Self-isolation doesn’t work for crowded households – Government needs to take the WHO’s advice and respond
How hard is it to self-isolate at home? Not hard at all if you’re empty nesters with a choice of bedrooms to hide away in.
But if you’re a family with no rooms to spare, and especially if you’re not just parents and children but grandparents too – then it may be impossible to observe the social distancing rules if one person starts to show symptoms. The danger this poses to the more vulnerable members of the household is obvious.
The difficulty of self-isolating faced by multi-generational families has been picked up by MP Neil O’Brien, who took the trouble to ask the ONS to provide statistics on the percentage of people aged 70 or over who live in a household with one or more non-pensioner (16+) adults.
O’Brien’s hunch that this might be important turns out to be spot on.
The figure for Leicestershire which covers his constituency is 16%, just above the national average of 15%. But in the City of Leicester, 29% of those age 70+ live in a household along with one or more working-age adults. The figures for Birmingham and its neighbour Sandwell are 28% and 30%.
At the top of the ONS list, on 40%, 44% and 45%, are for the London boroughs of Newham, Brent and Lambeth. With both the last two in the top 10 local authority areas for confirmed Covid cases, that poses the obvious question of how strong the link between these two statistics might be across the country as a whole.
On the latest local authority data (for 30th March), the correlation coefficient between the proportion of over-70s sharing with working-age (the ONS stat) and the proportion of the whole population with Covid is 0.6. For a rough-and-ready calculation, between two variables who had never set eyes on one-another before, that’s a pretty strong association – more than enough for the phenomenon of multi-generational households to be considered as one factor influencing the spread of the disease.
To underline this point, the graph shows how the strength of this association, almost completely absent at the start of March, has been rising over the past three weeks, as the infection (or at least the testing of it) spread out from the early hotspots in parts of London and South East England (e.g. Hampshire).
The day by day correlation across English local authority areas between total Covid cases (as a proportion of the population) and the proportion of those aged 70+ living in a household with someone of working-age
While the government has given clear guidance to those over 70 and those who are vulnerable to take extra precautions and to avoid all contact, they clearly face additional risks where they are in the same household as someone of working age, in particular if the accommodation does not allow for significant separation.
This points to a fundamental flaw in the Government’s strategy. For people who cannot, through force of circumstance, follow the official guidance, there needs to be an alternative to either self-isolation at home or admission to hospital.
The World Health Organisation (WHO) report on the Wuhan experience noted that in certain regions transmission of the disease was primarily through family clusters. WHO guidelines make clear that the decision to self-isolate for those with mild symptoms has to be based on a consideration as to whether that is practical in the particular case.
As one of the authors of the WHO report said in a recent interview, one of the lessons from Wuhan was that “to protect families the infected were taken to isolation centres”. The report advocates the use of hotels and gymnasiums as temporary facilities for those with mild symptoms, a step now being explored in Ireland (and, we think, France too).
Given the number of households with vulnerable people living alongside those of working age – and the emerging evidence that this is a factor in the number of cases in particular areas – there are two actions that Government, national and local, should take.
The first is to provide alternative accommodation for key workers who would normally be living with someone elderly or vulnerable.
The second is to establish isolation centres where those who have the disease – even if only mildly – can go if they would otherwise be living in close quarters with someone elderly or vulnerable.
Individuals should be left to make the decision as to whether they want to take these options, depending on the whole of their family position, but they should have that choice. Self-isolation can only work as a policy if people have the space to do it.
We stress that this is not a call to move old people out of their homes. The WHO’s advice is directed not at old people but at those who have mild symptoms, cannot self-isolate at home and so may infect other, vulnerable household members.
As they search for accommodation for those who are homeless or who are victims of domestic abuse, local authorities are already engaged in the task of housing or re-housing people who need help at this time. Local government cannot accept fresh duties without the resources to meet them but creating provision for those with mild symptoms who cannot self-isolate at home needs to be considered.
These are immediate responses to the crisis we are in. Beyond it, there needs to be a change in the official view of what space people need for the homes to be adequate (the “bedroom standard”). That view is not confined to the Conservative party but is shared across the political spectrum. This old consensus needs to be broken and remade.
This blog was amended at 4pm on 31st March to clarify that what we are calling for is the provision of accommodation so that people who are self-isolating and cannot safely do so at home should have another option.