How Elderly & Disabled in Housing Can Fight the Virus Covid-19

Image of COVID-19 virus showing spikes that seem like a 'crown'

Introduction

We provide information about the risks of COVID-19 to the elderly and disabled living in public and subsidized housing; steps that each person can take; and best practices & protocols that should be followed by landlords and local housing authorities.

COVID-19 stands for COronaVIrus Disease, 2019

COVID-19 is extremely dangerous to the elderly and those living with certain medical conditions, including lung disease, heart disease, or diabetes.

The best course of action is to avoid contracting the disease. We can reduce transmission in the community by reducing contact between individuals including self-isolation, social distancing, and by heightened hygiene.

The official and accepted terms are SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) when referring to the virus or infection and COVID-19 (coronavirus disease 2019) when referring to the disease or symptoms. We use COVID-19 to refer to the virus and the disease.

We provide references and links to sources because their information and advice may change daily; rely on those sources. Some key agencies provide free email updates.


Updated: March 21, 2020, 19:00, ET  Added article by Frieden.

Updated: March 22, 2020, 22:00, ET  References to NYT articles on national policy and need for aggressive controls; UK shielding policy

Updated: March 23, 2020. 13:00 Et Preventing the Spread of COVID-19 in Retirement Communities and Independent Living Facilities (Interim Guidance) from the CDC


CDC Provides Guidance for Elderly/Disability Housing

This guidance is for owners, administrators, operators, workers, volunteers, visitors, and residents of retirement communities and ILF that are not healthcare facilities. [The guidance covers] public housing for low- to-moderate income elderly.

The guidance document provides checklists for landlords and tenants. We urge you to read, apply, and share that document.

CDC also provides valuable advice on dealing with the stress that comes from isolation and the threat of disease.

Stress and Coping

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger. Source: Manage Anxiety & Stress, CDC 

Maneje la ansiedad y el estrés


Let's take this threat seriously.

The mortality data so far indicates a range of deaths at from 3.6% to 14.8% in people aged 60-80+ who have the virus. The Center for Systems Science and Engineering at JHU is tracking the COVID-19 spread in real-time.  As of March 18, 2020, 3:33 PM, they report a worldwide total of 214,894 confirmed cases, 8,732 total deaths, and 83,313 total recovered. The mortality rate is about 4%.

However, another report proposes that COVID-19 is possibly almost as deadly as the 1918 flu pandemic.

CDC Report for United States

This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years.

What are the implications for public health practice?

COVID-19 can result in severe disease, including hospitalization, admission to an intensive care unit, and death, especially among older adults. Everyone can take actions, such as social distancing, to help slow the spread of COVID-19 and protect older adults from severe illness.

Source: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. ePub: 18 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e2external icon.


More Aggressive, Science-based National Policy Needed

There is a chance to stop the coronavirus, according to experts who have first-hand experience with pandemics, according to a report by Donald G. McNeil Jr. in the New York Times.

But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.

In interviews with a dozen of the world’s leading experts on fighting epidemics, there was wide agreement on the steps that must be taken immediately.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

The value of very aggressive, well-designed intervention is shown in projections comparing different levels of intervention. The potential differences are dramatic, as show in models developed by researchers at Columbia University. Severe measures to control the spread of the virus have a better chance of limiting the disease. See: Coronavirus Could Overwhelm U.S. Without Urgent Action, Estimates Say

Extreme Isolation Advocated to Save Elderly and other At-Risk Persons

The public health service in the UK is initiating a 12-week period during which elderly and others at heightened risk will be isolated, and food and other services will be brought to their homes. See: Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19. 21 March 2020


What to do in housing communities?

What about best practices in public and subsidized housing?

Even the best resources on COVID-19, such as the CDC, do not give any specific guidance for the type of facility like those in public and subsidized housing: an apartment building with a single elevator and one entrance to the facility; common or public areas, including areas for social activity, laundry room, etc.

Aggressive and appropriate interventions to protect residents and staff from COVID-19 are essential to the health and safety of 92,000 elderly and disabled persons living in 1,400 public and subsidized housing developments throughout the state.

