October 13, 2020 Governor Larry Hogan 100 State Circle Annapolis, Maryland House Speaker Adrienne Jones State House H-101, 100 State Circle Annapolis, Maryland 21401 Senate President Bill Ferguson State House, H-107, 100 State Circle Annapolis, Maryland 21401 Dear Governor Hogan, Speaker Jones, and President Ferguson: As students, staff, community leaders, and faculty in the fields of medicine and public health, we urge you to take action to stabilize housing in Maryland during the COVID-19 pandemic. Specifically, we ask you to halt evictions and provide financial support that helps residential renters and small property owners as critical steps to mitigate the impacts of the ongoing public health crisis. More than 300,000 Maryland residents are expected to be at risk of eviction by the end of the year.1 We commend the previous executive order to halt evictions and utility shut offs, which aided thousands of renters in Maryland. These measures, along with the Coronavirus Aid, Relief, and Economic Security (CARES) Act national moratorium on evictions, ended on July 25, 2020. Federal unemployment benefits have also expired. Recent efforts to provide additional state unemployment benefits are an important support system for renters but fall short of protecting many renters from eviction. On September 4, 2020, the Centers for Disease Control and Prevention (CDC) announced a federal eviction halt through December 2020. The order temporarily prevents landlords from evicting tenants in states such as Maryland that do not already have comparable or greater protections for renters in place. Unfortunately, the CDC order does not adequately address the needs of Maryland renters for several reasons: • In order to be protected, renters must meet several eligibility criteria, including individual earnings under $99,000, a demonstrated inability to pay full rent, and likely homelessness if evicted. 1 McKay, K., Neumann, Z., & Gilman, S. 20 Million Renters Are at Risk of Eviction; Policymakers Must Act Now to Mitigate Widespread Hardship. (June 19, 2020) Retrieved September 10, 2020, from https://www.aspeninstitute.org/blogposts/20-million-renters-are-at-risk-of-eviction/ 1 • • • Marylanders will continue to face bills for past due rent, fear of the threat of eviction,2 and challenges with legal representation when confronted with formal landlord dispossessory actions. The moratorium does not prevent utility shutoffs, meaning that renters who are unable to pay their utilities may be in their homes without electricity, gas, and water. Additionally, moratoria on eviction court cases were not included. Indeed, judges in Maryland have already announced a reopening plan to hold hearings on eviction cases.3 The CDC moratorium is set to expire at the end of 2020, but renters may need protection well into 2021 as the trajectory of the pandemic is still uncertain.4 Given these developments and the continued financial hardship caused by job losses during the pandemic, organizers, legislative leaders, community members, and the Attorney General have advocated for several measures to support renters beyond the CDC moratorium. We write to you in support of their requests. As you consider taking these measures, here is what is at stake for public health: 1. Evictions facilitate the spread of COVID-19. Housing is a crucial safeguard during the COVID19 pandemic. Evicted families may need to move into substandard housing, overcrowded living conditions, or fail to find a residence.5 Overcrowded homes and large shelters facilitate the spread of COVID-19 because tenants are in close proximity.6,7 As a result, evictions, particularly when followed by homelessness, will increase transmission of COVID-19. A recent model projected that a 2% eviction rate could result in as much as a 12% increase in COVID-19 infections.8 The CDC highlighted this increase in infections in their moratoria, stating “homelessness increases the likelihood of individuals moving into congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19.”9 2Ramos, A. R. Despite Eviction Moratorium, Unemployed Marylanders Worry About What Happens When Rent Comes Due. (03 September 2020). Retrieved September 9, 2020, from https://baltimore.cbslocal.com/2020/09/03/evictionmoratorium-maryland-rent-coronavirus-pandemic-latest/ 3 https://mdcourts.gov/sites/default/files/import/district/phaseIV_communication_landlordtenant_9.4.20.pdf 4 Roberts, S. (2020, May 8). This Is the Future of the Pandemic. The New York Times. Retrieved September 15, 2020, from https://www.nytimes.com/2020/05/08/health/coronavirus-pandemic-curve-scenarios.html 5Desmond, M., & Kimbro, R. T. (2015). Evictions Fallout: Housing, Hardship, and Health. Social Forces, 94(1), 295324. doi:10.1093/sf/sov044 6Dougherty, C. (2020, August 01). 