People with intellectual disabilities and developmental disorders are three times more likely to die if they have Covid-19, the illness caused by the coronavirus, compared with others with the diagnosis, according to a large analysis of insurance claims data. The finding raises complex questions about how to allocate new vaccines as they become available in limited supplies. The drug maker Pfizer announced this week that its experimental vaccine is performing well in clinical trials.
So far, guidelines for distributing vaccines have recommended prioritizing emergency workers, health care providers and other essential workers, as well as people at heightened risk for severe disease, including some older adults and those with certain chronic illnesses. The guidelines, which are still evolving, have not specifically emphasized the importance of prioritizing the vaccination of children and adults with intellectual disabilities like Down syndrome and developmental disorders. They emphasize more generally the need to protect people with underlying health problems and those living in congregate settings.
The new analysis was performed by FAIR Health, a nonprofit that claims to host the nation’s largest private health insurance claims database, in collaboration with Dr. Marty Makary, a public health expert and professor of health policy and management at the Johns Hopkins University School of Medicine, and the West Health Institute.
The analysis was evaluated only by an academic reviewer and has not been published in a scientific journal. FAIR Health set out to identify who is at greatest risk for dying of Covid-19 by reviewing health claims from nearly half a million Americans of all ages filed from April 1 through Aug. 31, said Robin Gelburd, president of the organization.
“What we find particularly new is the identification of developmental disorders and intellectual disabilities really surfacing to the top in terms of linkages between these categories of comorbidities and the risk of death,” Ms. Gelburd said.
People with intellectual disabilities and related conditions include those with Down syndrome and other chromosomal anomalies and congenital conditions like microcephaly. Developmental disorders include those of speech and language, as well as central auditory processing disorders, some of which may be caused by an underlying condition like cerebral palsy. Neither category included autism, the authors noted.
“There is no question,” said Arthur Caplan, director of medical ethics at the New York University Grossman School of Medicine. “These people are high risk and must be given priority for vaccination.”
Individuals with Down syndrome are more likely to have congenital heart defects; they may have less muscle tone around the neck and a larger tongue, increasing the risk of choking frequently and developing lung infections.
“Historically, it’s been a challenge for this population to receive good medical care,” Dr. Landes, an associate professor of sociology at Syracuse University, explained. Because of their disabilities, they may have difficulty wearing a mask or maintaining social distance, or even understanding why the precautions are needed, he said.
“If you’ve got someone whose cognitive ability is severely reduced, just understanding what’s going on and why they have to wear a mask would be very confusing,” he said.
Vaccination will play a broader role beyond preventing infections. It will be critical to resuming education and the full array of treatments and other services for those with intellectual disabilities and developmental disorders, whose lives have been disrupted by the pandemic.
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Source: Roni Caryn Rabin of The New York Times