When I call up Harvard public health professor Joseph Allen to ask how apartment living could contribute to the spread of COVID-19, I don’t expect the director of the esteemed university’s Healthy Buildings Program to talk so much shit. But as Allen explains, coronavirus has been found in feces, and flushing the toilet releases tiny airborne particles. And because the virus can survive airborne for two to three hours, proper plumbing, ventilation and different poop schedules might be extra crucial for curbing COVID among people in apartment buildings.
Experts like Allen learned this the hard way in 2003 when Severe Acute Respiratory Syndrome, or SARS, ravaged a housing complex in Hong Kong, an outbreak that infected 329 and killed 42 people. “Someone was sick and shedding virus through their stool to the rest of the building and many people got sick. That can happen and that does happen,” Allen tells me.
On March 30th, almost exactly 17 years ago, police and public health officials swarmed Block E of the property in biological suits, masks and surgical gloves to try to contain the virus, but it was too late. Upwards of 140 residents had already fled to hotels and family members’ homes, with authorities having to track them down as they passed on SARS to others. The remaining tenants were eventually moved into confinement camps under quarantine laws that hadn’t been used since 1894 during the bubonic plague.
“When the bathroom was in use, with the door closed and the exhaust fan switched on, there could be negative pressure to extract contaminated droplets into the bathroom,” Yeoh Eng-kiong, Hong Kong’s secretary for health, welfare and food, explained to the Washington Post at the time. “Contaminated droplets could then have been deposited on various surfaces such as floor mats, towels, toiletries and other bathroom equipment.”
This time around, “people aren’t thinking about that,” Allen warns, even though he notes that authorities suspect that coronavirus spread this way in China. “Buildings, depending on how they’re operated and maintained, can spread disease, or they can help prevent it,” he explains.
Allen’s caution casts a modern light on an age-old problem of how easily infectious diseases spread in dense dwellings. Tenement-style housing in Europe, namely Scotland, simply meant multiple households in a single building in the mid-17th century. But as population growth skyrocketed in the U.S., tenements became packed with as many working-class people as possible, as cheaply as possible. By the end of the Civil War, in fact, there were more than 15,000 tenement buildings in New York City, where inhabitants typically occupied 90 percent of an average lot, leaving barely any room for air shafts or windows. Poor ventilation, combined with a lack of running water and physical space, primed residents to spread illnesses like smallpox and typhoid fever.
Reforms followed an 1865 report that found 65 percent of the city’s population was living in housing that threatened their health, including several laws or “Tenement House Acts” in 1879, 1901 and 1929. The 1901 act, known as “The New Law,” set out to rectify many of the issues the 1879 act, known as “The Old Law,” failed to address. Old-Law tenements squeezed as many as 10 to 20 families in four- to five-story buildings often with only one window per multi-room apartment and narrow air shafts that further prevented air circulation, and no running water. New-Law tenements, however, were constructed on corners, because two streets provided more opportunities for windows, natural light and fresh air circulation. Apartment complexes also grew to six or seven stories to allow for bigger air shafts and better ventilation.
Nearly three decades later, in 1929, the Multiple Dwelling Law replaced the New Law. This marked yet another turning point in New York City housing rights known as “slum clearance” that led many tenement buildings to be demolished.
Tenements may not have survived reform, but there’s evidence that up to 40 percent of apartments in Manhattan don’t live up to modern building codes. Further, New York City continues to be the densest population in the U.S. at more than 27,000 people per square mile, meaning about 5.6 million renters live on top of each other. Such a propensity toward apartment living might explain why the Tri-State Area currently has more coronavirus cases than anywhere else in the world, with more than 200,000 infections and 8,100 deaths.
At the very least, the city’s density accounts for why tenants are raising questions and concerns. One person asked The New York Times if landlords are required to disclose if someone in the building has coronavirus, or if that person has used any amenities like a shared gym. The short answer is no, they’re not, due to medical privacy laws meant to protect from harassment and discrimination. The more complex answer, according to Allen, is that it’s besides the point. The only thing such a notification would give residents is a false sense of security, he warns.
Because by now, everyone should assume someone in their building is infected with COVID-19 and stay vigilant by wearing gloves and masks in hallways and common areas. Experts agree that the probability of mail being infected is very low, but tenants should wear gloves at shared mailboxes, wait three days to open packages, and of course, always wash their hands thereafter. Landlords are responsible for cleaning hallways and common areas, but similarly cleaning door knobs, elevator buttons and buzzers with an EPA-registered disinfectant as a matter of due diligence is strongly advised as well.
If tenants live with infected people, or just terrible roommates, it’s best to operate on the assumption that they have the virus as well, Allen says. This means obvious measures like using different dishes and utensils and sanitizing surfaces, but more extreme tactics like wearing a mask in common areas, too. Since fresh air decreases the spread of coronaviruses, precautions like opening the windows and investing in a portable air-purifier are definitely beneficial. And when it comes to shitty roommates, that air might matter most in the aforementioned bathroom. “You may not want to go into the bathroom after your roommate is in there. Give the exhaust fan a little time to work, and the virus particles a little time to dilute,” Allen recommends, adding that everyone should be flushing with the lid down.
To ensure plumbing and ventilation systems are up to code, tenants should pay close attention to stuffy rooms that are difficult to heat or cool, high energy and water bills, low water pressure and slow drainage, among many other problems. Most cities also allow residents to search if the address has a certificate of occupancy, or proof that the building (and unit) has passed inspection. If there’s no certificate and the landlord fails to resolve it, tenants can report them to 311 or the Attorney General, and consult with tenants’ rights advocacy organizations like Make the Road New York. (This can be a very good reason to withhold rent as well.)
All that said, from a public-health perspective, it’s not realistic to recommend people simply spread out. The reality is, most people cannot afford to just pick up and move, even when their lives depend on it. Plus, to suggest that sprawl would be better for preventing the virus would be ignoring the reality of how it spreads — mainly, in asymptomatic people. Which only gives people in rural and suburban areas a false sense of security. “I don’t think suburban or rural living are protective,” Allen offers as the final word on the topic.
What is protective, however, is clean hands, social distancing and more transparency about our bowel movements than any of us are probably comfortable with.