Nearly 81 million Americans live in houses unsuitable for quarantine to check spread of Covid-19, finds study
This proportion is particularly high among minority and poor households which have experienced high rates of Covid-19 illness and death
More than 1 in 5 US homes, which houses about one-quarter of all Americans, lack sufficient space and plumbing facilities to comply with recommendations to isolate or quarantine to limit the household spread of Covid-19. Overall, about 81 million Americans live in units unsuitable for isolation or quarantine, according to researchers from Case Western Reserve University and the City University of New York at Hunter College. This proportion is particularly high among homes occupied by minority and low-income individuals and among apartments, a pattern that "mirrors both the high incidence of Covid-19 in those groups and racial discrimination in access to housing that was the federal policy until the 1960s and, unfortunately, persists today," says the team.
"Poverty and overt discrimination force many people of color into crowded and unsafe housing, fueling the spread of the pandemic. We need to implement emergency measures to minimize household spread. But we also need to assure that that all Americans can afford decent housing, and to finally begin enforcing the 1968 Fair Housing Act that too many landlords and realtors continue to flout," writes co-author Dr Steffie Woolhandler in the study published in Annals of Internal Medicine. Dr Woolhandler is a distinguished professor of public health at the City University of New York at Hunter College and lecturer in medicine at Harvard.
The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) advise those who are infected with or have been exposed to Covid-19 to stay at home, confining themselves to a separate bedroom and bathroom if possible. The research team wanted to determine the feasibility of providing separate bedrooms and bathrooms in US houses.
The authors obtained data on residential dwelling units (excluding group quarters) and occupants from the most recently available (2017) American Housing Survey. This survey includes a representative national sample of housing units and was done by the US Census Bureau, with a response rate of 80.5%.
The team determined the number of bedrooms, bathrooms, and occupants per unit, the type and age of units, and respondent demographics. "The 57,984 occupied dwellings in the sample represented 121.57 million dwellings nationwide that housed about 303 million residents; the dwellings averaged 2.80 bedrooms, 1.82 bathrooms, and 2.49 occupants."
"Single-family detached homes, newer units, and those occupied by higher-income households had more rooms. Isolation or quarantine was impossible in 25.29 million dwellings, accounting for 20.8% of all US residential units because they lacked sufficient bedrooms, bathrooms, or both. This included almost 30% of the 88.2 million units with more than 1 occupant," say researchers. They add, "Overall, an estimated 25 million houses, home to 81 million Americans, lack adequate space or plumbing to allow compliance with recommendations that a person who may have Covid-19 maintain physical separation from others in their household."
The analysis shows that relative to White non-Hispanic persons, Native American and Hispanic persons had 2 to 3 times higher odds, and Black and Asian persons had 1.7 times higher odds of occupying units unsuitable for isolation or quarantine. Apartments, older buildings and dwellings in the Northeast were more likely to be unsuitable for isolation or quarantine. "About 46% of Latinx people, 43% of Native Americans, and 32% of Black Americans live in dwellings where separation is not feasible, compared to less than 20% of non-Hispanic Whites," the findings state.
Lead author of the study, Dr Ashwini Sehgal, a professor of medicine at the Case Western Reserve University School of Medicine suggests that to help contain family spread, free masks, gloves and disinfection supplies can be offered to all families of potentially contagious persons. "But we need to go further than that. To protect their loved ones, many doctors and nurses caring for Covid-19 patients have been put up in hotel rooms that lie vacant because of the pandemic. We need to offer that option to potentially infectious patients. Similar strategies have helped contain the pandemic in several Asian countries," says Dr Sehgal.