Disability and Contingency Care

COVID-19, Disability, and the International Classification of Functioning, Disability and Health: A Scoping Review of Early-Stage Pandemic Response

Introduction

This study aimed to systematically identify the environmental factors that impacted people with disability during the COVID-19 pandemic.

Methods

A scoping literature review was conducted using LitCOVID (January 1-July 31, 2020). Sixty-six articles met the inclusion criteria that (1) discussed disability and/or health conditions related to functioning and (2) considered environmental factors. A qualitative content analysis was conducted using codes from the WHO International Classification of Functioning, Disability and Health.

Results

A total of 212 International Classification of Functioning, Disability and Health codes were used in the coding process. The most frequent codes referred to health services policies and public health guidelines. These policies, although generally considered facilitators for minimizing infection, were frequently identified as barriers to the health, participation, and human rights of people with disability. The lack of disability-specific population data was identified as a key barrier to planning and decision making.

Conclusions

The social determinants of health for people with disability were not adequately considered in the acute phase of infection prevention at the population level. Integrating the International Classification of Functioning, Disability and Health in emergency management provides a tool to evaluate functioning and address barriers for those in need.

Is It Possible to Allocate Life? Triage, Ageism, and Narrative Identity

Triage protocols can exclude older patients for the sake of effectiveness and this may be defended as the older have already had their fair share of life, which can mean fair amounts or complete lives. Nevertheless, if life is considered as a narrative, mentioning amounts might be nonsensical. Narratives have a quality of unity; so, life events are fragments whose meanings are dependent on the meaning of the whole. Thus, time units do not represent a reliable measure of the content of life. In addition, people's experience is different from the external flow of time, making its significance relative. Moreover, to compare the completeness of lives qualitatively, it is necessary to have a common cultural understanding, which is improbable to agree on in a modern society. Therefore, basic assumptions of the accounts that refer to fair shares of lives are mistaken, and these accounts do not support age-based rationing.

The Energy of Finance in Refining of Medical Surge Capacity

The availability of resources and their concentration in the place of greatest need, will not allow us to successfully overcome a medical surge without the energy required to activate these resources and activities, and increase their quantities if necessary, that is why the staff and management of healthcare institutions are forced to making ethical crisis decisions about who wins and who loses. This study highlights the versatility of the concept of ‘energy’ by attributing it to money or financial resources, which are highly essential in dealing with surges as the healthcare system adopts the appropriate capacity level. This study considers the means (space, staff, supplies, and specific resources) at the disposal of healthcare institutions for the control of diseases as economic resources to identify ways for enhancing their capacity, especially during periods of medical surges such as that caused by the coronavirus disease (COVID-19). The medical resources are dependent on ‘energy’, albeit not in the strictest sense of the term. The article, thus, points out that while limited resources are the norm in economic theory, a medical surge provides an opportunity to sufficiently extend the resources within the health system capacity through increased funding.