**8. Persons with disabilities (PWD) and the elderly**

According to Census 2011, India is home to 26.8 million persons with disabilities; 2.21% of the total population [69]. This statistic may also underrepresent the total number of people coping with a disability since there is not yet an established universal definition of disability in either the international or national discussions. The Coronavirus pandemic, along with the subsequent lockdown, has brought diverse challenges for PWDs. For example, procuring essential supplies, accessing medical treatment, and adopting physical distancing practices have devolved into further obstacles. The following case of Mr. AK, illustrates his experience of additional challenges with activities of daily living during the pandemic.

#### **More Challenges for PWD During COVID-19**

Mr. AK, a 33-year-old with vision impairment, shared how he has organized his life for an independent existence. However, with the pandemic, Mr. AK is under tremendous stress as cleaning utensils, fixing broken gadgets, and the ability to differentiate and select particular food items at the market have become more complicated. No longer having domestic help available to assist with errands only further adds to his stress during the pandemic [70].

Further, the Secretary-General of the United Nations, has declared that COVID-19 has "disproportionately [impacted] PWDs both directly and indirectly" ([71], p. 2). PWDs may face barriers to several protective measures. Access to water, sanitation and hygiene facilities can be hindered, along with public health information access. Additionally, people with disabilities who are placed in institutional care can be further at risk of infection due to overcrowded and unhygienic conditions in many institutions. PWDs also often rely on physical contact for mobility and to complete activities of daily living, thereby diminishing physical distancing protective measures. Elders, too, often face these same barriers.

Moreover, skill training programs for PWDs have all but stopped dead in their tracks in response to the COVID-19 lockdown in March, 2020. In 2018–2019, 47,286 people with disabilities participated in skill training programs which dropped to merely 1,434 participants in 2019–2020. The Department for Empowerment of Persons with Disabilities has empaneled 75 programs to meet the more stringent expectations, compared with the previous 280 programs [72]. It is essential that rigorous safety protocols are followed as training programs reopen. As an additional option, online training program proposals for people who are differently-abled are currently being explored.

Of the persons with disabilities in India, nearly half of them have vision impairment. Senjam [73] points out that 13 million of those with vision impairment have functional low vision. However, appropriate and accessible information related to COVID-19 are inadequate, especially for people with visual disability in the areas of transmission, nature of the virus, and prevention and protective strategies. They also require personal assistance with activities of daily living and rely on tactile sensory for performing "routine activities or outdoor movement which may further increase the chance of getting the infection from the virus" ([73], p. 1368). Protective techniques such as handwashing and face mask wearing rely on visual functioning, while assistive devices require regular disinfection in order to prevent the transmission of infection. For people with visual impairment and other disabilities, the "sudden disruption of [their] support system, including personal assistance, and potential economic hardship … will have serious consequences in health and wellbeing" ([73], p. 1368). The quality of life for people living with disabilities will be significantly impacted by the added risk factors and necessary precautions needed to interact with their surroundings during the pandemic [73–75].

The lack of priority given to establishing and distributing clear guidelines and recommendations for people with disabilities is further impacting persons with disabilities. If people with disabilities do not have disability certificates or ration card documentation, they can be denied food. Hospitals are closing their doors to non-COVID patients, leaving people with disabilities without the necessary and accessible healthcare infrastructure to support them [74, 76].

For elderly, as with people with disabilities, the physical risks of the pandemic and related issues are further exacerbated by the social isolation that they face [77, 78]. Elders have limited, if any, access and proficiency with technology to foster connections to information and alleviate social isolation. With such isolation and heightened anxiety, elders are also at an increased risk of suicide [79]. Further, with social isolation, particularly from their family systems, seniors are

also predisposed to greater risks of "inactivity, smoking, alcohol abuse, unhealthy diet, depression, introversion, poor social skills, and post-traumatic stress disorder leading to greater risks of cardiovascular diseases, dementia, and premature mortality" ([78], p. 1).
