Working Together Against COVID-19 in Multifamily Housing

Jerry Halberstadt Wed, 10/21/2020 - 15:55

We must work together to mitigate—to reduce the harm, illness and deaths—that COVID-19 threatens to bring to our housing community. Our success depends on a coordinated effort where everyone works together: landlord/housing authority, management, custodians, social workers, and tenants.

The rate of infections in the surrounding neighborhood and municipality is on the rise. We who live in public and subsidized housing are not isolated from the world outside. We go out to shop, people come into the building to provide services. Each of us has their own group or network of friends, people whom we trust. But any one of us can be the innocent carrier of COVID-19.

Anyone can be infected but not have any symptoms for several days, and during that time can infect others. Any one of our best friends and neighbors can be infected. The virus is not interested in your friends or foes; the virus is only interested in finding another human being to make new copies of the virus. So every contact between us is capable of infecting us. We need to be vigilant at all times.

How does COVID infect us?

COVID is spread by airborne droplets. Even more dangerous are the aerosols—very tiny droplets carrying the virus—which can linger for hours in an enclosed space.

Anyone can spread aerosols that carry the COVID-19 virus, even a person who does not have any symptoms. The aerosols spread further than six feet, and can linger in an enclosed space that lacks ventilation. Anyone sharing that space risks being infected, even hours after the infected person has gone. In many public and subsidized housing buildings, there are elevators. Nearly everyone must use the elevator, an enclosed space that can expose them to an invisible cloud of COVID-19 aerosol droplets. This creates the potential for an explosive, rapid spread of infection throughout the residential community. Since the duration of exposure is also a factor, indoor gatherings in rooms without exceptional ventilation also create a high risk even with mask wearing because of the possibility of airborne transmission by aerosols. We base these conclusions on a summary of the recent new understandings of COVID-19 transmission by Michael Siegel, MD, MPH, Professor in the Department of Community Health Sciences at the Boston University School of Public Health. An important recent publication, Airborne transmission of SARS-CoV-2, clearly states the risk posed by aerosols.

Viruses in aerosols (smaller than 100 microns) can remain suspended in air for many seconds to hours, like smoke, and be inhaled. They are highly concentrated near an infected person, so they can infect people most easily in close proximity. But aerosols containing infectious virus can also travel more than 2 m (6 feet) and accumulate in poorly ventilated indoor air, leading to super-spreading events.

Individuals with COVID-19, many of whom have no symptoms, release thousands of virus-laden aerosols and far fewer droplets when breathing and talking. Thus, one is far more likely to inhale aerosols than be sprayed by a droplet, and so the balance of attention must be shifted to protecting against airborne transmission. In addition to existing mandates of mask-wearing, social distancing, and hygiene efforts, we urge public health officials to add clear guidance about the importance of moving activities outdoors, improving indoor air using ventilation and filtration, and improving protection for high-risk workers [and tenants] .

What do we have to do to be safe?

Everyone should

Our best defense is for every member of the community to a few simple things:

  • Wear a mask in all the common areas of the building, including in the elevator.

  • Maintain social distance of at least 6 feet, inside and out.

  • Carry and use hand sanitizer and wash hands when possible.

  • Report symptoms for evaluation to your health care team.

  • If you have been exposed to a person with COVID-19, follow public health advice for isolation.

The landlord/management/staff should

The landlord has a unique role in the effort to prevent infection because under landlord-tenant law and the concept of peaceful enjoyment, only the landlord has legal authority over the common areas of the property.

  • Frequent cleaning of all high-touch surfaces in common areas

The landlord should also take a strong leadership role, while engaging with and enlisting the input and cooperation of tenants:

  • Carry out a program to inform, educate, and to enforce masking, social distancing; wall posters and fliers are not sufficient to change habits.

Protective protocols & best practices

Empower and listen to everyone to develop universal understanding and compliance

Provide materials to support implementing protective habits. Many tenants may not be able to afford or have difficulty finding materials. But the act of providing these materials demonstrates that the landlord and management are concerned for the safety of all.

  • Provide masks

  • Provide hand sanitizer

  • Make available the contact information for all health and support services

  • Reach out to every tenant with frequent wellness checks

  • Assure that people in isolation have needed support—food, medicine, laundry, social connections by phone or internet, mental health services, etc.

  • Share accurate information while respecting privacy and confidentiality to avoid wild gossip and rumor.

  • Intervene to prevent bullying of COVID cases; engage tenants to find ways to support people who are ill (without risking direct contact).

  • Help people to see the common good that serves to protect each individual.

Local Health Department Role

The health department should actively engage in and support educational efforts, and step in with oversight to make sure that landlord and tenants are following best practices.

  • On site testing with rapid turnaround and notification to each person about their status.

  • Education and guidance for landlord and tenants on best practices

  • Enforcement to protect the community; make sure everyone, landlords as well as tenants, is following best practices and public health guidance

Beacon Hill and the administration

Our legislators have mandated the collection of data and public disclosure of infections and deaths in housing for elderly and disabled persons. However, the Governor seeks to eliminate that mandate and the Department of Public Health has not implemented the reporting. We have proposed amending the law to collect and distribute information that already exists instead of relying on reports from housing managers who often are not in a position to know about tenant health. (https://stopbullyingcoalition.org/preventing) Such reporting can enable landlords and tenants to have a realistic assessment of the risk, and for everyone to double down on efforts to protect the community while providing support for those undergoing treatment and/or isolation. Factual information can eliminate harmful gossip and rumor.

Conclusion

In multifamily housing, the COVID-19 epidemic is a threat to the health and lives of staff, managers, and tenants, as well to the financial stability of public and private landlords. If we were all to follow good public health practices we could control and even eliminate this threat—however, we are forced to work without timely, actionable information about the presence of infections.

The lack of timely, site-specific information coupled with resistance and barriers to gathering and distributing this information, demonstrates a callous disregard for the health and well-being of staff and tenants alike in subsidized housing for elderly and disabled, as well as market rate and affordable housing.

We need reliable information based on testing and collection of data on COVID-related illness and death. Surveillance is a keystone of public health. Now is the time for us to come together. Each housing community can adapt and apply the public health principles and the emerging best practices. You can help us to create a better understanding of COVID-19 prevalence and identifying what does or does not work to protect the community by doing our survey: https://stopbullyingcoalition.org/littleredhen-survey That information can be used to inform ongoing efforts to advocate for the changes needed to protect us all.

Help us survey housing to pinpoint where there is COVID, and where it has been kept out. Because none of the government agencies are doing this survey, we'll do it ourselves. Join the Little Red Hen Survey. Together we will protect our communities.

Tags

COVID-19
housing