The neighborhoods where COVID collides with overcrowded homes

The pandemic has layered a health crisis on top of a housing crisis on top of a class divide.

A clear pattern has emerged as the coronavirus spares some California neighborhoods and strikes others: The virus takes a heavier toll in neighborhoods where people pack into overcrowded homes, according to a CalMatters analysis of neighborhood-level data from 10 counties.

Neighborhoods with large numbers of people per household have about 3.7 times the rate of confirmed COVID-19 cases per 1,000 residents as neighborhoods where few residents live in tight quarters.

The pattern was startlingly consistent across the counties, whether urban or rural, coastal or inland, northern or southern.

About one in six Californians — 6.3 million people — lives in overcrowded houses or apartments that make it difficult to isolate from one another, according to data from the U.S. Census Bureau. Overcrowded housing is defined as households where there are more people than rooms of all types, besides bathrooms. 

CalMatters collected case data from 10 California counties with large numbers of infected people in late May, totaling nearly 69,783 confirmed cases in 659 neighborhoods, or about 69% of all the state’s cases at the time. The 20% of neighborhoods with the highest rate of overcrowded households were compared with the 20% of neighborhoods with the least overcrowding.

The pattern was startlingly consistent across the counties, whether urban or rural, coastal or inland, northern or southern. Only in Sacramento was there no link between household crowding and COVID-19.

COVID and overcrowding in 10 counties

Each dot represents a neighborhood in Los Angeles, Riverside, San Diego, Orange, Alameda, Santa Clara, San Francisco, Kern, Tulare and Sacramento counties. Some neighborhoods were outliers — with large numbers of cases but relatively little crowded housing — usually because they contained a senior home or a prison, which are not counted as crowded housing.

Lee Riley, a UC Berkeley epidemiology professor who has studied infectious disease in urban slums in other countries, said the strong link between overcrowded housing and infections could point to one reason that California’s shelter-in-place order didn’t bend the curve right away: People continued to spread the virus to the people with whom they live.

The findings came as no surprise to Leslie Cariño, director of nursing at the Nestor Community Health Center in a South San Diego ZIP code that borders Mexico and where there were 7.4 confirmed cases for every 1,000 residents in late May. That’s among the highest rates in the state, and about 13% of homes are crowded, among the highest in the county. (The total does not include residents of Mexico who crossed the border to seek treatment.) 

“Probably 100 percent of our patients are (in) generational housing. They live with their grandmother, and daughter and daughter’s daughter,” said Cariño, adding that family members of her COVID-19 patients often also show symptoms.

Twenty miles to the north, in the ZIP code that envelops the palm-tree studded neighborhoods of Ocean Beach and Sunset Cliffs, there were 14 times fewer infected people per 1,000 residents and just 1% of homes are overcrowded.

“Then, what we’re seeing now could be the beginning of something much worse,” Riley said.

Read part one of the Close Quarters Series: Overcrowded homes fuel spread of coronavirus among essential workers.

In Los Angeles, the state’s epicenter of both the coronavirus and overcrowding, two in every five households are overcrowded in some neighborhoods. The problem has increased in the past decade as neighborhoods have gentrified, pushing rents to rise astronomically, said Michael Lens, a UCLA urban planning professor.

The pandemic-induced recession may push more Angelenos into crowded conditions. An estimated 365,000 households in Los Angeles County are at very high risk of being forced out of their homes when the statewide freeze on evictions is lifted, according to a report from the UCLA Luskin Institute on Inequality and Democracy.

“Absent some unexpected interventions and generosity… of course people are just going to be way less able to afford housing,” Lens said.

Riley said CalMatters’ analysis indicates that if job loss forces more people to move into overcrowded homes or even become homeless, infections could spike.

“Then, what we’re seeing now could be the beginning of something much worse,” Riley said.

Read: How CalMatters analyzed the link between COVID-19 and overcrowded housing in California.

A constellation of risk

Experts warn against concluding that any one factor drives the virus’s unequal toll.

Other factors that drive up infections are lax local shelter-in-place policies, reliance on public transit and even weather. Plus, with unequal access to testing, it’s hard to know whether higher case counts result from more testing or more infection.

Rather, think of the virus’s heavy toll on more disadvantaged neighborhoods as a “constellation” of interconnected risks, said Jennifer Ahern, a UC Berkeley professor of epidemiology.

