Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the United States
Authors: Ashwini R. Sehgal, David U. Himmelstein, Steffie Woolhandler
Journal: Annals of Internal Medicine (2020)

Letters21 July 2020Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the United StatesFREEAshwini R. Sehgal, MD, David U. Himmelstein, MD, and Steffie Woolhandler, MD, MPHAshwini R. Sehgal, MDCase Western Reserve University, Cleveland, Ohio (A.R.S.), David U. Himmelstein, MDCity University of New York at Hunter College, New York, New York (D.U.H., S.W.), and Steffie Woolhandler, MD, MPHCity University of New York at Hunter College, New York, New York (D.U.H., S.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4331 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to spread mainly through respiratory droplets between persons who are in close quarters. Such droplets are produced when an infected person coughs, sneezes, or talks. As a result, infected and exposed persons are instructed to separate themselves from others to limit further spread. The World Health Organization and the Centers for Disease Control and Prevention advise those who are infected with or have been exposed to coronavirus disease 2019 (COVID-19) to isolate or quarantine at home in a separate bedroom and bathroom if possible (1, 2).Objective: To determine the feasibility of separate rooms for isolation and quarantine for housing units in the United States.Methods and Findings: We obtained data on residential dwelling units (excluding group quarters) and occupants from the most recently available (2017) American Housing Survey. This survey includes a representative national sample of housing units and was done by the U.S. Census Bureau, with a response rate of 80.5% (3). We determined the number of bedrooms, bathrooms, and occupants per unit; the type and age of units; and respondent demographics.We estimated the proportion of dwellings where optimal isolation or quarantine was impossible because separate bedrooms and bathrooms were unavailable. We considered a separate bedroom to be available in all single-occupant dwellings and in multioccupant dwellings where allowing 1 occupant a private bedroom would not impose overcrowding (defined as >2 occupants per bedroom) on other household members. A separate bathroom was considered available in single-occupant dwellings with at least 0.5 bathroom and in multioccupant dwellings with at least 1.5 bathrooms.We generated descriptive statistics (means, proportions, and SEs) for all variables. Logistic regression was used to determine the bivariate relationship between a separate bedroom or bathroom being unavailable and characteristics of housing units and occupants. We used survey procedures in SAS, version 9.4 (SAS Institute), with weights and replicate weights provided by the American Housing Survey to generate national estimates, SEs, odds ratios, and 95% CIs using the balanced repeated replication method (4).The 57 984 occupied dwellings in the sample represented 121.57 million dwellings nationwide that housed about 303 million residents; the dwellings averaged 2.80 bedrooms, 1.82 bathrooms, and 2.49 occupants (Table). Single-family detached homes, newer units, and those occupied by higher-income households had more rooms.Table. U.S. Residential Dwelling Units, Number of Occupants and Rooms, and Suitability for Isolation and Quarantine, 2017*Isolation or quarantine was impossible in 25.29 million dwellings (95% CI, 25.04 million to 25.48 million dwellings), accounting for 20.8% of all U.S. residential units, because they lacked sufficient bedrooms, bathrooms, or both. This included almost 30% of the 88.2 million units with more than 1 occupant. Overall, about 81 million persons lived in units unsuitable for isolation or quarantine.Relative to White, non-Hispanic persons, Native American and Hispanic persons had 2 to 3 times higher odds—and Black and Asian persons had 1.7 times higher odds—of occupying units unsuitable for isolation or quarantine. Apartments, older buildings, and dwellings in the Northeast were more likely to be unsuitable for isolation or quarantine.Discussion: More than 1 in 5 U.S. homes, housing about one quarter of all Americans, lack sufficient space and plumbing facilities to comply with recommendations to isolate or quarantine to limit household spread of COVID-19. This proportion is particularly high among homes occupied by minority and poor individuals and among apartments, a pattern that mirrors both the high incidence of COVID-19 in those groups and racial discrimination in access to housing that was federal policy until the 1960s and, unfortunately, persists today.Several limitations apply to our findings. Respondents might under- or overreport the number of occupants and rooms. We could not directly assess individuals' ability to isolate or quarantine; in dwellings with large bedrooms, 3 or more occupants might be able to safely occupy 1 bedroom without overcrowding. Some persons may have altered their living situations in response to the pandemic, causing us to underestimate crowding—for example, if college students returned home or families doubled up because of job loss. Wearing face masks, physical distancing, and bathroom disinfection might prevent transmission even where separate rooms are unavailable.Policymakers should consider offering (but not requiring) persons needing isolation or quarantine the option of staying at no cost in underutilized hotels, under medical supervision, with free meal delivery and internet and telephone access. Similar strategies have been used successfully by several Asian countries (5) and might decrease COVID-19 transmission, particularly in minority communities. This might reduce medical costs and economic damage from work absenteeism and job loss, as well as the risks to and burdens on many families.References1. World Health Organization. Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19). 19 March 2020. Accessed at www.who.int/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19) on 15 July 2020. Google Scholar2. Centers for Disease Control and Prevention. COVID-19 quarantine and isolation. Accessed at www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine-isolation.html on 15 July 2020. Google Scholar3. U.S. Census Bureau. 2017 AHS Integrated National Sample. Updated 21 December 2018. Accessed at www2.census.gov/programs-surveys/ahs/2017/2017%20AHS%20National%20Sample%20Design,%20Weighting,%20and%20Error%20Estimation.pdf?# on 18 April 2020. Google Scholar4. Judkins DR. Fay's method for variance estimation. J Off Stat. 1990;6:22-239. Google Scholar5. Lai S, Ruktanonchai NW, Zhou L, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature. 2020. [PMID: 32365354] doi:10.1038/s41586-020-2293-x CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Ashwini R. Sehgal, MD; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPHAffiliations: Case Western Reserve University, Cleveland, Ohio (A.R.S.)City University of New York at Hunter College, New York, New York (D.U.H., S.W.)Grant Support: By grant MD002265 from the National Institutes of Health (Dr. Sehgal).Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4331.Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Himmelstein (e-mail, dhimmels@hunter.cuny.edu). Data set: Available from the American Housing Survey website.Corresponding Author: Ashwini R. Sehgal, MD, Center for Reducing Health Disparities, Case Western Reserve University, 2500 MetroHealth Medical Center, Cleveland, OH 44109; e-mail, sehgal@case.edu.This article was published at Annals.org on 21 July 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAdapting to changes in the COVID-19 pandemic: research and recommendations on spatial layout and resident experience in MURBsAddressing Racial Capitalism's Impact on Black Essential Workers During the COVID-19 Pandemic: Policy RecommendationsAre COVID ‐19 patients given adequate instructions about toothbrush hygiene? 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