Millions lack way to isolate with coronavirus
A study this week reports that some 25 million dwellings, home to 81 million Americans, lack the separate bedrooms and bathrooms needed to follow federal guidelines for isolating a household member sick with COVID-19.
Based on data from the American Housing Survey, the researchers concluded: “Isolation or quarantine was im
possible in 25.29 million dwellings ... accounting for 20.8% of all U.S. residential units.”
“This study resonates for us,” said Milwaukee Health Commissioner Jeanette Kowalik, referring to the city’s older dwellings, which often lack second bathrooms.
She said the city has made arrangements with some local hotels to provide temporary subsidized housing for people sick with COVID-19 but lack the space to isolate themselves from others in the household.
The study, published in Annals of Internal Medicine, also sheds light on one reason for the racial disparities in COVID-19 hospitalizations and deaths.
Researchers reported that Native American and Hispanic residents were twice to three times as likely as white, non-Hispanic residents to live in homes without sufficient space or plumbing for isolation.
Black and Asian American residents were 1.7 times more likely to live in such homes than their white counterparts. The study was produced by a team from Case Western Reserve University and the City University of New York at Hunter College.
“Unfortunately, the legacy of housing discrimination and red-lining still lives on in our segregated cities, which isolates communities from each other and amplifies the disparities that have left more Americans vulnerable during the pandemic,” said U.S. Rep. Gwen Moore, D-Milwaukee.
“We must be aggressive to expand access to affordable and quality housing and work to undo the harms of systemic racism with bold policies.”
The disparities in suitable housing for COVID-19 isolation are consistent with the higher rates of hospitalization and death from the disease among Blacks, Hispanics and other groups.
The Centers for Disease Control and Prevention reported that as of midJune, COVID-19 hospitalizations rates were five times higher among non-Hispanic Blacks than among non-Hispanic whites. Hospitalizations rates were four times higher among Hispanics than among non-Hispanic whites.
In Wisconsin, Black residents make up 6.7% of the population, but account for 23% of the deaths from COVID-19.
The space problems posed by isolating the sick came as no shock to Wisconsin health experts.
“I don’t think (the finding) was surprising, but it was good to see data that actually described it,” said Nasia Safdar, medical director of infection control and prevention at UW Health in Madison.
Safdar stressed that the study is significant because contact tracing to separate infected and exposed people from the uninfected is a “major cornerstone” of the effort to contain COVID-19.
“That’s a real challenge and there are no absolute solutions,” said Joyce Sanchez, an infectious disease specialist at Froedtert and the Medical College of Wisconsin, in response to the study.
She said families that have infected members, but a lack an extra bedroom or bathroom, can take steps to protect others in the home. For example, a family with just one bedroom might allow the infected person to be isolated there, while other household members live and sleep in the living room or in another common room.
Families might also consider having uninfected members stay with a relative, while the infected person stays in isolation in the home.
In cases in which families have no other options but to have infected and non-infected members sharing space, all should wear masks and maintain at least six feet of distance.
The study’s authors also offered suggestions to help families with inadequate space at home to separate the sick from the healthy.
“Wearing face masks, physical distancing and bathroom disinfection might prevent transmission even when separate rooms are unavailable,” the authors wrote.
“Policymakers should consider offering (but not requiring) persons needing isolation or quarantine, the option of staying at no cost in underutilized hotels, under medical supervision, with free meal delivery, and internet and telephone access. Similar strategies have been used successfully by several
Asian countries and might decrease COVID-19 transmission, particularly in minority communities.”
At the Milwaukee Health Department, Kowalik said the city has already taken some of these steps. Nurses engaged in contact tracing always ask those who have tested positive for COVID-19 about their housing situation.
While some of the sick are being housed in local hotels on a temporary basis, others are being hosted at Clare Hall, a religious institution at 3470 South Illinois Ave. in Milwaukee. Kowalik said people who are sick and in need of housing should call 211, the city’s social service hotline
Although the terms quarantine and isolation are often used interchangeably, they are not the same, according to the CDC.
Isolation applies to people who have tested positive for the virus, while quarantine applies to those who either feel sick or have been exposed to someone with the disease.
CDC guidelines say those in quarantine should stay home for 14 days after their last contact with an infected patient, monitoring themselves for fever, cough, shortness of breath or other symptoms.
Those in isolation should remain in a separate room, if possible, until they have gone 24 hours without a fever, and done so without requiring a fever-reducing medication