In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters. And coronavirus is proving to be the biggest disaster of all.
Arun Karpur, Vijay Vasudevan, Andy Shih & Thomas Frazier, "Brief Report: Impact of COVID-19 in Individuals with Autism Spectrum Disorders: Analysis of a National Private Claims Insurance Database," Journal of Autism and Developmental Disorders (2021), online first. Abstract
The COVID-19 pandemic continues to have a detrimental impact on individuals with disabilities. Data from FAIR Health’s FH® NPIC (National Private Insurance Claims) database, one of the nation’s largest databases of private insurance claim records, were analyzed to understand the experiences of individuals with ASD in the COVID-19 pandemic. Multivariate logistic regression models revealed that individuals with ASD + ID were nine times more likely to be hospitalized following COVID-19 infection (OR = 9.3; 95% CI: 6.9–12.5) and were nearly six times more likely to have an elevated length of hospital stay (OR = 5.9; 95% CI: 3.5–10.1) compared to those without ASD + ID. These findings point to the need for prioritizing access to vaccines to prevent COVID-19 infection and morbidities. This is the first study to illustrate a higher likelihood of hospitalization and elevated length of hospital stay from COVID-19 in individuals with ASD and other comorbidities.
From the article:
This is the first study to illustrate a higher likelihood of hospitalization and elevated length of hospital stay from COVID-19 infections for individuals with ASD and other comorbidities. While a lower proportion of individuals with ASD acquired COVID-19 infection than other condition groups, they were significantly more likely to be hospitalized for COVID-19 and have a longer length of stay in the hospital. Contrastingly, individuals with other chronic conditions had a higher prevalence of COVID-19 infections (e.g., Heart Failure, Obesity, Diabetes) had lower adjusted odds of hospitalization and elevated length of hospital stay. Underlying demographic patterns likely drive a lower overall prevalence of COVID-19 in ASD. A closer examination of the demographic distribution indicates that more than 90% of individuals with ASD were in the younger age range (i.e., less than 30 years old). Nearly 70% belonged to the 0–18-year-old group. As a result, most individuals with ASD in the data are likely living with their families during the pandemic, limiting their exposure compared to individuals in congregate living environments. A substantial increase in morbidity and mortality in COVID-19 among individuals with disabilities, especially among individuals with intellectual and developmental disabilities, has been associated with their living situation in congregate care settings (Landes et al., 2020).
Once individuals with ASD acquire COVID-19 infection, the regression models indicate a higher likelihood of hospitalization and elevated length of hospital stay. While Cunningham et al. (2020) described a similar pattern of lower COVID-19 prevalence and higher morbidity among young individuals using electronic medical records data, the quantitative differences in the likelihood of hospitalization and duration of stay for individuals with ASD is concerning and requires attention (Cunningham et al., 2020). Individuals with ASD, in general, have higher medical needs resulting from cooccurring mental health and other conditions such as epilepsy, digestive disorders, etc. (Karpur et al., 2018; Shea et al., 2018). It is possible that the COVID-19 infection, irrespective of severity, precipitates behavior health challenges leading to hospitalization and longer duration of stay (Bal et al., 2021; Righi et al., 2017; White et al., 2021). Further, several immunological theories, including the more recent preposition of abnormal melatonin production among individuals with ASD, might contribute to the increased severity of COVID-19 infection (Brown et al., 2021).
The findings of increased morbidity in COVID-19 are relevant from the perspective of growing discussion on the prioritization of populations for COVID-19 vaccines. Only a handful of states have considered prioritizing individuals with intellectual disabilities (see: https://www.kff.org/policy-watch/the-next-phase-of-vaccine-distribution-high-risk-medical-conditions/), and this does not include all individuals with ASD. However, given the challenges in consistently implementing social distancing practices and PPEs among individuals with ASD, it would be helpful to include them as one of the high-risk populations for immunizations.