COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic

Abstract

During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa’s Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are ‘worth’ saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.

Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis

“…In residential care settings, shielding and self-isolation were difficult during the first wave of the pandemic. This was due to the: initial unpreparedness of the facilities at the pandemic outset, shared use of essential living spaces, crowding and shared rooms, proximity to other residents, residents’ difficulty understanding new rules imposed suddenly, difficulty in maintaining standards of hygiene during home visits, multiple shift staffing patterns, staff working in multiple settings, and high levels of personal care assistance required from staff (e.g., with eating, toileting, or transferring from bed to wheelchair) [ 16 , 30 , 31 , 36 , 38 , 39 , 43 , 51 , 53 , 54 , 59 , 70 , 78 ]. Indeed, stemming from the latter reason, many articles pointed out that a wide range of people with disabilities who rely on assistants for basic activities of daily living have greater risks of infection [ 6 , 32 , 36 , 41 , 49 ].…”

“…Globally, another analysis showed that pages of the World Health Organization’s website, March–May 2020, were only 60% compliant regarding web accessibility guidelines [ 75 ]. Additionally, people with sensory processing and visual impairments may need to rely or depend on touch and tactile senses for stimulus or to perform their routine activities or outdoor movement, and thereby face greater infection risks [ 33 , 38 , 40 , 43 , 49 ].…”

“…Focusing on environmental circumstances, in Latin America, millions populate densely packed ‘favelas’ in which large families often share a single room, and many consider moving a grandparent to a nursing home inconceivable; hence, older people and those with disabilities are quarantined within crowded living quarters, where they can be exposed to asymptomatic carriers [ 64 ]. Moreover, in LMICs, many people with disabilities lack access to clean water, live in crowded institutional settings, and have added difficulties complying with hand hygiene, physical distancing, and other protective measures [ 38 ].…”

“…In South Africa, accounts of utilitarian COVID-19 triage policies and practices have been found, disadvantaging many people with disabilities, especially people with physical and intellectual impairments, from gaining intensive care unit access, while not providing care on a utilitarian basis, e.g., factoring in the patient’s cognitive impairment is argued to be against the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) [ 38 , 51 ]. In the UK, there was a higher threshold for frail elders and those with so-called challenging behavior in long-term care to be admitted to hospitals, as well as their access to intensive care was restricted [ 78 ].…”

Age discrimination in critical care triage in South Africa: The law and the allocation of scarce health resources in the COVID-19 pandemic

“…What the COVID-19 pandemic has revealed all too starkly is the hidden political and social prejudices that endure within modern health systems, [48] in which selective care is dispensed mainly for profit at the expense of the socially vulnerable.…”