COVID, Rent, and Housing : Short Wave When people can't afford rent, they often end up in closer quarters. NPR health policy correspondent Selena Simmons-Duffin shares two stories from her reporting and the research being done on housing and eviction policies in the US.

For more of Selena's reporting, check out "Why helping people pay rent can fight the pandemic" (https://n.pr/3BIluHt).

Follow Selena on Twitter @SelenaSD. You can email Short Wave at ShortWave@NPR.org.

Housing and COVID: Why helping people pay rent can help fight the pandemic

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MADDIE SOFIA, BYLINE: You're listening to SHORT WAVE from NPR.

MARIA GODOY, HOST:

Hola, SHORT WAVE listeners, it's Maria Godoy here, and I'm with NPR health policy correspondent Selena Simmons-Duffin. Hey, Selena, welcome, welcome.

SELENA SIMMONS-DUFFIN, BYLINE: Hi, Maria, it's nice to talk to you.

GODOY: Selena, it is always great to talk to you. And today, you're bringing us a story about something we at SHORT WAVE have been wondering about for a long time, which is what does the research actually show about the links between housing insecurity and COVID-19. When people get evicted from their apartment or house, does that lead to more spread of COVID?

SIMMONS-DUFFIN: Right. I mean, it's a big question because while it might seem straightforward on its face that people getting evicted would lead to more spread, it's actually kind of complicated. A lot of different things contribute to COVID spread - masks, distancing. And the way that eviction and COVID spread intersect is kind of nuanced.

GODOY: And it's a big deal because, as you've reported, roughly 1 in every 4 renters is having trouble paying rent. That's actually one of the key findings from a recent poll that NPR did with the Robert Wood Johnson Foundation and the Harvard Chan School of Public Health, right?

SIMMONS-DUFFIN: Yeah, exactly. So today on the show, I want to bring you this episode in three acts, bringing in some of the reporting I did recently for All Things Considered. Act 1, I'll introduce our listeners to a family and the trade-offs they had to make when they couldn't pay rent. Act 2, I'll explain research that's been done on housing policies and how they can affect viral spread. And in Act 3, I'll show you around a homeless shelter that was set up quickly in an empty office building and explain how evictions and policies are only part of the story.

GODOY: That's a lot to get into, and we're going to dive in right after the break. You're listening to SHORT WAVE, the daily science podcast from NPR.

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GODOY: All right, Selena, where do we start?

SIMMONS-DUFFIN: So, Maria, first I have the story of a family moving in together because rent was unaffordable. So it illustrates one way that housing insecurity connects to transmitting COVID-19.

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SIMMONS-DUFFIN: When I reach Erica Cuellar...

ERICA CUELLAR: Hello?

SIMMONS-DUFFIN: ...She's watching a show with her 2-year-old daughter.

CUELLAR: She's 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. So 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 and he did not feel good. So he got COVID. I got COVID. My 2-year-old got 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.

SIMMONS-DUFFIN: When I reach her, her dad had had to go back to the hospital with pneumonia.

CUELLAR: The nurse was explaining to me that because of COVID, like, your lungs aren't as strong as they used to be. So his heart and his lungs were working extra hard, and it wasn't enough.

SIMMONS-DUFFIN: So she worked the late shift at Domino's, which is her new job where she's a manager. And then she went to see him at the hospital.

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

SIMMONS-DUFFIN: Her dad has since come home from the hospital and he's doing better, although his doctors told him he now has congestive heart failure, and 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.

GODOY: Wow, Selena, so that's a really tough situation the Cuellar family was in. On the one hand, they were lucky that they had someplace to go. But on the other hand, having the whole family move in with Erica's dad ended up putting more people at risk.

SIMMONS-DUFFIN: Exactly. So now let's get into the research here. 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: We found that states that ended their moratorium 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. To be sure they were seeing the impact of the housing rules and not some other mitigation measure, they added controls to their model.

LEIFHEIT: The simplest version of the model would just say, OK, let's compare a state with an expired moratorium to a state without. But then we start adding in controls that say, now let's just compare conditional on a mask mandate, so let's only make that comparison within states that have a mask mandate in place. And let's only make that comparison when there's also a shelter-in-place order. So as you start adding these controls, you're sort of comparing apples to apples more and more.

GODOY: That's really interesting because while it may seem obvious that not having to move out of your home slows the spread of COVID, teasing out the effect of eviction moratoriums gets pretty complicated. You have to factor in all the other measures that a given city was using to curb transmission of the virus.

SIMMONS-DUFFIN: Yeah, exactly. Isolating the impact of one policy is tricky, but it's also really important. You don't want to accidentally capture the impact of restaurant closures, for instance, or indoor mask mandates. The way Leifheit explained it to me is they tried to break the model and make this finding go away.

LEIFHEIT: And we actually couldn't, which suggests that there is this sort of independent effect of eviction risk on COVID risk.

SIMMONS-DUFFIN: So allowing people to stay in their homes did indeed help stop the spread. But that is only one piece of the puzzle. Rental and utility assistance programs - giving people funding to pay rent - is another, and that may be especially important as the eviction rules lift and people find themselves in debt, Leifheit says.

LEIFHEIT: The eviction moratoriums were always, in a sense, just kicking the can down the road. You know, eventually they were going to expire. Meanwhile, it's not like people have gotten rich overnight.

SIMMONS-DUFFIN: Congress passed nearly $47 billion in funding to help with this problem across the country, but the rental assistance programs have been criticized for being too slow while people are in crisis.

LEIFHEIT: These states and cities are doing a monumental task of standing up these big programs and agencies that never existed before to get this money out. So I think it kind of always was going to be slow.

SIMMONS-DUFFIN: That said, she says, the pace now seems to be picking up.

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GODOY: So these programs and policies are mostly geared toward people who are trying to stay put in their homes. What about people who didn't have their own place to begin with?

SIMMONS-DUFFIN: Right. Leifheit pointed out to me this is all happening in the context of a housing affordability crisis. A lot of people can't find a place to live they can afford, and that didn't start with COVID. It's been going on for a long time, which brings me to the story of John Stangel. When the pandemic hit...

JOHN STANGEL: 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.

STANGEL: 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.

STANGEL: They'll put up jobs here, employment program referral, rental assistance programs. So they put all the applications here.

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.

STANGEL: 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.

STANGEL: What 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: I asked John what he thought of the eviction moratorium. He said it didn't help him directly. But then he added this...

STANGEL: I do believe, for the most part, we're compassionate people in a civilized nation, and I don't think that it's a part of who we are to just start dumping people in the streets in the middle of a worldwide pandemic with no place to go.

GODOY: That's really striking. You want people to have stable housing so that they don't get COVID and don't spread it. And there is the larger principle of protecting people from homelessness because they're people and being displaced, not having a safe place to live, is traumatic.

SIMMONS-DUFFIN: Yeah, exactly. Like so many other things the pandemic has highlighted, the housing crisis, a problem this country has had for a very long time, and it's reminded us that we're more connected to each other than we thought.

GODOY: Thanks so much for bringing us this story, Selena. It's important stuff.

SIMMONS-DUFFIN: Thanks, Maria.

GODOY: This episode was edited by Joe Neel and Gisele Grayson, produced by Thomas Lu and fact-checked by Margaret Cirino. The audio engineer for this episode was Josh Newell. Thanks for listening to SHORT WAVE from NPR. I'm Maria Godoy. Goodbye for now.

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