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COVID-19 Test Delivery Leaves Out Houseless and Multigenerational Households

Two years into the pandemic, the Biden administration’s first direct testing response leaves a lot to be desired.

Boxes of iHealth COVID-19 Antigen Rapid Test kits, provided by the state of California, are ready for parents to pick up, at Tulita Elementary School, as positive COVID-19 cases spike with the spread of the Omicron strain, in Redondo Beach, California, on January 6, 2022

This month, the Biden administration launched a program to deliver four COVID-19 rapid tests per household to people with an address across the country. While the program will deliver 500 million tests, advocates say it innately disadvantages houseless people, multigenerational households, and those who live in apartment buildings that may be subject to a glitch in the system that only allows one set per building. Ultimately, the program is most helpful for those who fulfill the traditional American nuclear family, leaving out the populations most at risk of contracting the virus because of their inability to afford living on their own. The demand for testing comes when community spread is rampant, and the country is still averaging close to 700,000 new cases a day. The Biden administration’s first direct testing response leaves a lot to be desired two years into the pandemic.

“There’s clearly a very myopic view of how to handle this rollout, which has consistently been a problem this entire pandemic,” said Dr. Imani E. McElroy, a physician at Massachusetts General Hospital. “[The rollout] directly benefits those who have the privilege of high-quality access.”

McElroy lives in an apartment building in East Boston with about six units in a neighborhood with a Latinx population of 52.9%, which she says has been severely impacted by COVID-19. Soon after the program was announced, she read that people who lived in apartment complexes could not order their quota if someone else in the building had already placed an order. She has held off on ordering her own until she confirms that her neighbors, including a multi-generational family, can apply for their tests. As a physician, she has access to COVID-19 tests through her department.

“I didn’t want to affect their ability to get their test,” McElroy said.

According to Generations United, an estimated 66.7 million adults, or one in four people in the U.S., live in a multigenerational household. While some live in multigenerational households for cultural reasons, many people have been forced into them because of the rising cost of living across the nation. In October last year, the Federal Register reported that the cost of living for 2022 would increase 5.9%. In Boston, where McElroy lives, the cost of living is 51% higher than the national average. In a 2016 Pew Research study, Black, Latinx, and Asian families were more likely to live in multigenerational households than white families. For these households, quarantining and self-isolating during a pandemic is much more precarious than usual. According to a public health study on multigenerational households in New York City, overcrowded homes and multigenerational housing are independent risk factors for COVID-19.

“The largest affected populations by COVID have been populations that can’t afford to live on their own and can’t self-quarantine,” McElroy said. “You’re getting rapid transmission throughout these communities.”

McElroy suggests that the federal government use census data to send more tests to households that may need more, and have an efficient way of requesting more tests as required. She also suggested having the option to send them to a P.O. box if needed. The U.S. Postal Service has not responded to a request for more information on any future distribution programs.

“There has to be a way to petition to be able to get more tests,” McElroy said. “There’s a lot of stopgaps that could have been used to prevent the issues that we’re consistently seeing in this response.”

Houseless people, who do not have a permanent address to include on the form, have also been left out of the current program. Referred to as “the invisible victims” of COVID-19, few resources keep track of the number of infections and deaths among the houseless community.

Even if houseless people were to have access to at-home rapid tests, David Peery, the founder of Miami Coalition to Advance Racial Equality, says it would be difficult to keep them in their possession. Many houseless people who live in encampments are subject to frequent street sweepings that trash and destroy all of their possessions.

“[The government] can give out a testing kit on a Monday, and the City can come and do a sweep the very next day and destroy everything and throw all your stuff away,” Peery said. “It’s very hard to keep possessions when you don’t have a home.”

According to Peery, a more comprehensive solution would be to expand non-congregated emergency shelters by contracting and renting hotel and motel rooms. He says that more private rooms used in cities across the country since the start of the pandemic for isolation purposes, including Atlanta, should be expanded as emergency shelter alternatives as opposed to the traditional emergency congregate shelters that pack people into a dorm room. A public health study supports Peery’s idea, suggesting that isolation hotels help mitigate the spread of Covid-19 among houseless populations.

“Non-congregate settings have proven to be much more effective in getting people off the streets. Now you have a roof over your head, you have a door you can lock, and you can store your possessions, including these at-home testing kits,” Peery said. “They’ll also be protected from infections and it will provide a path to permanent housing.”

Before the government launches another program to distribute tests or personal protective equipment, people across the country say considerations should be made to reach the communities most vulnerable with the least amount of access to these mitigating measures.

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