COVID-19 and Its Impact on At-Risk Individuals
Covid-19 and Its Impact on At-risk Individuals: Embracing A Disability Inclusive Response
It is no breaking news anymore that the world has been ravaged by a deadly virus termed Covid-19. What may seem novel or what gives more concerns is the way forward for every country and its citizens. While seeking solutions, it is important to ask- who is at risk?
The majority of answers being “everyone”. Who is at more risks and more vulnerable to the new conditions of life brought in by the pandemic? The answer will certainly not be “everyone” rather ‘Persons with Disabilities (PWDs)’.
Prior to and subsequent to the emergence of the Global disability movement in the late 20th Century, there have remained agitations and policies with a purpose of addressing the diverse barriers that PWDs encounter in everyday life; full participation and equalisation of opportunities for, by and with Persons with Disabilities (PWDs).
Smith (2011) recorded from a survey that Nigeria had approximately 14 million People living with disabilities. These figures have been questioned suggesting that Nigeria has no unified and actual estimate of people living with disabilities. However, the World Health Organisation (WHO) recently estimates that there are 25 million persons with disabilities in Nigeria, with 3 million persons with significant barriers to social and physical functioning.
The WHO goes further to predict that these figures will increase as time progresses making concerns about this special group an imperative discourse at national and international parlance. McKenzie & Ohajunwa (2017) have carried out some studies which reports that Disability is associated with old age, poverty, illness and other social factors.
Across the world, people with disabilities have poorer health outcomes, lower education achievements, less economic participation and higher rates of poverty than people without disabilities. These difficulties are exacerbated in less advantaged communities like the rural communities in Nigeria. It is disheartening that these difficulties are experienced in the urban areas of Nigeria – this calls for quick actions by governments, companies, organisations and individuals.
With the setting in of the unprecedented pandemic (COVID-19), disability activist, International organisations and governments become concerned on how the needs of PWDs can be met. However, in a country like Nigeria where Disability is yet to be understood by a large part of her population, what are the possible responses towards PWDs? Are there rescue channels for them or should they be neglected in the face of COVID-19?
This paper shall answer these questions while still x-raying the extent to which PWDs have been affected by the ravaging pandemic.
Understanding Disability and Covid-19
Disability is a term that has no generally acceptable definition. Different definitions abound as different scholars research into the term through distinct disability questions. The term Disability connotes more than the normal physical impairment that many people especially those that are not well knowledgeable in Disability Studies have understood it to be.
Disability goes beyond physical impairment to the understanding of sensory, functional, and activity limitations (Brucker, Houtenville, & Lauer, 2015). Erickson et Al (2018) through their survey, find it more convenient to explain the term disability by outlining and discussing different categories of disability which are: Hearing disability, visual disability, cognitive disability, Ambulatory Disability, Self-care and Independent living disability. Some scholars define disability as a social response, however, defining “disability” solely in terms of social responses like stigmatization and exclusion does not distinguish disability from race or sex (Bickenbach, 1993).
The World Health Organisation (WHO), the Americans with Disability Act (ADA) and the United Nations (UN) Standard Rules on the Equalization of Opportunities for People with Disabilities give definitions of disability that contains two major characteristics that are generally accepted about disability. These features about disability are: (i) a physical or mental characteristic labeled or perceived as an impairment or dysfunction and (ii) some personal or social limitation associated with that impairment.
Thus, disability is a phenomenon covering impairments, activity limitations, and participation restrictions. In all, it will be safe to say that these definitions revolve around the two major contrasting models (Medical and Social models) of disability amongst other models. The medical model understands disability as a physical or mental impairment of the individual and its personal and social consequences.
It regards the limitations faced by people with disabilities as resulting primarily, or solely, from their impairments. In contrast, the social model understands disability as a relation between an individual and her social environment: the exclusion of people with certain physical and mental characteristics from major domains of social life.
Their exclusion is manifested not only in deliberate segregation, but in a built environment and social activity that preclude or restrict the participation of people seen or labelled as having disabilities. While accepting the standard definitions of disability, this paper will adopt a liberal approach without tilting to just one model of disability.
The Coronavirus Pandemic
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). In more simple terms, Covid-19 is an infectious disease caused by a coronavirus (a type of virus) that usually affects the respiratory tract of the lungs.
