Governor Baker, Here's How to Mitigate & Prevent COVID in Housing

March 30, 2021

The Honorable Governor Charlie Baker
Massachusetts State House, 24 Beacon St., Office of the Governor, Room 280, Boston, MA 02133

To Mitigate and Prevent COVID in Public & Subsidized Housing

Dear Governor Baker,

I was proud to stand with you—and many friends, neighbors, and elected officials—against hatred of Americans of Asian descent in Peabody Square on March 27.

At your invitation, I am writing to share ideas for mitigation and prevention of COVID-19 in housing for elderly and disabled persons.

Today, too many people are getting COVID and some are dying in what should be a safe haven—public and subsidized housing for the elderly and disabled. These tragedies are largely preventable by improving policies at the state level and in the housing community. Where there are clear rules and boundaries, and penalties for anti-social behavior, we see a lower rate of infection. When everyone who manages, lives in, or works in residential settings complies with masking, distancing, personal hygiene, and sanitizing high-touch surfaces, we can be safe.

We have identified two problems that can lead to the spread of COVID and propose simple remedies for them; these are basic public health and management concepts. You and your administration may be able to resolve these issues by executive action.

•  We need aggregated site-specific data on COVID-related infections in public and subsidized housing to mitigate and control infection.
• Oversight: landlords as well as tenants must be held accountable for compliance with public health mandates and best practices.

Aggregated site-specific data is essential

Infectious disease control in public health works by identifying and isolating cases to prevent further infections. Residential settings for elderly and disabled persons may have different conditions and rates of infection than in other types of housing. The situation in such housing, while less conducive to the spread of infection than in a nursing home, nevertheless poses a high risk because of the inevitable interactions among staff and tenants in the public areas of the facility.

Unless everyone who lives or works in those settings complies with masking, distancing, personal hygiene, and sanitizing high-touch surfaces, no one can be safe. This is the meaning of community.

Despite my extreme caution and seclusion, I became infected in my home at Fairweather in Peabody, because some tenants and management where I live failed to follow the mandates and best practices. Similar problems resulting in infections and death are found in Salem Public Housing, and in other elderly/disabled housing facilities. If the 9% of people infected where I live were typical of the 92,000 residents of public and subsidized housing, we might be looking at about 8,000 cases. And at present, we can’t even count cases reliably.

We lack the ability to map COVID infections in public and subsidized housing. We need site-specific, anonymous aggregated data, so we can better identify a problem situation and intervene. This information would enable heightened awareness and action by tenants and management as well as by public health officials to limit the spread of COVID, support those who may be ill or in quarantine, and to reinforce compliance. And by identifying successful communities, we can identify best practices that can be emulated elsewhere.

Such data is already available to the Department of Public Health and to local health departments. However, it may only be released to first responders, following the order of the Commissioner of Public Health, Monica Bharel. https://tinyurl.com/y6tmju92

We must balance privacy concerns with the overriding need to protect the lives and well-being of the community during the COVID emergency.

HIPAA applies to the disclosure of personal health data by specific categories of health care professionals. The law allows public health departments to use and share health data in an emergency to support public health goals when allowed under state or local authorizations, such as under your emergency orders.

We already see aggregated health data published for the public, including as set forth for nursing homes and other settings under Acts 2020 Chapter 93. While your administration does not expect landlords to report on health matters, we can achieve the results of information and data transparency by using data already collected by the public health system.

I urge you to enable the publication and use of aggregated site-specific data, reporting illness and deaths related to COVID.

Oversight & accountability for compliance with public health mandates

Compliance with the emergency mandates is essential to protecting members of a housing community. When the landlord and management strive to enforce the mandates, the rate of infection can be kept down, even lower than in the surrounding municipality.

In Chelsea Public Housing, the managers set an example by masking; they have a supply of masks which they distribute to any tenant who has forgotten; and they do not hesitate to threaten eviction for those who refuse to comply. The numbers, such as I have been able to estimate, demonstrate their success.

In other settings, such as in Salem Public Housing and in Fairweather Peabody, a subsidized apartment building, the numbers reflect the failure of the housing providers to encourage and enforce compliance. Some tenants flout the rules, others simply fail to mask and distance, thus endangering themselves and their neighbors. And this continues, even while their neighbors are infected and die. 

