A tale of 2 pandemics: Why people are protesting despite COVID-19 risks

The protests that started in Minneapolis at the end of May, in response to the death of George Floyd while in police custody, have quickly ballooned into mass demonstrations across the U.S. As the movement has grown, so too have concerns from elected officials and public health experts that the protests are fertile ground for a second wave of the deadly coronavirus pandemic that has already claimed nearly 110,000 American lives.

The number of coronavirus cases in the U.S. continues to climb, though delays in observable symptoms and testing results mean it could be weeks before we’ll see the possible effect of the protests on COVID-19 stats. But while headlines warn of the risks posed by protesting in large groups, activists say they can overlook the need to address a sickness whose roots go much deeper than COVID-19.  

“The question is, ‘Why are people protesting during a pandemic?’ And it’s because there is not just one pandemic; there has been another pandemic that has been longer in existence,” Dr. Kali Cyrus, a psychiatrist and an assistant professor at Johns Hopkins Medicine, said in an interview with Yahoo News. “And that is racism.”

It's a sentiment shared by the president of the American Psychological Association, who on May 29 released a statement saying, “We are living in a racism pandemic.” According to the APA, racism is associated with conditions such as depression, anxiety, post-traumatic stress disorder, and substance use disorders, and it can contribute to the development of cardiovascular and other “physical diseases.” 

Public health experts are concerned that large, congested crowds create perfect conditions for the virus to be transmitted. Shouting and singing, which are common at protests, have been shown to hasten the spread of the virus via infected droplets.   

"There's going to be a lot of issues coming out of what's happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings," Dr. Scott Gottlieb, a former U.S. Food and Drug Administration commissioner, said on Face the Nation.  

Black communities are already significantly more negatively affected by the coronavirus pandemic; and long before the COVID-19 pandemic, black Americans were already more likely to contract a myriad of health conditions than white Americans. These health crises — coupled with the fact that black people are three times more likely to be killed by police than white people — can lead some to conclude that the possibility of contracting COVID-19 at a protest may be a risk worth taking if systematic change is a possible outcome.    

“The fact is that black lives are at risk whether or not they protest,” Dr. Uché Blackstock, an emergency medicine physician and CEO and founder of Advancing Health Equity LLC said in an interview with Yahoo News.

Though black people make up 13 percent of the U.S. population, they account for 24 percent of coronavirus deaths in which race is known, meaning they are dying at a rate nearly two times higher than their population share, according to the COVID Tracking Project.     

“Both racism and COVID-19 are public health issues that need to be dealt with right now and are definitely not mutually exclusive,” Blackstock said. “In fact, they are intimately linked at this point.” 

“We know that even before the case of George Floyd, what was getting a lot of media attention was the racial disparities in the COVID-19 pandemic,” Blackstock continued. “And looking at the key driving force behind that, we know it is practices and policies rooted in structural racism.”

The infant and maternal mortality rates for black Americans are over twice the rate of white infants and mothers. A 2016 study found racial biases in pain perception among white medical students and residents, who were more likely to prescribe pain medications to white patients than black patients because of false beliefs that blacks have higher pain tolerance than whites. And black Americans are more likely than white Americans to die at earlier ages from high blood pressure, diabetes, heart disease or stroke.        

Blackstock and others, including the Centers for Disease Control and Prevention, have cited underlying social and economic conditions pervasive in many African-American communities that are likely at play. The CDC says that factors such as racial residential segregation, lower access to health care, and working in lower pay essential industries that often don’t provide paid sick leave are some of the possible reasons for the racial disparity in COVID-19 deaths and hospitalizations.  

“It’s life or death, is essentially why people are protesting,” Cyrus says. “Because they’re going to die from one pandemic or the other.”

Demonstrators protest in Boston. (Maddie Meyer/Getty Images)

It isn’t just black people who are choosing to risk COVID-19 to go out and protest. Rep. Will Hurd, R-Texas, told Politico that people from “from all walks of life, all sizes, all colors” participated in a march he attended in Houston. Rep. John Lewis, D-Ga., an activist during the Civil Rights Movement, observed that across the U.S. and worldwide, these protests feel and look much different than they did in the 1960s. “It is so much more massive and all-inclusive,” Lewis told CBS This Morning of the George Floyd protests.  

