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03.11.20

Focus on Vulnerable Populations in the Public Health Response to COVID-19

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Cases of the new coronavirus that was first detected in China continue to increase in many parts of the world, including the United States. Commonly referred to in the press as simply coronavirus, which is a family of viruses that include SARS, MERS, and the common cold, the disease caused by the coronavirus has been named “coronavirus disease 2019” (abbreviated “COVID-19”). To effectively respond to COVID-19, it is important to focus on vulnerable populations.

According to data from Johns Hopkins University, there are more than 1100 confirmed cases of COVID-19 and at least 32 deaths in the United States. However, it is not possible to have an accurate count of how many people have COVID-19 because not enough people are being tested. Despite Vice President Mike Pence and Food and Drug Administration commissioner Stephen Hahn stating last week that at least 1 million test kits would be available by the end of the week, data indicate that far fewer tests have been conducted. As of the end of last week, fewer than 6000 people had been tested for COVID-19.

While the full ramifications of COVID-19 are still unknown, we know that traditional public health measures are effective. One of the best ways to prevent infection is to wash your hands to get rid of any pathogens you may have picked up. Other preventive behaviors include covering coughs and sneezes, avoiding touching your face, cleaning touched surfaces frequently, and staying home from work or school and consulting your doctor if you feel sick.

Beyond these individual behaviors, interventions such social distancing can help slow the spread of COVID-19. Social distancing is a way to keep people from interacting closely or frequently enough to spread an infectious disease. This can include closing schools, canceling large gatherings, and creating plans for remote education and working.

As public health interventions, along with health education and communication, are implemented, it is also important to safeguard the human and social rights of affected populations and center the needs of the most vulnerable. First and foremost, this means taking steps to protect older people and people with underlying health conditions, who are at higher risk of getting very sick from COVID-19. Not only is COVID-19 more fatal than the flu across all age groups, but older people are more likely to die from COVID-19 than younger people. According to figures from the Chinese Center for Disease Control and Prevention, among people aged 10 to 40 with COVID-19, about 4 out of every 1000 died. In contrast, 8 percent of people aged 70 to 79 with COVID-19 died, and about 15% of people over age 80 with COVID-19 died. For older people in long-term care facilities, like the Life Care Center of Kirkland, Washington where over 50 residents got COVID-19 and at least 13 residents have died to date, steps like curtailing all but essential visits, prohibiting visits from people experiencing flu symptoms, increased cleaning of surfaces, and implementing requirements for staff to monitor their own temperature to prevent infections to residents. The U.S. Centers for Disease Control and Prevention (CDC) also recommends that long-term care facilities have employees dedicated to caring for people with COVID-19 and assess the respiratory health of new facility residents. Even as long-term care facilities enforce limits on visits and implement other practices, combating social isolation is also important. More can be done to support older people as they avoid venturing out of their homes, including delivering groceries and introducing them to technology such as FaceTime, WhatsApp, or Skype to mitigate loneliness.

Just like more focus is needed on older people who are vulnerable to COVID-19, we also need to prioritize the needs of people with underlying health conditions, such as heart disease, lung disease, and diabetes, which are most associated with severe cases of COVID-19. A study of 150 patients with COVID-19 from Wuhan, China found that patients with cardiovascular diseases had a significantly increased risk of death. The U.S. CDC and the American Heart Association recommend that patients with cardiovascular diseases take extra precautions to protect themselves from COVID-19, such as getting vaccinated for the flu and bacterial pneumonia.

The unique needs of people living with HIV, those with disabilities, and other vulnerable populations with respect to COVID-19 must also be addressed. A recent presentation at the Conference on Retroviruses and Opportunistic Infections outlined recommendations for people living with HIV as the COVID-19 outbreak continues. The recommendations include ensuring an ample supply of medications (for example, a 30-day supply at all times), keeping vaccinations up to date, establishing a plan for clinical care if isolated or quarantined (for example, through telemedicine or physician online portals), and maintaining a social network including remote interaction if necessary. There are also unanswered questions for people living with HIV about whether HIV antiretroviral medication is protective against COVID-19 as well as concerns about safeguarding the supply chain of HIV antiretroviral medications in the context of COVID-19.

For people with disabilities, the COVID-19 outbreak presents challenges. In China, people with disabilities have been particularly hard-hit. An article in The New York Times noted that a “16-year-old with cerebral palsy in a village in Hubei Province, where Wuhan is the capital, starved to death days after his father was taken to a hospital.” Moreover, when the city was locked down, many neighborhoods were deprived of medical care, food supplies and social assistance that people with disabilities depend on. Another problem for people who are deaf or hard-of-hearing was that the Wuhan government made no announcements about the outbreak in sign language, so information about the outbreak’s seriousness did not reach them. Emergency preparedness and response plans for COVID-19 must be inclusive of and accessible to people with disabilities.

Yet another vulnerable population for COVID-19 are people in jails and prisons. As pointed out in an article published in Health Affairs, we need immediate baseline assessment of the degree of preparedness in prisons and jails in the event of an uncontrolled outbreak, guidelines tailored to prison health providers on prevention, diagnosis, and treatment of COVID-19, timely response to reported and observed symptoms, comprehensive criminal justice reform, improved continuity of health care during the transition of those released back to the community, and measures to protect the health of corrections staff.

By taking certain steps, governments can be effective at reducing the spread of COVID-19. To be successful, governments must meet the needs of vulnerable populations.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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