A recent news story focused attention on the plight of the elderly during the COVID-19 crisis. A young woman named Rebecca Mehra heard someone calling her from a car in a grocery store parking lot. When she approached, an elderly couple told Rebecca that they were afraid to enter the store. Because they were in their eighties, they were very anxious about exposure to the novel coronavirus. Rebecca won much praise for doing the couple’s shopping for them.
The elderly are not the only people with special needs during a public health emergency. Additional vulnerable groups include individuals with disabilities, prisoners, people with language barriers, the impoverished, and others. Years ago, I spent a sabbatical semester at the Centers for Disease Control and Prevention’s (CDC) Public Health Law Program. We worried a lot about vulnerable populations in public health emergencies, and I wrote a long article on the topic. It is critical to plan for the needs of all vulnerable populations while preparing emergency response strategies.
The Needs of Vulnerable Populations
Disregarding vulnerable populations can have catastrophic consequences. During Hurricane Katrina, at least 1,800 people died, and many were physically or financially unable to evacuate. Disabled individuals who survived faced significant challenges as well. For example, Gulf Coast shelters usually lacked sign language interpreters. Officials made verbal announcements that the hearing impaired could not understand. Furthermore, temporary housing was largely inaccessible to those with mobility impairments.
We must not forget these lessons. In the current public health emergency, the vulnerable will likewise face significant hurdles. For example:
- Those without health insurance may not be able to visit a doctor and have testing ordered.
- Frail and disabled individuals may not be able to self-quarantine because they require the care of others.
- People in homeless shelters and prisons cannot practice social distancing.
- Some people will not be able to see written instructions, and others will not be able to hear verbal instructions.
- Millions of people may not be able to understand or follow directions because of cognitive impairments.
- The same is true for people with language barriers.
- In light of shopping frenzies and dwindling supplies, those with mobility impairments may be unable to purchase necessities.
Vulnerable populations enjoy certain protections under the law. The constitutional Equal Protection Clause mandates that no state shall “deny to any person … the equal protection of the laws.” The Eighth Amendment governs the treatment of incarcerated individuals. It prohibits the infliction of “cruel and unusual punishment,” which may well include exposure to COVID-19. The federal Americans with Disabilities Act prohibits disability-based discrimination and requires accommodations for those with disabilities. Many states have similar protections under their own constitutions and laws.
Laws that are specific to emergency preparedness also address vulnerable populations. Congress passed the Pandemic and All-Hazards Preparedness Act in response to the Hurricane Katrina disaster. It includes a provision entitled “At-risk individuals.” The law makes addressing the “public health and medical needs of at-risk individuals” a national goal. The Robert T. Stafford Disaster Relief and Emergency Assistance Act includes an anti-discrimination mandate. The provision prohibits discrimination based on race, color, religion, nationality, sex, age, disability, English proficiency, or economic status.” The Post-Katrina Emergency Management Reform Act created the position of Disability Coordinator in the Federal Emergency Management Agency (FEMA). Her job is to assist in disaster planning for people with disabilities.
But none of these laws provide specific instructions as to how to assist vulnerable individuals in a pandemic. So, what should our government authorities and emergency responders do to translate the law into action?
I offer just a few suggestions as a starting point to address the needs of disadvantaged groups. My primary message is that government authorities must focus on them and respond to their special circumstances.
First, officials should consult with representatives of various vulnerable populations. Representatives can be leaders of advocacy organizations, such as the AARP and the American Association of People with Disabilities. These individuals are in the best position to assess and articulate their communities’ needs.
Second, the authorities must keep in mind that not everyone can access information in standard formats. They should disseminate public guidance in a variety of languages and forms (e.g. hardcopy, electronic, videos). These should include media that are accessible to individuals with physical and mental disabilities.
Third, provisions must be made for those who are not self-sufficient. Already, some food delivery companies are developing no-contact delivery options. Such options should be available for medications and other necessities.
Fourth, operators of institutions in which vulnerable people live in close quarters must proactively develop response plans. The following are a few examples:
- The CDC has issued “Interim Guidance for Homeless Shelters.” The guidance addresses, communication, supplies, staffing, sleeping arrangements, and more.
- The CDC has issued guidance for nursing homes as well. It urges facilities to restrict visitation, volunteers, group activities, and communal meals. Sadly, doing so could have adverse effects on the mood and mental health of residents.
- Many prisons and jails have suspended visits by family and friends and offer videoconferencing instead. They have increased cleaning and may allow hand sanitizer use (it is generally banned because of its alcohol content). Some urge that prisons release inmates early if doing so will not pose a risk to the public.
Vulnerable populations have special needs during public health emergencies, and the COVID-19 pandemic is no different. The law has recognized this reality and, in principle, offers various protections. But what happens on the ground in the chaos of an emergency often is not consistent with aspirational goals. To avoid past pitfalls, public health officials must engage in thoughtful and responsible emergency planning and implementation. One of society’s priorities should be to serve disadvantaged populations as best we can.
Sharona Hoffman is the Edgar A. Hahn Professor of Law and Professor of Bioethics, Co-Director of Law-Medicine Center, Case Western Reserve University School of Law; B.A., Wellesley College; J.D., Harvard Law School; LL.M. in Health Law, University of Houston; S.J.D. in Health Law, Case Western Reserve University. Professor Hoffman spent a sabbatical semester at the Centers for Disease Control and Prevention’s Public Health Law Program in 2007, working on emergency response issues. She has written several articles on the topic.