key: cord-0723376-fr85pf7t
authors: Murray, M. H.; Byers, K. A.; Buckley, J.; Magle, S. B.; Maffei, D.; Waite, P.; German, D.
title: I dont feel safe sitting in my own yard: Chicago resident experiences with urban rats during a COVID-19 stay-at-home order
date: 2020-11-30
journal: nan
DOI: 10.1101/2020.11.25.20238741
sha: 3023828ee623c3538598a3b46432a98be6c9d3c5
doc_id: 723376
cord_uid: fr85pf7t

Abstract Background: Encounters with rats in urban areas increase risk of human exposure to rat-associated zoonotic pathogens and act as a stressor associated with psychological distress. The frequency and nature of human-rat encounters may be altered by social distancing policies to mitigate the COVID-19 pandemic. For example, restaurant closures may reduce food availability for rats and promote rat activity in nearby residential areas, thus increasing public health risks during a period of public health crisis. In this study, we aimed to identify factors associated with increased perceived exposure to rats during a stay-at-home order, describe resident encounters with rats relevant to their health and well-being, and identify factors associated with increased use of rodent control. Methods: Urban residents in Chicago, a large city with growing concerns about rats and health disparities, completed an online questionnaire including fixed response and open-ended questions during the spring 2020 stay-at-home order. Analyses included ordinal multivariate regression, spatial analysis, and thematic analysis for open-ended responses. Results: Overall, 21% of respondents (n=835) reported an increase in rat sightings around their homes during the stay-at-home order and increased rat sightings was positively associated with proximity to restaurants, low-rise apartment buildings, and rat feces in the home (p[≤]0.01). Many respondents described feeling unsafe using their patio or yard, and afraid of rats entering their home or spreading disease. Greater engagement with rodent control was associated with property ownership, information about rat control, and lower incomes (p[≤]0.01). Conclusions: More frequent rat encounters may be an unanticipated public health concern during periods of social distancing, especially in restaurant-dense areas or in low-rise apartment buildings. Rat presence may also limit resident ability to enjoy nearby outdoor spaces, which otherwise might buffer stress experienced during a stay-at-home order. Proactive rat control may be needed to mitigate rat-associated health risks during future stay-at-home orders.

4 resources for rats in residential areas may therefore alter local rat abundance and rat-associated 69 health risks.

Local environmental changes can impact rat abundance and distributions, and these 72 changes can be influenced, in turn, by global phenomena. In spring 2020, millions of people 73 around the world were required to stay at home to mitigate the COVID-19 pandemic, resulting in 74 altered activity in and around businesses, food establishments, public spaces, and the home. 75 Urban residents in multiple countries reported increased rat sightings during this period, 76 prompting media articles and public health recommendations from the Center for Disease CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 5 The impacts of rats on residents will also be determined by the context of these 91 interactions. Resident experiences with rats while staying at home may vary depending on local 92 environmental and social factors. Previous studies have demonstrated that rat abundance and rat-93 associated health risks vary significantly between neighborhoods [5, 9] and is typically higher in 94 low-income areas [10, 11] , likely because of building conditions and resources available to 95 control rats. Residents' encounters with rats might also differ based on their housing conditions; 96 property owners may face monetary burdens from controlling rats while some renters may have 97 negligent landlords. Some residents may also be disproportionately impacted by rat infestations, 98 for example if they have young children, pets, or rarely leave the house. Identifying which 99 communities are most vulnerable to rat infestations will help prioritize proactive rodent control 100 policies and education campaigns to mitigate health risks from rats.

To understand how social distancing policies changed resident encounters with rats, we 103 evaluated how a stay-at-home order influenced three aspects of resident vulnerability to rats: 104 exposure to rats, impacts of rats on human health and well-being, and adaptive capacity to 105 mitigate these interactions [12] . We assessed rat exposure as the frequency of rat encounters and 106 changes to these encounters as compared to before the stay-at-home order; impacts of rats as the 107 frequency and change in rat encounters relevant to human health or well-being; and adaptive 108 capacity by identifying factors associated with engagement with rodent control. We did so by 109 surveying residents in Chicago, a large city with increasing problems with rats [5] and disparities 110 in public health outcomes between neighborhoods [13] . Based on anecdotal reports, we predicted 111 that residents living in proximity to more restaurants and especially in lower-income areas would 112 be more likely to experience an increase in rat encounters. We also predicted that engagement 113 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 6 with rodent control would be positively associated with increased rat sightings, motivation (i.e. 114 concern about rats), and capacity (i.e. information and income). Understanding resident 115 experiences with rats during the stay-at-home order will help further understand the impacts of 116 rat infestations on human health and well-being as well as anticipate community health issues as 117 cities re-open or restrict activities to control the current pandemic. A cross-sectional study design was used to collect information from Chicago residents 122 about their experiences with rats during the stay-at-home order. The survey was formatted to 123 collect responses through SurveyMonkey, an online survey service to ensure rapid distribution of 124 surveys, which would have been impossible using paper surveys. The survey was available 125 online between April 27 and June 6, 2020 corresponding with Chicago's stay-at-home order, 126 which was in effect from March 21 to June 3, 2020. During the stay-at-home order, all residents 127 were requested to stay at home except for essential needs and restaurants could not provide dine-128 in service [14] .

