Covid-19: we need urgent action on overcrowded housing

In a recent announcement, the UK government promised that people who face difficult life circumstances, will receive more support to self-isolate if they have covid-19. Part of this package of measures is help for households facing such overcrowding that safely distancing from others in their home is challenging. While this is an urgent and pragmatic measure to protect the nation from the pandemic, it is only a gasp of fresh air that will provide momentary respite. When it comes to healthy housing, we desperately need to take a bold, deep breath.

Data from 2020 suggest 829,000 (4%) households face overcrowding in the UK, a figure that keeps growing. Rates of overcrowding are highest among renters of social (9%) and private housing (7%) and are more common among lower socio-economic groups, women, ethnic minorities, and people with disabilities. Of course, overcrowding is an issue for social and economic justice, as well as health. Covid-19 makes up only a small part of the broader health concerns related to overcrowded housing. Perhaps, however, the pandemic can focus our minds on the wisdom inherited from Victorian public health, which has been long crowded out of a housing policy sphere so concerned with homeownership. One piece of new research should at least redirect our gaze.

Indoor environments are prime locations for transmission of SARS-CoV-2, so overcrowded homes are a key potential driver of the pandemic and the stark inequalities it has exposed. Earlier this year our findings from the Virus Watch study brought home this message with granular, household-level data based on both antigen and antibody testing. 

It had already been demonstrated that inhabitants of larger households, or those living in areas with a higher population density are at greater risk of being infected with SARS-CoV-2. These could, however, be explained by higher transmission outside the home; for example, with a larger household, there are more members to leave the house only to bring the virus back. Equally, with more people in the neighbourhood, the local shop or bus might be busier.

However, the Virus Watch study pins the overcrowding issue down directly. Our findings demonstrate that overcrowding, understood as having fewer habitable rooms than household members, carries a 2-to-4-fold increased risk of being infected with SARS-CoV-2, than households with more rooms than inhabitants (“under-occupied” households). The analysis suggests that even homes with one habitable room per occupant may have a higher infection risk than under-occupied homes.

To put this in context, the infamous “bedroom tax introduced by the Conservative/Liberal Democrat coalition government reduced the amount of housing benefit received by people in social housing if their home had more rooms than a calculated allowance. Supposedly a measure to tackle overcrowding by encouraging people to give up their “under-occupied” homes and allocating those homes to people in more crowded conditions, it was predicated on the view that the space they had was “spare” and unnecessary. With this new Virus Watch data, it is evident the story of “under-occupied” housing sold to us by the bedroom tax is divorced from the everyday health realities of our society. If one household member were to be infected, that additional room might have spared their child, parent, grandparent, partner, or friend. These measures aren’t efficient, they erode our resilience to adversity.

The UK prime minister, Boris Johnson is likely aware of his predecessors’ legacies. On housing policy during a pandemic, he might look to the Conservative Prime Minister Benjamin Disraeli (1874). During Disraeli’s second premiership, the Artisans’ and Labourers’ Dwellings Improvement Act 1875 was introduced. It was a policy designed to radically improve the housing of those worst off, by offering inexpensive finance to local authorities to clear and redevelop slum housing. Set against the backdrop of repeated cholera outbreaks, and approved alongside a new public health act, this measure was as much a social policy as a public health one.

Although this history should not be taken as a recommendation to identically replicate the policy—not least because the exact form of the policy still left many without a decent home—it is instructive politically today. It highlights that covid-19 offers us a window to make major improvements to poor housing and secondly, that Conservative housing policy needn’t focus so heavily on homeownership to have appeal. Indeed the similiarities behind Disraeli’s overtures to the working classes and Johnson’s levelling up agenda suggests that such a departure from recent Conservative housing policy may not be out of place in Johnson’s broader political strategy. 

Boldly financing the development of more quality, affordable, and healthy social homes would set a standard across the housing industry. 

If Boris Johnson is searching for a legacy, improving the estate of the nation could be it.

Nicholas Patni, medical student, Hertford College, University of Oxford.

Isobel Braithwaite, specialty registrar in Public Health and NIHR Academic Clinical Fellow, UCL Institute for Health Informatics. @izzybraithwaite

Parth Patel, clinical research fellow at the UCL Institute of Health Informatics. @pathwithanr

Robert Aldridge, professor at the Institute of Health Informatics, University College London. @rob_aldridge

Competing interests: The authors are part of the UCL Virus Watch study.