What about Covid and students in HMOs?

Every week the publication of minutes and papers from the government’s Scientific Advisory Group for Emergencies (SAGE) brings fascinating new revelations about advice ministers are getting that relates to students and universities – and this week is no different.

There’s nothing specifically or officially about “universities” in this week’s batch. But there is some material on housing and some fascinating stuff on the impact of financial and other targeted support on rates of self-isolation or quarantine.

On housing what we have here is a Scientific Pandemic Influenza Group on Behaviours (SPI-B) evidence review (focused on social and behavioural aspects) for a Ministry of Housing, Communities & Local Government (MHCLG) Housing Impacts Paper. We looked at the paper that this fed into on the site a week or so ago – but this review of evidence is very interesting in and of itself.

We don’t when the paper was written (although it was discussed on September 10th) but extraordinarily an opening gambit in the document is that there is a lack of data on the characteristics of housing environments for people with Covid-19, and both the routes of transmission and role of specific environmental, demographic and social factors are not known. There is, for example, currently no data on the number of residents for each property to characterise Covid-19 transmission rates because household data is not collected at the point of testing. That feels like something it would be useful to collect.

In terms of the evidence that we do have, SPI-B says that overcrowding within homes is a driver of infection, not population density per se – because overcrowded living conditions increases risk of droplet and aerosol transmission due to limited space, and this is exacerbated if there is insufficient space due to sharing of living spaces. Shared spaces, surfaces and objects, such as kitchen and bathroom areas, have high potential for fomite transmission and this risk increases with the number of people and frequency of use.

It specifically picks out houses of multiple occupation (HMOs), where the risks intensify according to the number of people co-habiting and the age profile (older groups having greater vulnerability, but younger adults potentially having greater exposure). And as well as the transmission issues, SPI-B worries that isolation could result in increased exposure to damp and/or poor ventilation and increased risk of cardiovascular disease and respiratory disease.

Here’s the thing. SPI-B says that mitigations and isolation may be difficult to enforce mutually within these settings as there are no “culturally agreed forms of mutual obligation linked to kinship”. Shared responsibility for maintaining the health of the group may not be present. Distrust and conflict may develop if one member of the household is suspected to have or is confirmed to have Covid-19. And since there is no agreed upon “social script” for these households, it is important to provide clear guidance on Covid-safe practices targeted to shared rented accommodation. Think students in these contexts and all of the red flags go up.

Maybe individual local authorities have been doing things to provide clear guidance on Covid-safe practices targeted to shared rented accommodation, but generally we suspect that very little has been going on to implement those sorts of mitigations in student HMOs.

If, then, students might get infected in an HMO, are they likely to get a test and then follow the other steps we have in place to contain the spread of the virus?

To answer that question we turn to another SPI-B paper released today, on the impact of financial and other targeted support on rates of self-isolation or quarantine. This matters because as previously noted on the site, the effectiveness of the NHS test, trace and isolate system (and its nations equivalents) in reducing transmission depends upon adherence.

Current rates of full self-isolation are likely very low (<20%) based on self-report, and the paper notes that they are even lower among the youngest and the poorest.

There’s a good review of the evidence, and four types of solution get proposed.

1. First, there’s tangible, non-financial support. The paper says that proactive outreach is needed to identify and resolve any practical needs that people have (e.g. access to food). The Universities UK work nods in this direction, although it’s not clear that this is practically extending to HMOs in much more than a tiny part of the sector, partly because it would be so complex and expensive to get universities to take this on.
2. It also identifies emotional support for those who need it – access to social support or more formal clinical interventions delivered remotely if possible. Again, this is in the UUK recommendations but universal coverage across the sector is less clear.
3. Unsurprisingly, improved communication explaining how and when to self-isolate, and why it helps is said to be in addition to more detailed advice for those self-isolating (e.g. a help-line or SMS service).
4. But crucially its #1 recommendation is financial support – ensuring that those required to self-isolate would not experience financial hardship in doing so. This is a real problem for students – the government’s £500 “self-isolation payment” doesn’t cover most students as entitlement to that is dependent upon entitlement to universal credit. And hardship funds won’t stretch. So for students who do have and need part time work (esp on 0 hours contracts) there are major disincentives.

Sadly what isn’t covered here in the evidence is a kind of reverse problem – where students have paid to be at university, feel they have made an investment and don’t want to miss out – either rationally in relation to their education and development, or more emotionally in terms of friendships and bonds. We perhaps shouldn’t be surprised that there’s not a lot of evidence that covers this different type of “loss” that might disincentivise a student from adhering, but anecdotally it’s a real issue.

And the paper doesn’t address what happens when you add all of that up and threaten students with fines for not self-isolating. But we can probably guess what that might do to students’ motivation to get tested – especially in the context of the two papers here.

Both of these papers came too late to influence DfE guidance, but as we hurtle towards January and the potential for some degree of a “reset”, maybe there’s still time to fix what look like major issues when it comes to students – as long as DfE, the DWP and MHCLG can agree who’s responsible.