To obtain responses from all Chicago neighborhoods, we distributed the link to our 131 online survey via email to all 50 Aldermanic offices (i.e. elected officials who represent city 132 wards) and at least one community organization in all 77 community areas. Prior to distributing 133 the survey, a list of potential questions was pilot tested (n = 21) and refined to improve 134 comprehension. The survey was available and advertised in English and Spanish. Survey 135 respondents were deemed eligible if they were over the age of 18 and had lived in their current 136 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint exposure to rats (i.e., frequency and context of rat encounters), the impacts of rats on their health 146 or well-being (i.e., zoonotic exposure risk and mental health impacts); and their adaptive 147 capacity to addressing rats (i.e., changes in behaviors including use of rodent control). Within 148 each topic, we asked respondents to report the frequency of an event in the past month from 149 "never" to "daily or almost daily" and we asked about any change relative to a month prior to 150 taking the survey. Respondents also had the opportunity to describe their feelings and 151 experiences associated with rats in their own words (see below).

We hypothesized that resident experiences with rats would be mediated by several 154 demographic and environmental factors. To understand these relationships, we asked 155 respondents to self-report their age group, gender, children in the household (yes/no), type of 156 housing, whether they were renters or property owners, time spent outside the house per week, 157 their neighborhood, and their closest major intersection. For analysis, we grouped housing types 158 into single-family homes, low-rise multi-unit buildings (<10 units), and high-rise multi-unit 159 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 8 buildings (≥ 10 units; [15, 16] . We also included the median household income of the 160 respondent's census tract [15] if they provided their closest major intersection. To determine whether residents experienced more frequent rat encounters during the stay 165 at home order (i.e. exposure), we asked respondents to report the frequency and change in rat 166 sightings at two geographic levels: in/around their home; and on their city block. Because rat 167 abundance is known to increase during the spring [5, 8] , and because our survey coincided with To test the hypothesis that rat activity would increase in areas near restaurants during the 172 stay-at-home order, we undertook a spatial analysis. To do this, we compared respondents' CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint

We also accessed municipal rat complaint data to complement survey responses about 183 any increase in rat infestations. The city of Chicago records public complaints about rats made 184 via 311 calls and online. In response to complaints, city managers will distribute rodenticide bait 185 in the complainant's alley. Rat complaint data can be a useful way to measure the timing or 186 locations of rat infestations [5, 8, 19] . Although rat complaints are not a direct measure of rat 187 populations, the biases associated with complaints (e.g. knowledge of the 311 system) may differ 188 from sampling bias in survey research (e.g. internet access) and therefore similar trends in these 189 complementary data sources may support survey results. We accessed rat complaints made to the To understand the impacts of rats on public health risks, we asked respondents to report 199 the frequency and change in rat encounters that may lead to the transmission of zoonotic 200 pathogens such as touching rat feces or being bitten by a rat. We also asked respondents to 201 describe how they felt about their interactions, including their concerns about these encounters. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint

