Saturday 28 March 2020

Potential risk factors for the impact of COVID-19 on health: People with learning disabilities


Potential risk factors for the impact of COVID-19 on health: People with learning disabilities


In this blogpost I want to set out some evidence related to people with learning disabilities and the potential impact of COVID-19 on people’s health. This is a separate issue from which factors might influence the likelihood of people with learning disabilities getting infected with COVID-19 – this blogpost is about the extent to which people with learning disabilities have co-occurring health issues that make the impact of COVID-19 potentially more serious.

The UK government has set out a list of groups which it considers to be at greater risk in terms of the potential impact of COVID-19 on people’s health, recommending that people in these group exercise social distancing and for some conditions self-isolation[1]. People with learning disabilities are included as a blanket group in this list as an example of a ‘chronic neurological condition’. There has also been more recent guidance[2] where “people defined on medical grounds as extremely vulnerable from COVID-19” have been advised to ‘shield’ themselves in self-isolation for 12 weeks – the list of medical conditions do not explicitly include people with learning disabilities as a blanket group.

How many people with learning disabilities are there in England?

People with learning disabilities as a whole are a big and very diverse group of people. The most recent estimate of the total number of people with learning disabilities in England, derived from 2015 figures and estimates[3], was almost 1.1 million people (1,087,100 people). Most people (930,400) were adults, with over three-quarters (77%) likely to be not known as such to health or social care services. In 2020 that overall number is likely to be bigger[4], although education and adult social care services have not kept pace with the increasing numbers and needs of some groups of people with learning disabilities[5].

In terms of people with learning disabilities recognised by services to the point of getting some form of meaningful support, in 2018 there were 67,765 children with an Education Health and Care Plan and a label suggestive of learning disabilities (Moderate Learning Difficulty – 28,241 children; Severe Learning Difficulty – 29,492 children; Profound Multiple Learning Difficulty – 10,032 children)[6].

In 2018/19 there were 133,575 adults with learning disabilities aged 18-64 and 17,045 adults with learning disabilities aged 65+ getting some form of long-term social care, a total of 150,620 adults. In 2018/19 a larger number of 297,174 people with learning disabilities of all ages were registered as a person with learning disabilities with their GP[7].

What are the potential risk factors for COVID-19 potentially having a greater impact on the health of people with learning disabilities?

There is still a lot of uncertainty about what might be linked to having a poorer reaction to COVID-19 if you catch it. It is also really important to say that we are talking about probabilities here for groups of people – it you are in a group at greater overall risk that does not at all guarantee that you will have a worse reaction to COVID-19 (and being in a low risk group does not guarantee that you will have a better reaction).

Based on the list of provided by the UK government in its social distancing guidance, what do we know about how common these risk factors are amongst people with learning disabilities?

Age – the general message seems to be that older people are more susceptible to COVID-19. Because of a range of factors, including how people with learning disabilities can be treated (or mistreated, or not treated) by health services[8], there are proportionally fewer people with learning disabilities in older age groups although (thankfully) the number of older people with learning disabilities has been increasing. For some groups of people with learning disabilities potential risk factors will be present either from birth or from an earlier age than the population generally, so younger people and those supporting them as well as older people should be getting the best support and healthcare.

There is also an emerging picture that more men than women are more likely to become more ill with COVID-19. A consistent international finding is that more men than women are identified with learning disabilities.

[Added 30/3/2020]. Finally, smoking appears to be associated with more serious consequences of COVID-19. Although good evidence on rates of smoking amongst people with learning disabilities is scarce, it appears that people with learning disabilities who are eligible for and using long-term social care support may be less likely to be smokers than the general population, whereas people with learning disabilities (including adolescents) who are less likely to be eligible for long-term social care support may be more likely to be smokers than the general population.

People with learning disabilities registered with GPs

From 2014/15, NHS Digital every year has been publishing information from around half of GP practices in England, comparing people with and without learning disabilities on what GPs record about people’s health and selected aspects of their treatment. Although geographical coverage is patchy, you can also get detailed information area by area[9]. Overall, it is important to say that this database is reporting that people with learning disabilities are 4 times more likely to die than people without learning disabilities of the same age and sex.

What does this database (and research, much of which is summarised by Public Health England here[10]) say about whether people with learning disabilities are more or less likely than other people to experience the risk factors associated with ‘vulnerability’ to COVID-19? Overall, the general pattern is that people with learning disabilities are more likely to experience a range of risk factors at younger ages than other people, but are less likely to be living long enough to experience risk factors or health conditions that are common amongst over-75s.

