Evictions would raise COVID-19 risk for everyone

Stopping evictions could play a critical role in controlling the COVID-19 pandemic, a new study shows. Without eviction moratoriums, case counts would rise as those evicted from their homes sought shelter elsewhere, the study suggests. 

And the effects of that displacement spill over to people who haven't been evicted.

Record levels of unemployment have left many U.S. residents unable to pay rent during the pandemic. To prevent a surge of evictions, individual states and local jurisdictions issued moratoriums earlier in the year, according to The Eviction Lab at Princeton University; but some of these policies have now begun to expire. In early September, the U.S. Centers for Disease Control and Prevention (CDC) issued a four-month eviction moratorium at the federal level "to prevent the further spread of COVID-19." 

The CDC issued this moratorium under the Public Health Service Act, which grants the agency authority to "make and enforce such regulations as ... are necessary to prevent the introduction, transmission, or spread of communicable diseases," such as COVID-19. However, landlords and lobbyists are currently challenging the order in court, The Washington Post reported. 

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But overturning eviction moratoriums, at any level, would make the still-raging pandemic harder to control, according to the new model, posted Nov. 1 to the preprint database medRxiv. The study has not yet been peer-reviewed, but experts told Live Science that the model is "very well thought-out" and highlights the threat evictions pose to public health during a pandemic.

"Across a wide set of scenarios, the researchers found that evictions could lead to significant increases in COVID-19 infections in U.S. cities," said Kathryn Leifheit, a social epidemiologist and postdoctoral researcher at the UCLA Fielding School of Public Health, who was not involved in the study. 

These high infection rates not only affected evicted households and those who took those people in, but they also rippled through the city at large, author Alison Hill, an assistant professor at the Institute for Computational Medicine at Johns Hopkins University, said in an email to Live Science. "Preventing evictions helps everyone — not just those who might experience evictions themselves," Hill said. 

A double-disaster 

In a previous study, posted to medRxiv in June, the study authors modeled the role of household structure and size in COVID-19 outbreaks. At the time, social-distancing measures had begun to relax in some places, and the idea of fusing multiple households into a single "quarantine bubble" emerged. But the team found that creating these extended bubbles would be safe only in places where case counts were steadily declining, and where all members of a household could minimize their outside contacts.

"In situations where infection levels had stabilized but were barely declining, forming bubbles always led to at least some resurgence of cases, which returned to or exceeded peak levels," the authors wrote in the study. 

"We realized that evictions were going to create a lot of fused bubbles that wouldn't be able to unfuse — even more dangerous still," study author Michael Levy, an associate professor of Epidemiology in Biostatistics and Epidemiology at the University of Pennsylvania's Perelman School of Medicine, told Live Science in an email.

Available evidence from studies and government reports suggests that the majority of evicted households double-up with others immediately after losing their homes, essentially forming one large bubble. With COVID-19 spreading like wildfire in the U.S., mass evictions could create a double-disaster, Levy said. The new model illustrates how this scenario might unfold.

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The team used a so-called SEIRD model, which categorizes people based on the stage of infection they're in, from "susceptible" to "exposed" to "infected and infectious," and finally, to "recovered" or "deceased." The authors assumed that an epidemic in the modeled city would mimic early outbreaks seen in metropolitan areas like Boston, Chicago, New Orleans and Seattle: A large early peak would be followed by lockdown measures and falling infection rates, and then cases would rise as the lockdown relaxed.

Using this framework, the team modeled how infections would ripple through social networks in a city of 1 million people; these chains of infection changed in response to different citywide rates of eviction, ranging from 0.1% to 2% of households per month.

"We found that in all scenarios, evictions lead to significant increases in COVID-19 cases, with anywhere from [approximately] 1,000 to 100,000 excess cases attributable to evictions depending on the eviction rate and the infection rate during evictions," the authors wrote. The relative risk of infection was highest for evicted individuals and those they doubled-up with; however, across all scenarios, the risk of infection also rose for those who were neither evicted nor part of merged households, the authors noted.

'Second waves' are the worst scenario 

At first, the team assumed that all households across the theoretical city would have an equal chance of being evicted, and afterwards, would have an equal chance of doubling-up with any other household in the area. They found that, at a 0.25% eviction rate, 0.7% more of the population would catch COVID-19 by the end of 2020 than would have if no evictions occurred. This 0.7% increase amounts to about 7,000 excess COVID-19 cases per million residents. At a 2% eviction rate, these excess cases rose more than 6% above the baseline. 

