January 5, 2021
To the Honorable Chairs of the Joint Committee on Covid-19 and Emergency Preparedness and Management: Senator Joanne M. Comerford & Representative William Driscoll, Jr.
Dear Senator Comerford and Representative Driscoll,
Today, too many people are getting COVID and dying in what should be a safe haven—public and subsidized housing for the elderly and disabled. These tragedies are largely preventable by improving policies at the state level and in the housing community. We have identified two problems that can lead to the spread of COVID and propose simple remedies for them; these are basic public health and management techniques—gather information, do oversight, and enforce accountability.
These remedies could be authorized by amending Chapter 93 of the Acts of 2020 to enable better data reporting (respecting individual privacy) and to enforce the public health mandates in public housing and privately owned subsidized housing for elderly and disabled persons, as well as elderly and disabled persons living in affordable and market rate housing, persons whose rent is subsidized by vouchers.
Site-specific data on COVID is essential to locating infections and to initiating interventions. Despite the clear requirements of Chapter 93, such data is not available.
Housing providers as well as tenants may fail to comply with mandates designed to protect people from COVID. Our research shows that although some housing providers follow best practices and official mandates and have good results, in other situations tenants are being infected and dying due to a failed or lax implementation. We propose to require the Department of Public Health and the local health department to initiate intervention, oversight, and accountability over tenants and landlords.
The legislature can guide the Governor and the Department of Public Health to take new steps to reduce the spread of COVID, and better protect citizens. We can prevent COVID from spreading if we assure compliance by enforcing the public health mandates. To address the public health threat we must know where people are infected and dying.
1) Collect, combine, and publish aggregated health data
Infectious disease control in public health works by identifying and isolating cases to prevent further infections. The Department of Public Health counts cases of COVID morbidity and mortality—disease or death. This amendment will provide timely access to site-specific, non-personally identifiable, aggregated data to help inform and guide public health authorities, the housing provider, and tenants. The identity of sick or deceased persons would not be revealed, so there is no privacy issue and HIPAA rules will not apply. The timely publication of aggregated site-specific data will facilitate effective control and prevention actions in elder care facilities.
2) Enforce public health mandates
No one is safe unless everyone in the community acts prudently. Where public health mandates are not followed, tenants in housing are getting COVID and dying. We propose to amend Chapter 93 to assure that the public health system oversees and enforces the emergency mandates, holding the housing provider as well as tenants accountable.
Essentials for Preventing COVID in Housing
The several methods for limiting transmission of COVID in a semi-closed setting such as multi-unit housing can work if, and only if, there is a continuing and enforced agreement that everyone will work together as a community. No one is safe unless everyone is safe. There must be oversight, accountability, and enforcement to assure that all parties—housing providers as well as tenants—follow the methods. These procedures apply to all persons in the public or common areas of the facility.
Senator Joan Lovely and Representative Tom Walsh alerted us to the creation of your committee and recommended we wait to see if your work might resolve our concerns. We were gratified and impressed by your first hearing which exposed the wide expanse of problems in addressing COVID. We are sharing our concerns and observations as testimony submitted for your consideration. Please do not hesitate to get in touch if you have any concerns or questions or to seek additional information.
Thank you for your consideration and for what you do.
Bonny Zeh, Co-founder, Stop Bullying Coalition
Somerville Public Housing
COVID in Housing—Case Examples (see below)
COVID in Housing—Case Examples
How can a person who has followed every precaution and lived like a hermit catch COVID? For residents of public or subsidized housing, what factors outside their control may impact their catching COVID?
Within a residential facility, people are exposed to possible aerosol and droplet infection in the lobby, mail room, laundry room, elevator, and even in the corridors. The nature of the public areas of a housing development makes disease transmission highly likely—unless everyone is masking and distancing.
Where there is a positive, caring community environment in a residential setting, there is better control of infection. Where there is a toxic and indifferent environment, COVID can spread like wildfire. And in the absence of public health data, at some point there will be another disaster, and all the agencies will express surprise. We can’t find the problem if we don't even look for it.
Salem Public Housing
In a Salem public housing apartment building, despite exercising great caution to avoid catching COVID, three friends got COVID. Two of them, both in their 60s, were in hospital with COVID; one of them has returned home, while the other has died. A number of other tenants have or have had COVID. In that residential setting, people are catching COVID because there are people who don’t comply with the mandates intended to protect everyone; and because the housing provider does not enforce the rules; and because the health department also fails to hold the housing provider or the tenants accountable.
