Researchers have found that individuals with learning disabilities are more likely to suffer from severe cases of COVID-19 infection, with higher rates of hospitalization and mortality, which is exacerbated for individuals with profound disabilities such as Down's syndrome and cerebral palsy.
SARS-CoV-2 Virus. Image Credit: Corona Borealis Studio/Shutterstock.com
Further evidence indicating symptom severity of COVID-19 increases with comorbidity
From the onset of the pandemic, researchers have attempted to identify individuals at high risk from the symptoms of COVID-19, and mounting evidence has suggested that individuals suffering from other medical conditions are particularly susceptible. However, it is difficult to disentangle the effects of COVID-19 from other conditions, making accurate predictions difficult.
This pattern has also been observed in people with a learning disability, as clinical results of patients have often been confounded by multiple factors such as deprivation, lack of standardization, and comorbidities.
To address this limitation, UK researchers have compared the risk of COVID-19 related hospital admissions and deaths among children and adults with learning disabilities in England with the general population.
Researchers used data from over 17 million people registered with a general practice in England linked to hospital admission and mortality data totaling 14,312,023 adults and 2,627,018 children. Data dated back from both infection waves: wave 1 (registered with a general practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The team then accounted for potentially confounding factors including age, sex, ethnicity, and geographical location.
From the data collected, adults with a learning disability had a 5-fold higher risk of COVID-19 related hospital admission and an 8-fold higher risk of COVID-19 related death than adults not on the register. This increase was even higher for individuals with severe to profound learning disabilities than those with a milder learning disability and was also higher among those in residential care.
For children, similar patterns were observed, but authors described that the absolute risks of COVID-19 hospital admission and death among children were limited, so comparative analyses did not reveal major differences.
The findings of this study are primarily observational, and researchers stress that the results demonstrate the need to establish more preventative measures and post-infection treatments for individuals in this group. Such a drastic increase in case of severity warrants prioritization as well as further examination.
Moreover, the findings also provide insights into another issue of concern, which is the quantity and quality of the data in learning disability registers. The study is published in the journal The BMJ.
Gaps in the census for learning disability registers with worrying implications
This study collected extensive data from learning disability registers, but the quality, spatiotemporal diversity, and disability range of the data in the register are very limited, which in turn limits the reach of treatment measures for a group at high risk.
For instance, the vaccination program is based upon this data, meaning many individuals may not receive adequate care. In response, the authors of the current study call for greater efforts to update and maintain accurate registers so that all eligible individuals can benefit.
Authors also recommend that further attention is needed to register people with mild learning disabilities, which are also at risk, as well as to establish more preventative measures to protect people with profound learning disabilities including people with Down's syndrome and cerebral palsy.
Ken Courtenay at the Royal College of Psychiatrists and Vivien Cooper at the Challenging Behaviour Foundation, points to "a hidden calamity" taking place among people with learning disabilities, and state "reasonable adjustments should be made to ensure that information about the pandemic and risk of infection are accessible, and that practical support is provided to protect people and manage risks."
In addition, they say that the value of the lives of people with learning disabilities are suffering from worrying attitudes and prejudices from the general population during the pandemic. For instance, prioritizing vaccinations for people according to age group rather than disabilities or disadvantaged individuals has put individuals at avoidable risk.
Before the next pandemic, investment in research is essential, to help us understand the risks faced by people with learning disabilities and how best to protect them from the high risks of hospital admission and death from COVID-19. People with learning disabilities have the same rights as everyone else, including the right to good health and to be safe from harm."
Importantly, this study contributes key evidence that the pandemic is affecting vulnerable groups significantly, and adds to the accumulating evidence that comorbidities are key factors exacerbating symptom severity.
- Williamson E J, McDonald H I, Bhaskaran K, Walker A J, Bacon S, Davy S et al. Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform BMJ 2021; 374 :n1592 doi:10.1136/bmj.n1592