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Nande A, Sheen J, Walters EL, Klein B, Chinazzi M, Gheorghe AH, Adlam B, Shinnick J, Tejeda MF, Scarpino SV, Vespignani A, Greenlee AJ, Schneider D, Levy MZ, Hill AL. The effect of eviction moratoria on the transmission of SARS-CoV-2. Nat Commun 2021; 12:2274. [PMID: 33859196 PMCID: PMC8050248 DOI: 10.1038/s41467-021-22521-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
Massive unemployment during the COVID-19 pandemic could result in an eviction crisis in US cities. Here we model the effect of evictions on SARS-CoV-2 epidemics, simulating viral transmission within and among households in a theoretical metropolitan area. We recreate a range of urban epidemic trajectories and project the course of the epidemic under two counterfactual scenarios, one in which a strict moratorium on evictions is in place and enforced, and another in which evictions are allowed to resume at baseline or increased rates. We find, across scenarios, that evictions lead to significant increases in infections. Applying our model to Philadelphia using locally-specific parameters shows that the increase is especially profound in models that consider realistically heterogenous cities in which both evictions and contacts occur more frequently in poorer neighborhoods. Our results provide a basis to assess eviction moratoria and show that policies to stem evictions are a warranted and important component of COVID-19 control.
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Affiliation(s)
- Anjalika Nande
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, USA
| | - Justin Sheen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Emma L Walters
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Brennan Klein
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Matteo Chinazzi
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Andrei H Gheorghe
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, USA
| | - Ben Adlam
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, USA
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria Florencia Tejeda
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Alessandro Vespignani
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Andrew J Greenlee
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Daniel Schneider
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Michael Z Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Alison L Hill
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, USA.
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Benfer EA, Vlahov D, Long MY, Walker-Wells E, Pottenger JL, Gonsalves G, Keene DE. Eviction, Health Inequity, and the Spread of COVID-19: Housing Policy as a Primary Pandemic Mitigation Strategy. J Urban Health 2021; 98:1-12. [PMID: 33415697 PMCID: PMC7790520 DOI: 10.1007/s11524-020-00502-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic precipitated catastrophic job loss, unprecedented unemployment rates, and severe economic hardship in renter households. As a result, housing precarity and the risk of eviction increased and worsened during the pandemic, especially among people of color and low-income populations. This paper considers the implications of this eviction crisis for health and health inequity, and the need for eviction prevention policies during the pandemic. Eviction and housing displacement are particularly threatening to individual and public health during a pandemic. Eviction is likely to increase COVID-19 infection rates because it results in overcrowded living environments, doubling up, transiency, limited access to healthcare, and a decreased ability to comply with pandemic mitigation strategies (e.g., social distancing, self-quarantine, and hygiene practices). Indeed, recent studies suggest that eviction may increase the spread of COVID-19 and that the absence or lifting of eviction moratoria may be associated with an increased rate of COVID-19 infection and death. Eviction is also a driver of health inequity as historic trends, and recent data demonstrate that people of color are more likely to face eviction and associated comorbidities. Black people have had less confidence in their ability to pay rent and are dying at 2.1 times the rate of non-Hispanic Whites. Indigenous Americans and Hispanic/Latinx people face an infection rate almost 3 times the rate of non-Hispanic whites. Disproportionate rates of both COVID-19 and eviction in communities of color compound negative health effects make eviction prevention a critical intervention to address racial health inequity. In light of the undisputed connection between eviction and health outcomes, eviction prevention, through moratoria and other supportive measures, is a key component of pandemic control strategies to mitigate COVID-19 spread and death.
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Affiliation(s)
- Emily A Benfer
- Wake Forest University School of Law, 1834 Wake Forest Road, Winston Salem, NC, 27109, USA.
| | | | - Marissa Y Long
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | - Gregg Gonsalves
- Yale School of Public Health, Yale Law School, New Haven, CT, USA
| | - Danya E Keene
- Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
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Nande A, Sheen J, Walters EL, Klein B, Chinazzi M, Gheorghe A, Adlam B, Shinnick J, Tejeda MF, Scarpino SV, Vespignani A, Greenlee AJ, Schneider D, Levy MZ, Hill AL. The effect of eviction moratoria on the transmission of SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.10.27.20220897. [PMID: 33140067 PMCID: PMC7605580 DOI: 10.1101/2020.10.27.20220897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Massive unemployment during the COVID-19 pandemic could result in an eviction crisis in US cities. Here we model the effect of evictions on SARS-CoV-2 epidemics, simulating viral transmission within and among households in a theoretical metropolitan area. We recreate a range of urban epidemic trajectories and project the course of the epidemic under two counterfactual scenarios, one in which a strict moratorium on evictions is in place and enforced, and another in which evictions are allowed to resume at baseline or increased rates. We find, across scenarios, that evictions lead to significant increases in infections. Applying our model to Philadelphia using locally-specific parameters shows that the increase is especially profound in models that consider realistically heterogenous cities in which both evictions and contacts occur more frequently in poorer neighborhoods. Our results provide a basis to assess municipal eviction moratoria and show that policies to stem evictions are a warranted and important component of COVID-19 control.
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Affiliation(s)
- Anjalika Nande
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
| | - Justin Sheen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Emma L Walters
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL 61820
| | - Brennan Klein
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Matteo Chinazzi
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Andrei Gheorghe
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
| | - Ben Adlam
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Maria Florencia Tejeda
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | | | - Alessandro Vespignani
- Network Science Institute, Northeastern University, Boston, MA, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, USA
| | - Andrew J Greenlee
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL 61820
| | - Daniel Schneider
- Department of Urban and Regional Planning, University of Illinois at Urbana-Champaign, Champaign, IL 61820
| | - Michael Z Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Alison L Hill
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218
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Nande A, Adlam B, Sheen J, Levy MZ, Hill AL. Dynamics of COVID-19 under social distancing measures are driven by transmission network structure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.06.04.20121673. [PMID: 32577691 PMCID: PMC7302300 DOI: 10.1101/2020.06.04.20121673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the absence of pharmaceutical interventions, social distancing is being used worldwide to curb the spread of COVID-19. The impact of these measures has been inconsistent, with some regions rapidly nearing disease elimination and others seeing delayed peaks or nearly flat epidemic curves. Here we build a stochastic epidemic model to examine the effects of COVID-19 clinical progression and transmission network structure on the outcomes of social distancing interventions. Our simulations show that long delays between the adoption of control measures and observed declines in cases, hospitalizations, and deaths occur in many scenarios. We find that the strength of within-household transmission is a critical determinant of success, governing the timing and size of the epidemic peak, the rate of decline, individual risks of infection, and the success of partial relaxation measures. The structure of residual external connections, driven by workforce participation and essential businesses, interacts to determine outcomes. We suggest limited conditions under which the formation of household "bubbles" can be safe. These findings can improve future predictions of the timescale and efficacy of interventions needed to control second waves of COVID-19 as well as other similar outbreaks, and highlight the need for better quantification and control of household transmission.
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Affiliation(s)
- Anjalika Nande
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
| | - Ben Adlam
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
| | - Justin Sheen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104
| | - Michael Z Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104
| | - Alison L Hill
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218
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