Update, March 18, 2021
At least 9 persons have had or are currently experiencing COVID in an apartment building with 112 units. This is an 8% infection rate, including one death. Some tenants persist in sitting without masks in the entry lobby. "Oh, isn't it great that the pandemic is almost over, we can hang out without masks."
Lowell Public Housing
In Lowell Public Housing, Lynn Costello got COVID-19 when she let down her guard at a time when the management and tenants had relaxed their prior efforts at education, enforcement, and compliance.—Never Say “Never”— Competence and Compassion In Housing
Privately owned, subsidized in Peabody
In Fairweather Peabody, a subsidized building owned by Preservation of Affordable Housing, many tenants failed to mask and distance; no effective efforts were made by management to enforce the rules; and the local department of health insisted that the management was responsible, but failed to hold the management/landlord to account. Although Halberstadt had not left the building and had followed with great care all protective measures, he could not leave his apartment without encountering people who were not masking and distancing; and thus he was infected and had to be hospitalized for COVID. Clearly, he was infected in the building by those who failed to follow the simple rules on masking and distancing, people who were not held accountable, nor was management held accountable for failing to enforce the rules.
Of course I have carefully followed the public health advice, including choosing almost complete isolation and acting with great care in any social interaction. But I live in a subsidized housing apartment in Peabody where some people do not have the ability to understand and follow these mandates, where some can’t afford masks, and where some, just as in other public settings, claim the right not to mask, or see it as a flag of a hated opponent. But their actions put others at risk.
In some housing situation, the caring landlord sees an obligation to help their tenants, and are able to reduce their exposure to COVID. They will remind and assist people who forget, but they do not hesitate to deal with defiant individuals if their actions threaten the well-being of other tenants, and will use the tool of eviction if need be. Where I live, despite our efforts, the actions of the landlord have been inadequate to change behavior, and there has been a strong reluctance to do more based on assertions that this is “independent living.” This callously and cynically ignores the mutual obligations of the lease and laws affecting tenant-landlord relations. Don’t we deserve to be safe in our homes? We tenants demand action.
Landlords and managers in other settings have demonstrated that it is possible to prevent the spread of COVID-19.
Compliance in Chelsea
In Chelsea, managers strive for timely and effective intervention, hoping to help to save many from illness and death. Although public health best practices can significantly reduce the risk of infection, many people resist compliance with the mandates on masking and social distancing. They claim that personal “rights” enable them to ignore social responsibility; this attitude poses a problem throughout society, and can create a risk threatening the health and life of many tenants. Since the threat of eviction is virtually the only sanction available to the landlord, management must be prepared to use it. Paul Nowicki explains his approach to enforcing compliance.
“The message is the same for everyone, but the tone will vary. Some people just need a reminder or they don’t have a mask. We may talk to family members. We explain that we want to protect all the tenants from infection. And we set an example, always wearing a mask, and carrying a box of masks to hand out to anyone we meet. By getting a person to wear a mask, we help them experience success. A few people claim a right not to wear a mask, and believe that nothing can be done to them. In that case, I take an assertive tone and explain that, since not wearing a mask is contrary to the state mandate, and since this threatens the well-being of other tenants, management can go to court and move for immediate eviction.—We’re Here to Help
Despite the fact that Chelsea has had a very high infection rate, elderly and disabled tenants in the Chelsea Housing Authority have been spared from extensive infections.
Also consider the experience at Trestle Way in Georgetown.
The impact of state policy
Clearly, the level of prevalence in the surrounding municipality impacts the chance of infection getting into a local facility. The policy of the Governor to permit “reopening” despite continuing high levels of prevalence in the Commonwealth can prolong the crisis and can lead to an uncontrollable surge, while increasing the chances for infection in housing facilities. See: "Are We Safe Now?"
A note on data
The founders of the COVID Tracking Project write about the need for good data to guide policy and enable effective responses. In addition to stressing the value of data, they stress the importance of knowing what methods and procedures have been used to develop this information.
Data are just a bunch of qualitative conclusions arranged in a countable way. Data-driven thinking isn’t necessarily more accurate than other forms of reasoning, and if you do not understand how data are made, their seams and scars, they might even be more likely to mislead you....To avoid another data calamity, our public-health system must expend as much energy on understanding the present as it does on modeling the future. Governing through a pandemic—or any emergency—is about making the least-bad decisions with the best information available. That information can take many forms; it doesn’t have to be data. But if you do look at the data, then you must understand how each point, each cell, was made; otherwise, you’re likely to be misled. --- Robinson Meyer and Alexis C. Madrigal, Why the Pandemic Experts Failed, March 15, 2021 . The Atlantic