Need to be vaccinated on priority basis, says study
Persons with intellectual disabilities such as Down Syndrome and autism are at a higher risk of dying due to Covid-19 than the general population and should be vaccinated on priority basis, researchers have said calling it as “a profound realisation” that was not “fully appreciated until now”.
They reached this conclusion after examining records of 64 million patients from 547 healthcare organisations between January 2019 and November 2020 to understand the impact of the Covid-19 pandemic on patients with intellectual disabilities.
The results were heartbreaking, Dr Jonathan Gleason and Dr Mary Jo Danella Chief Quality Officer for Jefferson Health System said as they shared that those with intellectual disabilities were 2.5 times more likely to contract Covid-19, were about 2.7 times more likely to be admitted to the hospital and 5.9 times more likely to die from the infection than the general population.
The first of its kind study is published in the New England Journal of Medicine (NEJM) Catalyst which has put intellectual disability, second to older age category as a risk factor for dying from the deadly virus.
The study holds importance in the India’s context too where a Public Interest Litigation (PIL) has been filed by an advocate and mental health activist Guarva Kumar Bansal in the Delhi High Court seeking direction to the Government to include severe mental illness in the list of specified co-morbidities for Covid-19 vaccination.
Presently, the Modi Government is vaccinating people with old age above 60 years and 45 years with co-morbidities like diabetes on priority basis in its nationwide vaccination drive launched in January 16, 2021.
The authors of the international study attributed a variety of medical and institutional reasons for their vulnerability to the deadly infection.
“Patients with intellectual disabilities may have less ability to comply with strategies that reduce the risk of infection, such as masking and social distancing.” In addition, the researchers showed that these patients are more likely to have additional health conditions that contribute to a more severe course of Covid-19 disease.
“The chances of dying from the virus are higher for those with intellectual disability than they are for people with congestive heart failure, kidney disease or lung disease,” Dr Gleason said adding that “that is a profound realisation that we have not, as a healthcare community, fully appreciated until now.”
“Our failure to protect these deeply vulnerable individuals is heart-breaking,” said co-author Dr Wendy Ross, MD, a developmental and behavioral pediatrician and director for the Center for Autism and Neurodiversity at Jefferson Health. “I believe that if we can design a system that is safe and accessible for people with intellectual disabilities, it will benefit all of us.”
Dr Gleason further said, “We need to understand more about what is happening with these patients. I do believe these patients and their caregivers should be prioritised for vaccination and healthcare services. We should reflect on why we have failed this vulnerable population, and how we can better serve them during this health crisis, and into the future.
“Even prior to the pandemic, individuals with intellectual disabilities have had poor health outcomes. We need to do much better.”
The authors suggested key action steps that require a rapid response. “First, those with intellectual disabilities and their caregivers should be prioritised for vaccines by organisations that set federal guidelines...,” said Dr Gleason. “Second, federal and state healthcare regulatory offices should measure access, quality and safety in this population in order to track our ability to improve health outcomes for these patients."
Bansal in his petition said, “By way of the exclusion of the mental illness from the list of specified comorbidities, the Union Health Ministry has not only prohibited the patients from availing the benefits of the vaccine but has also created barriers in getting it. It is also important to keep in mind that homeless persons with severe mental illness have a higher risk of contracting Covid-19 infection due to their disability.”
According to Dr Smita Deshpande, Professor & Senior Consultant at Centre of Excellence in Mental Health, ABVIMS- Dr RML Hospital New Delhi, people with intellectual and developmental disabilities are often immunocompromised, leaving them vulnerable to complications if they get sick. “Also, they can have tough time with mask-wearing and social distancing, and their caregivers have to worry about their health as they would be less likely to get immediate healthcare when coronavirus cases are surging again.”