Based on the most authoritative sources responsible for the public health, we have assembled some basic information including best practices for individuals and landlords, including local housing authorities, of public and subsidized housing.

Landlords have authority over common/public areas in housing, and they have a legal responsibility for providing safe and sanitary housing. We need to make sure that they will do what is needed to protect their elderly and disabled tenants as well as their staff.


Who is at Risk

The elderly who are infected are at increased risk of complications or death from COVID-19, and the risk rises with age.

Persons with another health condition who are infected are at increased risk.

Older adults and people of any age with certain serious underlying medical conditions like lung disease, heart disease, or diabetes are at higher risk for developing more serious complications from COVID-19 illness and should seek care as soon as symptoms start. Source: Caring for someone at home; CDC

Problem:

Contagious diseases like a cold or virus are transmitted by direct personal contact: shaking hands, hugging, kissing; coughing and sneezing (airborne droplets) and by touching surfaces that are touched by an infected person, such as door handles, elevator buttons, etc.

Solution:

Keep at least 6 feet away from all other persons. If you have a cough or a fever, don't go out; do call your doctor or other medical resources for advice. Wash your hands and use a hand sanitizer when you can't wash.

Mass. Emergency Information; Emergency source for hand sanitizer, pharmacies.

The general public may visit a participating pharmacy on a walk-in basis and purchase compounded OTC hand sanitizer. The compounded OTC hand sanitizer may be sold in the front store. The Board expects pharmacies and pharmacists to price products fairly, to use judgment to avoid bulk sales that may result in hoarding or resale, and to uphold the integrity of the profession during this emergency.

Problem:

COVID-19 can remain on surfaces for hours or days and cause infections.

[Several experts affiliated with reputable institutions] investigated the stability of viable HCoV-19 on surfaces and in aerosols in comparison with SARS- CoV-1. ...We found that viable virus could be detected in aerosols up to 3 hours post aerosolization, up to 4 hours on copper, up to 24 hours on cardboard and up to 2-3 days on plastic and stainless steel. Source: Neeltje van Doremalen et al, Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1,  https://doi.org/10.1101/2020.03.09.20033217

Solution:

Cover your cough, keep 6 feet away from others, avoid touching surfaces that may be contaminated, and wash or sanitize your hands frequently. Make sure that your landlord does cleaning and sanitizing of high-touch surfaces several times a day.


What Tenants Can Do to Protect Themself and the Community

  • self-isolation
  • social distancing
  • heightened hygiene

The basic ways for an individual to protect themself is to maintain a distance of at least 6 feet from other persons, to be careful about touching surfaces that could harbor the virus, and to use hand sanitizer and to wash hands often. Avoid shopping, public transport, gatherings and stay at home to minimize possible exposure. As far as responding to someone who is ill, if someone appears ill with a fever or respiratory illness, bystanders should try to remain approximately 6 feet away until such time as the ill person can be transported for medical care by personnel wearing appropriate personal protective equipment.

You can protect yourself and others by acting as if you had COVID-19, and that everyone else around you has it.

Share good information, not gossip and rumor, with your neighbors.

Insist that the housing authority/landlord and management use best practice protocols to help prevent spread of infection.

Seek appropriate support and intervention if your neighbor has an urgent need for food, health care, etc.

Build your own support community/network locally. Use your phone, cell phone, computer, and internet tools:

  • zoom, free online meetings with video
  • signal: free; texting and phone/video calls, group texting, secure communications
  • facebook & other social media: avoid if possible, these media tend to have a lot of wrong information and a lot of nastiness
  • Hear what the Rotterdam Philharmonic does while in isolation: https://bit.ly/33Evh1T

Society Has Responsibilities

In order to limit their circulation in public and stay home as much as possible, older adults may need assistance and support from employers, government, the private sector and younger individuals to help with food and necessity deliveries, assist with telework connections, and otherwise help facilitate online ways of connecting.