Since cities and states began reopening amidst the coronavirus pandemic, Americans have had to weigh the risks and examine their own priorities when choosing whether to re-engage in public activities like going to the beach, the store or a restaurant. And Cyrus says the decision to participate in a protest is another activity of which individuals will have to weigh the risks for themselves. She points out that in many cases, social distancing guidelines had already been abandoned in communities across the U.S. Crowded restaurants, packed Memorial Day pool parties and protesters rallying against coronavirus lockdowns were making headlines before the George Floyd protests began. And meatpacking plants, jails and nursing homes have long been cited as hotspots for coronavirus infection but continue to operate.     

“For me, the issue of sparking a mass-infection is sort of a picky one,” Cyrus says of criticism that the George Floyd protests could cause a second wave of coronavirus. “Because we’ve already been putting people in situations where the risk of a second wave is all ready to happen.”

Still, some say the protests could be another instance of history repeating itself. Many comparisons have been made between the 1918 influenza pandemic and the COVID-19 pandemic, and Dr. Howard Markel, a medical historian, told The New York Times that the protests reminded him of the bond parades held during the 1918 pandemic — which were followed by spikes in influenza cases.     

“Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering. That’s one reason we’re not having large baseball games and may not have college football this fall,” Markel said. 

Yet as officials worry about how large public gatherings could be harming efforts to fight the COVID-19 pandemic, some practices used in response to the protests could be exacerbating the problem. Some states and counties temporarily closed certain COVID-19 testing sites, with some citing “the safety of patients and employees.” Testing has already been identified as a key tool against the coronavirus pandemic, and these closures could make COVID-19 cases more difficult to track and trace.  

Blackstock also points to some police tactics that increase the risks protesters are already taking when they choose to march. 

“A lot of the news stories are saying that the protesters congregating are going to increase the transmission of coronavirus. But what we’re seeing is the techniques that are being employed by police officers to control the crowds, to disperse crowds, are also increasing the risks as well,” Blackstock says. “Tear gas and pepper spray increase watery eyes, coughing, runny noses. And all of those bodily secretions can increase the transmission of coronavirus. Also pushing people further together into smaller groups so that they can’t socially distance also increases the risk of coronavirus.”

Infectious disease experts, including National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci, have expressed concerns about the protests, with Fauci saying on Friday that the protests are “a perfect set-up” for spreading COVID-19.  

“I get very concerned, as [do] my colleagues in public health, when they see these kinds of crowds,” Fauci said. 

“It’s a delicate balance, because the reasons for demonstrating are valid, and yet the demonstration itself puts one at an additional risk. So the only thing we can do as public health officials is to keep warning people, ‘Be careful.’ If you are going to go out, please make sure you wear a mask and you keep the mask on at all times.” 

Several hundred doctors, nurses and medical professionals come together to protest police brutality on Friday. (Michael B. Thomas/Getty Images)

Some doctors and healthcare workers have come out in support of the protests and participated themselves, with the movement “White Coats for Black Lives” gaining traction on Friday. 

Health organizations and experts have also published suggestions for how to protest safely during the pandemic. The NYC Department of Health and Mental Hygiene tweeted a list of recommendations including wearing a face covering, sticking to small groups and social distancing from others when able. It also recommend using noisemakers instead of shouting and singing. 

For those who believe the COVID-19 risk of protesting on a crowded street is too high, Cyrus says other actions, such as having honest conversations about race, can also help create change. But while the ease of methods like social media activism can be alluring and have some impact, Cyrus says it’s important to also find other ways to engage.     

“My belief is that there are a lot of different ways that you can protest, but I think that it comes down to how impactful they are,” Cyrus says.

“I can’t just say that you’re a horrible person because you don’t go out and protest. But doing something else besides just posting a black square,” Cyrus says, alluding to the viral Blackout Tuesday campaign, “you have to think about what impact it’s actually having.”   

Blackstock observes that the choice between staying safe during a pandemic and fighting racial injustice is a choice Americans shouldn’t have to make.  

“The tension is between the protests and being concerned about COVID-19 transmission, and how do we balance the two,” Blackstock says. “And the fact is that this is the system working as designed; people shouldn’t even have to make that choice. 

“If things had been handled well from the outset, we wouldn’t be in this situation.”  

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