CHICAGO -- At the age of 24, Francy Sandoval has unwittingly become the sole breadwinner for her family, after her mom, dad and brother -- a nanny, a painter and a server -- all lost their jobs in the coronavirus pandemic.
Her family needs the money, so the aspiring nurse feels she has no choice but to keep her high-risk job at the front desk of a suburban Chicago community health clinic treating many COVID-19 patients. But her home hardly feels like a haven either.
"Working during this time is not as stressful as coming home," she said. "You were surrounded with patients who could have been or are positive and you might get your parents sick by just opening the door."
Sandoval, an immigrant from Colombia, is among tens of millions of Americans living in multigenerational homes where one of the main strategies for avoiding infection -- following social distancing protocols -- can be near impossible.
The problem reverberates deepest in communities of colour, where families from different generations live together at much higher rates, in some cases nearly double that of white families. Joint living also often intersects with factors like poverty, health issues and jobs that can't be done from home, offering another glimpse of what fuels the troubling racial disparities of COVID-19.
"When you have generations in a household, some of them have to work, especially if they are in the service jobs or the retail or the grocery. They have to come in and out of that household," said the Rev. Willie Briscoe, who leads a black church on Milwaukee's north side, where the pandemic has hit hard. "You cannot safely quarantine."
Families live together for many reasons -- saving money, pooling resources, child care, elderly care or just culture. It's a practice that's been on the rise since the 1980s, particularly after the recession, experts say.
In the U.S., roughly 64 million people live in multigenerational family households, or 1 in 5 households, according to Richard Fry, a senior researcher at the Pew Research Center. But it's far more common among people of colour: 29% of those households are Asian, 27% are Hispanic, 26% are African American and 16% are white.
Fry said two major factors accounting for multigenerational living are location, with higher rates in densely populated urban centres where the cost of living is high, and culture, especially for immigrants in the U.S. Living with family into adulthood, common in many parts of the world, was blamed for contributing to the spread of the coronavirus in Spain and Italy.
For families of colour in the U.S., there's also more chance that household members can't work from home as federal guidelines suggest. Fewer than 20% of black workers can telework, according to a March study by the nonpartisan Economic Policy Institute.
Anthony Travis, a 65-year-old retired black man who's diabetic, has high blood pressure and is a cancer survivor, shares a home with his adult daughter and his elderly sister. The daughter works as a technician for a cable and internet company -- a job deemed essential during the pandemic.
For them, living together in suburban Chicago was a matter of taking care of one another. Then Travis got diagnosed with COVID-19.
For weeks, he suffered alone in his room, with sweats and chills, struggling to breathe. He would think twice about venturing to the microwave, where his sister, who has a heart condition, would leave his food.
The worst part was when his daughter got pneumonia: He could hear her through the walls.
"I have to, as a parent, sit up and listen to my child go through pain and agony and suffering because of not being able to breathe," he said. "I couldn't give her comfort, other than with my words."
Dr. Garth Walker, an emergency room physician at a Chicago veterans' hospital, said he has trouble counselling families living in cramped quarters about what they should do. His best advice is to choose one person to grocery shop and consider sending the most at-risk person to live elsewhere if possible.
"They just have a difficulty adapting to a pandemic because they can't adhere to the recommendations that we suggest to everybody, like physical distancing, because it is a privilege," he said of multigenerational families.
That's echoed by Dr. Lisa Green, who runs the Family Christian Health Center south of Chicago, a low-income clinic where most of the nearly 20,000 patients each year are black or Latino and multigenerational living is common.
"Those options that we are telling everyone else over the phone to do are not options for them," Green said. "When you have a fixed income, your options are fixed."
Sandoval follows strict procedures at home, removing her work clothes immediately and wiping every surface she touches before retreating alone to the attic. That's where she spends her time, including her most recent birthday.
She hopes to start nursing school online soon and dreams of stress-free family time again.
"My mom said, `I can't wait until you are able to come home, and I can hug you,"' Sandoval said.