Seniors also need targeted and specific advice for how to protect themselves in the event that they do have to go out – such as frequent handwashing, consolidating trips, avoiding indoor places where people gather, using hand sanitizer and running errands during off-hours. Source: Jennifer Nuzzo & Tara Kirk Sell: Here’s how to help protect elderly from coronavirus


What Landlords & Managers Must Do

None of us have had to confront this challenge to our daily routines and the level of threat posed to housing staff as well as those of us who are elderly and with underlying medical conditions. Landlords can help by providing information, guidance, and by instituting increased levels of cleaning and disinfection. Please do provide ongoing updates to the tenants, in all the languages they use, via your website and in notices distributed in the buildings. Survival at this time is a community responsibility, even though we can't assemble together.

The common areas, including the elevators and stairways, are likely sources for spreading the disease. Surfaces that people touch such as the elevator buttons can harbor the virus and spread to the next persons.

  • Can you make available tissues on each floor that people can use to prevent hand contact with the controls of the elevator?
  • Can you have the elevator cleaned or disinfected several times a day?
  • Can you provide disinfecting wipes, rubbing alcohol, or hand sanitizer at key points, as is done in many public settings?
  • What about some guidance for what to do if someone is ill and needs assistance short of an ambulance? How to help without becoming a victim?

Best Practices

We have protocols from two landlords. CHAPA held a very useful online meeting for over 100 professionals and others in the housing field.  Amy Schectman, President & CEO, 2lifecommunities, described their protocol.

Protocol, 2lifecommunities

  • Restricting Access: As of Monday, March 16, our buildings will be closed to all outside visitors, except for health- or essential-service-related personnel.
  • Hygiene: We have installed additional hand sanitizer stations throughout all of our campuses and request everyone coming into the building to use upon entry. We have posters in multiple languages encouraging frequent (and 20-second-sustained) handwashing, respiratory hygiene (coughing/sneezing into tissues, elbow nook) and other tips for our residents.
  • Disinfecting: We have increased the hours for professional cleaning and disinfection in all public spaces, with specialized high-power equipment, including adding weekend hours. We have shifted maintenance personnel from routine tasks to disinfecting ones.
  • Employee Health: We are instructing staff to stay home if any symptoms occur and to practice extra levels of hygiene if here.  For people whose job can be conducted from home, we are recommending they do so and providing support to make that possible.
  • Social Distancing: For our residents and staff – only offering programs where 6 feet between people is possible and transitioning meetings to video or phone conferencing.

Preservation of Affordable Housing

POAH is a national nonprofit organization whose mission is to preserve, create and sustain affordable, healthy homes that support economic security and access to opportunity for all. In response to our questions, Aaron Gornstein, President, and Julianna Stuart, Vice President of Community Impact shared their protocols and asked for our help in informing tenants.

COVID-19 NOTICE TO RESIDENTS

Updated March 16, 2020; CHECK FOR UPDATES

The safety and health of our residents and staff is our top priority. During this time of uncertainty related to the Coronavirus, we are taking measures recommended by the Centers for Disease Control and Prevention (CDC) to protect all POAH buildings. We also ask all residents to take important steps to help limit the spread of germs.

What We Are Doing:  

  • Enhanced cleaning. We have increased the number of times each day that we clean all common areas of our buildings. We use the CDC-recommended disinfectant cleaners most effective against the coronavirus that causes COVID-19. All staff will wash their hands regularly and use Personal Protective Equipment, such as gloves.  Where possible, staff coverage will be modified to allow for enhanced cleaning procedures daily.
  • Promoting “social distancing” to limit interactions. While one-on-one interactions are still safe to have according to the CDC we have asked staff to limit close social interaction by meeting with residents by appointment only. We will postpone any group gatherings until further notice. In the case of emergency or immediate need we will make a conscious effort to reduce close contact while still offering the highest level of service to you.  Amenity spaces such as exercise rooms, libraries and lounge spaces will be closed.  Laundry facilities will remain available for your use.
  • Regular communication to residents.  The Coronavirus / COVID-19 situation is rapidly changing. We will sending flyers with updates and post the latest information to this website.  We will also utilize text and email messaging. You will receive a postcard with which to provide POAH Communities an updated phone number and email address to ensure more rapid communication.
  • Work Order Management.  During this time, Maintenance Supervisors and Technicians will only address emergency and safety related work orders.
  • Limited Access: Our buildings will soon display signage that discourages all outside visitors, except for caregiver/immediate family, health or essential service-related personnel.

