HEALTHCARE IN THE UNITED STATES

SPECIAL POPULATIONS

sneezes. The tiny droplets fall and are inhaled by people close by and they become infected. The virus is very contagious and spreads quickly within a community. The COVID-19 virus has created tremendous risk to all Americans. However, special populations noted in this chapter are at increased risk for exposure and death.

The American Indian and Alaska Native (AIAN) population has been disproportionately affected by COVID-19. According to the CDC (2020c), the total amount of laboratory-confirmed cases is 3.5 times more in AIAN than non-Hispanic whites. The CDC also reports large data gaps for this population, which makes incidence, severity, and outcome analysis difficult (Hatcher et al., 2020). As discussed above, AIAN has a high prevalence of health conditions, such as respiratory diseases, diabetes, hypertension, and obesity. These conditions have been associated with more severe COVID-19 symptoms and a higher risk for death. The Indian Health Service has received more than $1 billion to provide enhanced services to AIAN’s in response to the COVID-19 pandemic (IHS, 2020b). These funds were distributed to tribal health and urban Indian health programs to increase access to testing and the response to the virus pandemic.

Older adults often live with chronic diseases, which has been found to increase the risk for severe illness related to the virus. A lowered immune system may also contribute to the severe symptoms seen in older adults. According to the CDC (2020d), eight out of ten deaths in the U.S. are adults 65 years and older. Older adults have a higher risk for contracting the virus if they are reliant upon others for care or to assist in tasks related to daily living. Many nursing home residents are at high risk for infection related to living in a confined space and the inability to social distance. While the statistics are still emerging, one-third of all U.S. coronavirus deaths are nursing home residents or workers (Yourish et al., 2020). Additional risk factors include social isolation and an inability to access food and healthcare.

Adults and children with a disability are not inherently at risk for getting COVID-19. However, individuals with underlying chronic illnesses, such as chronic lung disease, severe heart disease, or a weakened immune system, are at higher risk for infection and severe illness (CDC, 2020e). According to the CDC (2020e), adults with disabilities are three times more likely than adults without disabilities to have chronic diseases, such as heart disease, diabetes, or stroke (para 1). Disability groups who are more at risk include people with limited mobility or those who cannot avoid close contact with others, those who have difficulty understanding information, and those who are unable to communicate symptoms of illness.

COVID-19 virus spreads quickly within communities, and the prison system is susceptible as well. Inmates are often housed in close quarters, which prevents social distancing and the ability to protect from infection. As noted above, many inmates have chronic diseases, which puts them at a higher risk of severe symptoms from COVID-19 infection. In response, the Federal Bureau of Prisons (BOP) (2020) has implemented modified operations by limiting social visits, decreasing inmate movement within and outside of a facility, and screening for the virus. According to the Marshall Project (2020), at least 25,239 cases and 373 deaths from COVID-19

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