To Avert COVID-19 Outbreaks in Elderly Housing
Tenants in housing facilities for elderly and disabled persons are at elevated risk for serious outcomes or death from COVID because their age and other health conditions make them highly vulnerable.
Prevention is the best protection. But in many housing developments, neither management or tenants enforce or follow the best practice protocols for protection and mitigation.
The potential for a COVID disaster affecting elderly and disabled tenants has escalated because of the increased level of infection in many Massachusetts communities.
The Massachusetts Department of Public Health's COVID risk assessment map as of October 29, 2020 shows that 121 Massachusetts cities and towns are now at ‘high risk’ for coronavirus spread amid a sharp rise in infections.
The heightened risk of infection in “yellow zones” — 4-8 new cases/100,000 and “red zones” — 8 and more new cases/100,000 can lead to infection within public and subsidized housing facilities in these high risk areas.
The examples of Peabody, Somerville, and Salem demonstrate the need for immediate action.
UPDATED: 20 November, 2020 with current data.
The COVID-19 daily case rate in Peabody had doubled in 20 days, from 5.5 on October 8 to 12 by the 28th of October, according to reports by Peabody Mayor Ted Bettencourt.
The continuing rise in new cases brought the current 2-week daily average incidence to 36.9. And the positivity rate per 100,000 was up to 4.82%. ---Weekly COVID-19 Public Health Report - November 19, 2020
In Peabody Fairweather, a privately owned, subsidized apartment building, a property of Preservation of Affordable Housing (POAH), with 88 units for elderly and disabled persons, neither management nor tenants has been observed to follow the protocols that are defined as best practices.
The observed failure at Peabody Fairweather of management and tenants to adopt effective prevention methods further endangers the staff as well as the tenants.
“Preservation of Affordable Housing (POAH) is a nonprofit developer, owner, and operator of more than 11,000 affordable homes in eleven states and the District of Columbia. POAH’s primary mission is to preserve, create and sustain affordable, healthy homes that support economic security, racial equity, and access to opportunity for all.”
Not following protocols in Peabody increases risk
Within the Peabody Fairweather facility, including on the grounds, masking and distancing are not universal, there are groups that congregate without masking or distancing; individuals and groups use the small elevator without masking; and there is no sanction for failure to follow these essential safety protocols.
There has been no observed effort to educate and reinforce the protocols, although rules and guidance have been posted in English and Spanish. Sometimes a manager or staff person will urge a tenant to wear a mask, but there is no known enforcement.
Testing for COVID is an important tool for surveillance, but there has been no on-site testing, although the health department is probably able to provide on-site testing.
Tenants lack confidence that high-touch surfaces in public areas are being cleaned and sanitized with adequate frequency.
In contrast to the lack of effective response to the need to protect life by protecting against COVID transmission, other public health threats are dealt with. Fairweather management inspected and treated all apartments against an infestation of roaches. Management did respond to our concern about the potential for infection if tenants were to share a community room during the treatment, and modified the treatment procedure. When a sewer line backed up and flooded several apartments, the tenants were moved to a motel while their apartments were completely cleaned and rebuilt.
Risk is high in housing
Comparable situations are reported in public housing in both Somerville and Salem, although Somerville has now acted to advise and warn residents on following the protocols for protection.
Fairweather management oversees similar buildings for elderly and disabled in Danvers, Beverly, and Salem. Each of these municipalities has significant levels of COVID.
UPDATE: The average daily incidence rate per 100,000 for each municipality mentioned in this writing as of 29 October is reported by MassLive.by And these rates had risen dramatically by November 19, 2020.---Weekly COVID-19 Public Health Report - November 19, 2020
29 October ~ 19 November
Peabody, 13 (high risk) ~ 36.9
Beverly, 11 (high risk) ~ 26.3
Danvers, 9 (high risk) ~ 24.9
Salem, 7 ~ 41.6
Somerville, 7 ~ 26.5
“I live in an 80-unit, medium rise, federally subsidized housing for elderly and the disabled run by the local housing authority. We have a group of tenants who have a history of spreading malicious gossip—their main form of entertainment—and bullying other residents. They gather by the main entrance of the building and by the mail boxes. They continue to loiter near the main entrance, even though their favorite spot has been roped off (because of COVID-19). Most of them don’t follow the COVID-19 rules as strictly as they should. Sometimes, they don’t wear masks. When they wear masks, they wear them with the mask only covering their mouths. They don't consistently practice social distancing.”
“Last week, I overheard gossip about COVID-19 in my building from the loiterers. I also heard that gossip from two other tenants. The gossip is that three residents have come down with COVID-19.”
“As of 30 October, the Somerville Housing Authority is advising residents to act as if everyone they encounter in the building has COVID-19. They advised residents to properly wear their mask, keep social distance, one person at a time in laundry room and in elevators, reminded them about hand hygiene, and warned that these rules will be enforced.”