What You Must Do:

POAH Communities will do everything we can to promote and protect the health and safety of residents. We ask that you join us in taking proactive steps to limit the spread of germs.

  • Limit your guests. We ask all residents to limit their guests to essential caregiver/immediate family, health or essential service-related personnel. This is to promote the health and safety of all residents. Please have all guests come directly to your apartment.
  • Practice personal hygiene. Wash your hands, cover your cough or sneeze, clean and disinfect surfaces in your home, avoid touching your eyes, nose and mouth. Stay home when you are sick, except to get medical care.
  • Limit your interactions. By avoiding close interactions with others, you can help limit the spread of germs. Avoid crowds or gatherings. At this time, the CDC suggests canceling mass gatherings of any size.

Thank you for working with us to stop the spread of germs and promote the health of all residents and staff.  If you have any questions, please contact your property manager.

COVID-19 Information, March 16, 2020  THE PLAN

POAH Communities is responding actively to mitigate the threat that the COVID-19 virus poses to our residents, our staff, and the communities we serve. To coordinate that response across our properties, we have implemented the following plan of action.

Protocol of POAH communities for COVID-19, March 16, 2020 CHECK FOR UPDATES

Task Force & Communications:  We have created an internal COVID-19 Task Force which will manage ongoing response and coordination including:

  • Communicating with residents through text messaging and emails
  • Providing resource documents for property managers to distribute to residents who need to access assistance from public health department, nearest hospitals, food and household supplies, counseling services, etc.

Education:  We have provided staff and residents information regarding the transmission of the virus including:

  • CDC publications in relation to COVID-19 which can be found online here
  • CDC information for  on-site teams on how infectious diseases can spread along with OSHA’s “How to Protect Yourself in the Workplace during a Pandemic”

Site Cleaning and Hygiene:  We have implemented an enhanced cleaning regime and provided methods to promote proper personal hygiene and the use of personal protective equipment including:

  • Providing hand sanitizing stations for all senior properties
  • We have instructed the on-site teams to purchase and wear personal protective equipment (PPE) as needed.
  • We have developed and trained on-site teams on an enhanced property cleaning protocol to be utilized at all sites.  The maintenance team is focusing on enhanced cleaning of common areas and follow proper cleaning protocol.
  • We have instituted protocols for staff to stay at home if they are ill and providing for remote work from home

Social Distancing:  We have provided guidelines for interactions and social distancing between our staff and residents and other members of the public including:

  • Limiting close social interaction with residents and appointment-only basis in the case of emergency
  • Policy for maintenance supervisors and technicians to address only emergency and safety related work orders
  • Policy instructing residents to limit access to all outside visitors, except for caregiver/immediate family, health or essential service-related personnel.
  • Restricting access to community rooms, computer rooms, or exercise rooms at properties until further notice. 

We commit to continuing to provide our residents with timely and useful information and professional handling of all situations related to this crisis.

Aaron Gornstein, President & CEO, POAH


DHCD: Public housing

See DHCD Guidance for Local Housing Authorities


Resources/Links

We provide references and links to the sources because their information and advice may change daily; rely on those sources.

CDC Centers for Disease Control & Prevention  Authoritative Information

WHO: INTERNATIONAL REPORTS AND INFORMATION

Johns Hopkins, Resources and Updates

COVID-19 Affordable Housing Updates

Guidance for Owners & Managers of Multifamily Residential Properties - Nixon Peabody

DHCD Guidance for Local Housing Authorities

Interim Environmental Cleaning and Disinfection Recommendations for US Community Facilities with Suspected/Confirmed Coronavirus Disease 2019 (COVID-19)

COVID-19 FAQ for Public Housing, Housing Choice Voucher, and Native American Programs


Coronavirus Resource Center

Coronavirus Resource Center

Massachusetts: Updates, emergency orders, and guidance associated with the COVID-19 State of Emergency

In Massachusetts: Need Help Fast?Get the answers you need!   It's Free.  Confidential.  Multilingual. Dial 2-1-1 or search online.

Mass. state information

Who is at higher risk?

