April 6, 2020

Coronavirus Guidance for Individuals with Disabilities

Our team does plan to continue to review, update and expand our recommendation and guidelines.  As able, we will develop specific guidelines for patients with different types of disability as well as summarizing recommendations for clinicians working with patients with disabilities.

Initially submitted 4/5/2020

Members of our task force include:
  • Mr. Ted Allaire, PMR
  • Dr. Edmund Chadd, PMR
  • Dr. Joshua Ehrlich, Ophthalmology
  • Dr. Steve Erickson, Pharmacy
  • Dr. Susan Ernst, OB/GYN
  • Mr. Donn Hilker, Rehab Engineering
  • Dr. Michael McKee, Family Medicine
  • Dr. Michelle Meade, RPN/ PMR
  • Dr. Carrie Pilarski, RPN / PMR

We are monitoring statewide and national recommendations closely.

The coronavirus (COVID-19) pandemic is a rapidly evolving situation, and the medical community continues to learn more about the virus and how it is spread.

Everyone – including patients with disabilities and chronic medical conditions – should practice basic infection control and prevention to minimize the risk of getting or spreading coronavirus.

All patients should follow national, state, and local recommendations regarding prevention of illness and presenting the spread of the disease.


Additional guidance for our patients from the Center for Disability Health and Wellness at Michigan Medicine includes:

High Risk Conditions

The Centers for Disease Control (CDC) identifies certain patient populations at higher risk for serious illness with COVID-19.  This includes older adults (greater than age 60), and patients with lung disease (e.g. asthma or chronic obstructive pulmonary disease), heart disease, diabetes, liver disease, kidney disease, severe obesity, or conditions and/or medications that suppress your immune system (e.g. cancer treatments, HIV/AIDS or long term corticosteroids).

While very little specific information is currently known about the impact of COVID-19 infection on patients with disabilities, many of these patients experience high rates of conditions associated with increased morbidity and mortality, including

  • Diabetes
  • Cardiovascular disease
  • Respiratory failure or dysfunction

The University of Michigan Center for Disability Health and Wellness Center has identified patient groups we are concerned may be at the highest risk of complications with COVID-19.

  • Patients with quadriplegia
  • Patients with respiratory dysfunction or failure
  • Patients who require nocturnal or continual ventilation
  • Other chronic illnesses (lung disease, cardiac disease, kidney disease)
  • Patients with who are immunosuppressed with disorders associated with compromised immune systems
  • Patients with sensory impairments (blind or visually impaired, deaf or hard of hearing)

Risk of Infection

Individuals with long-term disabilities are at often at increased risk of contracting and experiencing more severe symptoms from COVID-19.


  • Many individuals with disabilities need caregivers. To the extent that these caregivers are not isolating in place with the adult with disability, this increases the risk. Individuals receiving care from individuals outside their own home may be working with essential care workers with unknown ability or willingness to reduce their social distancing.
  • Decreased ability to complete behaviors independently to prevent (hand washing, etc)
  • Immunocompromised states
  • Secondary Conditions, as noted above
  • Reduced Lung Functioning
    • Decreased ability to overcome respiratory illness
  • More likely to have be living in poverty / disadvantaged (social determinants of health) as related to reduced
  • Access to care – navigational literacy
  • Nutritious food
  • Good sleep
  • Other health behaviors – smoking, alcohol use, etc.
  • Difficulty accessing relevant information




We are currently recommending that all patients remain up to date on required immunizations, especially influenza and pneumonia when appropriate.

  • All individuals are currently advised to work from home if possible
  • We are recommending that high risk patients avoid working jobs where they are exposed to a large number of people (including retail).
  • Patients with disabilities with conditions that are not listed among the group in the highest risk group listed above should discuss work recommendations with their healthcare provider.
  • We are currently recommending that patients with high risk conditions who are health care workers not participate in the care of patients with respiratory symptoms or patients known to be positive for COVID-19.
  • Please contact your health-care provider if you are concerned about your work situation or if you require a letter.
Travel Recommendations
  • We are currently discouraging all non-essential travel at this time

Disability Specific

Sanitizing Wheelchairs and other equipment

Individuals with disabilities may use wheelchairs or other equipment outside the home. Cleaning and sanitizing this equipment may need additional thought and consideration. For example, Peter Axelson, a rehabilitation engineer, has compiled guidelines regarding wheelchair cleanliness and how these practices may further reduce individuals’ risk of contracting COVID-19.

Interacting with Caregivers and Home care providers

  • All people should wear a mask; this does not need to be a hospital grade (N95) mask, even a cloth mask or face covering could help prevent the spread of saliva and infection;
  • Hand washing, as previously described;
  • As much as possible, ask all individuals entering your home / space to monitor their health, including their temperature for signs of fever, and to work to find alternative support for you if they are showing signs;

Using Public Transportation

For individuals who need to use public transportation to either provide or access relevant supports (e.g., groceries)

  • Wear masks over your nose and mouth
  • Work to maintain 6 foot distance
  • Wash your hands both before and after use
  • Bring sanitizer / wipes to disinfect areas that you do need to touch

Doctors Visits

  • Michigan Medicine patients with long-term specialty providers should contact them to determine the preferred methods of handling
  • Integrate requests for accommodations (e.g. sign language interpreter) during your virtual visit as you request appointments
  • If you have a primary care provider, get in touch with them to check about specific considerations and ask for needed prescriptions to have additional supplies and medication


Michigan Medicine is committed to respect the rights of individuals with disabilities and will not make care related decisions on the basis or disability status or provider perceptions of quality of life. 

In the event of limited healthcare resources, decisions will be made on the basis of research evidence about immediate survivability.

Michigan Medicine will not remove or take away equipment, supplies, medications or care from individuals with disabilities in order to re-allocate them to others.  This would include, but not be limited to, home ventilators, masks and gloves.

Individuals and family members should work with the Emergency Department and Healthcare team to plan for how disability related accommodations may be integrated into care, including (but not limited to):

  • Allowing a family member or caregiver to accompany the patient; that individual would need to be informed of the risk and provided with appropriate protections.
  • Developing a plan to facilitate virtual visits / communication with family members and caregivers while in the hospital

Adults with disabilities should plan to bring written information about specific guidelines or protocols for their health management, to include both health behaviors (rolling, cathing, etc.) and medications.  This should include a list identifying areas of risk for future problems or infection.  For example, if individuals have a history of pressure sores or and flap surgery on a particular area, it will be important to consider this when planning to prevent skin breakdown (e.g., avoiding rolling to particular sides, further protecting the area).