Millions stuck at home with no plumbing, kitchen or space to stay safe | Health

In nearly half a million American households, washing hands to prevent COVID-19 is not as easy as soaping up twice and singing “Happy Birthday” twice while scrubbing.

In many of these houses, people cannot even turn on a tap. There is no running water.

In 470,000 homes in the United States – across all states and most counties – inadequate installation is a problem, the greatest of several challenges that make it harder for people to avoid infection.

This comes from an analysis by Kaiser Health News, which includes data from the Census Bureau and Housing Assistance Council in Washington, DC. The analysis reveals other ways in which inadequate housing conditions in the US are putting people at risk during this pandemic. Almost a million homes, scattered across almost all counties, do not have full kitchens, which increases the risk of hunger and susceptibility to disease, even if people are expected to eat all their meals at home there. And more than 4 million homes are overcrowded, with more than one person per room, making it nearly impossible to isolate the sick.

In fact, around 828,000 people face more than one of these housing issues.

“We expect this to happen in third world locations,” said Greg Carter, assistant professor at Indiana University School of Nursing. “But it happens here.”

Carter’s work takes him to Orange County, southern India, a community of just under 20,000 that has confirmed 113 COVID-19 cases and 18 deaths as of Sunday. It is also one of 322 US states with inadequate plumbing rates at least three times the national average of four in 1,000 homes.

Phil Mininger, site manager for Habitat for Humanity, said he knew a man in his early 70s who lived in a rundown house with no running water or electricity. The man goes to a Walmart about half a mile away to go to the bathroom and wash his hands.

Conditions like these also occur in states like Colorado, Alaska, and New York where there are no water pipes, are in poor condition, or have water turned off.

Overall, the percentages are twice as high in rural areas, but similar conditions exist in urban centers. Just under half a percent of New York City homes, for example, have inadequate plumbing, but that’s still about 14,000 homes.

Public health experts say substandard housing reflects huge socioeconomic inequalities that make America a breeding ground for the coronavirus. Poverty and the ill health that it brings is fueling the spread and increasing the chances of dying from COVID-19, both in places where the disease has been badly hit and in places it is about to reach.

“The discrepancies between those with and without privileges existed before our pandemic. What happens after that?” asked Jessica Hanson, an assistant professor of community and behavioral health at the University of Minnesota-Duluth. “I hope when this happens, we as a community and as a society will recognize that there are people who have no access to what they need. And that needs to be addressed.”

The federal government made huge gains in public health in the early to mid-20th century by spending a lot of money on water infrastructure. The result was healthier people who lived significantly longer. However, that changed in the 1980s, according to a 2019 report by the US Water Alliance, researchers at Dig Deep, and Michigan State University. From 1977 to 2014, according to another report, federal spending on water infrastructure declined from in inflation-adjusted dollars $ 76 to $ 11 per person. Local and state spending increased but did not come close to meeting demand.

Then the COVID pandemic struck.

Nick Slim, administrator of the tribal council in the remote Yup’ik Eskimo village of Kipnuk, about 500 miles west of Anchorage, said the people there “did the best we can” to follow the advice on hand washing, but they can be a fight. You don’t have tap water; He and the other 650 residents are dependent on hauling ice and collecting rain.

“We’re all concerned about the virus,” said Slim.

Just over a third of the homes in the Alaska Bethel Census are inadequately equipped. This is the nation’s second highest rate behind the adjacent Yukon-Koyukuk census.

According to government officials, most homes in Alaska with no running water and flush toilets are in Native Alaska villages that are either not served by water utilities, or in places where water needs to be transported or where plumbing is aging and deteriorating. Compared to the entire US population, KHN said, Native Americans are eight times more likely to lack adequate plumbing in their homes.

In the absence of running water, the respiratory disease festers. The rate of invasive pneumococcal disease in southwest Alaska is among the highest in the world.

Still, Alaska had fewer confirmed cases of COVID-19 than many other states, with 381 as of Sunday. However, a University of Texas study found that a county with only one case of COVID-19 has a 51 percent chance that an outbreak is ongoing.

