Erica Cuellar's dad wasn't worried, even if she was.

It was still the early days of the coronavirus pandemic — March 2020 — and Cuellar and her husband were becoming anxious about whether they could afford the $1,200 rent for their house in Houston. She'd lost her job as a home health aide for a boy with autism, and the news made it sound like most businesses were about to shut down, which would likely mean her husband would be getting fewer hours at the pipe yard where he works — or maybe even be laid off.

"If there was going to be shutdowns, those shutdowns would be not paid," she says. And, of course, "working with pipes is not really something you can do at home."

Her dad, on the other hand, lives in town, and owns his home. So he invited the couple and their toddler to move in with him — even though he was in his mid-60s and having a houseful of people could put him more at risk of getting COVID-19.

This story of families moving in together when their rent became unaffordable illustrates just one way that housing insecurity has connected to viral transmission during the pandemic.

"A person loses their home; they often move in with friends or family, [or] they might enter a homeless shelter," says Kathryn Leifheit, a postdoctoral fellow and epidemiologist at the UCLA Fielding School of Public Health. They might move into a motel, so everyone's in closer quarters. Losing a home "increases your number of contacts in the community, and it increases the efficiency with which COVID can spread through a community."

Bringing the virus home

"My dad was like, 'Don't worry about it. We'll be fine,' " Cuellar says. "My dad — he doesn't like going to the hospital or anything. He believes he can cure himself. He was like, 'Don't worry. I'll be fine.' "

The young family broke their lease early and moved in with him. Cuellar's husband had fewer hours, but he was still going in to work at the pipe yard, so there was a risk he could bring the virus home. "His job did not take [the pandemic] seriously, whatsoever," Cuellar says.

Then, in July 2020, her husband got sick.

"July the 4th — that's the day that he came home and he did not feel good," she recalls. "He got COVID, I got COVID, my 2-year-old got COVID, my dad got COVID."

She and her toddler didn't have any symptoms, but both her husband and dad got very sick.

"My husband went to the hospital first because he couldn't breathe. And then, three days later, my dad was having trouble breathing, so I took him to the same hospital," she says. "All the doctors were asking me, 'If they need to be ventilated, are you OK with that?' Thankfully, neither one of them had to be, but it was the most stressful time of my life."

More than a year later, both men still have health problems. Her dad was recently back in the hospital with pneumonia and congestive heart failure — aftereffects from COVID-19, Cuellar says. Her husband has had trouble breathing too, and he has had to use an asthma inhaler for the first time in years.

"Rent eats first"

Rent is unaffordable for a lot of people right now. One in every 4 renters has had trouble paying rent in the last several months, according to NPR's recent poll with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

"There's a saying that 'the rent eats first,' " Leifheit says. "People take on all kinds of work to avoid that eviction — and that might actually drive up the risk of COVID."

One way policymakers have tried to curb that financial stress is by making it illegal, at least for a time, for landlords to evict tenants when they can't pay rent. The Centers for Disease Control and Prevention issued a nationwide eviction moratorium, effective Sept. 4, 2020, citing these public health concerns. That moratorium was in effect until Aug. 26, 2021. States and cities issued their own eviction rules as well, some of which are still in place.

These laws have been far from perfect. There have been loopholes and workarounds, and some tenants certainly have had to leave their homes.

Research finds an eviction moratorium can slow viral spread

Even so, Leifheit has found in her research that these policies do help. In March 2020, nearly all states blocked evictions. Over the next few months, some states kept those eviction rules in place, and others let evictions start back up again. Leifheit and her collaborators looked at the six-month-period — from March 13 to Sept. 3, 2020 — and compared coronavirus infections and deaths for states that permitted evictions with states that did not.

"We found that states that ended their moratoriums saw over 430,000 more cases and over 10,000 more deaths than they would have if they had maintained their moratoriums," she says. These results held true even when the scientists took into account the effect of other measures known to curb viral spread, such as mask mandates in public places and shelter-in-place orders.

Those cases of illness and death cast a pall across whole communities, Leifheit notes — the impact is not restricted solely to the people who have insecure housing situations.

And outlawing evictions is only one piece of the solution, she adds. Giving renters money, through rental and utility assistance programs, so they are able to settle their debts and pay rent and utilities going forward is another approach that can work to keep people in their homes. Still, these policies are mostly geared toward people who are trying to stay put.

Extra challenges for those without a home

For people who aren't in their own place to begin with, finding and moving into stable housing can be an even bigger challenge.

John Stangel, for example, was living in a hostel in Philadelphia when the pandemic hit. He's now 55 years old and is a plumber by training. When construction jobs shut down in early 2020, he left Pennsylvania to find work in the D.C. area and ended up moving to Maryland.

"To me, there was just a blanket risk" of getting COVID-19, he says. Whether he was at a crowded shelter, working at a job or staying with friends, he says, he was at high risk everywhere he went. He didn't have a door he could close against the outside world to keep the coronavirus at bay.

Now Stangel is vaccinated, and as far as he knows, he says, he never got COVID-19 — to his amazement. He's now living just outside Washington, D.C., in an emergency shelter in Rockville, Md., that was quickly set up in an empty office building owned by the city. Even though people in that county were shielded from eviction because of the pandemic, there were still more people needing emergency shelter than ever. So the Montgomery County Coalition for the Homeless more than tripled its number of beds — from 60 to 200 — and moved some of the clients it was helping into the building where Stangel now lives.

Stangel is very happy with the shelter. There's food, laundry machines and a closet with donated extra clothes for anyone in need, plus ready access to dentists, doctors and counselors. The bunks and mattresses on the floor are socially distanced, and to keep air circulating, the shelter staff added temporary clear plastic ducts along the ceiling.

Even though he's vaccinated and comfortable with the shelter's policies to prevent viral transmission, Stangel says he also knows sharing your living space with dozens of other people during a pandemic is risky. He wants to get his own place, but it's expensive.

"Usually, to get into a room, it's somewhere between $1,200 to $1,800 to get in," he says of the Rockville area. He has just gotten a job working 40 hours per week, bought a small car and begun saving money for that rented room.

"What I'm trying to do now is save up enough money so I can get the first month's rent and the deposit — and maybe have a month to fall back on," he says.

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