Respiratory conditions are obviously an important risk factor in relation to COVID-19. The GP database reports:
·         Asthma: overall 9.2% of people with learning disabilities vs 5.8% of other people, with asthma more common amongst people with learning disabilities in all age groups up to 64 years old.
·         Chronic Obstructive Pulmonary Disease (COPD): overall 1.2% of people with learning disabilities vs 1.8% of other people, but more common amongst people with learning disabilities in age groups 35-54 years.

It is absolutely crucial to note that respiratory diseases, particularly pneumonias including aspiration pneumonia, are possibly the leading cause of death for people with learning disabilities and are much more common amongst people with learning disabilities than amongst other people[11].

[Added 30/3/2020, after a prompt from Jane Bernal.] People with Down syndrome are more likely than people with learning disabilities generally to experience more serious consequences of respiratory infections.

One of the major risk factors for aspiration pneumonia is dysphagia (problems with swallowing), which is not on the government’s list of ‘vulnerabilities’ but is common amongst people with learning disabilities and increases with age. GP recording of dysphagia amongst people with learning disabilities is improving but still only stands at 5.8% of people, where research suggests a much higher rate of around 14%[12]. Related health issues that are not in the government list but are an issue for many people with learning disabilities are constipation (GPs report this for 13.1% of people with learning disabilities, but research suggests much higher rates of constipation, and unrecognised constipation can have fatal consequences) and Gastro-Oesophageal Reflux Disease (GPs report this for 9.8% of people with learning disabilities).

Another major set of risk factors concerns the heart and circulatory system. The GP database reports:
·         Heart failure: overall 1.0% of people with learning disabilities vs 1.0% of other people, but heart failure is more common in people with learning disabilities in all age groups up to age 74 years.
·         Coronary heart disease: overall 1.1% of people with learning disabilities vs 2.8% of other people, largely because CHD is far more common amongst older people.
·         Hypertension: overall 9.8% of people with learning disabilities vs 12.8% of other people, but hypertension is more common amongst people with learning disabilities aged 25-54 years.
·         Stroke or Transient Ischemic Attack: overall 1.6% of people with learning disabilities vs 1.6% of other people, but stroke or TIA is more common amongst people with learning disabilities of all ages up to age 74 years.

Again, circulatory diseases are a leading cause of death amongst people with learning disabilities[13].

A range of other ‘vulnerabilities’ including the following, as reported by the GP database:
·         Type 1 diabetes: overall 0.8% of people with learning disabilities vs 0.4% of other people, more common amongst people with learning disabilities up to the age of 74 years.
·         Non-Type 1 diabetes: overall 7.0% of people with learning disabilities vs 4.8% of other people, more common amongst people with learning disabilities at all ages.
·         Cancer: overall 1.6% of people with learning disabilities vs 2.8% of other people, but more common amongst people with learning disabilities at all ages up to age 44 years.
·         Chronic Kidney Disease: overall 2.9% of people with learning disabilities vs 3.0% of other people, but CKD is more common amongst people with learning disabilities from age 25 to 74 years.
·         Being seriously overweight: in the government guidelines a Body Mass Index of 40+ is stated as a ‘vulnerability’ factor. The GP database only reports on people with a BMI of 30+ - this reports 37.5% of people with learning disabilities with a BMI of 30+ vs 30.1% of other people, with these BMIs more common amongst people with learning disabilities at all ages up to 54 years.

Although definitions vary, it is clear that ‘multimorbidity’ (experiencing more than one long-term health condition) is much more common amongst people with learning disabilities, beginning at much earlier ages than the general population.

People with profound and multiple learning disabilities in England

Although there is much less evidence than there should be, it is clear that people with profound and multiple learning disabilities are much more likely to experience the risk factors for susceptibility to COVID-19 than other groups of people with learning disabilities. In England, this is estimated to be 10,969 children in schools[14] and 18,925 adults[15].

The kind of information I’ve described above from GPs is not available specifically for people with profound and multiple learning disabilities, and even international research evidence on the health of this group of people is lacking. A review of the international research evidence[16] could not always produce overall estimates of health conditions because the research evidence was too diverse, but it reports the following for people with profound and multiple learning disabilities:
·         21% of people with profound and multiple learning disabilities experience respiratory disease.
·         30% of people with profound and multiple learning disabilities experience dysphagia.
·         Much higher rates of cardiovascular health problems and hypertension.

Issues that are particularly important for people with profound and multiple learning disabilities, such as tube feeding and much higher rates of epilepsy[17] (which is much more common in people with learning disabilities generally compared to other people, with GPs reporting 17.3% of people with learning disabilities experiencing epilepsy compared to 0.6% of other people), are not listed as ‘vulnerability’ factors but are likely to be really important for this group of people.

