The first of the month is approaching, and a record number of Americans will not be able to pay their rent on time, as the COVID-19 pandemic has left millions unemployed. A study led by a University of Pennsylvania epidemiologist offers a cautionary tale about the collision of these two national crises: Even a low rate of evictions would significantly accelerate the spread of SARS-CoV-2 throughout the entire country, the research team’s preliminary findings show.

Mass unemployment paired with a virus that is primarily transmitted within the home creates a deadly combination, according to Michael Z. Levy, PhD, an associate professor of Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. That’s because when tenants are evicted, research suggests that most people tend to “double up” with other households.

“A larger household has more opportunities for the virus to get into the home, and once it’s there, it can spread more,” Levy said. “Those two things act multiplicatively and have outsized repercussions on the growth rate of the epidemic.”

Moreover, Levy notes, traditional public health measures that can slow community transmission — like social distancing — cannot easily be applied inside a crowded home.

Imagine, for instance, that a family of three is evicted and moves in with a couple. One of those three is unknowingly infected with COVID-19. He spreads it to two other members of the household, who, in turn, infect a coworker and a classmate. In Philadelphia, this is happening particularly in poorer communities of color, where people are more likely to have the types of essential jobs that do not allow them to work from home.

Evictions would raise COVID risk for everyone 

Seeing that the economic impact of COVID-19 meant the country faced an impending eviction crisis in the summer of 2020, Levy and colleagues decided to create an epidemiological simulation to quantify exactly how dire its pandemic repercussions could be.

“We knew that evictions were bad for the spread of COVID-19, but how could we prove it? It’s not like we could do an experiment; but we could make a model,” said study co-author Alison Hill, PhD, an assistant professor at the Johns Hopkins University School of Medicine. “Models sound fancy and complicated, but they are really just a formal way of integrating all of the information we have in order to make a prediction about something that you can never test directly.”

Combining data from multiple sources, such as surveys and contact tracing studies, the researchers created a model to track the transmission of SARS-CoV-2 through a hypothetical metropolitan area with a population of 1 million. They used a network to represent contacts that could lead to transmission of the virus between individuals grouped in houses and mapped out how changes in public health interventions (such as work-from-home policies and school closures) would increase or decrease interactions with contacts outside of the home, subsequently leading to more or fewer infections. The researchers then modeled evictions that resulted in “doubling up” by merging each evicted household with one randomly selected household in the network.

Across various scenarios, the research team found that evictions could lead to a considerable uptick in COVID-19 infections in U.S. cities. When eviction rates are low, around 0.25 percent per month, the doubling up of households would still lead to anywhere from 1,000 to 10,000 excess COVID cases per million residents. When eviction rates rise to 2 percent, those numbers get even higher — up to 100,000 excess cases of COVID in a single city. Specifically, in Philadelphia, evictions could cause 53,000 extra infections, the team found.

Science supports contested housing policies

On September 4, 2020, the Centers for Disease Control and Prevention announced a national moratorium on evictions until December 31, 2020, arguing that preventing evictions is key to preventing COVID spread.

“It is pretty amazing to think that one of the largest federal actions around housing has been a health-based one,” said Vincent Reina, PhD, MBA, an assistant professor of City and Regional Planning in Penn’s Weitzman School of Design and faculty director of the Housing Initiative at Penn.

Since then, various states and municipalities have passed their own housing bills in response to the pandemic, expanding upon the national mandate or creating local moratoria in case the federal policy were to expire.

However, many of these policies have been challenged by opponents at the federal, state, and local levels. In response, Levy’s research has been heavily cited by attorneys, advocates, and policymakers, who have been fighting for renter protections during the pandemic.

On the day of his inauguration, President Joe Biden signed an executive order extending the CDC’s national eviction moratorium through March 2021. While the order was a welcomed relief for many Americans, delaying evictions is only a temporary solution for a growing crisis, public health and housing experts say.

“We still haven’t dealt with the root problems, like the reasons why people are facing evictions in the first place. At some point, the moratorium is going to lift, and most families are going to be in a worse situation than they were before the pandemic, having to pay months and months of back rent,” said study co-author Andrew Jordan Greenlee, PhD, an associate professor at the University of Illinois at Urbana-Champaign. “The missing piece here is anticipating what the magnitude of that crisis will be, whether or not COVID is still a factor.”

In Philadelphia, the city has begun to think of more sustainable, flexible solutions for addressing the housing crisis. Philadelphia officials announced this month that the city would be extending its eviction diversion program and has rolled out an improved rental assistance program of its own, funded by a $25 billion federal relief package.

“The idea of local rental assistance programs was largely non-existent before COVID,” said Reina, the Penn City and Regional Planning professor, who is also aiding Philadelphia in streamlining the process for tenants to receive this assistance, as well as evaluating the success of similar programs in other U.S. cities. “So we’re actually in a really unique time.”

Reina says that it’s the impact of research like Levy’s that may be one of the positive lessons to emerge from the pandemic.

“The research is really essential for thinking more broadly about this connection of housing as a determinant of health and who is most affected,” Reina said. “The big leap will be translating this moment into formative action that really solidifies that connection. That’s been one of the biggest challenges — for health systems and public health officials to view housing investment as core to their efforts.”