To assess adaptive capacity, we asked residents about changes in their behaviors during 206 the stay-at-home orders that were specifically meant to minimize contact with rats. We also 207 included questions about resident engagement with rodent control as a measure of adaptive 208 capacity. To test whether an increase in rat sightings during the stay-at-home order was 209 associated with increased engagement with rodent control, respondents were asked about the 210 frequency and change in their use of rodent control such as reporting rat complaints to the city 211 and/or calling a pest professional. We hypothesized that engagement with rodent control is 212 mediated by motivation and ability. We thus asked if respondents were more concerned about 213 rats now than they were a month ago and if they had enough information to control rats on a 5-214 point Likert scale from "strongly disagree" to "strongly agree". CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint respondents' feelings about rats) and by identifying concepts that were mentioned by multiple 228 respondents in relation to the study objectives. For quantitative analysis of survey questions, we used generalized linear models to 233 identify variables significantly associated with exposure to rats (i.e. change in rat sightings), 234 impacts of rats (i.e. change in contact with rats or rat feces), and adaptive capacity (i.e. 235 engagement with rodent control). For all of these three outcomes, the response variables were 236 rating scales with the categories "more often", "about the same", and "less often" relative to a 237 month prior. Because the response variables of interest were ordered categories, we used ordinal 238 regression in R using the package MASS [24, 25] and the reference category for all three 239 outcomes was "more often". We included the demographic and socioeconomic variables listed 240 above such as housing type and income in all models. We added additional predictor variables to 241 the models based on the factors we hypothesized would be associated with a change in rat 242 sightings (i.e. number of restaurants within 500m), change in contact with rats or rat feces (i.e. 243 change in rat sightings), and engagement with rodent control (i.e. change in rat sightings, 244 concern about rats, information about rats). All continuous variables were centered and scaled 245 prior to analysis. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 12 251

The online survey was shared electronically by nine community organizations and by the 252 aldermanic offices in 29 of Chicago's 50 wards. In total, we received 835 at least partially 253 completed surveys from eligible respondents but none in Spanish. Of the 672 respondents who 254 provided demographic data, 67% (N = 453) identified as female, 31% as male (N = 205), 1% as 255 non-binary (N = 5), and 1% preferred not to say (N = 9). Because a small proportion of 256 respondents self-identified as non-binary, we were unable to include their responses when 257 including gender as a covariate in generalized linear models. All age groups were represented 258 although there were fewer respondents in the 18-24 category (3.5%) relative to other categories 259 (13% -19%, Table S1 ). Relative to Chicago's population, respondents were disproportionately 260 more likely to self-identify as female (51% vs 67%, respectively) and property owners (45% vs 261 66%), but there was no significant bias in age class (Table S1, Impacts of rats; and Accountability and responsibility for rodent control (Figure 2 ). We will 286 discuss these themes as they relate to our study objectives below.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Of eligible respondents, 21% observed more rats in or around their home and 23% 296 observed more rats on their block during the stay-at-home order (Table 1) . Conversely, half as 297 many respondents observed fewer rats around their home (11%) or on their block (10%) during 298 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 15 the stay-at-home order (Table 1) . Respondents were more likely to observe an increase in rats on 299 their block if they lived near more restaurants (p = 0.001), spent more time outside (p = 0.001), 300 and lived in a small multi-unit building (p = 0.003) (Table 2, Figure 3 ). Respondents who 301 observed an increase in rats were also more likely to report more rats in 2020 relative to previous 302 years (p < 0.001; Table 2 ). Respondents were also more likely to observe greater numbers of rats 303 in or around their homes if they lived in a small multi-unit building (Table S2) . We found no 304 significant correlation between an increase in rat sightings from survey responses and increased 305 311 complaints in the same census tract (Table 2 and Table S2 ).

