There’s been lots of discussion about student migration – at the start of term, the end of term, and to some extent during the term.
But one of the major emerging issues is housing itself in viral transmission and amplification – as halls (in particular traditional halls) grab the headlines, so-called “households” within them come into question and we wonder whether the advice we got given (on for example masks in halls) was appropriate.
Regular readers of Wonkhe will know that one of the things that vexes us is the extent to which students are seen exclusively as the Department for Education’s problem – with similar allocations of responsibility around the nations. Why, for example, do we barely ever hear about students and student accommodation from the Ministry of Housing, Communities and Local Government (MHCLG)? Why isn’t Robert Jenrick touring the studios answering on accommodation?
From what we know over the years, it’s very easy to understand why much of the guidance over the summer from DfE to universities focussed on campuses rather than communities, and why nothing from MHCLG has focussed on the great student migration, student HMOs or university/private halls.
It’s because neither department ever tends to view students in the community as their problem.
We’re back on this little hobby horse because it’s Friday, there’s a fresh batch of papers out from SAGE, and this time we have a paper written in response to an MHCLG commission for advice to better understand the role of housing in transmission and how it might be mitigated.
Basically what we have learned over the weeks is that different government departments have been able to ask SAGE for specific advice when issuing guidance.
Back in March SAGE advised government that:
It is clear that household quarantining would lead to increased risk of others within the household becoming infected, as described in the modelling.
…and in April its modelling group also observed that:
Some institutional settings, such as care or nursing homes, boarding schools, barracks, prisons, etc. are already self-contained, highly connected, networks and SARS-CoV-2 is likely to spread quickly and easily. As a result, all efforts should be made to prevent the virus entering such a setting in the first place i.e. shielding the whole institution and greatly reducing movement between them.
What we then know is that as “early” (I know, I know) as 8th July, DfE was asking SAGE for specific advice on student accommodation:
Ahead of September, we need clear guidance on the appropriate measures to put in place including in large scale university accommodation, in particular in relation to shared spaces such as kitchens, bathrooms and common areas. We will need guidance on whether and how the concept of “protective bubbles” can be usefully applied to (particularly large-scale) accommodation blocks and/ or additional hygiene or other measures recommended if these go beyond existing guidance issued.
Now though, we have a paper prepared specifically in response to an MHCLG commission for advice on the role of housing in transmission, discussed on September 10th – the same day we got DfE’s advice. When you read it, you think crikey, if only we’d seen this sooner – even though much of it is pretty obvious.
In the opening section to the paper, we naturally discover that the relationship between housing and health is well established but multifactorial and complex. That said, likely housing related risk factors for Covid-19 include four factors that we might well tend to associate with student accommodation…
“Large household size;
High density occupancy;
Poor quality housing;
And “likely household related risk factors” include another four factors that we might well tend to associate with student accommodation…[my bold]
High level of risk due to numbers of occupants, shared spaces and facilities, poor ventilation and length of exposure;
High risk of exposure of household members outside the home due to a high level of occupational, family and social connectivity;
high level of risk within the home due to vulnerable household members, caring and domestic responsibilities, intimate social relationships (families) or barriers to communication and shared action (in houses of multiple occupation);
contribution of social deprivation to risk of occupational exposure, poor health and inadequate housing, and barriers to implementing mitigations, including overcrowding and lack of resources and control over housing conditions.
The paper suggests four mitigations likely to reduce risk:
guidance for housing providers and occupants on improving ventilation provision and use
co-designed strategies and communications to support all mitigation behaviours in the home, tailored for all types of households and household visitors
provision of support for socially deprived households at high risk to implement all feasible mitigations
guidance for housing providers and regulation to improve housing quality and reduce occupied density
Yes, you read that right. We really ought to have been reducing occupied density. Why might that help?
Larger households are more at risk simply due to the increased opportunities for transmission, and higher numbers of potential infections (including when household members are quarantining or self-isolating at home). Larger households may also have larger social networks.
Higher density occupation may be due to larger household sizes or limited space within the home, and may be linked to poor ventilation, shared spaces and limited facilities for washing, cleaning and cooking. Homes with greater density (amount of space vs number of occupants) and fewer rooms (e.g. shared bedrooms) will be less able to physically isolate a sick household member. Key shared areas in the home (bathrooms and kitchens) are used by all occupants, and there will be multiple high touch sites (surfaces, handles, etc). These shared spaces may undermine engineering mitigation measures for fomite, droplet and aerosol transmission, and compliance with NHS advice for self-isolation at home.
We’re not just talking about halls though:
Houses of multiple occupation may be at high risk due to a combination of large household size, household members with different social networks, poor environmental conditions (including overcrowding), socio-economic disadvantage, and additionally the absence of a clear social script about how to carry out domestic work and manage interactions. There are sub-types that should be considered differently in terms of risks, mitigations and communications. For example, student has distinct social relations, domestic labour and responsibility.
Although that said:
Communications should not stigmatise particular household or community types as “risky” as this would be premature, divisive to the collective national effort of cooperating to combat Covid-19 and could contribute to social disorder.
Someone should do something
Of course, we didn’t reduce density or occupancy. We spent the summer carefully reducing the capacity of lecture theatres, classrooms, libraries, toilets, corridors, catering outlets and social space – whilst our communities spent the summer carefully the reducing the capacity of cafes, bars, nightclubs, public transport and shops.
While all of that tumbled to 30%, we left student accommodation at 100% – and in the absence of an alternative vision, our assumption by default became that students will spend even more time in student accommodation than usual, because of the lower capacity available to students to spend their days on campus and in the community.
In other words, our plan has been to keep people carefully apart for three or four hours a week, but for the rest of the week to ram them into spaces never designed to be used this intensively, with inevitable results.
As I said over the summer, there is an argument that says that the sector of science #madeatuni should have spotted this earlier. But if you run with “we’re following the guidance”, what we don’t know – and we may never know – is why this only got discussed by SAGE as late as September 10th.
Did DfE/MCHLG ask for it earlier but get knocked back? Why hasn’t it re-emerged in guidance almost a month on?
And what happens now? Are we just going to attempt the whole academic year with the occupancy levels we have now but with a “bit more social distancing” within?
Jane McDonald presents
So far, much of the coverage has been on the large “landlocked cruise ships” of student halls, but the evidence from the US is that once you deal with the dorms you remind yourself that the rest of student housing poses a major problem too.
So given these SAGE warnings on HMOs, are we going to heed them and start to reduce occupancy before that chunk of student housing stock becomes the next big issue in terms of both press interest – and more importantly, virus transmission and amplification?
Are we prepared to cause them to reduce capacity and find ways to compensate either tenants or landlords, particularly where shared tenancy arrangements specifically disincentivise a student from leaving?
Or given where we are in the term, if instead we have to live with the virus at the occupancy we have, can we at least ramp up testing of students to incentivise symptom declaration and give the occupants of HMOs and private halls the same kinds of support to self-isolate that we’re now panic-adorning on those in university-run halls?