Box 1.

Examples of groups of people who may be vulnerable to the COVID-19 pandemic, apart from people experiencing a disability, organized by type of vulnerability

Health- and age-related characteristics

People with comorbid, chronic, or secondary health conditions, including those with an effect on the respiratory, cardiovascular, or immune function. These persons can be more severely affected by the COVID-19 disease.

People at an older age or with frail health conditions, including people with a history of debilitating health conditions (eg, dementia) and people with history of substance abuse. These persons can also be more severely affected by the direct health consequences of the COVID-19 disease, or can be subject to relapses or aggravation of their health status or functional limitations by the lack of support or assistance that may arise from the pandemic or resultant lockdowns.

People facing social isolation and lack of social support from lockdown or other preventive measures, especially older populations who can be subject to tighter or longer physical proximity restrictions. These persons can be vulnerable to negative psychosocial effects of the COVID-19 pandemic, including in terms of mental health, disfranchisement, occupational injustice, and social isolation.

People with depression or other mental health conditions (or who are at risk of having mental health conditions) can have their mental health status aggravated by the health or socioeconomic effects of COVID-19. These include any suicidal ideation or behaviors arising from the unemployment, financial, and other stresses coming from the public health and economic crisis.

Children with sensory processing difficulties who have unusual responses to sensory input can have difficulty coping with activities of hand washing and wearing masks.

Access to health services and equipment

People who are uninsured, underinsured, or who have no universal access to health care, including care directly related to COVID-19. This includes capacity to get (timely) diagnostic tests for COVID-19 or for accessing adequate treatment, including access to ventilators.

People living in medically underserved or undersupplied areas (eg, rural or remote locations with limited access to diagnostic and treatment facilities, face masks, or other personal protective equipment).

People with no or reduced access to transportation facilities or personal assistance services as a means to satisfy health and functional needs or access to health care.

People whose need for timely access to assistive devices has been affected by disruptions in the supply chain or distribution of these products as a result of the COVID-19 pandemic and labor restrictions.

Living and housing conditions

People who are homeless, homebound, underhoused, and who thereby may struggle to ensure physical distancing and adequate hygiene measures.

People living in densely populated communities or households, who may struggle to ensure physical distancing, including during mandatory or self-imposed quarantine measures.

People institutionalized, including the hospitalized and those living in nursing homes or residential facilities, who are subject to infection spread within the institutional environment.

Prisoners or those who are incarcerated and in detainment or correctional facilities, where maintaining physical distancing and containing the spread of the disease can be complex or unattainable.

People without (reliable) access to clean water and soap for the recommended hygiene measures.

People living in locations whose living conditions or social order have been threatened by military conflict, natural disasters, or other humanitarian crises.

Income-related

Populations identified as pertaining to low- or middle-income countries, regions, or areas, who may struggle to financially access health care beyond any universally assured, afford a living with the loss of income associated to preventive measures (eg, periods of lockdown), or in which lockdown measures for containing the pandemic have not been taken, at the population level, for economic reasons.

People otherwise facing poverty or with no stable or sufficient income, economically exploited, underpaid, working in the informal economy, without access to a paid sick (or quarantine) leave, or the so-called working poor, who may have limited to no capacity to afford lockdowns and may have higher exposure to the socioeconomic shockwaves of the COVID-19 pandemic, without sizeable social protection.

Access to developmental-related services

Children and youths with special education needs may have important restrictions in the in-person participation in school and other (eg, therapeutic) activities, restricted by lockdown measures. Virtual schooling or therapy may be demanding, unpractical, or less effective for many (eg, requiring caregiving assistance, skills in communication and information technologies from the caregivers or the children, digital devices and internet access, performed without tactile or bodily sensation such as that provided by a hands-on therapeutic input at the backdrop of children with sensory processing issues).

Children and youths with developmental disabilities as well as their informal caregivers may have restricted access to health, social, or child protection services they may need to rely on, because of lockdowns or because these services and resources have been prioritized for addressing acute needs arising from the COVID-19 pandemic.

Children and youths with developmental disabilities may be exposed to increased adverse childhood experiences such as abuse and neglect, exacerbated by COVID-19 related stress and the effect on caregivers and family.

Children and youths with developmental disabilities may have restricted opportunities to develop social abilities, interpersonal relationships, and other key developments as a result of the restricted social and physical contact, or may have difficulty adjusting to a suddenly altered routine.

Working roles and conditions

People with frontline, essential jobs (eg, in health care, pharmacy, grocery stores, transports), which need to be carried out even during lockdown periods.

People otherwise not able to telework, either by the nature of their job, lack of skills in using information and communication technologies, or lack of reasonable accommodations.

People who are unemployed, underemployed, laid-off, pressured to anticipate retirement, or pressured to take over frontline essential jobs without enough preparation, may face economic or health risks, including mental health risks.

Minority or socially disadvantaged populations

Refugees or asylum seekers as well as migrants, including those who are undocumented, may face cultural or language barriers to understand or comply with public health measures, poor living or preventive isolation conditions, poor to no access to health care, and poor economic resources, among other drivers of vulnerability and social disadvantage, likely exacerbated during a pandemic scenario.

People from minorities or socially disadvantaged races (eg, African Americans), ethnicities, minority religions within an area, or indigenous populations, who may lower working and livelihood conditions, lower access to health care, and cultural differences not accounted for in public health measures designed with the majorities or better-off in mind.

People who are victims of interpersonal or domestic violence, coercion, or sex-based prejudice may face health care access restrictions, may be unwillingly exposed to physical contact, or may be vulnerable to violence during lockdown periods.