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How the housing crisis collides with public health


It's incredibly stressful not knowing how you're going to make rent. That stress is amplified in the pandemic. When people can't pay their rent and have to leave their homes, they can be at greater risk for COVID-19. Right now, 1 in every 4 renters is having trouble paying. That's according to NPR's recent poll with the Robert Wood Johnson Foundation and the Harvard Chan School of Public Health. NPR health policy correspondent Selena Simmons-Duffin reports on the housing crisis and how it collides with public health.

SELENA SIMMONS-DUFFIN, BYLINE: When I reach Erica Cuellar, she's watching a show with her 2-year-old daughter.

UNIDENTIFIED CHILD: (Unintelligible).

ERICA CUELLAR: She is currently in her Spider-Man costume that she does not want to take off ever.

SIMMONS-DUFFIN: She is 26 and lives in Houston. Last year, when the pandemic hit, she lost her job as a home health aide for a boy with autism. Her husband works in a pipe yard.

CUELLAR: They were talking about shutting down at work. And, of course, those shutdowns would be not paid.

SIMMONS-DUFFIN: They were worried about affording the rent - $1,200 a month for their house. So her dad invited the family to move in with him even though he's 67 and having a house full of people could put him at more risk.

CUELLAR: My dad was like, don't worry about it. We'll be fine. He's - my dad's a big like - he doesn't like going to the hospital or anything. He believes he can cure himself. He was like, don't worry. I'll be fine.

SIMMONS-DUFFIN: They broke their lease and moved in with her dad. So then they didn't have to worry about the rent, only the pandemic. Her husband's job at the pipe yard...

CUELLAR: His job did not take it seriously whatsoever.

SIMMONS-DUFFIN: So there was a risk he could bring the virus home. At this point, in the spring and summer of 2020, there was no vaccine. Then in July, he got sick.

CUELLAR: July the 4, that's the day that he came home. He did not feel good. So he got COVID. I got COVID. My 2-year-old get COVID. My dad got COVID.

SIMMONS-DUFFIN: Both her husband and dad had to be hospitalized.

CUELLAR: My husband went to the hospital first because he couldn't breathe. And then three days later, my dad was having trouble breathing, so I took him to the same hospital. Thankfully, me and my daughter, we had it, but we didn't have any symptoms whatsoever. But it was super stressful having to call the hospital and deal with both of them. And all the doctors are asking me, you know, like, if they need to be ventilated, are you OK with that? You know, just having to make all those decisions

UNIDENTIFIED CHILD: When I reach her, she is exhausted.


SIMMONS-DUFFIN: Over a year later, her dad is back in the hospital with pneumonia and congestive heart failure - after effects from COVID, she says.

CUELLAR: That's why I'm yawning because, like, I was at work last night, and I went straight over there.

SIMMONS-DUFFIN: He's now back home from the hospital and is doing better. Her husband has had trouble breathing, too. He's had to use an inhaler for the first time in years.

CUELLAR: He's not the same after that, either.

SIMMONS-DUFFIN: This story of a family moving in together because rent was unaffordable illustrates one way that housing insecurity can lead to more viral spread. Kathryn Leifheit is a postdoctoral fellow and epidemiologist at the UCLA Fielding School of Public Health.

KATHRYN LEIFHEIT: So a person loses their home, they often move in with friends or family. They might enter a homeless shelter. That increases your number of contacts in the community, and it increases the efficiency with which COVID can spread through a community.

SIMMONS-DUFFIN: Another way not being able to afford rent can affect the spread of the coronavirus - there's a saying, she says. The rent eats first.

LEIFHEIT: People take on all kinds of work to avoid that eviction, and that might actually drive up risk of COVID.

SIMMONS-DUFFIN: One way policymakers have tried to curb this is by outlawing landlords from evicting people when they can't pay rent. The Centers for Disease Control and Prevention issued a nationwide moratorium citing these public health concerns in September 2020, and it was in place until this past August. States and cities have had their own laws, too. Some are still in effect.

The eviction policies haven't been perfect. There have been loopholes and workarounds, and people certainly have had to leave their homes. Even so, Leifheit has done research that shows these policies do help. In March 2020, nearly all states blocked evictions. Over the next few months, some states kept those eviction rules in place, and others let evictions start back up again. So Leifheit and her collaborators looked at the six months from March to September 2020 and compared states that allowed evictions to states that blocked them.

LEIFHEIT: So we found that states that ended their moratoriums saw over 430,000 more cases and over 10,000 more deaths than they would have if they had maintained their moratoriums.

SIMMONS-DUFFIN: Ten thousand more deaths - and that's just looking at a stretch of six months. Eviction laws are only one piece of the puzzle. Giving people funding to settle their debts and pay rent going forward through rental and utility assistance programs are another. Still, those programs and policies are mostly geared towards people who are trying to stay put. What about those who aren't in their own place to begin with? People like John Stangle. He's 55 and a plumber by training when the pandemic hit.

JOHN STANGLE: I was in Philadelphia working. And they shut the whole state down. And I didn't have a lot of money saved.

SIMMONS-DUFFIN: He had been living in a hostel. When construction jobs shut down, he left to find work in the D.C. area and ended up moving to Maryland.

STANGLE: To me, there was just kind of like a blanket risk.

SIMMONS-DUFFIN: Whether he was installing plumbing fixtures at a job, sleeping at a shelter or staying with friends, he was at risk everywhere. He didn't have a door he could close to the outside world to keep the virus at bay. Now he's vaccinated, and amazingly, as far as he knows, he says he never got COVID-19. When we meet, he's living in an emergency shelter in Rockville, just north of Washington, D.C. He loves it here. He shows me a big bulletin board.

STANGLE: Put up jobs here, employment program referral, rental assistance programs. So they put all the applications here if you need them.

SIMMONS-DUFFIN: Before the pandemic, this whole place was an empty office building. The Montgomery County Coalition for the Homeless needed to scale up quickly. Even though people were shielded from eviction, there were still more people needing emergency shelter than ever. They more than tripled their beds and moved into this space owned by the city. There is food, laundry machines, dentists and doctors and counselors and, of course, beds.

STANGLE: So this is where I sleep.

SIMMONS-DUFFIN: Stangle sleeps on a mattress on the office carpeted floor with a suitcase tucked neatly beside it. Along the ceiling, there are these temporary clear plastic air ducts. They look like something out of a sci-fi film.

STANGLE: They came in and brought these AC. And this is for fresh air, so they keep it going 24 hours a day.

SIMMONS-DUFFIN: Even though he's vaccinated, sharing your living space with 60 other people still has risks.

STANGLE: This is a good facility. They're on top of testing. They keep it clean. There's plenty of masks. There's hand sanitizers. There's a lot of precautions taken here. You know, I think the greater risk was around the areas I work.

SIMMONS-DUFFIN: He quit one job because a lot of his co-workers wouldn't get vaccinated. Now, though, he's pretty upbeat. He just got a small car and found a new job. It's full time, 40 hours a week. He says of course he wants his own place, to have that sense of control and the front door he can close against the outside.

STANGLE: When I'm trying to do now is save up enough money so I can get the first month's rent and the deposit and maybe have a month to fall back on.

SIMMONS-DUFFIN: He's trying to save so he has a cushion, he says, so next time, if another pandemic or some other catastrophe comes along, he won't be in a desperate situation without a home. Selena Simmons-Duffin, NPR News. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.