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REVIEW • Cad. Saúde Pública 37 (9) • 2021 • https://doi.org/10.1590/0102-311X00291720 linkcopy

Persons with disabilities during the COVID-19 pandemic: guaranteeing fundamental rights and equity in care

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Abstract

This is a scoping review of the PubMed, Scopus, BIREME, SciELO, and Web of Science databases, including publications from December 2019 to May 2020 with the objective of identifying and systematizing the literature on the status of persons with disabilities in the initial months of the COVID-19 pandemic. The review aimed to search for original peer-reviewed articles published in indexed journals, in addition to the specialized gray literature. We reviewed 386 texts and included 33 articles and documents in the study. The review’s results pointed to three thematic categories that reflect the main discussions on the theme in the literature: vulnerabilities of persons with disabilities during the pandemic; rights of persons with disabilities in this context; and protective measures and access to information on COVID-19 for persons with disabilities. In the context of the public health emergency, historically marginalized communities such as persons with disabilities run the risk of feeling more vulnerable, suffering deprivations, discrimination in screening plans for care, and prejudices and stigmas that influence decision-making in healthcare and exacerbate preexisting inequalities, making this group more susceptible to illness and lack of social protection. Although persons with disabilities have been acknowledged as a risk group for COVID-19, governments have been slow to develop plans to fight COVID-19 for this population. Few studies have attempted to understand the effects of the COVID-19 pandemic on persons with disabilities, especially in the sense of implementing measures in prevention, control, and protection that guarantee equity in care.

Keywords:
Disabled Persons; Coronavirus Infections; COVID-19

Study (year)	Country	Type	Objective	Main findings
Safta-Zecheria ¹⁷ (2020)	Romania	Editorial	Discuss the potential health risk for persons with disability in residential care institutions during the COVID-19 outbreak.	High risk of contagion requires public policies and government actions to guarantee measures for protection and care for persons with disabilities: financing, support for family/caregivers, and maintenance of care.
Pan-American Health Organization ¹⁵ (2020)	United States	Editorial	Identify additional measures for persons with disabilities to mitigate the impacts of COVID-19 on this population.	Specific government actions for protection such as maintenance of care, support for families, caregivers, and the community based on prevention and control of the infection.
Jalali et al. ²³ (2020)	Iran	Opinion article	Present the challenges that persons with disability face during the COVID emergency in Iran.	Interruption of specialized care, difficulties with subsistence, precarious access to health services and information, and strict isolation measures are challenges imposed on persons with disabilities.
Courtenay ¹⁸ (2020)	United Kingdom	Editorial	Present the challenges for persons with intellectual disability in the United Kingdom during the COVID-19 pandemic.	Maintenance of care requires adaptations and collaboration between service providers and the family to reduce the risk of infection and impacts from structural changes on services.
Bettger et al. ²⁴ (2020)	United States	Opinion article	Describe adjustments for continuity of rehabilitation services in the context of national responses to COVID-19.	Actions to guarantee workers’ safety, implementation of services for maintenance of care such as telerehabilitation, training of teams to orient patients and families in homecare, and measures for monitoring patients in recovery from COVID-19.
Vieira et al. ²² (2020)	Switzerland	Opinion article	Explore the impact of COVID-19 and preventive measures on the well-being of vulnerable populations.	Barriers to accessing health services require preventive measures that include information in simple and accessible format. The supply of mental health services via telehealth should be encouraged.
Pineda & Corbuan ²⁰ (2020)	United States	Opinion article	Debate the impacts of the current pandemic for persons with disabilities, based on the principles of urban equity and the social theory of disability.	Equitable cities can modify the state of vulnerability based on actions planned with participation by persons with disabilities that guarantee accessible information and communication, financial support, and maintenance of care.
Mukherjee ¹⁹ (2020)	United States	Opinion article	Reflect on markers of vulnerability in contexts of the pandemic related to disability, race, and ethnicity.	Refusal to provide treatment has been common, and prejudice can influence discrimination in screening plans and healthcare decisions. Judicialization has been frequent. Oversight and guarantee of rights for persons with disabilities are necessary.
Qi & Hu ²⁷ (2020)	United Kingdom	Current issues	Analyze the Law on Prevention and Treatment of Infectious Diseases (LPTID) during the COVID-19 pandemic.	The LPTID does not address the specific needs of persons with disabilities, creating difficulties and barriers to protective measures required by the COVID-19 pandemic. The disability perspective should be included in the development of laws, policies, and practices.
Shew ²¹ (2020)	United States	Opinion article	Present the contributions by persons with disabilities for confronting the COVID-19 pandemic.	Technologies, adaptation of spaces and worktime, and infrastructure solutions created by persons with disabilities have been used as the basis for adjustments to the functioning of various services during the COVID-19 pandemic.
Yarımkaya & Esentürk ²⁸ (2020)	Turkey	Essay	Describe the benefits of physical activity for children with autism spectrum(ASD) disorder and present strategies during the COVID-19 pandemic.	High-intensity exercise for at least 20 minutes or moderate-intensity exercise 30 minutes every day with ample space and participation by the family has positive effects on health and quality of life for children with ASD and their families in lockdown.
Armitage & Nellums ⁷ (2020)	United Kingdom	Editorial	Discuss the impact of COVID-19 on healthcare provision for persons with disabilities.	Improving the provision of healthcare for this group based on awareness-raising on the rights and needs of persons with disabilities, guaranteed continuity of care with safety for workers and families, access to employment and education. Persons with disabilities should be included in the elaboration of strategies and actions.
Schiariti ¹⁶ (2020)	Canada	Editorial	Present the challenges faced by persons with disability in the COVID-19 pandemic.	During the pandemic, an inclusive approach should be adopted, based on rights and guaranteed participation by persons with disabilities in designing and implementing emergency plans.
Negrini et al. ²⁵ (2020)	Italy	Observational, cross-sectional	Furnish preliminary data on the impact of COVID-19 on rehabilitation services during the initial stages of spread of the pandemic in Europe.	The interruption of admissions for rehabilitation, early discharge, and reduction of activities involved 194,800 hospitalized patients in 10 countries. Outpatient activities were suspended in 87%. Seven countries reported experiences in rehabilitation for acute COVID-19 patients.
Lakhani ²⁶ (2020)	Australia	Ecological study with spatial analysis	Identify areas with the highest concentration of elderly with disability and the barriers to accessing primary healthcare services in the city of Melbourne.	Of the 8,910 areas that were identified, 2,085 present a significantly high level of difficulty in accessing primary healthcare services and 807 present a significantly high percentage of elderly with disability. This method can be used to define regions for priority measures in public health emergencies such as COVID-19.