COVID-19 and people with learning disabilities – redressing an injustice or making it worse?

The evidence is clear that people with learning disabilities are more likely to experience a range of health conditions associated with a greater likelihood of a more severe reaction to COVID-19 infection. Even when overall rates of a particular health condition are similar between people with and without learning disabilities, people with learning disabilities are more likely to be experiencing these conditions are earlier ages. There are also particular groups of people with learning disabilities at particularly high risk of having a poor reaction to COVID-19.

Extensive research also shows that people with learning disabilities, as a group, experience systematic inequities when it comes to health – both in experiencing the social and economic conditions likely to result in poorer health, and in the (non-)response of health services to people’s health needs[18]. Now, when it really matters, there is an opportunity to begin to redress this injustice. Is everything possible being done to support people, families and support services such that the risk of COVID-19 infection is as low as possible? And if people do contract COVID-19 is everything being done to ensure that people and families are properly informed and supported to make decisions, starting with the assumption that health services will do everything they can to treat people? I among many, many others are concerned that scarcity of health services (itself the consequence of political choices) is potentially being used, in the cloak of clinical prioritisation, as a rationale for further discrimination against ‘vulnerable’ groups, including people with learning disabilities. Time to step up and show we’re better than that.







15 comments:


  1. I was having Herpes Simplex Virus then i came across a review of people saying that they got treated from Herpes Simplex Virus by Dr Voke., So i gave a try by contacting him through his email and explain my problem to him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken by any deadly diseases like HERPES HIV, shingles,low sperm count or bringing back your ex lover, this great man is extremely the best in which I have seen and applauds and if you also need a help, you can also email him via email [doctorvoke@gmail.com]

    ReplyDelete
    Replies
    1. Joy and happiness is all i see around ever since i came in contact with this great man. i complained bitterly to him about me having herpes only for him to tell me it’s a minor stuff. He told me he has cured thousands of people but i did not believe until he sent me the herbal medicine and i took it as instructed by this great man, only to go to the hospital after two weeks for another test and i was confirmed negative. For the first time in four years i was getting that result. i want to use this medium to thank this great man. His name is Dr aziegbe, i came in contact with his email through a friend in UK and ever since then my live has been full with laughter and great peace of mind. i urge you all with herpes or HSV to contact him if you willing to give him a chance. you can contact him through this email DRAZIEGBE1SPELLHOME@GMAIL .COM or you can also WhatsApp him +2349035465208
      He also cured my friend with HIV and ever since then i strongly believe he can do all things. Don't be deceived thinking he does not work, i believe if you can get in contact with this man all your troubles will be over. i have done my part in spreading the good news. Contact him through his email and you will be the next to testify of his great work.

      Delete
    2. I’m recommending Dr Godday to everyone who have herpes virus to get the cure from him. I was diagnose of genital herpes in 2015 and i have been searching and asking questions to see if i could get something to cure the disease because i did not believe what the doctors say that no cure is found yet. I came across a comment on Youtube and the person testify how she was cured from herpes and hpv after using Dr Godday herbal medicine. I quickly contact Dr email and explain my problem to him and he prepare the herbs and send it to me through courier and gave me instructions on how to use it and tell me to go for checkup after usage which i did after two weeks of taken the herbal medicine and my result was NEGATIVE. I waited another month and retested the result was still NEGATIVE and my doctor told me that am completely free from herpes. Am so happy and grateful to Dr Godday for what he has done for me and i will continue to share this for people out there to know that there is cure for herpes. You can contact Dr Godday on email and WhatsApp to get the cure from him. Email:goddayspiritualhome@gmail.com Or Call/What’s-app +1{919}4956404

      Delete

  2. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  3. DON'T BELIEVE THERE IS A CURE FOR HERPES? Well here is my testimony about a doctor who helped me when I was infected with HERPES on September 22, 2014, I went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution so that my body can be okay. One day I was online and i saw the testimony of Mrs Amy Kendral speaking on how a man called Dr Razor helped her Eradicate the Herpes Simplex Infection that was eating her up every day, I Immediately emailed the Herbal Doctor Razor with the Details provided by This Woman on how to reach Him and I explained everything to him. Dr Razor told me all the things I needed to do and also gave me instructions to take a wish I followed properly. Before I knew what was happening after 18 days of taking the medication I started having changes in my body, so i told the herbalist of the development in my health and he asked me to go for a medical check up, the Doctors There were Amazed that Herpes have a Permanent and complete cure. Visit Doctor Razor's Website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome . You can Reach him on his Email via drrazorherbalhome@gmail.com . WhatsApp/Call him on +2349065420442. I made sure the Virus wasn't laying dormant in my nerve cells because I have heard of a situation like that. Before deciding to write this testimony so that many who are Battling with different kinds of Challenges Can also get cured.

