After spending five days at a mental health hospital in October, Quinn West left feeling as though they hadn’t gained much from their stay. They spent most of their time in their room, finding group therapy pointless because, as a Deaf person, they couldn’t fully participate in conversations. They communicated with hospital staff primarily through writing and lipreading. They repeatedly asked for an American Sign Language (ASL) interpreter, but in-person interpretation wasn’t an option because of COVID-19 restrictions.

Although West could use Video Remote Interpretation, they found they couldn’t necessarily rely on it. “[It] is tricky when the room has bad audio quality, the interpreter constantly gets disconnected, and the iPad is not always catching everything happening in the room,” says West. Every new call also means a new interpreter, and having to adjust to a different signing style every time only adds to the stress.

West’s hospital experience is not an outlier. Many deaf and hard of hearing people have been alone in hospitals without consistent ways to communicate with doctors and staff, according to the National Association of the Deaf (NAD). For deaf people — in hospitals, at work, in their homes — the COVID-19 pandemic has exacerbated gaps in communication access, from a lack of reliable technology to an underutilization of certain tools when people need them most.

“I’ve learned to always be wary when I see [mentions of] accessibility, many times it is faulty or access that isn’t good enough,” says West. While social distancing has been hard on just about everyone, the isolation is intensified for deaf people because their access is so often an afterthought.

For many people, face masks were one of the first, most obvious causes of trouble. “Before, I would rely on lipreading and residual hearing to communicate with everyone from cashiers to bank tellers to the dentist and more,” says Beatrice Bachleda, a Deaf yoga instructor. “With masks, I sometimes don’t even realize if anyone is talking to me which can lead to some pretty awkward encounters.”

As masks became the norm, even people who didn’t realize they had hearing loss noticed they were struggling to understand speech. Around the beginning of the pandemic, audiologists noticed an uptick in patients coming in with concerns about their hearing. People who already had hearing aids were having more difficulty understanding speech, says Catherine Palmer, former president of the American Academy of Audiology. People with mild hearing loss, who weren’t previously using hearing aids, suddenly found that they couldn’t understand speech without them.

“Masks create two barriers for individuals with any level of hearing loss,” says Palmer. They reduce visual cues — mouth movement, facial expression — that support communication for people with reduced hearing, while also decreasing the transmission of certain frequencies of sound that lend to clarity of speech.

Some have pointed to masks with transparent windows to make communication easier for people who depend on lipreading and facial expressions. But they’re not widely used, and “the weakness is that it’s not something the deaf person can do or wear; the person we are trying to understand must wear them,” says Jenna Beacom, a Deaf writer and editor.

The materials used in transparent masks also dampen sound more than cloth masks, making for a difficult trade-off for people who use both residual hearing and visual cues to understand speech. The dampening effect is also a problem for people who don’t have hearing loss but struggle with auditory processing, like many autistic people.

Transparent masks aren’t the only imperfect solution. Every deaf person’s needs and preferences are unique, and sometimes one accessibility option isn’t enough. “When I had to get a COVID test I had a hard time understanding over video phone, it would have been easier for me to have someone email me or text me,” says West.

Some people have been left with very few communication options because of the pandemic. Social distancing is particularly hard to navigate for DeafBlind people who use tactile ASL, which involves touching hands while signing. In many contexts, including hospital visits, tactile ASL is difficult to accommodate for: video calls aren’t feasible, and COVID-19 restrictions may prevent a family member or friend from assisting with communication.

While some accessibility problems are difficult to address even with multiple tools available, in many cases, it comes down to a lack of willingness to use existing technology like video captions and interpreting services. “Over time, I see that technology is slowly catching up,” says Bachleda. “I do wish we could progress a bit faster because there are still lots of gaps though, and it’s sometimes more to do with attitudes rather than the technology itself.”

The proliferation of virtual events and remote work has made some things easier for deaf people, but there are still challenges. Thanks to the move to more online training, Bachleda was able to advance her yoga certification after years of being unable to arrange in-person classes with an interpreter. She says that with online resources she can get “some semblance of access,” but that access has often been limited to auto-captions. “Asking anyone to provide an interpreter is almost always a tough battle,” she says, and she’s been told “no” enough times that she rarely asks anymore.

“So much is video-based, and so little of what’s video-based is accessible,” says Beacom. She’s been disappointed by many virtual events, which either had no captions or used frequently inaccurate auto-captions, in addition to missing out on family Zoom calls.

The battle for ASL interpretation has been fought all the way to the level of national COVID-19 briefings. In August, the NAD filed a lawsuit against the White House after months of briefings with no ASL interpreters. Part of the argument in the White House’s original response was that the briefings included closed captioning and that transcripts were available for each one. But even if live captions are accurate, people whose first language is ASL may not completely understand English. “We have received many complaints from deaf and hard of hearing people unable to understand from the briefings what they are supposed to do or avoid to stay safe and healthy,” says the NAD’s website.

Because interpretation and captioning on live TV are so often unreliable, many deaf people don’t bother watching news stations. “My local news has had interpreters but sometimes, they cut the interpreter off or graphics and captions will be covering their window and it makes it complicated to view,” says Rikki Poynter, a Deaf YouTuber and activist. “Obviously, the Trump administration never gave interpreters to begin with so that was a struggle to keep up with if captions were also being wonky at the same time.”

Between struggling with masks and being left out of everything from virtual hang-outs to COVID-19 briefings, many deaf people have found the pandemic taking a serious toll on their mental health. “Life has been much more isolating,” says Poynter. She had already struggled to communicate with people who don’t know ASL, “now everyone is having zoom parties and stuff, but deaf folks tend to be uninvited because we’re not as thought about and the lack of accessibility (small cameras, laggy Internet, etc) make it extremely difficult to take part in any of it.”