12 People in a 3-Bedroom House, Then the Virus Entered the Equation. Retrieved September 8, 2020, from https://www.nytimes.com/2020/08/01/business/economy/housing-overcrowding-coronavirus.html 7Maxmen, A. (2020, May 07). Coronavirus is spreading under the radar in US homeless shelters. Retrieved September 7, 2020, from https://www.nature.com/articles/d41586-020-01389-3 8 Sheen, J., Nande, A., Levy, M., Adlam, B., Greenlee, A., & Schneider, D. (2020, September 7). COVID19EvictionSimulations. Retrieved from https://github.com/alsnhll/COVID19EvictionSimulations 9 https://www.govinfo.gov/content/pkg/FR-2020-09-04/pdf/2020-19654.pdf 2 2. Evictions harm physical and mental health.10 People who have experienced eviction or the threat of eviction are more likely to experience depression,11 anxiety, suicidal ideation, high blood pressure,12 and other health issues.13 Nationally, rates of depression, anxiety, and stress have increased as a result of the COVID-19 pandemic alone.14 Drug- and alcohol-related deaths in Maryland have also risen during the pandemic15 and could be worsened by housing instability.16,17 Marylanders should not need to face the additional stress of housing instability and financial insecurity. 3. Evictions place children at great risk. Eviction is a traumatic event that has long lasting effects, particularly among children. Evicted children are reported to have over twice the prevalence of food insecurity relative to stably housed children.18 As the school year begins, evictions increase gaps in children’s education, affecting mental health, social support, and academic performance.19 4. Black and Latino families are disproportionately impacted by evictions.20 The pandemic has magnified long standing racial inequities and health disparities. The confluence of the COVID-19 pandemic and housing insecurity stands to worsen the existing inequities, especially as Black and 10 Sable-Smith, B., Bebinger, M., & Benson, D. (2020, September 29). Evictions Damage Public Health. The CDC Aims To Curb Them ― For Now. NPR. Retrieved October 1, 2020, from https://www.npr.org/sections/healthshots/2020/09/29/916972891/evictions-damage-public-health-which-is-why-the-cdc-has-banned-them-fornow?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social 11Desmond, M., An, W., Winkler, R., & Ferriss, T. (2013). Evicting Children. Social Forces, 92(1), 303-327. doi:10.1093/sf/sot047 12Vásquez-Vera, H., Palència, L., Magna, I., Mena, C., Neira, J., & Borrell, C. (2017). The threat of home eviction and its effects on health through the equity lens: A systematic review. Social science & medicine (1982), 175, 199–208. https://doi.org/10.1016/j.socscimed.2017.01.010 13Says:, J. K., & Says:, C. G. (2018, October 5). The Hidden Health Crisis of Eviction: SPH: Boston University. Retrieved September 7, 2020, from https://www.bu.edu/sph/2018/10/05/the-hidden-health-crisis-of-eviction/#:~:text=People who are threatened with,, anxiety, and psychological distress 14Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Network Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686 15 Cohn, M. (2020, June 11). Opioid-related deaths make a disappointing uptick in early 2020, possibly related to coronavirus. The Baltimore Sun. Retrieved October 1, 2020, from https://www.baltimoresun.com/health/bs-hs-overodose-deathsfirst-quarter-20200611-r5pvlyzqrffo3ndvwc2oh3y7cy-story.html 16 Bradford, A. C., & Bradford, W. D. (2020). The effect of evictions on accidental drug and alcohol mortality. Health services research, 55(1), 9-17. 17 Volkow, (2020, July 7). Collision of the COVID-19 and addiction epidemics. 18Leifheit, K. M., Schwartz, G. L., Pollack, C. E., Black, M. M., Edin, K. J., Althoff, K. N., & Jennings, J. M. (2020). Eviction in early childhood and neighborhood poverty, food security, and obesity in later childhood and adolescence: Evidence from a longitudinal birth cohort. SSM - population health, 11, 100575. https://doi.org/10.1016/j.ssmph.2020.100575 19Shelly, B. (2020, August 06). Children Will Bear The Brunt Of A Looming Eviction Crisis. Retrieved September 7, 2020, from https://www.huffpost.com/entry/children-eviction-crisis_n_5f2affd2c5b6e96a22ace087 20 Ong, P. Systemic Racial Inequality and the COVID-19 Renter Crisis. 7 August, 2020. https://newsroom.ucla.edu/releases/blacks-latinos-more-likely-to-face-housing-displacement. Accessed 9 August, 2020. 3 Latino people have been disproportionately affected by COVID-19 in Maryland. Although Black people represent 29 percent of Maryland’s population, they represent 38 percent of cases and 41 percent of deaths. Hispanic or Latino people represent 10 percent of the state population, 26 percent of cases, and 12 percent of deaths.21 Black and Latino renters are also less likely to report feeling confident about paying rent22 and to report COVID-19 related job and income loss.23 Across the country, the communities with the highest risk of COVID-19 have faced the highest eviction rates.24 Housing is integral to health. Promoting housing stability will help thousands of individuals and families in Maryland stay safe and healthy during this unprecedented pandemic, while improving equity. We ask that you consider taking the following actions, which fall into three broad categories: 1. Provide rent relief by allocating additional funds from the CARES Act to support rent assistance and eviction prevention. Attorney General Brian Frosh suggested the apportionment of $135 million to rent relief, $5 million to civil legal aid funding, $2.8 million to case management, counseling, and social service supports, and $800,000 to public awareness about evictions and evictions support systems. Rent relief would not only protect the public health of renters, but also provide financial relief for small property owners and landlords who have been hard hit by the pandemic. 