Why are people with intellectual disabilities clinically vulnerable to COVID-19?

In The Lancet Public Health, Maarten Cuypers and colleagues (1) add to the growing literature showing that people with intellectual disabilities were more likely to die from COVID-19 during the first 2 years of the pandemic— in this paper around five-times more likely. Putting these figures into context, around 600 more people with intellectual disabilities died in the Netherlands than would be expected if they had the mortality rates of others in the population. Cuypers and colleagues also showed that this mortality gap existed before the pandemic, and that non-COVID causes of death were elevated for people with intellectual disabilities during the pandemic. Other sources of data show that the adverse impact of COVID-19 for people with intellectual disabilities went beyond mortality risk. For instance, qualitative research highlights the isolation, loneliness, and lost sense of selfworth experienced by people with intellectual disabilities during the COVID-19 pandemic. (2,3) Family members and caregivers were also put under immense strain. (4 ) A key question is why the impact of COVID-19 was greater for people with intellectual disabilities? More fundamentally, why was this group clinically vulnerable?