    ReplyDelete
  4. God bless Dr Uromi for his marvelous work in my life, I have been suffering from herpes virus since 2015 and I was taking my medications, and I wasn't really satisfied i needed to get this disease out of my system, I searched about some possible cure for herpes and hsv infections online when i saw some wonderful comments about Dr Uromi, how he cured hsv infections with his herbal medicine, I was relieve a little so I contacted him through the emaiL i got from the testifier, and i told him my problem and asked for solutions, he told he can help cure me completely if only i can trust him to work for me and i said yes i can and immediately he started the remedy for my health, and after which he sent me the medicine through UPS SPEED POST. I took the herbal remedy as directed by him and 14 days later i was cured from my herpes infection, thank you so much sir, so my dear viewers online if you have or know anyone out there suffering from Hsv, Herpes, Cold Sore, Fibroids, Anemia, Hiv etc i urged you to recommend them to Dr Uromi and i assure you he will be of great help. you can reach Dr Uromi on Email:: Druromiherbalhome@gmail.com . You can also add him on WhatsApp +2349021374574    .   

    ReplyDelete
  5. I want to share my happiness to the world on how i was cured from (HERPES VIRUS) by Dr Oseremen herbal , i visited different hospital but they gave me list of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat the symptoms, but i did not have that kind of money to buy the drugs.the one i used before did not cured me. on one faithful day, a friend of my in united kingdom told me about Dr Oseremen herbal, he told me that,it is the herbal treatment that cure is husband from hepatitis B and she told me that he have cure so many people from herpes virus with is herb medicine,then she told me to contact him that he we cure me with is herb . when i contacted Dr Oseremen, he gave me hope and say that i we be cure once i get his herbal, he send the Herbal medicine to me and i take it for two weeks and it seriously worked for me, i went to the hospital to check, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that there is no cure for herpes that is Not true, just contact him and get cure from Dr Oseremen healing herbs, he also have the herb to cure any kind of hepatitis B,C A. AND DIFFERENT KIND OF SICKNESS Remember delay in treatment leads to death.. contact Dr Oseremen on is email at (Dr.Oseremenvadi@gmail.com) or whatsapp him on is Number :+2349056394313 and he we cure you with is HEALING HERB MEDICINE , thanks to Dr  Oseremen for cure me is healing herbs medicine

    ReplyDelete
  6. Thanks for posting this info. I just want to let you know that I just check out your site and I find it very interesting and informative.

    norton.com/setup
    mcafee.com/activate
    office.com/setup mcafee.com/activate mcafee.com/activate

    ReplyDelete
  7. It’s obvious some patients with herpes are being enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2015 until I was introduced by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr Asaka Herbal Medicine. This is a year and 2 weeks since I was delivered from genital Herpes. All thanks to God for using this Great herbalist to heal me. I have promised to keep telling good things about Dr Asaka. Please feel free to share Your problems with him and don’t forget to tell him I did refer you to Him. Thanks. Write him on mail drasakanaturalremedies@gmail.com He deals with Alzheimer virus, Cancer, HIV, Herpes, Genital, warts, ALS, BV, UTI, Virginal infection, Genital, Wart, HPV, Hepatitis A/B, Good luck, HSV, Pregnancy, Ex back.  here is his website: https://drasakanaturalremediesherbalcure.wordpress.com/  

    ReplyDelete
  8. My health was horrible before I decided to try the Protocol Of taking Dr Ebhota herbal mixture. I felt there was no hope for my health and I was doubtful to try the Protocol thinking it wouldn’t work because I have visited so many hospital but same result. However, I was convinced by my friend to try the herbal medicine because I wanted to get rid of HPV/WART. The herbal mixture that was given to me was really quick and easy to take, and since I have be taking it for less than 3 days I have less outbreak. But within one week i was fully cured from WART/HPV. The herbal medicine really work and I will like to share this great herb doctor contact with you all email him drebhotasolution@gmail.com or whatsapp +2348089535482. Pls try and help yourself out of warts completely today. he also c My health was horrible before I decided to try the Protocol Of taking Dr Ebhota herbal mixture. I felt there was no hope for my health and I was doubtful to try the Protocol thinking it wouldn’t work because I have visited so many hospital but same result. However, I was convinced by my friend to try the herbal medicine because I wanted to get rid of HPV/WART. The herbal mixture that was given to me was really quick and easy to take, and since I have be taking it for less than 3 days I have less outbreak. But within one week i was fully cured from WART/HPV. The herbal medicine really work and I will like to share this great herb doctor contact with you all email him drebhotasolution@gmail.com o r whatsapp +2348089535482. Pls try and help yourself out of warts completely today. he ure DIABETIES ULCAL CANCER etc.
    He also told me that he has solution for the flowing.
    1 Cancer cure
    2 Diabetes cure
    3 Ringing ear
    4 Herpes cure
    5 Warts cure
    6 HPV cure
    7 Get your ex back
    8 Pregnancy herbal medicine
    9 Prostate enlargement
    10 Hepatitis B
    11 Disability
    12 Kidney problem Etc.

