How limitations in energy access, poverty, and socioeconomic disparities compromise health interventions for outbreaks in urban settings

Low-income households (LIHs) have experienced increased poverty and inaccess to healthcare services during the COVID-19 pandemic, limiting their ability to adhere to health-protective behaviors. We use an epidemiological model to show how a households' inability to adopt social distancing, owing to constraints in utility and healthcare expenditure, can drastically impact the course of disease outbreaks in five urban U.S. counties. LIHs suffer greater burdens of disease and death than higher income households, while functioning as a consistent source of virus exposure for the entire community due to socioeconomic barriers to following public health guidelines. These impacts worsened when social distancing policy could not be imposed. Health interventions combining social distancing and LIH resource protection strategies (e.g., utility and healthcare access) were the most effective in limiting virus spread for all income levels. Policies need to address the multidimensionality of energy, housing, and healthcare access for future disaster management.