Study (year)	Country	Type	Objective	Main findings
Humanity & Inclusion ³⁷ (2020)	Switzerland	Opinion article	Identify appropriate measures to reduce the impact of COVID-19 on persons with disabilities.	Recommends the adoption of an approach based on the guarantee of rights of persons with disabilities, which includes participation in the development of responses to the impacts of COVID-19, the availability of information in an accessible format, and support for health services and telerehabilitation.
International Labour Organization et al. ³³ (2020)	International agency	Institutional document	Present elements that can help take full advantage of the response to COVID-19 by social protection systems to support persons with disability.	Access to information should be guaranteed, including persons with disabilities and families in financial recovery, assessing needs, and expanding support and support networks.
World Health Organization ² (2020)	International agency	Institutional document	Present individual government measures for health professionals and service providers on ways to deal with and reduce the impact of the COVID-19 pandemic on persons with disabilities.	Access should be guaranteed to information and health services, encouraging remote activities to avoid crowding, including telerehabilitation. Government measures should be inclusive for persons with disabilities and service providers, besides guaranteeing support to deal with complex needs.
International Labour Organization ³⁰ (2020)	International agency	Institutional document	Highlight actions for the promotion of equal opportunities and decent work for persons with disabilities during the COVID-19 pandemic.	Emphasizes the need for social justice, effective inclusion, equal opportunities, and decent work. The document suggests ensuring home office work, accessible and inclusive communication such as access to public information, with persons with disabilities sharing in the creation. An adequate social protection system should also be provided.
United Nations ³ (2020)	International agency	Interview with Catalina Devandas (United Nations expert)	Present accommodation measures for the reduction of risks of infection to deal with COVID-19.	Incentives for home office work or paid leave, additional financial aid, and adequate support for persons with disabilities and their families.
Ofner et al. ³⁸ (2020)	Canada	Opinion article	Describe preventive measures for individuals and health services during the COVID-19 pandemic.	Individual actions involve receiving help for essential tasks and avoiding leaving home, besides seeking ways to protect, listen, support, adapt, and accommodate. Services should guarantee care for needs and the presence of the accompanying person, considering individual characteristics in COVID-19 screening services, which should be accessible and receptive.
Office of the High Commission of the Human Rights, United Nations ³¹ (2020)	International agency	Institutional document	Reflect on difficulties encountered by persons with disabilities in the context of the COVID-19 pandemic, based on social determinants of health.	Discrimination, dependency, exclusion from schooling, lower income, and other factors are involved in the increased risk of infection for persons with disabilities. Social distancing should be adopted, but offering information in accessible formats, guaranteeing financial resources and quality healthcare.
Office of the High Commission of the Human Rights, United Nations ⁴⁰ (2020)	International agency	Editorial	Reflect on government involvement to deal with the COVID-19 pandemic and emphasize the application of principles of nondiscrimination.	Government is responsible for life-saving interventions. The principles of nondiscrimination, participation, empowerment, and responsibility need to be applied to all policies. States should adopt additional measures for social protection for its support to reach those at greatest risk of being disproportionately affected by the crisis.
Pan-African Network of Persons with Disability ³⁴ (2020)	International agency	Institutional document	Present measures for protection of persons with psychosocial disability by local and national governments during the COVID-19 pandemic.	Emphasizes the guarantee of access to information and services, as well as their continuity for harm reduction. Suggests avoiding measures of coercion/medication that compromise health. Community and psychosocial support should be established, with channels for support and care in cases of domestic violence. Inclusion of persons with disabilities in decisions.
United Nations Children’s Fund ³² (2020)	International agency	Institutional document	Present the impacts of the COVID-19 pandemic for persons with disabilities and measures to prevent and overcome them.	Difficulties in access to remote education, interruption of support services, discrimination in the supply of care, and barriers to access information increase the risks of morbidity and mortality from COVID-19. Accessibility and continuity should be guaranteed in education and health services and actions for prevention of domestic violence.
