the disease and infection control should be a priority for related organizations.

In people with disabling hearing loss (5% of the world population),[6] lip reading as one of the most common ways of communication, can’t be used while wearing a mask. Providing deaf-specific training and valid informative materials is crucial.

Proper handwashing is considered to be one of the best ways to control the infection.[7] However, unilateral upper limb amputees have significant problems for effective hand washing. Limb prostheses can turn into Trojan horse for the virus. The amputee should be instructed to safely cover their prosthetic limb from direct contact with the environment, as it may not be possible to disinfect the prosthetic limbs effectively and easily.

People with physical disorders including cerebral palsy and spinal cord injury [8, 9] may not able to follow general safety precautions independently.

People with mental retardation also need special assistance during this period. About 200 million people have an intellectual disability.[10] Free and uncontrolled public presence of these individuals in some countries[11, 12] can impede breaking the transmission chain.

Awareness and accurate information are vital parts of the prevention process. But in the process of notification, vulnerable groups like the elderly need to be considered. Unfortunately, for persons 80+, the probability of dying if infected by virus has been reported to be 14.8%.[13] In many news sections, COVID-19 elderly mortality statistics are highlighted which may cause undue anxiety for the elderly.

In total, people with disabilities despite their susceptibility, are often invisible in vulnerability and must be considered during COVID-19-related decision- and policy-making processes. Ensuring that people with disability and their families have access to information and facilities according to their needs is of great importance.

Disclosure statement
The authors report no conflicts of interest.

References
1. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020
2. Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet. 2020
3. Liu S, Yang L, Zhang C, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020
4. Organization WH. World report on disability 2011. Geneva: World Health Organization. 2011.
5. Gupta N, Kocur I. Chronic eye disease and the who universal eye health global action plan 2014-2019. Can J Ophthalmol. 2014;49(5):403-04.
6. www.who.int [Internet]. Geneva: World Health Organization; [cited 2020 March 08]. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss.
7. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020
8. Müller R, Brinkhof M, Arnet U, et al. Prevalence and associated factors of pain in the Swiss spinal cord injury population. Spinal Cord. 2017;55(4):346-54.
9. Ostojic K, Paget S, Kyriagis M, et al. Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management. Arch Phys Med Rehabil. 2020;101(2):213-19.
10. LIT: Labour interest test for people with intellectual disabilities. Conference on Creativity in Intelligent Technologies and Data Science; 2017. Springer.
11. Kiling IY, Due C, Gyss C, et al. Intervention research addressing environmental risk threatening young children with disabilities in developing countries: a systematic review. Disabil Rehabil. 2019;41(17):1987-2005.
12. Liman B, Abubakar H. Street Begging Reduction through Educating and Counseling Physical Challenged Persons in Sokoto State, Nigeria. Int J Res Engr Soc Sci 2016;6(12):35-40.
13. www.worldometers.info [Internet]. Shanghai: Dadax company; [cited 2020 March 11]. Available from: https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics.

Competing interests: No competing interests

12 March 2020
Saeed Shahabi
Research associate
Maryam Jalali, Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Kamran Bagheri Lankarani, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran Mohammad Kamali, Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Parviz Mojgani, Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences
Health Policy Research Center, Medical Faculty, Shiraz, Iran