A lack of space or vital facilities makes it difficult for many to abide by health guidelines aimed at battling the coronavirus.
In nearly half a million American homes, washing hands to prevent COVID-19 isn't as simple as soaping up and singing "Happy Birthday" twice while scrubbing.
In many of those homes, people can't even turn on a faucet. There's no running water.
In 470,000 dwellings in the United States — spread across every state and in most counties — inadequate plumbing is a problem, the starkest of several challenges that make it tougher for people to avoid infection.
That's according to a Kaiser Health News analysis of data from the Census Bureau and the Housing Assistance Council in Washington, D.C. The analysis reveals other ways that inadequate housing in the United States puts people at risk during this pandemic. Nearly a million homes scattered across almost all counties don't have complete kitchens, raising the risk of hunger and vulnerability to illness, even as people have been expected to eat all meals there amid stay-at-home orders. And over 4 million homes are overcrowded, with more than a person per room, making it nearly impossible to isolate the sick.
In fact, about 828,000 people have to deal with more than one of these housing problems.
"We assume this is happening in Third World places," said Greg Carter, an assistant professor at the Indiana University School of Nursing. "But it's happening here."
Carter's work takes him to southern Indiana's Orange County, a community of just under 20,000 that had 113 confirmed COVID-19 cases and 18 deaths. It's also one of 322 U.S. counties with rates of inadequate plumbing at least three times the national average of four homes in every 1,000.