Four years since the beginning of the COVID-19 pandemic, experts are already planning for the next one. In addition to strengthening disease detection systems, pandemic preparedness should prioritize improving the condition of rental housing in the U.S. to eradicate health disparities and better position the tenant population to weather the coming virus.
Black patients are hospitalized for COVID-19 at a rate three times higher than White patients. For Hispanic patients, this number is four times higher. Native American patients are twice as likely to die of COVID-19 than White patients, and across all races, Asian patients face the highest relative risk of hospitalization and death. Social determinants of health, including transportation, education, and employment, provide a partial explanation for these disparities. But one of the most important social determinants of health is housing. Specifically: who has it, and what it looks like.
Through 2020 and 2021, even with a federal moratorium on evictions and a concomitant decrease in filings, evictions were still happening across the country. We now know these evictions were associated with increased infection and death rates, and that most tenants who were evicted were people of color, particularly Black and Latinx renters. In some cities, homeless mortality rates due to COVID-19 were 75% higher than the mortality rates of housed people, and most experts contend that homeless deaths were vastly undercounted. But even for tenants who remained housed, the threat of COVID-19 did not disappear, because it was in their homes.
In addition to facing a higher rate of evictions, renters of color are disproportionately impacted by poor housing conditions. Substandard housing can include asbestos, peeling lead paint, and rodent infestations, to name just a few. The health impacts of these conditions are pervasive and severe. Mold can produce allergens and exacerbate preexisting conditions such as asthma. Poor ventilation can increase exposure to smoke and is associated with higher mortality rates. Even the stress of living in an uninhabitable home is tightly linked to poor mental health, particularly for low-income women. Experts estimate that more than 4 million children across the U.S. live in substandard housing, thereby exposing them to illnesses that could determine their health for the rest of their lives.
The health conditions created by substandard housing, including poor respiratory capacity, impeded the ability of low-income renters to survive COVID-19. Across the country, counties with a higher percentage of households living in poor conditions also had higher incidence and mortality rates due to COVID-19. Looking ahead, the combination of substandard housing and Long COVID is potentially deadly. The pandemic pushed an already splintering healthcare system to its breaking point, such that there are now fewer physicians available to study and treat Long COVID and its nebulous impacts, even though the disease is estimated to affect almost 7% of the adult U.S. population. If the healthcare system is to survive the next pandemic, it must prioritize treating lingering respiratory conditions such as Long COVID, especially among low-income renters of color.
Improving housing conditions should be a top priority for policymakers seeking to improve U.S. pandemic preparedness. Tenant advocates and attorneys have long pushed for stricter enforcement of housing codes and common law standards like the implied warranty of habitability, which grants many tenants the contractual right to live in a home that is inherently suitable for human habitation. Some have even argued that enforcing a warranty of habitability would place downward pressure on rents and thereby save renters money at the expense of slumlords.
In the wake of 2020, which saw an unprecedented explosion of popular support for renters’ rights, policymakers should capitalize on this political moment. Not only will strengthening habitability standards create safer homes, it will also reduce health disparities across race, class, and gender, thereby better preparing vulnerable communities to defend themselves against the next virus.