People with disabilities who are at high risk for COVID-19 — and their caregivers — are now eligible for vaccination in Washington state.
But how disabilities and risk are defined is not simple, and it will largely be left to individuals, their doctors and caregivers to assess who newly qualifies.
"In the world of disability, there's not a super clear-cut definition. It really, oftentimes, is a personal thing," said Robin Tatsuda, executive director of The Arc of King County, which serves all people with intellectual and developmental disabilities. "It's hard to generalize."
State guidance says those with Down syndrome, developmental and intellectual disabilities, deafness and blindness could be eligible. It also opens access to people with disabilities who have underlying medical conditions the Centers for Disease Control and Prevention says could lead to severe outcomes, such as cancer, heart conditions or kidney disease.
The state Department of Health is leaning toward inclusiveness in how it defines this group of people newly eligible for vaccines, particularly as research develops on COVID-19 risks, spokesperson Kristen Maki wrote in an email.
"People with disabilities wondering about their eligibility should apply the definition to their situation: Does their disability put them at increased risk for COVID-19?" Maki wrote. They are urged to consult a health care provider to assess eligibility.
People need not receive government-sponsored services to qualify, Tatsuda said.
The open-ended eligibility language is designed to reflect a complex array of views on disability, identity and health, said Tatsuda, who welcomed the department's new approach.
"The original prioritization really focused more on health conditions and didn't really think about it through the lens of disability, which left some people out," Tatsuda said. "The newest guidelines explicitly call out people with intellectual and developmental disabilities."
Risk factors for COVID-19 could include health complications that result from a disability or having a more difficult time with measures that protect against the disease.
For example, someone with autism could be at greater risk to contract COVID-19 because they are sensitive to wearing a mask or have difficulty with guidelines that recommend 6-foot distancing. The level of risk depends on the individual.
"Autism is not, in itself, in the category of co-occurring health conditions, but it is a risk factor for contracting COVID," Tatsuda said.
The increased risk of COVID-19 to some people with disabilities has become more apparent with time and more nuanced research.
"It wasn't always showing up in our epidemiological data, We don't collect disability status," said Michele Roberts, the DOH acting assistant secretary in charge of the vaccine rollout.
Roberts cited developing research about Down syndrome and COVID-19.
A February paper published in a peer-reviewed journal, The Lancet's EClinicalMedicine, suggests adults with Down syndrome could be roughly three times more likely to die from COVID-19 than the general population.
Roberts said the risk of death for people with Down syndrome is comparable to people 65 and over.
Caregivers of those with disabilities are also now eligible for the vaccine. The health department, in a Wednesday news release, said anyone who "supports the daily, functional and health needs of someone who is at high risk of COVID-19 illness due to advanced age, long term physical condition, co-morbidities, or developmental or intellectual disability is considered a health care worker and is therefore eligible."
That qualification applies to caregivers of adults or children whether or not they are paid, licensed or in a formal caring arrangement, the department said.
Tatsuda said those with disabilities could face barriers to vaccination beyond the technology, transportation and language difficulties experienced by many seeking doses of vaccine.
"Anything that's written is often a barrier for folks with intellectual and developmental disabilities. Some people are readers, but not everyone," Tatsuda said.
Access to interpretation services at vaccine sites could be important for those who are deaf or blind, Tatsuda said. Those with autism or sensory needs might be more comfortable in certain physical environments.
Her organization is working with the city of Seattle and Public Health — Seattle & King County to chip away at such barriers.
"We're working with them on potentially hosting pop-up clinics that are geared toward the community and have those accommodations automatically built in," Tatsuda said. "We're hoping to get something on the schedule in early April."