Safe havens key to fighting COVID-19

Housing inequities lead to racial disparities

EARLIER THIS YEAR, Alex, a grocery store cashier in Boston, lost his apartment and moved into a small home shared by his parents and his brother’s family. When Alex’s brother developed a fever and cough, likely indicating COVID-19 infection, lack of bedrooms made isolation and self-quarantine impossible. Complicating matters, Alex’s cashier job was deemed “essential” and staying home meant loss of income and possibly his job. Alex had no good options for protecting both his health and his livelihood.

This situation played out over and over again in Chelsea, Malden, Everett, and Revere, communities with some of the highest rates of COVID-19 infection in the commonwealth. A household member was the likely source of infection in about one-third of all confirmed COVID-19 cases in these communities.

We are not alone in this pattern of housing inequity impacting health; studies from New York and Californiasuggest that crowded housing increases risk of COVID-19 transmission three-fold.  Racial inequalities in housing conditions are likely contributing, in part, to significant racial disparities in COVID-19 infection ratesthat have been observed in Boston and across the nation.

Now is the time to tackle these disparities and prepare for the next wave of COVID-19 cases. Several key steps must happen immediately:

  • Expand testing:  Make it possible for entire households to be tested close to home, ideally with a rapid diagnostic test that gives quick results.
  • Create safe havens: Offer individuals who have been exposed to COVID-19 a private room and bath for self-quarantine until their ill family member at home returns to health. This reduces risk for those with underlying health conditions, limits transmission from community spread, and likely speeds the return to work. To further the return to work goal, those who quarantine in a safe haven could shorten their voluntary isolation and return to work sooner if COVID tests repeatedly return negative.
  • Improve management of COVID-19 in the community:  If a safe haven guest tests positive, they would return home to complete their recovery with the support of a coordinated program for management of COVID in the community. If negative, they could be clustered elsewhere and resume work until it is deemed safe for their ultimate return home.
  • Create a monetary stipend for safe haven residents:  Early experiences with self-isolation sites showed that basic economic needs outstripped public health concerns. A stipend could serve as an additional incentive and supplement any lost income or other hardships the household is facing due to COVID.
It will also be critical to partner with communities in designing safe havens to build trust and ensure that these facilities actually meet the needs of the people they are intended to serve. And, of course, safe havens will go unused if residents are not granted respect, autonomy, and assurance that immigration status will not be assessed.

Though this approach might seem costly,  avoiding COVID-19 infections (with a treatment price tag of $3,045 per infection and up to $15,000 if someone is hospitalized) is fiscally prudent. The financial justification is even stronger when we add the tremendous economic costs of broad-based lockdowns which must be relied upon whenever more targeted public health measures aren’t successfully implemented.

These are critical short-term steps for reducing COVID-19 infections, but we should not miss this opportunity to treat the underlying conditions shaping this condition in the first place. Looking ahead, there is an opportunity to expand upon recent rental assistance policies and pandemic eviction moratoriums, with the goal of improving access to affordable housing, eliminating structural racism in the US housing system, and rebuilding our public health infrastructure.

Meet the Author

Lou Ann Bruno-Murtha

Division chief of infectious diseases, Cambridge Health Alliance
Meet the Author

Kirby Erlandson

Fourth year graduate student MD-MBA, Harvard University
Meet the Author

Assaad Sayah

CEO/Commissioner of public health, Cambridge Health Alliance/City of Cambridge
We know that socioeconomic factors like housing and employment have a tremendous impact on one’s physical health, and COVID-19 is just our most recent example. Addressing unsafe housing and working conditions is a critical part of containing COVID-19 and preparing for future pandemics.

Lou Ann Bruno-Murtha is the division chief of infectious diseases at Cambridge Health Alliance, Kirby Erlandson is a fourth-year joint Harvard MD-MBA graduate student, and Dr. Assaad Sayah, is CEO of Cambridge Health Alliance and the commissioner of public health for the city of Cambridge. All three are members of the city of Cambridge’s COVID-19 expert advisory panel.