Overcrowded housing goes hand-in-hand with low-paying essential jobs. About two-thirds of Californians who live in overcrowded homes are essential workers or live with at least one essential worker, according to CalMatters’ analysis. Of those, 75% live in poverty and 92% are people of color.

People forced by poverty into overcrowded homes are much more likely to be people of color, due to discriminatory housing, education and banking policies that have segregated neighborhoods and prevented non-white families from amassing wealth, Ahern said. People of color also are more likely to suffer chronic conditions, such as diabetes or high blood pressure, that can worsen COVID-19 outcomes.

Read about how California’s housing crisis sickens families

Millions of workers in crowded homes

Overcrowded homes are defined as households with more occupants than rooms of any type, excluding bathrooms.

Who lives in high-risk households?

Crowded households with essential workers are overwhelmingly less white, poorer and less insured. High risk refers to overcrowded households in which at least one member is an essential worker.

The intertwined risks of being poor, non-white and living in overcrowded homes are clear from the data.

The hardest hit neighborhoods had three times the rate of overcrowding and twice the rate of poverty as the neighborhoods that have largely escaped the virus’s devastation. In the least affected neighborhoods, about half of residents are white while in the neighborhoods most heavily burdened by the virus, 82% of residents are people of color.

Take, for instance, Pico-Union near downtown Los Angeles, one of the hardest hit neighborhoods in California. About 56% of residents are immigrants, largely from El Salvador and Mexico. Just 4% are white. A third are living in poverty and more than 42% of homes are crowded.

About 15 miles away, in the beach enclave of Venice, the median household income of $102,548 is nearly three times higher than in Pico-Union, and there are six times fewer confirmed coronavirus cases per capita. More than two-thirds of Venice residents are white, 10% experience poverty and 3% of households are crowded.

“The history of our country has structured who lives where and has structured places of extreme disadvantage and places of extreme advantage,” Ahern said.

Oakland is another example of a city with wide disparities in infection rates and housing conditions. In the ZIP code that contains affluent Montclair neighborhood and Piedmont city, where winding roads slope up towards a ridge of lush nature preserves overlooking the Golden Gate Bridge, just 1% of homes are overcrowded. Fewer than one in every 1,000 residents tested positive for the coronavirus there. But across the city in the ZIP code that encapsulates majority Latino neighborhoods like Fruitvale, the infection rate was six times higher and 21% of homes are overcrowded.

A focus on Alameda County

In Alameda County, the virus has hit harder in neighborhoods with more overcrowded homes. Each circle represents a ZIP code in the major cities of the county.

Ahern explained that the differences between how COVID-19 affects people in advantaged versus disadvantaged neighborhoods shines a new light on a centuries-old “epidemic of health disparities.”

“The history of our country has structured who lives where and has structured places of extreme disadvantage and places of extreme advantage,” Ahern said.

Overcrowding not the same as density

Overcrowded housing, or how many people pack into a home, is different from population density, or how many people pack into a square mile.

Researchers and politicians alike have said that population density may exacerbate the spread of the virus, explaining why cities like New York and Los Angeles have been so hard hit. Others counter that tightly-packed cities can actually help fight the virus, because people can get medical care more easily and public health systems are stronger.

The CalMatters analysis found that the link between density and the virus varied across the state.

In several urban counties CalMatters analyzed — Los Angeles, Orange and San Diego — denser neighborhoods had higher numbers of coronavirus cases per capita. Because these neighborhoods also have more household crowding, it’s difficult to parse out which factor — overcrowded houses or dense neighborhoods — better explains the higher case rates.

In those areas, both factors likely contribute to transmission, said Riley, the Berkeley epidemiologist: “It’s not going to be one or the other. It could be both.”

Especially in Los Angeles, both population density and overcrowded housing track with the rate of positive cases. There, denser neighborhoods have more infected people — even if they have low rates of overcrowded homes. And places with more residential overcrowding have more cases, regardless of how dense the neighborhood. Pico-Union, a working-class, immigrant neighborhood where 42% of households are overcrowded, is nearly three times denser than Venice, for instance.

A look at Los Angeles

Los Angeles is another clear example of where the coronavirus has hit neighborhoods with more overcrowding. Each circle represents a neighborhood in Los Angeles or a nearby city in the county.