Gunnison County, Colorado has already been badly hit by the coronavirus, with 173 confirmed cases as of Sunday and six deaths in just over 17,000 people. That makes the county known for the Crested Butte ski area one of the highest fall rates in its state. It also has one of Colorado’s highest rates of inadequate plumbing – about 1 in 45 homes. It is a place of extreme living conditions. The average home is $ 339,000, and some mobile homes make up a tenth of that.

Loren Ahonen, program administrator at the Gunnison Valley Regional Housing Authority, recalled a mobile home with an unrepaired frozen water pipe. The water was restored about a week after the county’s residents were asked to stay home during the pandemic, he said. But until then, he said, tenants relied on 5-gallon water jugs from the grocery store, neighbors, and good Samaritans.

As in many other communities, Ahonen said, all utility companies in Gunnison County have suspended lockdowns for non-payment during the pandemic. But emergency water shutdowns still occur when leaks occur, as he recently noted while driving through a RV park that was prone to water problems.

Such problems exacerbate another persistent problem in mobile homes: overcrowding. Ahonen said he saw up to six people crowd into a small house. A Social Distancing Index compiled by the Colorado Health Institute found that 1 in 20 homes in a Gunnison County census area were overcrowded.

Overcrowded homes are also a major problem in urban areas and have been linked to higher rates of COVID-19. An analysis of the New York City cases by New York University’s Furman Center found that the zip codes with the highest rate of positive cases had more than twice as many renters in overcrowded conditions as those with the lowest rates.

Pascual Pena, 33, an advisor to a New York City Councilor, said he and seven family members were staying in a small four-bedroom apartment in the Manhattan neighborhood of Washington Heights.

Recently, his parents and sister developed COVID-19 symptoms, he said, and “it has been difficult to part with so many people.” Pena said he spent most of the time in the kitchen while his father stayed in a bedroom, his mother in the living room and his sister in her room. Everyone shares the bathroom, keeps cleaning, and hopes the virus doesn’t spread any further.

Carter of Indiana University said that people who live in unhealthy housing conditions are often older or have chronic illnesses, which further increases their risk of developing seriously COVID-19. Carter remembered a woman with diabetes who lived in a house full of fruit with meat rotting in a derelict refrigerator.

While Carter and his team were able to help her, getting help is more difficult these days as many outreach programs are on hold. Organizing repairs has been made difficult by social distancing rules.

As the pandemic and the accompanying economic crisis persist, public health experts fear that people living in substandard housing could turn down further – especially since housing is usually just one of their challenges. They may have lost low-wage jobs to COVID-19. Or they lack medical supplies, solid foods, or other ingredients for healthy living.

“We will see that they have a greater lack of access to these things.” Said Carter. “People are already dying of poverty.”

Carter and other experts said policymakers and society at large need to focus more on the differences in housing and health. Pandemic or not, no one in America should live without the basics of indoor plumbing, said Lance George, research director for the nonprofit Housing Assistance Council, which helps build homes in rural America.

“That’s 2020,” said George. “These are problems that should have been solved.”



For estimates of households in the United States with inadequate plumbing, inadequate kitchens, or overcrowded, KHN analyzed data from the five-year estimates of the American Community Survey (ACS) (2014-18), specifically the Integrated Public Use Microdata Series (2014-18 ). IPUMS) provided by the University of Minnesota. This data provides demographic information on individual members in each household. KHN excluded those who lived in group neighborhoods.

For race / ethnicity categories, Whites, Native Americans, Blacks, and Asians include only non-Hispanics; The Asians include Pacific Islanders and the Indians include Alaskan Natives. and Hispanics are of any race or combination of races. Non-Hispanics who responded that they represented more than one race are placed in the “other” category.

The installation is considered inadequate if one or more of the following items is missing: hot and cold tap water; a bathtub or shower; or a toilet. A kitchen is considered inadequate if it lacks a refrigerator, stove or stove, or a sink with a tap. A household is considered overcrowded if it has more than one person per room.

To compare rural and non-rural areas, KHN used data from the Housing Assistance Council, which provided census areas as rural, urban, or suburban / suburban and provided household estimates by census area for inadequate plumbing and kitchen facilities based on ACS five-year estimates (2013) – 17).


Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. KHN data reporter Hannah Recht contributed to this report.

©) 2020 Kaiser Health News

Distributed by Tribune Content Agency, LLC.

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