    ReplyDelete
  9. My health was horrible before I decided to try the Protocol Of taking Dr Ebhota herbal mixture. I felt there was no hope for my health and I was doubtful to try the Protocol thinking it wouldn’t work because I have visited so many hospital but same result. However, I was convinced by my friend to try the herbal medicine because I wanted to get rid of HPV/WART. The herbal mixture that was given to me was really quick and easy to take, and since I have be taking it for less than 3 days I have less outbreak. But within one week i was fully cured from WART/HPV. The herbal medicine really work and I will like to share this great herb doctor contact with you all email him drebhotasolution@gmail.com or whatsapp +2348089535482. Pls try and help yourself out of warts completely today. he also c My health was horrible before I decided to try the Protocol Of taking Dr Ebhota herbal mixture. I felt there was no hope for my health and I was doubtful to try the Protocol thinking it wouldn’t work because I have visited so many hospital but same result. However, I was convinced by my friend to try the herbal medicine because I wanted to get rid of HPV/WART. The herbal mixture that was given to me was really quick and easy to take, and since I have be taking it for less than 3 days I have less outbreak. But within one week i was fully cured from WART/HPV. The herbal medicine really work and I will like to share this great herb doctor contact with you all email him drebhotasolution@gmail.com o r whatsapp +2348089535482. Pls try and help yourself out of warts completely today. he ure DIABETIES ULCAL CANCER etc.
    He also told me that he has solution for the flowing.
    1 Cancer cure
    2 Diabetes cure
    3 Ringing ear
    4 Herpes cure
    5 Warts cure
    6 HPV cure
    7 Get your ex back
    8 Pregnancy herbal medicine
    9 Prostate enlargement
    10 Hepatitis B
    11 Disability
    12 Kidney problem Etc.

    ReplyDelete
  10. since late 2015 and i was on my doctor prescription ever since, I satisfied i needed to get the virus out of my system,i was going through a blog to find new informations about the Herpes Simplex Virus i came across a review of a lady who was cured by drosasherbalhome@gmailcom I contacted the herbal foundation and they guided mwasn’t e on how to purchase the herbal formula. the herbal products las me for 3 weeks which helps me to get rid of the virus totally, for easy communication you can reach Dr Freeman Osas on his WhatSapp via 
    +2349035428122  

    ReplyDelete
  11. Using herbal natural remedy was what got me tested negative to HSV 2 after been diagnosed for years.I have spend so much funds on medications like acyclovir (Zovirax), Famciclovir (Famvir), and Valacyclovir (Valtrex). But it was all a waste of time and my symptoms got worst.  To me It is very bad what Big pharma are doing, why keep making humans suffer greatly just to get profits annually for medications that doesn't work. I'm glad that herbal remedies is gaining so much awareness and many people are getting off medications and activating their entire body system with natural herbal remedies and they are become holistically healed totally. Quickly contact Dr Akhere herbal home now on his contact field on his website: http://drakhereherbalhome.wixsite.com/website  or email him directly on drakhereherbalhome017@gmail.com

    ReplyDelete
  12. I was in severe ribs and stomach pain at about this time last year. And I went to the hospital for treatment and was diagnosed for CHRONIC HEPATITIS B I was told it has no cure and i was so devastated because all hope seems to be lost, some drugs was given me to slowdown the viral load, and it got worse after sometime. I came across Dr. Iyabiye’s recommendation online while studying about the disease, and then I reach out to him just to try but I was taken by surprise. I got completely cured, all the pains were gone and I went back to the hospital for another test and I was tested negative to the disease. Here is the doctor’s contact if interested: iyabiyehealinghome@gmail.com (+234-815-857-7300)

    ReplyDelete

Note: only a member of this blog may post a comment.