We can't relax as everyone reopens

Preventing hospitalization, death from COVID-19

Those of us who are elderly and/or disabled are at increased risk for COVID-19, especially those who live in public and subsidized multifamily housing, do now seek effective public health measures.

We must speak out at this time of the ongoing COVID-19 epidemic out of concern for the well-being of tenants of public and subsidized housing for elderly and disabled residents.

We can't relax as everyone else reopens

With the general "re-opening," many people will feel it safe to relax public health measures. But as long as there are any cases in the community, the highly contagious COVID-19 remains a serious threat to elderly and disabled people. A vaccine is a year or more in the future, and existing treatments offer little relief. So prevention of infection is key to survival.

The CDC reports that elderly people, especially those with underlying medical conditions including cardiovascular disease, diabetes, and chronic lung disease, who have COVID-19 infections, have high rates of hospitalization and deaths.

"Prevalence of reported severe outcomes increased with age; the percentages of hospitalizations, ICU admissions, and deaths were highest among persons aged ≥70 years, regardless of underlying conditions, and lowest among those aged ≤19 years. Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported. These findings are consistent with previous reports that found that severe outcomes increased with age and underlying condition, and males were hospitalized at a higher rate than were females."

"These findings highlight the continued need for community mitigation strategies, especially for vulnerable populations, to slow COVID-19 transmission."(1,2)

The main way the infection is spread is through aerosols, droplets from speaking, coughing, and sneezing and these drops carry the virus through the air.

"The virus that causes COVID-19 is spreading very easily and sustainably between people...the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread."

Protect yourself and others

"The best way to prevent illness is to avoid being exposed to this virus. You can take steps to slow the spread.

The importance of community norms

Ideally, management and tenants work together to follow the best practices for preventing infection, including controlling access to the institution, cleaning and sanitizing all high-touch surfaces in public areas, maintaining social distancing, masking, and personal care including hand sanitizer and hand washing. The key to this effort lies in the relationships among housing provider, management and staff, and residents.

Community norms can either promote a healthy, caring community or lead to a toxic community that is harmful. In public and subsidized housing for the elderly and disabled, failure to control bullying and mobbing (group bullying) creates a toxic community, while failing to prevent transmission of COVID-19 can create a deadly situation. Among the factors that may influence community norms and adherence to those norms are the goals and methods of several actors—norms of the local municipality, the landlord or local housing authority, the management and staff, and tenants, including tenants associations.

One method of management to maintain community norms is compassionate: establishing trust and improving communication and understanding.

Another method is assertive: intervening to stop inappropriate behavior by warnings and sanctions.

A flexible selection of the appropriate method in a specific context is the best approach.(4)

Dealing with existing infection

We tenants, as well as providers of our housing, need to know when there are infections where we live. All of us—elderly and disabled residents, as well as providers of our housing—need information to take control of our lives. We have seen how the failure of oversight and transparency allowed infections to take the lives of veterans, elderly, and people with special needs. We have also seen how even a short delay in diagnosis and response can result in many more people becoming infected. This can be prevented in public and subsidized housing if we act on information in a timely way.

If a case of COVID-19 is found,  the housing provider and the local health department should make redoubled efforts to stop further spread, possibly including the use of enforcement powers to assure that both tenants and the housing provider comply with public health directives; as well as education and frequent reminders. In addition to confidential contact tracing, we believe that it is imperative for the housing provider and tenants to know when a tenant or staff member is diagnosed with COVID-19. The identity of that person does not need to be shared publicly, and management can target needed resources to prevent further infection and to support the person who is sick.

Some "best practices" are developing for managing infection in independent and assisted living facilities for elderly and disabled. When COVID-19 is found in the facility, these measures have demonstrated they prevent further transmission. And they have demonstrated value in preventing infection.

  • An effective step is to drastically limit social interactions, which may be mandated by the local health department.
  • Free testing for all staff and tenants should be made available on site.
  • A number of support services are essential to enable people to stay home, i.e., food shopping, meals, laundry, emotional and social support.
  • Social distancing, cleaning and sanitizing the facility (EPA list of disinfectants), using masks, hand sanitizer and/or hand washing.

Leaders who have spoken on this issue at online meetings of Affordable Senior Housing and COVID-19 include Leslie Reid, Madison Park Community Development; Kim Brooks, Hebrew SeniorLife; and Amy Schectman at 2life Communities. (5)

Advocacy for greater transparency

The Stop Bullying Coalition is advocating for legislation that will enable providers of housing, their staff, and tenants to work together on the basis of the best available information. See: http://stopbullyingcoalition.org/S2753

Knowing that there is an infection can lead to a renewed effort to prevent further infection and to improved collaboration. The nearby threat of this disease tends to focus the attention and change behavior. We urge the legislature to enable this vital information to be shared in a timely way. Public health is not about documenting what has happened, it is a way to document events in real time and take proactive action to prevent the spread of disease.


(1) CDC, How COVID-19 spreads, https://tinyurl.com/ybl6nkql

(2) CDC surveillance report: Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2

(3) Lena H. Sun, Patients with underlying conditions were 12 times as likely to die of covid-19 as otherwise healthy people, CDC finds, The Washington Post,

June 15, 2020. https://www.washingtonpost.com/health/2020/06/15/patients-with-underlying-conditions-were-12-times-more-likely-die-covid-19-than-otherwise-healthy-people-cdc-finds/

(4) Jerry Halberstadt, Community Norms, Social Distancing & Bullying

(5) The weekly online meetings of Affordable Senior Housing and COVID19 are hosted by Leading Age Massachusetts, CEDAC, the Department of Housing and Community Development (DHCD), Executive Office of Elder Affairs (EOEA), and MassHousing continue to discuss COVID19 areas of interest for those who manage affordable senior housing.  SeniorHousingCOVID19@mass.gov

To register for the listserv, go to https://tinyurl.com/yc9sulws

Recordings of meetings at Affordable Senior Housing and COVID-19. www.leadingagema.org/ashcalls

Detailed protocols

Kim Brooks, Chief Operating Officer, Senior Living, Hebrew SeniorLife. See: https://www.hebrewseniorlife.org/covid-19/resources-senior-care-organizations

Amy Schectman, President and CEO at 2life communities: 2Life Communities Protocols