The disease may lead to a severe or less severe illness. The virus can be spread through contact with certain bodily fluids, such as droplets in a cough of infected persons. It can also be caused by touching something an infected person has touched and then touching one’s mouth, nose, or eyes.
The critical nature of the virus makes it life threatening and has caused an unprecedented lockdown for so many economies around the globe, Nigeria included. The effects of the pandemic have been felt by all persons irrespective of class, race, gender or Creed.
Persons with disabilities are not out of the box which Covid-19 has placed all persons around the globe rather it is evident that in the light of the threatening pandemic, persons with disabilities are at a higher risks and ways through which these risks can be reduced becomes a top priority for stakeholders and concerned authorities. Covid-19 has caused everyone in different countries to be disabled in some way, yet these disabilities can be managed compared to the disabilities faced by those whose disabilities is not due to the pandemic but only worsened by the pandemic.
Thus, to what extent has PWDs been affected by the ravaging pandemic and what are the right responses towards the situation? These questions are what the succeeding subheadings answers.
The Impact of Covid-19 On PWDs
People with disabilities are at risk in times of global pandemics. Emerging research on COVID-19 shows that the coronavirus pandemic has increased psychological distress both in the general population and among high-risk groups. Behaviours such as physical distancing, as well as their social and economic impacts, are worsening mental health consequences (American Psychological Association, 2020).
More so, research on the psychological impact of mass trauma (e.g. natural disasters, flu outbreaks) suggests that the pandemic might particularly harm the mental health of marginalized populations who have less access to socioeconomic resources and supportive social networks (e.g. Goldmann & Galea, 2014).
There are unique stressors and challenges that could worsen mental health of people with disabilities during the COVID-19 crisis. Research on past pandemics shows that disabled people find it harder to access critical medical supplies which can become even more challenging as resources become scarce (Campbell, Gilyard, Sinclair, Sternberg, & Kailes, 2009).
Some people with disabilities report higher levels of social isolation than their non-disabled counterparts (O’Sullivan & Bourgin, 2010). They may experience intensified feelings of loneliness in response to physical distancing measures; social isolation and loneliness have been associated with increases in heart disease, dementia and other health problems according to the National Academies of Science, Engineering, and Medicine (2020).
Furthermore, policies around rationing of medical care can intensify discriminatory attitudes towards disabled individuals during times of crisis (Priestley & Hemingway, 2006). This can understandably worsen one’s anxiety about getting sick and the need to seek medical care. While adequate research on the specific impact of COVID-19 on the disability community is not yet available, several studies are underway or in planning phase.
Data is needed on rates of infections, hospitalizations, outcomes and deaths disaggregated by disability, age, race and income, among other factors, so one can verily understand the impact of COVID-19 on multiple vulnerable groups – PWDs.
Who is at Risk?
It is important not to conflate health status with disability. Many people with disabilities are healthy. However, some have underlying or secondary aspects of their disability, like suppressed immune systems or respiratory concerns, that COVID-19 could worsen.
Some have underlying acute health conditions, such as skin breakdown or urinary tract infection, which increase risk of severe symptoms associated with COVID-19. Being classified as “high risk” in the current pandemic can cause additional stress and fears (American Psychological Association, 2020).
The social gradient of risk may influence policies and decision-making related to access to care or treatments. Medical discrimination is always a dangerous reality for many people with disabilities in need of healthcare. Many disabled adults (60% report being “very concerned” in a recent survey – National Disability Institute, 2020 ) and disability rights organizations are anxious about how these policies may prevent them from getting equitable and fair treatment.
Thus, it is necessary that PWDs ensure that they and their families or care providers are aware of the former’s rights. They should also know the risks they are prone to and take appropriate precautions where they have an underlying condition.
The Rights of PWDs in the face of the Pandemic
The UN Convention on Rights of Persons with Disabilities (CRPD), the (1999) Constitution of the Federal Republic of Nigeria, as amended (CFRN), the Discrimination against Persons With Disabilities (Prohibition) Act, 2018 and other extant laws are development, human rights and cross-sectorial policy instruments that enshrines provisions on the rights of PWDS and ensures the protection of these vulnerable sect.