Health departments should be actively engaged in assisting management and tenants, and where necessary, doing oversight and applying sanctions to tenant or landlord alike.

Thank you for your consideration and for what you do.

Sincerely,

Jerry Halberstadt, Coordinator, Stop Bullying Coalition

Bonny Zeh, Co-founder, Stop Bullying Coalition
Lori Bermani, tenant at Charter St., Salem Public Housing
Michael Siegel, MD, MPH; Professor, Department of Community Health Sciences, Boston University School of Public Health

Call to action

I was able to speak to Governor Baker to explain the reality as we experience it, and I urged action that can protect those of us who live in public and subsidized housing for the elderly and disabled. I followed up at his invitation with the letter which is included in this newsletter. Let us hope he will act---indeed, let us all follow up and call or write to the Governor and our legislators demanding immediate action.

Advocate with facts

One way to change policy is to provide good data. I was able to get the attention of Governor Baker by telling him facts that surprised him, facts that I could demonstrate. Today, we don't know how bad the epidemic is in housing. As residents of public and subsidized housing throughout the Commonwealth, our observations and reports can help replace the vacuum of official data. Use your best estimate of COVID infections and deaths among tenants and staff in your housing facility, and let me know so I can include in our research and advocacy efforts. Of course, your identity is confidential. Please take a few minutes to do the Little Red Hen Survey https://tinyurl.com/y6t68h8u  The survey program is a bit quirky, be sure that the required questions marked * are filled. 

Background

When you appointed me to the Commission on Bullying I was able to  undertake and lead research to help advance our understanding of the causes of bullying in housing, and to identify some of the factors that can make a housing community either healthy or toxic. When the COVID-19 pandemic struck, our coalition shifted focus to protecting the elderly and disabled tenants of housing from infection. I found, by comparing housing communities, that some of the same factors we saw in bullying also were important in determining success in preventing COVID.

The issues in both bullying and managing COVID are social, interpersonal relationship and community issues.

And that means that the governance of the residential unit, which is primarily a responsibility of the landlord and management, ideally with collaboration of tenants, determines the outcome. When there are no clear rules and boundaries, and no penalties for anti-social behavior, we see bullying; and where managers fail to protect their tenants from bullying and from COVID, the outcome is a higher rate of infection.  Where landlords and managers work to protect their tenants from bullying and from COVID, the outcome is clear: tenants are less likely to get COVID.

People are more likely to comply with masking and other protocols designed to keep everyone safe, if they are part of a community that cares for each other. The policies and the inaction of some landlords and a few tenants can prevent the development of a healthy, mutually supportive community.

Effective oversight and accountability is lacking in the public and subsidized housing environment. When landlords ignore their responsibilities under the law and the lease, we need to hold them to account.

Resources

Commissioner Monica Bharel, “ORDER OF THE COMMISSIONER OF PUBLIC HEALTH REGARDING THE SHARING OF CRITICAL INFORMATION WITH FIRST RESPONDERS”
https://tinyurl.com/y6tmju92

U.S. Department of Health and Human Services, Office for Civil Rights, BULLETIN:  HIPAA Privacy in Emergency Situations
https://tinyurl.com/5eywcep5

“Persons at risk of contracting or spreading a disease. A covered entity may disclose protected health information to a person who is at risk of contracting or spreading a disease or condition if other law authorizes the covered entity to notify such individuals as necessary to carry out public health interventions or investigations.” Disclosures for Public Health Activities  45 CFR 164.512(b) https://tinyurl.com/55xwd4vv

Stop Bullying Coalition: https://StopBullyingCoalition.org

“We’re Here to Help”
https://stopbullyingcoalition.org/chelsea

Vaccine Day at Peabody Fairweather
https://stopbullyingcoalition.org/vaccination
Adventures With COVID-19 & Vaccination https://stopbullyingcoalition.org/adventures

Are We Safe Now?
https://stopbullyingcoalition.org/safety

Stop COVID in Elderly Housing
https://stopbullyingcoalition.org/stop-covid

Competence and Compassion In Housing
https://stopbullyingcoalition.org/compassion

Legislation to Protect Tenants from COVID
https://stopbullyingcoalition.org/amend-chapter93

Community Norms, Social Distancing & Bullying
https://stopbullyingcoalition.org/norms