Note: Dr. Ruffin is deaf and wears bilateral cochlear implants. This article was written with feedback from Deaf and hard of hearing healthcare professionals (see acknowledgements below).

Please see our special COVID-19 resource section for the Deaf and hard of hearing.

Coronavirus

The COVID-19 pandemic is on track to become the greatest disruption to society since World War II. This virus is the most widespread infection since polio during the 1900-50s. The U.S. has declared a state of emergency to decrease the spread of COVID-19. Currently the recommendations are to stay 6 feet away from other people and to practice social distancing.

Our one page summary contains all you need to know about COVID-19. It is easy to read and low-vision accessible. It covers the following topics:

• What COVID-19 is
• The risk of COVID-19 to you
• Why it is a problem for the healthcare system
• Symptoms
• What to do if you are sick
• How to stay calm and positive
• Information for healthcare providers

ASL COVID-19 resources:

• Dr. Michael Mckee who is deaf discusses COVID-19
• CDC COVID-19 videos: overview and prevention of COVID-19
• Dr. Jaime Wilson who is Deaf discusses how to stay calm and positive

Deaf and hard of hearing may be at higher risk of getting COVID-19 and becoming seriously sick.  

MEDICAL ISSUES

First, deaf and hard of hearing (DHH) people may have more heart and blood pressure disease than hearing people, which can place them at a higher risk of dying from COVID-19.

Second, DHH people experience communication issues that make it hard to interact with other people. These issues can result in loneliness, anxiety, and depression. These feelings can occur at home or at a hospital. Most importantly, these feelings may weaken the immune system. The immune system fights disease. When it is weaker, you may be at increased risk of catching COVID-19.

SOCIAL ISSUES

Third, DHH may experience discrimination and fewer job opportunities. They also spend more money on health care such as hearing aids and assistive technology. Because of more limited financial resources, it is important to be aware of how COVID-19 can affect you.

Lastly, DHH people may know less about how to manage health problems. Hearing people overhear families talking about health problems at the dinner table. During these discussions, stories are shared about how “Granny managed her heart attack.” These stories may be brief, but knowledge is exchanged. People learn how to manage illness, communicate with doctors, and take care of loved ones after discharge from a hospital. In the COVID-19 pandemic, hospitals may be chaotic and overwhelmed. It may not be possible to get interpreting services.

For all of these reasons, it is critical for DHH people to plan ahead.

Plan ahead for healthcare

BEFORE GOING TO THE HOSPITAL

Have a plan in place before you get sick. Being prepared ahead of time is key. In an epidemic, the hospital can be overwhelming. You may be in a temporary isolation tent or placed in a hallway. You may not have access to communication tools that you usually get. Again, being prepared ahead of time is key. Make a plan with your family if you’re not ready.

First, see our guide on COVID-19. Second, become familiar with your doctor’s office to decrease confusion in case you need them. Contact your doctor’s office ahead of time. For hard of hearing people who If you use the phone to call in become familiar with their phone menu. Use a Video Relay Service for ASL or text-based relay service, with or without Voice Carry Over (VCO) such as SprintIP if needed. To save time and frustration, see if the office will give you a direct line to their nurse. Many offices now have smartphone apps or online webpages to bypass the telephone and contact their office directly. Check your doctor's website to see if they have a MyChart or MyHealth login.

AT THE HOSPITAL

Right now, hospitals can be very overwhelming and may seem to be a chaotic place. You may be placed in a temporary isolation tent (by yourself) or in a hallway.

If you must go to the hospital, you may experience some communication frustrations. Follow this checklist to help:

• If at all possible, bring a friend or loved one to act as your advocate. It helps if this person has medical knowledge.
• Bring things with you if you will stay at the hospital (smartphone, chargers, hearing equipment). Have a bag for your chargers.
• Keep your hearing equipment in your ears to prevent loss.  

When hospitals are busy, it is easier for nurses and doctors to make mistakes. See this hospital survival guide for tips before going to the hospital. It includes tips such as bringing a list of your medications and creating a living will so family members understand your wishes. This healthcare access toolkit provides information for healthcare providers about accessible healthcare.

PLANNING TO GO HOME

Plan for how you will leave the hospital before you leave (see link). Social workers and discharge planners usually help with this. Some of the things they do are:

• Determine where you will go—home, a relative’s place, or facilities such as skilled nursing or rehabilitation.
• Determine who will care for you after discharge.
• Make sure you have access to medications and services after discharge.

Having a plan is essential. Remaining in the hospital with discharge-related delays is dangerous. You can catch infections that are transmitted in the hospital. There could be an error related to your treatment. Contact the social worker on your hospital ward to get this process started. Check in twice a day. During such a busy time, you may need to take charge and look out for yourself.

Preparing for communication needs

SELF-ADVOCACY

• See this video for how to introduce yourself as a person with a disability.
• Resources for knowing your rights and how to establish a communication access plan in the hospital.
• Consider printing these useful signs to place in your hospital room. See if your hospital has assistive technology or a hospital kit for those with hearing loss.

COMMUNICATING IN THE HOSPITAL

Know your communication rights in the hospital. Healthcare providers will be wearing masks. You will likely be in isolation to stop disease from spreading. This can make communication challenging. Some ideas:

• You have the right to communication access whether you speak or hear. Options can include:
• a live ASL interpreter and if not available, quality video interpreting services. Ask that the following information be posted in your room and on your medical chart: Your need for and the name/number of the interpreting service.
• access to real-time captioning.
• an assistive listening device.
• Apps such as Google LiveTranscribe and Microsoft Translator can be backup communication aids that provide captions for speech.  Wired or wireless lavalier microphones can increase accuracy. Wired mics are easier and less prone to being lost in the hospital.
• Use a personal whiteboard or a boogie board.
• Clear face masks and biosafety suits (see figure) are types of clear surgical masks. They are in incredibly short supply and are most likely unavailable. Clear face masks must be purchased ahead of time. They are currently backordered. For help obtaining communication-friendly equipment, ask for the charge nurse of your ward or hospital nursing supervisor.

Getting a Cochlear Implant During Pandemic COVID-19

COCHLEAR IMPLANTATION IS GENERALLY “ELECTIVE”

In general cochlear implant surgery is elective or non-urgent surgery. Given the seriousness of COVID-19, you should strongly consider rescheduling your surgery. It may be some time (e.g. a year) before you may get your surgery. Some patients may be concerned about longer durations of deafness since this has been shown to worsen cochlear implant outcomes. Fortunately, the short period of time to wait for COVID-19 to pass should not have an appreciable effect on cochlear implant outcome. This is because “long duration of deafness” is defined as longer than 10 years since hearing aids were beneficial.

WHEN IS COCHLEAR IMPLANTATION URGENT?

In two instances cochlear implantation is not elective and surgery must proceed urgently. For patients with meningitis, bony growth (ossification) start to quickly block the inside of the cochlea. The inside of the cochlea must be free of bone so that the electrode can be successfully placed. The second instance is congenital hearing loss. For families who wish to maximize their hearing potential, cochlear implantation as early as possible has been shown to improve language outcomes. The latest research shows that even a month can make a difference in final outcomes.