2. Provide legal and financial protections for renters such as free legal assistance to tenants facing landlord disputes and the suspension reporting of rent non-payments. Reporting non-payment of rent could negatively impact renter credit scores and exacerbate inequities by making it harder for people of color to access the credit they need to help build and pass on wealth. Additionally, as landlords have begun filing for evictions despite the moratorium, tenants need legal support, notification of their rights, and support with processing the CDC declaration.25 3. Extend the eviction moratoria through at least 90 days after Maryland’s state of emergency is over, including: preventing landlords from serving evictions and collecting late fees, extending the prohibition of court-ordered evictions, suspending failure to pay court hearings until 2021, and extending the emergency order protecting renters from losing access to utilities such as 21Racial Data Dashboard. (n.d.). Retrieved September 7, 2020, from https://covidtracking.com/race/dashboard#state-md 22 Greene, S., & McCargo, A. (2020, June 02). New Data Suggest COVID-19 is Widening Housing Disparities by Race and Income. Retrieved September 6, 2020, from https://www.urban.org/urban-wire/new-data-suggest-covid-19-wideninghousing-disparities-race-and-income 23Cornelissen, S., & Hermann, A. (2020, July 07). A Triple Pandemic? The Economic Impacts of COVID-19 Disproportionately Affect Black and Hispanic Households - Blog: Joint Center for Housing Studies of Harvard University. Retrieved September 6, 2020, from https://www.jchs.harvard.edu/blog/a-triple-pandemic-the-economic-impacts-of-covid-19disproportionately-affect-black-and-hispanic-households/ 24 Tolan, C., & Lah, K. (2020, October 1). Neighborhoods at risk for COVID see disproportionately high eviction rates. CNN. Retrieved October 1, 2020, from https://www.cnn.com/2020/09/29/us/covid-evictions-cdc-moratoriuminvs/index.html 25 Arnold, C. (2020, September 15). Despite A New Federal Ban, Many Renters Are Still Getting Evicted. NPR. Retrieved October 1, 2020, from https://www.npr.org/2020/09/14/911939055/despite-a-new-federal-ban-many-renters-are-stillgetting-evicted 4 internet, electric, gas, and water if they are unable to pay as a result of the pandemic. Moratoria may need to be further extended if there is insufficient recovery from the pandemic by April 2021. We appreciate your consideration of this request. Swift action will not just address housing instability during the COVID-19 pandemic; these important measures will protect the health and safety of all Marylanders. Sincerely, Olivia Veira, AB MPH Candidate Johns Hopkins Bloomberg School of Public Health Joshua M. Sharfstein, MD Professor of the Practice Johns Hopkins Bloomberg School of Public Health Kevin Lindamood, MSW President and Chief Executive Officer Health Care for the Homeless Craig Pollack, MD Associate Professor Johns Hopkins Bloomberg School of Public Health Keshia Pollack Porter, PhD, MPH Professor Johns Hopkins Bloomberg School of Public Health Susan Sherman, PhD, MPH Bloomberg Professor of American Health Johns Hopkins Bloomberg School of Public Health Prashasti Bhatnagar, JD/MPH Candidate Georgetown University Law Center/Johns Hopkins Bloomberg School of Public Health Mihir Chaudhary, MD, MPH Johns Hopkins School of Public Health Lisa Cooper, MD, MPH Blomberg Distinguished Professor Director, Johns Hopkins Center for Health Equity Director, Johns Hopkins Urban Health Institute Darrell J. Gaskin, PhD, MS Richardson Professor in Health Policy Director, Johns Hopkins Center for Health Disparities Solutions Johns Hopkins Bloomberg School of Public Health Monica Guerrero Vazquez, MPH, MS Executive Director, Centro SOL Johns Hopkins University School of Medicine Tisha Guthrie, MSW, LMSW The Johns Hopkins Hospital Patient & Family Advisory Councils Baltimore Renters United, Steering Committee Bolton House Residents Association, Treasurer Rev. Debra Hickman, M. Div The Johns Hopkins Hospital Patient & Family Advisory Councils, Community Co-Chair Sisters Together And Reaching, Inc. (STAR) Pres./CEO Nicole Iarrobino, MS, Senior Project Administrator Staff Co-Chair, The Johns Hopkins Hospital Patient & Family Advisory Councils Staff Co-Chair, Johns Hopkins Medicine Patientand Family Centered Care Clinical Community Katherine Narvaez Mena, MPH/MBA Candidate Johns Hopkins Bloomberg School of Public Health/Carey Business School Caroline F. Plott, MS MD Candidate Johns Hopkins School of Medicine 5 Leonard Rubenstein, JD Professor of the Practice, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Paul Spiegel MD, MPH Professor, Dept of International Health Director, Center for Humanitarian Health Johns Hopkins Bloomberg School of Public Health Rachel Thornton, MD, PhD Associate Professor of Pediatrics Associate Director for Policy, Johns Hopkins Center for Health Equity This letter represents the views of the signers, and not necessarily the views of Johns Hopkins University. 6