Excess infections fell slightly when the authors instituted a "second lockdown" in their model, but the rate still exceeded the baseline rates. Infection rates were worst in cities that experienced a substantial second wave of infection without a second lockdown, the authors found; in these scenarios, a 1% eviction rate meant 5% more of the population would catch COVID-19, above baseline, while a 2% eviction rate propelled infections more than 11% above baseline.

This scenario of rising infection rates and no lockdowns isn't just imaginary. "We are under those circumstances in many places in the United States," said Hilary Godwin, dean of the University of Washington School of Public Health and a professor in the Department of Environmental and Occupational Health Sciences, who was not involved in the study. The model suggests that "now is an important time for us to maintain those eviction moratoriums and not to reverse them," she said.

Although evictions clearly drove COVID-19 transmission in their generic city, the authors "worried that these simplifications might not represent a more realistic scenario," Hill said. For instance, in reality, different neighborhoods experience different eviction rates, as well as different rates of COVID-19 infection. Poorer neighborhoods face more evictions and infections, because residents often hold essential jobs and therefore can't practice effective social distancing, Hill noted.

To better capture this reality, the authors devised a different city — one with a mix of poorer and wealthier neighborhoods, based on the socioeconomic status (SES) of the residents.

In this scenario, instances of eviction, doubling-up and infection clustered in the poorer neighborhoods. But due to "spillover effects," the relative risk of infection rose in wealthy neighborhoods, too, and infection rates across the whole city surpassed the model where everyone had an equal chance of eviction. 

For instance, in the scenario where lockdowns lift and case counts rise but don't mount into a huge second wave, a 0.25% eviction rate results in a 1% increase in infections in the adjusted model. In the "equal chance" model, infections only increased 0.7%. At a 2% eviction rate, infections rose 9% in the adjusted model, but only 6% in the equal chance model.

Reality could be even worse 

The authors then applied their model to a real city: Philadelphia, Pennsylvania, where COVID-19 infection rates tend to be higher in poorer neighborhoods with a history of racial segregation, according to a recent analysis, which has not been peer-reviewed. 

To capture this disparity, the authors divided the city by zip code and categorized neighborhoods as high-, moderate- or low-SES. They found that, if eviction rates double compared with pre-pandemic levels, an additional 1% of the city's population would catch COVID-19 by year's end.

And some studies suggest that without moratoriums, evictions could skyrocket even more than that.

"With a 5-fold increase in evictions, predicted by some economic analyses, this would increase to 2.6% or [approximately] 41,000 extra infections," the authors wrote. As in their previous model, the relative risk of infection rose across all neighborhoods, not only in low-SES zip codes. 

"The Philadelphia example is great because it grounds a study which may seem very theoretical in reality," Leifheit told Live Science. What's more, "the city-specific estimates make a really powerful case for extending [and] reinstating eviction moratoriums in Philadelphia, specifically."

Although the model already makes a compelling case, Hill said that, in reality, the effect of widespread evictions could be even worse than they estimate. That's because not every evicted household would be able to find shelter with others in the area.

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For instance, evicted people who cannot find housing would likely come into contact with more people than the average housed person, whether in homeless shelters or on the street. Therefore, the risk of COVID-19 transmission would be driven higher, she said. Alternatively, rather than finding nearby housing, some evicted households may travel elsewhere to find shelter, raising the risk of catching and transmitting COVID-19 on the way, Godwin said.

"The other alternatives to that of moving into that house with another family, locally, are actually much worse from a disease transmission standpoint," she said.

In addition to the new modeling study, data from early in the pandemic also suggests that pausing evictions helps control viral spread. For instance, Leifheit and her colleagues have been studying the observable effects of moratoriums instituted in the early months of the pandemic. Early results suggest that states that lifted their moratoriums experienced higher COVID-19 infection rates and mortality, compared with states that kept evictions on hold, she said.

In observational studies, however, the effect of moratoriums can be difficult to separate from that of other policies, such as stay-at-home orders, social distancing guidelines and mask mandates, and how well people adhere to all those rules, Godwin noted. Models are useful because they can zoom in on one variable — like evictions — and illustrate how viral spread changes as rates go up or down, Godwin said. And as the new model suggests, when evictions go up, infections go up.

Of course, to keep eviction moratoriums in place, both tenants and landlords may need more financial relief from the government, The Washington Post reported. Without new relief packages, debt will likely continue to pile up on both sides as the moratoriums persist, The Post reported. 

But that does not change the take-home message: that eviction moratoriums are key to slowing COVID-19 transmission, regardless of whether you are personally at risk of losing your home.

"We all need to have some interactions with others in our community, and to reduce our own risk, we need to make sure everyone is able to keep themselves safe," Hill said. "When it comes to controlling a contagious disease, we're all in this together."

Originally published on Live Science.