By virtue of section 2(2) of the Discrimination Against Persons with Disabilities (Prohibition) Act 2018, the Federal Ministry of Information of Nigeria is tasked with a great responsibility to organise awareness programmes to further reinforce the rights, respects and dignity of persons with Disabilities as well as their Capabilities, contributions and achievements to the society.
The Act protects the rights of persons with disabilities but how well these rights are enforced becomes the problem. Also, a transitory period of five years from the period the Act came into force has been stipulated as a period of compliance for all outfits to be restructured, policies of private and public institutions amended and major services like health care and transportation services adjusted to accommodate Persons with disabilities.
The transitory period is 3 years to an expiration, yet actions in compliance with this act is on a very slow pace which makes the situation more pathetic during this Covid- 19 pandemic. Thus, there is a call for immediate attention of all concerned persons, corporate bodies, authorities and organisations to take pragmatic steps towards realising the tenets of these laws so as to ensure a fair deal for PWDs.
As earlier stated, the coronavirus pandemic has threatened the livelihood and health of persons across the globe and this threat seems worse for persons with disabilities who are at a high risks of poor living and even death.
The fear is deepened as PWDs may experience discrimination in terms of health, employment, food and more.
However, the world cannot continue to talk of development in any ramification without persons with disabilities. Thus, it is high time that we begin seeing things as normal and not abnormal with persons with disabilities. It is time that the rights of PWDs be strongly protected and promoted.
In all, there is hope that in this time of pandemic, people can learn lessons in resilience, adaptability and mutual support from the disabled community. While having a disability probably doesn’t by itself put someone at higher risk from Coronavirus, many persons with disabilities do have specific underlying conditions that make the disease more dangerous for them.
Thus, our recommendations for all stakeholders, authorities, corporate bodies and persons are enumerated below.
The following recommendations are hereby proffered:
- Provision of accurate, accessible, and timely information about the disease and additional handwashing guidelines for Persons with disabilities.
- Strategic activation of adequate security checks for PWDs (particularly Women and Children) living in segregated and often overcrowded residential settings.
- Rapid awareness raising and training of personnel involved in the response are essential.
- Addressing the specific needs of persons with disabilities (particularly women and children) through awareness programmes, special prevention plans; to maintain their health, safety, dignity, and independence in the community throughout the COVID-19 outbreak.
- Administration of home services to PWDs/paid leave
- Decongestion or Discontinuance of specialised institutions housing PWDs.
- Adapting safe confinement measures for persons with psychological disabilities
- Inclusion of individual representatives of PWDs in decision making (prevention, mitigation and monitoring plans) during this pandemic.
- Designing and production of accessible disinfection machines to combat the virus.
- Creation and management of reliable financial systems for increased revenue to manage current and future pandemics.
- Enabling dedicated shopping hours for the vulnerable, and a huge upswing in the use of virtual conferencing technology.
- Activation of “Compliance check” to ensure inclusive rather than discriminatory employment for PWDs.
- Rapid implementation of already existing laws enshrining the rights of PWDs.
Altman, B., (2001), “Disability Definitions, Models, Classification Schemes, and Applications,” in Handbook of Disability Studies, G. L. Albredht, K.D. Seelman, and M. Bury, Thousand Oaks, CA: Sage Publications, pp. 97–122
Americans with Disabilities Act, (1990), https://www.ada.gov/pubs/ada.html [Accessed online, 18th May, 2020]
American Psychological Association (2020). [Accessed online on May 15th, 2020]
Anastasiou, D., (2013), “The Social Model of Disability: Dichotomy between Impairment and Disability,” Journal of Medicine and Philosophy, 38(4): 441–459
BridgingtheGapEntry, (2020) https://bridgingthegap-project.eu/the-impact-of-covid-19-on-people-with-disabilities/
Brooks, J. M., Iwanaga, K., Chan, F., Lee, B., Chen, X., Wu, J.-R., Walker, R., & Fortuna, K. L. (2020). Psychometric validation of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists. Psychiatric Rehabilitation Journal. Advance online publication.
Brucker, D. L., Mitra, S., Chaitoo, N., & Mauro, J. (2015). “More likely to be poor whatever the measure: Working-age persons with disabilities in the United States”. Social Science Quarterly, 96(1), 273–296.