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 1 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. In their open-ended responses, several residents mentioned that they see more rats now 323 that restaurants have closed. Most surmised that there was less garbage available to rats 324 following restaurant closures, which caused rats to move into residential areas. Several respondents also mentioned that rats appeared to be less afraid of people during 332 the stay-at-home order. These respondents described rats being more visible and active during 333 the day, potentially because rats were searching for new food sources after restaurant closures. Several respondents reported interactions with rats of public health concern. In the month 343 prior to taking the survey, 11% of respondents had touched a rat, 10% touched rat feces, and four 344 respondents (0.5%) were bitten by a rat at least once (Table 1) . Although over 70% of our 345 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint respondents resided in the North Side of Chicago, three respondents that reported being bitten by 346 a rat lived in less-affluent South Side neighborhoods, representing 5.0% of all South Side 347 respondents. Respondents who observed an increase in rats in their home were also more likely 348 to observe increased rat feces in their home (p < 0.01; Table 3; Figure S1 ). Many respondents mentioned being concerned for their family's health or safety because 365 of the risk of disease transmission or aggression from rats. Specifically, many respondents 366 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 7 mentioned being concerned about their children playing in areas with rats or rat feces or about 367 their pets being exposed to diseases from rats or rat poison. Residents who reported observing more rats during the stay-at-home order also described 374 feeling frustrated about rats or worried about rats entering their home more frequently than other 375 respondents. These respondents were also the only group who mentioned feeling unsafe because 376 of rats or being concerned or afraid about the risk of disease from rats. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint 8 When describing this discomfort, respondents often mentioned feeling unsafe or 390 unwelcome on their own property. These feelings were often shared in association with 391 perceptions that parties responsible for pest control were being neglectful. Several residents highlighted that this discomfort with using private outdoor spaces 404 because of rats felt especially limiting or frustrating during the stay-at-home order because they 405 had few options to safely leave their home or recreate outdoors. Adaptive capacity to control rats: "I can't do this by myself" 410 411 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint Respondents were more likely to report using more rodent control during the stay-at-412 home order if they observed increased rat sightings in their home (p < 0.001), if they were more 413 concerned about rats than they were previously (p < 0.001), if they were property owners (p < 414 0.001), if they had enough information about rats (p = 0.03), and if they had lower incomes (p = 415 0.01; Table 4 ). Of respondents who reported observing rats daily, 42% never called 311 and of 416 respondents who reported observing rats weekly, 59% never called 311. Respondents were 417 significantly more likely to call 311 at least once in the past month if they observed an increase 418 in rats in their home (β = 1.77 ± 0.44, p < 0.01), if they were more concerned about rats than 419 they were previously (β = 1.85 ± 0.40, p < 0.01), if they strongly agreed that they had enough 420 information to control rats (β = 1.27 ± 0.37, p < 0.01) and if they were property owners rather 421 than renters (β = -1.14 ± 0.40, p < 0.01; Table S3 ). These same variables were significantly 422 associated with calling a pest professional at least once in the past month (Table S4) . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint Change in concern about rats (Linear) 1 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. Several others pointed out that they feel alone in dealing with rats and that rats require a 441 community approach for effective rodent control. Many respondents emphasized that they take 442 multiple measures to control rats but they still see rats on their property because of rat burrows or 443 food sources on their neighbor's property.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Indeed, many respondents mentioned how difficult it is to eradicate rats from their 450 property. Many described spending money on multiple control methods that did not always 451 succeed in reducing rat populations. In these cases, many expressed hopelessness that rats can be 452 eradicated. One resident also mentioned that they were unable to manage rat harborage because they 459 were taking care of others during the COVID-19 pandemic, leading to increased rat problems 460 during the stay-at-home order. In this study, we evaluated whether a stay-at-home order increased resident vulnerability 471 to rat infestations. We found that residents living in proximity to restaurant-dense areas or in 472 small apartment buildings were more likely to report an increase in rat sightings. Residents 473 expressed feeling frustrated with neighbors, restaurants, and restaurant closures for attracting 474 rats. We also found several types of public health risks from rats during the stay-at-home order, 475 including increased exposure to rat feces in the home and feeling unsafe using outdoor spaces.

Residents who observed more rats during the stay-at-home order did increase their use of rodent 477 control, however this was more likely for residents with adequate information about rats and 478 lower incomes. Our results suggest that some urban communities may be particularly vulnerable 479 to rat infestations during this stressful and challenging time (Figure 4) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint

We also found unequal health risks from rats during the stay-at-home order. Respondents 505 who reported increased rat sightings were also more likely to report increased rat feces in the 506 home. Residents in small apartment buildings in restaurant-dense areas may thus be especially at 507 risk for rat-associated zoonotic exposure. Many respondents also reported exposure to rat urine.

For example, one respondent stated that "odor from rat urine" made their home office 509 uninhabitable as a result of past rat problems. For many Chicago residents, home offices became 510 primary work locations during the stay-at-home order. Home environments that contain rat feces 511 or urine can expose residents to a variety of zoonotic pathogens such as Leptospira interrogans, 512 Seoul hantavirus, and infectious organisms such as Escherichia coli and Salmonella spp. [9, 26] .

Perhaps more concerning, we found that rat bites were mainly reported from Chicago's 515 South Side neighborhoods. One respondent who reported a rat bite described themselves as In addition to public health risks from potential zoonotic exposure, rat infestations during 525 the stay-at-home order may negatively impact resident well-being by restricting their activities.

