Effect of the COVID-19 Pandemic on College Students With Disabilities

In this issue of AJPH, Kendall et al. (p. 1774) contribute an analytic essay examining the difficulties people with disabilities continue to face during the coronavirus disease 2019 (COVID-19) pandemic. Framed by literature on the effect of disasters and pandemics on people with disabilities, the authors explore the ethics of rationing health care, physical and emotional consequences of COVID-19 infection, technological advances, and the incorporation of the needs of people with disabilities into future pandemic planning. They conclude by highlighting the challenging paradox that people with disabilities face—on the one hand, associated restrictions have a tremendous, negative effect on quality of life, and on the other hand, these same restrictions may be lifesaving. They assert that although people with disabilities may now be even more isolated than they were before the pandemic, it is imperative that we acknowledge and resolve the disparities that COVID-19 has exacerbated for the disability community to create new and lasting opportunities for employment, connection, and inclusiveness.

Although not specifically addressed in Kendall et al.’s essay, one area that has garnered much attention because of its widespread impact is the disruption that COVID-19 has had on education—particularly, educational opportunities for students with disabilities. At the time of this writing, public and private schools, as well as college campuses across the United States, are facing substantial challenges in balancing the push to reopen with increasing infection rates. There seems to be little consensus on how to mitigate spread, who should return to campus, how classes will be delivered, and whether gatherings should be permitted. Even though the rapid transition to virtual education has increased accessibility, it also has created myriad new challenges for college students with disabilities, who represent 19.4% of all undergraduate students in the United States (although this estimate is likely low because of underreporting).¹ When considering returning to campus, some students with disabilities must take into account any conditions associated with a higher likelihood of adverse outcomes from COVID-19. Thus, even within disabled students as a group, the risks, limitations, and factors influencing decision-making are distributed differently and unevenly.

EFFECT ON HIGHER EDUCATION

The Association on Higher Education and Disability released a report detailing the perspectives of higher education professionals on the effect of COVID-19 for students with disabilities.² The Association on Higher Education and Disability report found that students are experiencing a wide range of challenges in the rapid transition to online learning, with almost all of these challenges being more prevalent for students with disabilities.² Difficulties include accessing equipment, Wi-Fi, technological support, examinations, and libraries; using online learning platforms; and communicating with instructors and peers. The survey also found that the transition to virtual education has created challenges in accessing and receiving accommodations (which students with disabilities have a right to receive under the Americans With Disabilities Act and Section 504 of the Rehabilitation Act—if the institution receives federal funding).

Although toolkits for designing and delivering accessible online courses are available (e.g., http://www.exploreaccess.org), in sudden transition to online learning, attention often is not given to designing online learning experiences that are truly accessible to students with a wide range of disabilities. Virtual education may be the only option, but it also may be an inequitable option for some students with disabilities. For example, migraines can be triggered by excessive screen use, forcing students into a situation in which they must choose between participating in education and limiting their exposure to stimuli that could trigger a migraine.

Achieving educational equity for students with disabilities has long been a goal, but the pandemic has highlighted how advances toward equity are often lost during crises. Recognizing the risk of infringement on the rights of students, including students with disabilities, the US Department of Education released a fact sheet titled, “Addressing the Risk of COVID-19 in Schools While Protecting the Civil Rights of Students.” The guidance pertaining to postsecondary institutions was limited to recommendations that these institutions consult with public health officials and comply with federal nondiscrimination laws.³ In essence, very little concrete guidance on protecting the rights of college students with disabilities was provided, which is unfortunate given the current lack of consensus on how to adhere to public health recommendations and nondiscrimination laws.

EFFECT ON AND ACCESS TO HEALTH CARE

Another issue of pressing importance is the effect that COVID-19 has had on accessing health services. Many students rely on campus-based health services that were abruptly closed or transitioned to virtual services. Although most college students need health services only periodically, students with disabilities tend to require more frequent engagement with a variety of health services to address their ongoing needs, some of which cannot be replaced through virtual encounters. Therefore, the disruption of services has a greater effect on their lives. For example, people with disabilities who use adaptive equipment such as wheelchairs require a provider encounter for equipment to be prescribed, but a virtual visit might not allow for the adequate assessment of their needs. The disruption of services is likely particularly detrimental for students with disabilities who do not have a reliable source of care in their communities.

Of additional concern is the reduced access to mental health services, especially during a time of great stress caused by the pandemic and the pandemic response. Psychiatric disorders are one of the top three disabilities reported by college students with disabilities⁴; however, the true prevalence may be higher given that one third of first-year college students screen positive for a major psychiatric disorder.⁵ Among college students broadly, 60% report that it is now more difficult to access mental health care.⁶ Some psychiatric disorders can be more easily managed via telehealth therapy, whereas others may require in-person visits such as in the case of therapeutic dose monitoring through regular blood tests. Given this widespread impact, students with disabilities—who report higher rates of mental health problems than do students without disabilities⁷—likely are experiencing both increased need for mental health support and decreased access to such support. Finally, barriers to accessing telehealth remain, including issues with privacy (e.g., for students with disabilities who live at home or with roommates), poverty, and difficulty using standard telehealth services because of visual, hearing, and fine motor impairments.

CONCLUSIONS

A common theme throughout discussions of inequity and the COVID-19 pandemic is how the pandemic has magnified existing disparities. The experiences of students with disabilities are no exception. The rapid transition to online instruction has meant many additional transitions for students with disabilities, from ensuring that they have access to equipment needed to participate (standard or adaptive) to implementing new, remote methods of receiving accommodations, mental and physical health care, and any other needed services and supports (e.g., tutoring). As we continue to navigate the pandemic and grapple with meeting the needs of people with disabilities, the words of caution from Kendall et al. regarding the hardening of attitudes toward minority groups should give us pause. It is not enough to point out the inequities; it is essential to emphasize why they must be addressed, even in times of crisis. Whether it is the service needs of children with disabilities as codified in their individualized education programs or the adaptations needed by college students with disabilities, optimizing their ability to learn should not be pushed aside. It is imperative that future pandemic planning in higher education is responsive to the needs of students with disabilities and that clear guidance on protecting their rights, access, and equitable educational experiences is available.