An article published today in the Annals of Internal Medicine reports that 25 million dwellings that house 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 World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) advise those who are infected with or have been exposed to COVID-19 stay at home, confining themselves to a separate bedroom and bathroom if possible. Researchers from Case Western Reserve University and the City University of New York at Hunter College used data from the American Housing Survey to determine the feasibility of providing separate bedrooms and bathrooms in U.S. dwellings. They found that more than 1 in 5 homes -- housing about one quarter of all Americans -- lack sufficient space and plumbing facilities to comply with the WHO and CDC recommendations.
The proportion of homes unsuitable for isolation or quarantine is particularly high among minority and low-income households, which have experienced high rates of COVID-19 illness and death. 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. Crowding is worst for apartment dwellers, particularly in the Northeast.
Dr. Ashwini Sehgal, a Professor of Medicine at the Case Western Reserve University School of Medicine and lead author of the study commented, "To help contain family spread we should immediately offer free masks, gloves, and disinfection supplies 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."
"Poverty and overt discrimination force many people of color into crowded and unsafe housing, fueling the spread of the pandemic," noted study co-author Dr. Steffie Woolhandler, a Distinguished Professor of Public Health at the City University of New York at Hunter College and Lecturer in Medicine at Harvard. "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."
"Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the
United States," Ashwini R. Sehgal, M.D.; David U. Himmelstein, M.D.; Steffie Woolhandler, M.D., M.P.H., Annals of Internal Medicine, published online ahead of print July 21, 2020.