United Nations ²⁹ (2020)	International agency	Institutional document	Present the impact of COVID-19 on persons with disabilities with a view towards inter-sector collaboration and recommendations for dealing with the pandemic.	Preexisting inequalities, specific health needs and conditions, interruption of essential services, social distancing, and lack of access to information contribute to the increased vulnerability of persons with disabilities. Continuity should be guaranteed in access to health services, education, social security and protection, access to information, preventive measures, and representativeness in planning strategies.
United Nations ³⁶ (2020)	International agency	Opinion article	Present the impact of COVID-19 pandemic on persons with disabilities.	The pandemic is intensifying preexisting inequalities for persons with disabilities. Measures adopted by governments face numerous barriers, creating exclusion and increasing this population’s vulnerability. Persons with disabilities should be part of the process of developing measures in the pandemic that include their needs, based on the rights of persons with disabilities and investing in a more inclusive and accessible society.
Chilenean National Service for Persons with Disability ³⁵ (2020)	Chile	Institutional document	Furnish guidelines for communication and care for persons with disabilities during the COVID-19 pandemic.	Professionals should adhere to inclusive practice, guaranteeing the individual’s participation in the process of care, access to medicines, treatments, and essential equipment for life. Such practice should respect and prioritize the autonomy of persons with disabilities, whenever possible addressing questions and comments to the individual rather than to the accompanying person. Accessibility in the environment, information, and different forms of communication should be guaranteed.
Chilenean National Service on Disability ⁴³ (2020)	Chile	Protocol	Present guidelines and actions for residences of adults with disability during the COVID-19 pandemic.	Recommends the presence of a coordinating professional in the strategies for prevention, in collaboration with primary care, altering the functioning to guarantee the protective measures recommended by health organizations, maintaining residents informed about such measures and isolating a worker or resident in case of symptoms.
Brazilian National Secretariat for the Rights of Persons with Disability, Brazilian Ministry for Women, Family, and Human Rights ¹⁰ (2020)	Brazil	Booklet	Announce recommendations on COVID-19 for professionals that provide care to persons with disability and rare diseases.	Recommends investigating problems related to disability that are potential risk factors, working with prevention, maintenance of remote care or homecare, orienting accompanying persons and caregivers on protective measures, and prioritizing the guarantee of human rights based on scientific knowledge in all the actions.
Brazilian Office of the Public Prosecutor for Labor Affairs ⁴²	Brazil	Technical note	Present guidelines for protection in labor relations for workers with disability.	Work flexibilization measures should guarantee the right to perform work activities remotely, and when possible, dispense with obligations for guaranteed pay or workday flexibilization, covering the cost of private transportation, ensuring that such measures do not mean a cut in pay. Adopt measures for prevention and protection. Individuals should be placed on sick leave in case of a COVID-19 diagnosis.
U.S. Department of Health and Human Services ⁴¹ (2020)	United States	Bulletin	Orient service providers on actions guided by compliance with the civil rights of different segments of the population.	Emergency planning should meet the needs of persons with disabilities with diverse conditions, guaranteeing accessible information through all the available tools for effective communication, stocking items that can help persons maintain independence and respecting requests for treatment adjustments based on religion, as well as faith-based practices.
United Nations ³⁹ (2020)	International agency	News story	Inform on the emergency response plan for COVID-19 by the Australian Health Protection Principal Committee and the impact for persons with disabilities.	Vulnerability of persons with disabilities during the pandemic is the result of interaction between biological factors and attitudinal, environmental, and institutional barriers. The original emergency plan did not include the needs of persons with disabilities and disability support workers. This triggered a significant defense of the community, leading the Australian government to create an advisory group for PWDs to provide their input and develop a specific plan for the COVID-19 context. It is essential for countries to adopt a human rights approach to build equitable societies.

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