COVID-19 is a new disease and we are learning more about it every day. Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more serious complications from COVID-19.  Based upon available information to date, those most at risk include

  • People 65 years and older
  • People who live in a nursing home or long-term care facility
  • People of any age with the following underlying medical conditions, particularly those that are not well controlled
    • Chronic lung disease or asthma
    • Congestive heart failure or coronary artery disease
    • Diabetes
    • Neurologic conditions that weaken ability to cough
    • Weakened immune system
    • Chemotherapy or radiation for cancer (currently or in recent past)
    • Sickle cell anemia
    • Chronic kidney disease requiring dialysis
    • Cirrhosis of the liver
    • Lack of spleen or a spleen that doesn’t function correctly
    • Extreme obesity (body mass index [BMI] >40)
  • People who are pregnant

Additional important information and advice from CDC.

Data and Statistics on Covid-19  This page will be updated regularly at noon Mondays through Fridays. Numbers close out at 4 p.m. the day before reporting.

CCDC: Surveillance programme (PDF)
CCDC: Epidemiological investigations (PDF)
CCDC: Contact tracing (PDF)
CCDC: Laboratory diagnostics (PDF)

Pandemic | Ready.gov

Coronavirus Disease 2019 (COVID-19) | CDC
Coronavirus Disease 2019 (COVID-19) Peer-Reviewed Publications (list maintained by the CDC)

Massachusetts

Daily updates on situations related to the covid-19 situation, State House News, free

COVID-19 Cases, Quarantine and Monitoring

Information about COVID-19 cases and residents subject to quarantine in Massachusetts, testing at the State Public Health Laboratory, and guidance for clinical laboratories.

Understanding the science

Why outbreaks like coronavirus spread exponentially, and
how to “flatten the curve”
Has some nice visual displays to help explain the models used to better understand the policy options.

How fast does the Covid-19 spread?

This is a simplified model of an epidemic. The main factor, the rate a disease is able to spread through a susceptible population, is called the basic reproductive number, or R0. For a new disease, like covid-19, almost everyone in the population is susceptible — a prime scenario for an epidemic.The basic reproductive number (R0) of the virus causing covid-19 is estimated to be 2.3, meaning that each person infected with the virus will spread it to 2.3 others, on average, over the course of their illness. This simulation shows a virus with an R0 of 2.3 in a completely susceptible population....Quarantines and personal hygiene work to slow an epidemic by limiting the ability of infectious people to spread the virus to others.

Models that inform current policy

Worst-Case Estimates for U.S. Coronavirus Deaths Projections based on C.D.C. scenarios show a potentially vast toll. But those numbers don’t account for interventions now underway.

White House Takes New Line After Dire Report on Death Toll  Federal guidelines warned against gatherings of more than 10 people as a London report predicted high fatalities in the U.S. without drastic action.

2019-nCoV: preliminary estimates of the confirmed-case-fatality-ratio and infection-fatality-ratio, and initial pandemic risk assessment Mike Famulare (Institute for Disease Modeling)

What do we call it?

WHO CRITICIZES STIGMATIZING LANGUAGE At yesterday’s WHO COVID-19 press conference, a senior WHO official denounced the use of stigmatizing language and terminology with respect to COVID-19 and other diseases. Mike Ryan, Executive Director of the WHO’s Health Emergencies Programme, noted the importance of adhering to the accepted and appropriate terminology for infectious diseases in order to reduce the stigma and negative connotations for individuals and populations associated with slang terms. The comments follow recent pushback against the repeated use of unofficial and stigmatizing terms, including by US President Donald Trump.

The official and accepted terms are SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) when referring to the virus or infection and COVID-19 (coronavirus disease 2019) when referring to the disease or symptoms.

These terms were selected based on existing WHO guidance, which aims to reduce stigma associated with a particular place, group of people, animal, or others that was common under historical virus and disease naming practices that often referred to how or where they were first discovered.

Source: March 19, 2020 Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.  jhu.edu

Caution

This is information assembled from a variety of sources. We are not qualified to give advice, so use your own judgement and go to the sources we have listed. The situation is changing rapidly and experts are scrambling to understand the actual situation and to interpret it, and to provide updated and improved models and solutions.

We provide references and links to the sources because their information and advice may change daily; rely on those sources.

Take care!

 

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