Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Flattening the Inaccessibility Curve


There's been limited attention addressing the disability perspective during the pandemic. Finding creative solutions to accessibility challenges during this time is critical.

As an epidemiologist with low vision, the phrase “flatten the curve” has come to symbolize three things: an urgent call to action, a reminder of this challenging time, and a reflection of how people with disabilities remain sidelined in our society.


I have great concern and admiration for the front-line workers of the COVID-19 response. But, I have equal concern for people in our communities with disabilities—people like me—as this group is not often considered in public health and medical emergency response.


Approximately one in four Americans has a disability, defined as any condition or impairment that limits daily activities or impacts societal participation, and includes sensory, movement, learning, cognitive, and mental health disabilities. Disability impacts most of us in some way, and is the only minority group that anyone can join at any time.


COVID-19 presents unique challenges for people with disabilities. Critical public health and medical information is often not accessible, public health prevention strategies (such as hand washing or social distancing) may not be feasible, barriers to accessing healthcare have become amplified, and concern over medical rationing has increased.


In order to ensure that people with disabilities are not being left behind, a movement to “flatten the inaccessibility curve” has emerged. The goals are to include people with disabilities in the COVID-19 response, as well as learn from this time of crisis how to address inequities for this group.


A few important steps can be used to improve care for patients with disabilities during the COVID-19 pandemic and beyond.


Consider invisible disabilities.

It’s important to remember that disability is heterogeneous and not always visible. Patients may not immediately identify as having a disability, but asking questions about functional difficulties can help to start discussions about accommodations and tailor care to all patients.



Make communication accessible.

As the medical setting has shifted to meet the COVID-19 surge, including the roll-out of telehealth, focusing on accessible communication is critical. For people with many types of disabilities, including those who have low vision or are blind, or have moderate or greater levels of hearing loss, or have cognitive disabilities, accessing information can be challenging. Understanding and leveraging multiple communication modalities will improve success, including using technology (such as patient preferred communication applications), low tech options (such as white boards), plain language messaging, image descriptions, and language services when needed and available.



Find flexible and creative strategies.

It’s important to discuss and understand personal preferences for patients with disabilities. Talking with your patient about what works at home or in other situations can help identify creative accommodation solutions. It’s also important to ensure clinical team members know where to find or who to contact about accessible medical equipment and COVID testing sites.



Don’t make judgments about the quality of people’s lives.

The disability paradox reminds us that people with all types of disabilities and levels of functional impairments can have high quality lives. Be aware of the biases against people with disabilities, as well as how these perceptions may impact care decisions.


These steps present opportunities to parlay current challenges and transform them into better care for people with disabilities.