New study explicitly links protection of water access with lower COVID-19 infection and death rates

States that issued water shutoff moratoria ensuring low-income households had continued access to clean water experienced significantly lower daily COVID-19 infection and death rates, researchers report in the American Journal of Preventive Medicine


Ann Arbor, October 27, 2021

A new analysis finds US states that prevented utilities from turning off water service to households that were behind on their payments during the COVID-19 pandemic experienced significantly lower rates of infection and death from the pandemic while the moratoria were in effect. The study in the American Journal of Preventive Medicine, published by Elsevier, underscores the importance of water equity and the need for government actions to create more uniform protections from water shutoff across all states.

During the COVID-19 epidemic, 34 states enacted moratoria on water shutoffs from most water utilities so that people could access clean water. Among the 34 states, 20 states imposed a comprehensive moratorium covering both public and private water systems, while the rest issued moratoria covering only public water systems. Only 11 states still had an active moratorium by the end of 2020, and this number decreased to three by September 2021.

“This study shows the importance of state governments’ leadership in public health,” said lead investigator Xue Zhang, PhD, Departments of City and Regional Planning and Global Development, Cornell University, Ithaca, NY, USA. “Using modeling typical of other public health studies, we found states with moratoria on water shutoffs had lower infection and death growth rates. We hope what we learned from the pandemic can contribute to universal access to water in the future.”

The researchers used event study analysis, a common epidemiological model, to estimate the impacts of state water policy on public health. The study looked at daily infection and death growth rates from April 17 to December 31, 2020 in every state. Data from Food and Water Watch were used to determine if states had a water shutoff moratorium in place on each day of the study period. The study controlled for mask mandates, at-risk groups, and percentage of health insurance coverage.

Map of the USA showing state water shutoff moratoria actions in 2020
State water shutoff moratoria actions in 2020. Author analysis based on Food and Water Watch 2021 (Credit: American Journal of Preventive Medicine).

Across all 50 states, on average, a moratorium was in place about 42% of the time, and comprehensive coverage about 22% of the time. For the days in states with a moratorium on water shutoffs, daily infection growth rate was 0.235% lower, and the death growth rate was 0.135% lower. For states with comprehensive moratoria there was an additional 0.169% decrease in the infection growth rate and a 0.228% decrease in the death growth rate. The study also found that states with a higher percentage of minorities and essential workers had higher COVID-19 daily infection and death rates.

A related analysis of the data suggests that a nationwide moratorium on water shutoff might have prevented as many as half a million people from COVID-19 infections and nearly 9,000 deaths.

“Access to water is absolutely critical during the pandemic,” said co-investigator Mildred Warner, PhD, Departments of City and Regional Planning and Global Development, Cornell University, Ithaca, NY, USA. “This study shows the importance of a national standard for access to water, especially for low-income households. The COVID-19 pandemic has revealed so many structural inequities in our society, and access to drinking water is one that demands our attention.”

The investigators observed that while Congress acted to prevent housing evictions during the pandemic, national leadership is absent in protecting equitable access to water. They noted that in the US, water bills have increased faster than inflation. Research suggests that 35.6% of US households may not be able to afford their water bills over the next five years. They propose payment plans and arrearage management programs for low-income households. Better data collection and reporting are necessary to help inform policy and solutions.

“The study confirms that water shutoff moratoria are an important public health tool to help prevent the spread of disease,” said co-investigator Mary Grant, Food and Water Watch and Food and Water Action, Baltimore, MD, USA. “Since March 2020, we have called on all levels of government to suspend water shutoffs, so that people would have the water necessary to stay safe at home. Now, during the Delta wave, nearly all of the protections that were in place have expired. This research should help inform policy solutions to improve water access to protect public health.”

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Notes for editors
The article is “Water Shutoff Moratoria Lowered COVID-19 Infection and Death Across U.S. States,” by Xue Zhang, PhD, Mildred E. Warner, PhD, Mary Grant, BS (https://doi.org/10.1016/j.amepre.2021.07.006). Published online in advance of the American Journal of Preventive Medicine, volume 62, issue 2 (February 2022), published by Elsevier.

The article is openly available at https://www.ajpmonline.org/article/S0749-3797(21)00432-3/fulltext.

The research was conducted in collaboration with Food and Water Watch, with support from a Rapid Response Fund award by the Cornell Atkinson Center for Sustainability and funding from the Cornell Center for Social Sciences.

Full text of this article is also available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact Xue Zhang at xz435@cornell.edu, Mildred Warner at mwarner@cornell.edu, or Mary Grant at mgrant@fwwatch.org.

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About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

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