Campbell, V. A., Gilyard, J. A., Sinclair, L., Sternberg, T., & Kailes, J. I. (2009). Preparing for and responding to pandemic influenza: Implications for people with disabilities. American Journal of Public Health, 99, S294-S300.
Charlton, J., (1998), Nothing About Us Without Us: Disability, Oppression and Empowerment, Berkeley: University of California Press, 1998.
Discrimination against Persons with Disability (Prohibition) Act, LFN, 2018
Erickson, W. (2012). A guide to disability statistics from the American community survey (2008 forward). Ithaca, NY: Cornell University.
Erickson, W., Lee, C., & von Schrader, S. (2016). 2014 disability status report: United States. Ithaca, NY: Cornell University Yang Tan Institute on Employment and Disability (YTI).
Galea, S., Merchant, R. M., Lurie N. (2020). The mental health consequences of COVID-19 and physical distancing: The need for prevention and early intervention. JAMA Intern Med.
Goldmann, E., & Galea, S. (2014). Mental health consequences of disasters, Annual Review of Public Health, 35, 169-183.
IDA, (2020)”Toward a Disability- Inclusive COVID- 19 Response: 10 Recommendations from the International Disability Alliance.
InternationalClassificationofFunctioning,DisabilityandHealth(ICF),(2001)Geneva:WorldHealthOrganization.[Accessed online, 18th May, 2020]
International Disability Alliance Entry,(2020).http://www.internationaldisabilityalliance.org/content/covid-19-and-disability-movement.
Judith McKenzie et Chioma O.Ohajunwa(2017). “Understanding Disability in Nigeria: A Commentary on ‘country profile: Intellectual and Developmental Disability in Nigeria'”. Tizard Learning Disability Review, Vol. 22, Issue 2, pp. 94-98.
Lai, J., Ma, S., Wang, Y, et al. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open.
National Academies of Science, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. Washington, DC: National Academies Press.
OHCHR, (2020) “Covid-19 and the Rights of Persons with Disabilities”. [Accessed online on 20th May, 2020]
O’Sullivan, T., & Bourgoin, M. (2010). Vulnerability in an influenza pandemic: Looking beyond medical risk. White Paper funded by Public Health Agency of Canada.
Priestley, M., & Hemingway, L. (2007) Disability and disaster recovery, Journal of Social Work in Disability & Rehabilitation, 5:3-4, 23-42
Qi, F., Qian, S., Zhang, S., & Zhang, Z. (2020) Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochemical and Biophysical Research Communications.
Smith Natalie (2011). “The Face of Disability in Nigeria: A Disability survey in Kogi and Niger States. Disability, CBR and Inclusive Development, Vol 22, No.1, 2011
Wang W, Xu Y, Gao R, et al. (2020). Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. Published online March 11, 2020.
Wasserman, D., (2001), “Philosophical Issues in the Definition and Social Response to Disability,” Handbook of Disability Studies, G.L. Albrecht (ed.), Thousand Oaks, CA: Sage Publications, pp. 219–251.
Wasserman,David,Asch,Adrienne,Blustein,JeffreyandPutnam,Daniel.(2016) “Disability:Definitions,Models,Experience”,TheStanfordEncyclopediaofPhilosophy(Summer2016Edition),EdwardN.Zalta(ed.). [Accessed May 15th, 2020]
World Economic Forum (2020) https://www.weforum.org/agenda/2020/05/3-steps-to-boost-your-digital-safety-while-working-from-home/ [Accessed May 15th, 2020]
World Health Organization, (1980), International Classification of Impairment, Disability and Handicap (ICIDH), Geneva: World Health Organization.
World Health Organization, World Report on Disability, (2011), http://www.who.int/disabilities/world_report/2011/report.pdf?ua=1
Grace Bassey Udofia is a young and collaborative lawyer who is passionate about Persons with disabilities in Africa, particularly her home country Nigeria. She is a volunteer with the Association of Lawyers with Disabilities in Nigeria (ALDIN), which is supported by Disability Rights Fund (DRF). Grace has written this article with the intention that it adds to the library of literatures on Disability Studies and it is used as a tool of advocacy for Persons with Disabilities which is one of the works of ALDIN. Educationally, the author is a graduate of the University of Uyo and the Nigerian Law School (First Class). She hopes that her contributions reflected in this article will be published.
what a great article! it is very educative.