“This is exactly what I want housing to do.”—Bonny Zeh
In an apartment building of the Salem Housing Authority, a number of persons fail to observe the protocols on masking and distancing, and despite the absence of official verification, many tenants believe that COVID infections do exist in their facility. Some tenants were tested in an on-site program, but the results are only available to the tested tenant and the public health department.
Essential protective protocols
Here are some basic infection prevention protocols based on current public health understandings:
masking in all public areas
distancing of 6 feet
avoid gatherings indoors, especially in the absence of strong ventilation to avoid aerosol transmission (aerosols are tiny droplets that can remain in the air for hours)
frequent cleaning and disinfection of high-contact surfaces in all public areas
Must-do now actions
The following actions and procedures are relevant for all public and subsidized housing for elderly and disabled persons, including for Peabody Fairweather.
Educate, reinforce, and sanction non-compliance
masking in all public areas (provide masks for all)
provide hand sanitizer dispensers at key locations and to all in individual dispensers
distancing of 6 feet
avoid gatherings indoors, especially in the absence of strong ventilation
control over visitors
enforce compliance; seek collaboration
Transparency and accountability
frequent cleaning and disinfection of high-contact surfaces in all public areas
public health department should guide and enforce all essential protective measures
Public health measures
On-site flu vaccine
Continuing frequent on-site testing for COVID
Find a way to inform management and tenants of the presence of any COVID infections, without revealing the identity of an infected person.
Appropriate support for people infected or in isolation.
Manage and deal with rumors and anxiety.
Tenants with suspected or confirmed infections can be encouraged to share this information with management to enable providing needed support to the tenant, and to better protect the community from spread of COVID.
At present, the Commissioner of the Department of Public Health does not permit local health departments from informing anyone except first responders about the address of an infection. This limitation on sharing existing information prevents rapid and effective interventions. Enabling the appropriate sharing of surveillance information should be done by administrative action; the Governor or the Commissioner of Public Health should mandate the public sharing of site-specific data.
Furthermore, landlords could make appropriate use of information about COVID infections in their facilities, including sharing that information with tenants and others to enable cooperative efforts to inhibit the spread of disease.
“[Public Housing Agencies (PHAs)] can provide notification of positive COVID-19 cases without giving the name/apartment number/other personally identifiable information to their residents and staff. PHAs generally are not “covered entities” as defined by HIPAA but should exercise discretion in communications to avoid stigma and mistreatment of residents.”—Office of Public and Indian Housing (PIH), COVID-19-Related Frequently Asked Questions (FAQs) for Public Housing Agencies (PHAs), September 29, 2020, p.46
Moral and legal responsibilities
Does a landlord have a responsibility to act in order to minimize harm? What are the obligations of the Commonwealth in respect to their support of public and subsidized housing, and in their oversight of housing safety?
There is a principal of public health that has been stated by Michael Siegel, MD, MPH, Professor of Community Health, Boston University School of Public Health. I read him as asserting that No institution has the right to expose persons to avoidable risk.
Siegel has had to confront policies of his employer, policies that could expose faculty and students to harm, insofar as in-person lectures can readily expose everyone in the hall to COVID-19 by means of virus-laden aerosols.
“One of the principles of public health practice is that when we develop policies to protect the population (whether it be a state, city, school, etc.) from recognized health hazards, we do not just protect the people who are least vulnerable to the hazard. We protect the entire population, including and especially those who are most vulnerable to the hazard.”
[In addressing an apartment building with a health hazard] Siegel asserts, “In public health, our approach would be to require the landlord to mitigate the hazard so that everyone can live safely in the apartment building.”
We must protect elderly and disabled tenants from COVID in their homes. In the face of a dramatic increase in community transmission, it is urgent that we act. Public health officials, both state and municipal, have a critical role. Landlords, managers, staff personnel, social workers, tenants, and family members must cooperate and act diligently to protect the whole community. The Governor and the legislature must act to assure the effective, rapid, and transparent access to surveillance data and must provide such additional resources as may be required to protect the health and lives of elderly and disabled tenants.
This article has been reviewed by Michael Siegel for the accurate interpretation of public health principles.
Michael Siegel, MD, MPH, is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. Siegel writes a blog detailing his objections to policies that endanger faculty, staff, and students through in-person learning, and discriminate against those who use on-line learning. He asserts that public health can be more effectively taught through on-line instruction. http://sacrificingourprinciples.blogspot.com
Follow him on Twitter at @mbsiegel
Bonny Zeh, co-founder of the Stop Bullying Coalition, contributed to this article.
The opinions expressed herein reflect those of Jerry Halberstadt and may not reflect those of all the partners of the Stop Bullying Coalition or the contributors to this article.
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