Nearly two years into the pandemic, the Centers for Disease Control and Prevention is for the first time acknowledging that people with intellectual and developmental disabilities have an elevated risk of severe disease from COVID-19.

The agency quietly updated its list of medical conditions known to be associated with a heightened chance of severe illness from the virus in mid-February.

“People with some types of disabilities may be more likely to get very sick from COVID-19 because of underlying medical conditions, living in congregate settings, or systemic health and social inequities,” the latest guidance states.

The list includes people with intellectual and developmental disabilities, birth defects, cerebral palsy, Down syndrome, attention-deficit hyperactivity disorder, learning disabilities, spinal cord injuries and “people with any type of disability that makes it more difficult to do certain activities or interact with the world around them, including people who need help with self-care or daily activities.”

Individuals with conditions on the CDC list are “more likely to get very sick with COVID-19,” according to the guidance. That could mean being hospitalized, needing intensive care, requiring a ventilator or death.

The CDC said that people with such conditions should stay up to date on COVID-19 vaccines and use preventive measures like wearing masks and avoiding crowded spaces.

Prior to the change last month, Down syndrome was the only disability mentioned, but there was a note suggesting that those with other conditions could be affected too.

“People with disabilities are more likely than those without disabilities to have chronic health conditions, live in congregate settings, and face more barriers to healthcare,” the note read. “Studies have shown that some people with certain disabilities are more likely to get COVID-19 and have worse outcomes.”

The CDC has been clear that the research around COVID-19 is constantly evolving and the agency’s list of conditions associated with a greater risk of severe disease could continue to grow.

Research dating back to the middle of 2020 has found people with developmental disabilities to be at higher risk than others from COVID-19.

Scott D. Landes, an associate professor of sociology at Syracuse University who has studied the experiences of people with intellectual and developmental disabilities during the COVID-19 pandemic, said he’s happy to see these conditions added to the CDC list, but he wonders why it took so long.

“All evidence I have seen to date, including our own work, in the U.S. and other countries reports increased risk of COVID-19 infection, hospitalization and death for this population,” Landes said. “While I imagine that the CDC has a process it used to determine when to add conditions to this list, I can not help but wonder how things might have been different had these disabilities been indicated on the list of risk factors at an earlier date.”

The updates to the CDC list come as the agency is relaxing masking guidelines, a move that has disability advocates concerned.

Under new guidance released last week, CDC officials are using different metrics to assess community risk from COVID-19. With the new criteria in place, only about 30% of Americans live in areas considered to be at high risk where universal indoor masking is still recommended.

“This change to the masking guidance specifically lays out a completely separate set of rules for people with disabilities, recognizing that they are still at risk, but not asking the general public to continue to take protective measures to help reduce their risks,” said Peter Berns, CEO of The Arc. “As this abrupt policy change disregards the needs of people with disabilities begins to be implemented, we ask everyone to think about others in their neighborhoods, in their communities, in that moment when questioning whether it is necessary to put on a mask.”

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