Page - 438 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE438 illnesses and trigger distress,8 people may leave mandatory isolation and risk infecting others. People with substance use problems may put themselves at risk of infection in order to access the substances upon which they depend.9 Some have expressed concern that triage policies that make prog- nosis a key factor would mean that people with pre-existing comor- bidities would fare less well under these policies should they become infected and require intensive care support, and it became necessary to triage. People who have mental illnesses, particularly those who are also homeless, are among those groups that tend to have medical comorbidities at higher rates, and this might affect prognosis and tri- age decision-making.10 Another suggestion is that unless appropriate procedural safeguards are in place, subconscious stigma toward this group—for example, with respect to perceptions of their quality of life—might affect triage decisions made under pressure, further dis- advantaging the population with mental illness.11 There are other kinds of possible vulnerabilities that people with mental illnesses may face during the pandemic. One potential risk is hostility from members of the public. In some cases, people with mental illness may behave in ways that do not comply with evolving community norms about personal distancing and social interaction. Members of the public may perceive this as unpredictable or threat- ening, and it may provoke hostile responses. Harassment, aggression, and vigilantism toward people perceived as posing a risk of infection to others is already being documented around the world during this 8. A Fiorillo & P Gorwood, “The consequences of COVID-19 pandemic on mental health and implications for clinical practice” (2020) 63:1 European Psychiatry e32 at 1–2. 9. A Guirguis, “There is a vulnerable group we must not leave behind in our response to COVID-19: people who are dependent on illicit drugs” (28 April 2020), online: Pharmaceutical Journal <www.pharmaceutical-journal.com/news-and-analysis/ opinion/comment/there-is-a-vulnerable-group-we-must-not-leave-behind-in- our-response-to-covid-19-people-who-are-dependent-on-illicit-drugs/20207926. article?firstPass=false>. 10. Katie Savin & Laura Guidry-Grimes, “Confronting Disability Discrimination During the Pandemic” (2 April 2020), online: The  Hastings  Center  Bioethics  Forum <www.thehastingscenter.org/confronting-disability-discrimination-during-the- pandemic/?fbclid=IwAR2ssY8aVhxj5284prI9S2WqZUM3VZvtSzJGQ6DeX4cB_ FhqmZ7vOv90msk>; Sean Fine, Mike Hager & Tom Cardoso, “Ontario draws up health-care plan in event hospitals become overcrowded”, Globe  and  Mail (3 April 2020), online: <www.theglobeandmail.com/canada/article-ontario- hospitals-instructed-to-prioritize-life-saving-coronavirus/>. 11. Savin and Guidry-Grimes, supra note 10; Fine, Hager & Cardoso, supra note 10.