For many Chicago residents, the stay-at-home order caused dramatic changes to their daily 527 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint Although residents with increased rat problems were more likely to increase their use of 540 rodent control, knowledge and income appear to be important mediating factors. The city of 541 Chicago receives tens of thousands of rat complaints per year [5] . However, most survey 542 respondents did not report complaints about the rats they saw during the stay-at-home order, 543 potentially because they are not aware of the risks from rats, aware of the 311 rat complaint 544 program, or are not aware that the city will abate rats in their alley for free. The high proportion 545 of respondents who did not report rat complaints might also explain the lack of correlation 546 between our survey results and trends in 311 rat complaints. Beyond the need for information 547 about rats, residents might not engage with municipal rodent control if they do not believe the 548 city will act in response to their rat complaints. Surprisingly, increased use of rodent control was 549 associated with lower incomes, even while controlling for the frequency of rat sightings.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint Residents in lower income neighborhoods may be more likely to take on the responsibility and 551 cost of rodent control themselves rather than rely on neighbors or the city. In Baltimore, low-552 income residents in perceived problem rat areas had less confidence that their neighbors or the Our results suggest avenues for future research to understand the impacts of rat 559 infestations on resident health and well-being. Of note, our sample only included residents with 560 internet access and residents with rat issues may have been more motivated to participate in the 561 study. We received a disproportionately high amount of responses from the North Side of 562 Chicago, potentially because of the aforementioned factors. Future surveys that are mailed to 563 randomly sampled households may provide more robust estimates of rat infestations across the 564 entire city. Importantly, with our survey, it was difficult to determine whether respondents 565 observed a true increase in rat abundance or a perceived increase because residents were 566 spending more time at home. Residents who spent more time outside in their neighborhood were 567 more likely to report increased rat sightings in or around their home (Table S3 ), suggesting that 568 sightings were likely not only driven by time spent indoors. Future studies that link survey 569 responses with local rat abundance could tease apart actual and perceived risks from rats in urban 570 neighborhoods. Such studies could also document health outcomes associated with rats, which 571 we were unable to examine due to other health concerns during the pandemic. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint Our results suggest that more frequent rat encounters may be an unanticipated public 576 health concern during periods of social distancing to mitigate the COVID-19 pandemic. Some 577 urban communities may be more vulnerable to rat infestations based on their location, housing, Availability of data and materials 594 A summarized version of the datasets used and/or analysed during the current study are available 595 from the corresponding author on reasonable request.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint

Rats, cities, people, and pathogens: A 621 systematic review and narrative synthesis of literature regarding the ecology of rat-associated 622 zoonoses in urban centers

Exposure to urban rats as a community stressor among low-income 624 urban residents

Environmental and economic costs of vertebrate species invasions into the United 626

Ecologically-based management of rodent pests -628 re-evaluating our approach to an old problem

Public complaints 632 reflect rat relative abundance across diverse urban neighborhoods

Coronavirus: Why more rats are being spotted during quarantine

COVID-19): Rodent Control. Centers for Disease Control 636 and Prevention

Rats 639 and the COVID-19 pandemic: Early data on the global emergence of rats in response to social 640 distancing

City 642 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted

sanitation and socioeconomics predict rat zoonotic infection across diverse neighbourhoods

The relationship 645 between socioeconomic indices and potentially zoonotic pathogens carried by wild Norway rats: 646 A survey in Rhône

Disturbance, reassembly, and disease 648 risk in socioecological systems

A 650 framework for vulnerability analysis in sustainability science

White Health Disparities in the United States and Chicago: 1990-653 2010

Executive Order 2020-10: Executive order in response to COVID-19

Government of Illinois

Year Estimates

Integrated pest 661 management in an urban community: A successful partnership for prevention

Rats about town: A systematic review of rat 664 movement in urban ecosystems

International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted

Rat sightings in New York City are associated with neighborhood 670 sociodemographics, housing characteristics, and proximity to open public space

QGIS Development Team. QGIS Geographic Information System. Open Source Geospatial 673 Foundation Project

Thematic analysis: Striving to meet the 675 trustworthiness criteria

They're always there": Resident experiences 677 of living with rats in a disadvantaged urban neighbourhood

Dedoose Version 8.0.35, web application for managing, 679 analyzing, and presenting qualitative and mixed method research data

Modern applied statistics with S. Fourth

Prevalence and characteristics of Escherichia coli and Salmonella spp

Norway and black rats (Rattus norvegicus and Rattus rattus) from an inner-city neighborhood of 686

Neighborhood disparities in investment 688 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted

Estimates of resident population change and rankings

United States -combined statistical area

Social vulnerability and racial inequality in COVID-19 deaths in 696

Mental health during the COVID-19 pandemic: Effects of 698 stay-at-home policies, social distancing behavior, and social resources

Intersecting household level health and socio-economic 701 vulnerabilities and the COVID-19 crisis: An analysis from the UK. SSM -Popul Heal

The new proxemics: COVID-19, social distancing, and sociable space

Illinois unemployment rate rises to 16.4% amid COVID-19 Pandemic

 598 The authors declare that they have no competing interests. Figure S1 ).

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintThe copyright holder for this this version posted November 30, 2020. ; https://doi.org/10.1101/2020.11.25.20238741 doi: medRxiv preprint