But in suburban and rural counties, there was no clear link between density and coronavirus.

Take sprawling Riverside county. The ZIP code that holds the farmworker community of Mecca, in the desert tucked between fields and vineyards just north of the Salton Sea, is not a densely populated area. But it has a high rate of overcrowded housing and led the county with 8.9 cases of the virus for every 1,000 residents.

Read about the housing crisis among California farmworkers.

“This is consistent with what we know about this virus. It really takes intimate, close contacts to be transmitted,” Riley said. “That can happen anywhere. But in small population areas, it’s the crowding that’s going to be more important than population density.”

This has important implications as the state begins to re-open, Riley said. Though people may be tempted to think that less populated areas will be spared an outbreak, CalMatters’ analysis may indicate that the virus could spread quickly in rural areas.

“In low population areas, if the virus is there, it’s going to be transmitted in crowded places” such as crowded homes, churches, prisons and nursing homes, Riley said.

Will COVID-19 drive more overcrowding?

In San Diego, many people are essential workers and live in tightly packed quarters, often with other families, said Nancy Maldonado, chief executive officer of the Chicano Federation, a nonprofit organization that provides education, nutrition and housing services to families across the county. Social distancing simply isn’t an option, she said. 

Ironically, the virus brings a double threat: Job loss forces some families into more congested living arrangements.

One front-line worker told her he’d live in his car if he got sick to avoid bringing the virus to his family. Another man who was infected shares a one-bedroom apartment with his three children and wife.

Ironically, the virus brings a double threat: Job loss forces some families into more congested living arrangements.

“People have lost income and have had to move in with family or friends, or moving around to different homes of people they know,” said Maldonado. “Again that’s just exacerbating the situation.”

A spotlight on San Diego

In San Diego County, poorer neighborhoods with more overcrowded housing have more cases of the virus. Each circle represents a ZIP code in the major cities of the county.

This could soon be the case for Mariana, a client of Maldonado’s organization, who asked that CalMatters only use her first name because she, her husband and her daughter are undocumented.

In mid-March, when the shelter-in-place order was enacted, the people whose houses Mariana cleans stopped calling. Her husband’s job selling windows door-to-door disappeared. So they struck a deal with their landlord. For now, they’re paying about a third of the $1,200 rent for the one-bedroom apartment they share with their 2-year-old son and 7-year-old daughter, who set up a remote learning station in the kitchen, complete with a mini-whiteboard and a princess-themed pencil holder. All four sleep in the bedroom, though Mariana said worries often keep her and her husband awake through the night.

Mariana has considered moving her family into a single room in a home shared with other families, though she knows the risk of getting sick at home would rise.

They live in National City, south of San Diego, not far from the border with their home country, Mexico. Here, 14% of households are overcrowded, compared with the county median of 4%. Their neighborhood is one of the county’s hardest hit.

Mariana’s husband recently found a full-time job in construction. This increases the likelihood he brings the virus home, but Mariana has a plan: anyone who falls sick will stay in the bedroom, while those still healthy would sleep in the living room.

Even so, they owe about $2,400 in overdue rent. 

“No sé cuánto tiempo nos vayan a querer seguir apoyando. Por mientras, pues todavía vamos a estar aquí,” Mariana said. In English, “I don’t know how long (the building manager) is going to want to continue helping us. But for the time being, we’ll still be here.” 

Mariana has considered moving her family into a single room in a home shared with other families, though she knows the risk of getting sick at home would rise.

Formerly a social worker in Mexico, Mariana’s comfortable accepting help when she needs it. She visits the food bank and gets free diapers from a nonprofit. She also hoped to qualify for $1,000 in state disaster relief for undocumented people. But each time she called, the phone lines were jammed, Mariana said in Spanish, pausing to comfort her two-year-old son whose television show had suddenly disappeared when his sister took the remote. Once, she stayed on the line for 11 hours with no answer.

Mariana said the aid would be a relief for her family: “un descanso, un alivio.”

But without it, there will be difficult consequences, she said. “(Pero si) no se logran, van a ser consecuencias difíciles.”

Story by Jackie Botts, data analysis by Jackie Botts and Matt Levin, graphics by Lo Bénichou.

This article is part of The California Divide, a collaboration among newsrooms examining income inequality and economic survival in California.