When Disability Equates to Disposability

On January 7th, an interviewer for ABC’s “Good Morning America” spoke to CDC director Rochelle Walensky about the effectiveness of COVID-19 vaccines in preventing severe illness. In one particularly damning remark, Walensky said: “The overwhelming number of deaths, over 75 percent, occurred in people who had at least four comorbidities. So really these are people who are unwell to begin with. And yes: really encouraging news in the context of Omicron.”

A clip of Walensky’s comments soon went viral, as outraged netizens castigated the director for implying that the deaths of disabled people are acceptable.

After a few days of frantic damage-control (read: tweets) on the part of CDC officials, ABC released the full version of the interview—revealing that Walensky had actually been referring to a recent study of vaccinated people, rather than talking about COVID deaths as a whole.

Yet even in its full context, Walensky’s description of the deaths of those with four or more comorbidities as “encouraging”—because they were “unwell to begin with”—only highlights the acute failure of the pandemic response to care for those with disabilities.

As of 2018, 61 million Americans live with a disability. That is shockingly one in every four Americans. Disabled people are more likely to have co-occurring conditions such as diabetes, obesity, heart disease, lung disease, and kidney disease. To put it simply: those with one disability are more likely to have multiple disabilities or illnesses—yes, those same comorbidities that Walensky referenced. 

The fact that anyone finds it encouraging that disabled, chronically ill, and immunocompromised people are disproportionately dying from COVID should ring warning bells. The lives of disabled people are not disposable, and it is highly alarming that medical treatment institutions still see them as such. Since the beginning of the pandemic, disabled people in the United States have been forced to constantly live on edge, largely fending for themselves amidst an ineffective public health response that has continually disregarded their physical and mental well-being. 

A cumulation of various factors places disabled people in a disproportionately dangerous situation because of COVID. Disabled people generally have a higher risk of serious illness and death upon contracting COVID. They are also disproportionately unhoused or living in congregate settings, each of which creates high-risk conditions for COVID infections. Furthermore, disabled people face immense challenges in accessing vital information, food, supplies, transportation, and health care services. With the reduction—and at some points, total shutdown—of vital services, disabled people have been left without human contact, food, and medicine.

Throughout this pandemic, and far before, we have witnessed vast inequities in access to health care—including vital services and medical equipment. In the early days of COVID-19 in the United States, overcrowding in hospitals and a pressing scarcity of resources pushed many hospitals to ration health care.

COVID can seriously impair the lungs, making it impossible for those infected to breathe adequately on their own. Ventilators are used to supply oxygen to people who are unable to breathe—often meaning the difference between life and death for those faced with the most severe respiratory effects of COVID. But an acute lack of ventilators pushed states overwhelmed by COVID infections to create triage (rationing prioritization) guidelines—many of which contained provisions raising red flags for disability activists. 

A 2020 investigation by the Center for Public Integrity revealed that in the early months of the pandemic, at least 25 states had triage guidelines that relegated disabled and elderly people to the back of the line for ventilators and other life-saving equipment and care. Some states’ triage guidelines even provided that hospitals could take away ventilators from people who depended upon them in everyday life. 

In March 2020, ER physician Dr. James Keany was quoted in a Los Angeles Times article as saying: “As it stands in the U.S., if your family member is adamant that you would want everything done and you’re 90 years old, wearing a diaper, severely demented, you would get put on a ventilator. Most countries consider that malpractice because what are you saving that person for?”

Dr. Keany’s words highlight the lack of regard that many medical practitioners hold toward disabled people as a product of ingrained biases. When a physician such as Dr. Keany has to decide if providing health care treatment is “medically futile,” their ingrained biases can interfere with evidence-based factors. Ethical guidelines for triage leave far too much room for a physician’s implicit judgments of whether a patient’s life would be “worth living” were they to survive treatment. All too often, and even unknowingly, many medical practitioners harbor misperceptions about disabled people’s capacities and quality of life—which directly impact their decisions to provide life-saving care.

Now, public support for COVID restrictions is plummeting. People are frustrated with the inconveniences caused by the pandemic, and pessimistic about defeating the virus. California is adopting the nation’s first “endemic” virus policy. There’s a growing consensus among politicians and pundits alike that we need to learn to “live with COVID.”

“This is exactly what people are going to be asking in the next few weeks: Are we in a new phase? How do we live with this disease without living in fear?” said California Gov. Newsom in a recent press conference.

For disabled and immunocompromised people, who will be forced to choose between risking their lives in interacting with others sans COVID restrictions and continuing to sequester themselves at home, there is no living with COVID without fear.

Attitudes of “living with COVID” come with the implication that we will all contract COVID eventually—that we should let the pandemic run its course. Often, these conversations come with nary a consideration of the most vulnerable members of society. But with the continued lessening of COVID restrictions, it will be disabled, chronically ill, and elderly people who die first, who suffer the direst health consequences, who are left with the worst of the virus’s lingering effects. Protective mask and vaccine policies, along with vital accommodations like flexible working conditions, are disappearing, and so is disabled people’s already-tenuous trust in public health institutions.

Disabled people deserve to live in a society where their voices are heard and their needs are met, to be treated with respect by public health institutions and other individuals, to not fear imminent illness and death when they leave their homes. The pandemic has revealed gaping fissures in America’s health institutions predating COVID. Disabled and chronically ill people have ceaselessly experienced barriers to health care due to providers’ skepticism and stereotypes about disability and lack of accessible medical facilities and equipment.

COVID was not the first public health crisis America has experienced, nor will it be the last. And COVID was not the first failure of the American public health system, but it can be the last. As individuals, we must make responsible choices; as citizens, we must advocate for structural changes to public health policy that will protect disabled people in our community.