Q&A: Protesting during the COVID-19 pandemic

Across the country, the death of George Floyd has led thousands to take to the streets to protest police brutality and racism in the United States.

There is concern that these protests could create a spike in COVID-19 cases in the upcoming weeks, and that the use of agents like tear gas and pepper spray could worsen or help spread COVID-19 among protesters.

Healio Primary Care spoke with Amesh A. Adalja, MD, a senior scholar at Johns Hopkins Center for Health Security, to learn more about how these protests could affect the COVID-19 pandemic and what protesters can do to protect themselves and others from the virus.

Q: Should COVID-19 prevent people from protesting in large gatherings?

A: I don’t think it necessarily should prevent people from protesting, but it is a risk that they’re going to have to take into account. They should think about ways to minimize that risk, especially those in high-risk groups. But there’s going to be countless situations as we move through this pandemic where people are going to take risks that they believe are worth taking. And I think this is, for many people, that type of a risk. That being said, it is a mass gathering. These types of protests may set off chains of transmission, and we have to be prepared in the health care industry to take care of patients. We want to be able to support our health departments — we’re going to need to be able to do contact tracing of large numbers of people based on how many exposures could occur in these types of events.

Q: How can people safely protest amid the pandemic?

A: It is difficult, but there are things you can do. We’ve seen protests — for example, in Israel — where people stood 6 feet apart from each other. That’s one way to do it. Another way is to be very meticulous about hand-washing and not touching your face. It’s also important to think about alternatives. In these protests, you’ve got people chanting and screaming and yelling, which create droplets that could spread the virus, so are there alternatives to doing that? Maybe banging a drum, maybe doing something differently that doesn’t involve droplets emanating from your mouth. The other thing is that when you see protesters getting hit with tear gas and pepper spray, that’s invariably going to make them cough. Are there alternatives to using those types of agents, or can you stand away from where those agents are likely to be aimed at? Because those types of things are going to cause you to cough, and are more likely to result in disease transmission. It’s more likely that you’re going to transmit this virus if you are coughing, so if you can, stay away from those areas where police personnel are firing those agents. If you’ve attended a protest, you should probably consider yourself exposed to the virus and really think about monitoring yourself for symptoms and being mindful of your contacts with other individuals in the 14 days after the protest.

Q: Should hospitals be preparing for a spike in cases caused by the protests? What should they be doing?

A: Hospitals should be preparing, because anytime we have social interaction, invariably there’s going to be disease transmission. Hospitals are now in a better place with handling these cases. In many places in the country, it’s come to sort of a lull in hospitalizations — they should be preparing to think about capacity, their infection control capacity, ICU bed capacity and ventilator capacity. We need to be thinking about all of that. It isn’t going to be instantaneous — it’s going to be a period of 2 to 3 weeks after the protest for the incubation period and for people to get sick enough to require hospitalization. But they should be monitoring the number of cases that are positive in their communities and using that as an indicator of when you may start to see it spilling into hospitals. They also should be asking people who come in with compatible symptoms, “Were you at a protest?” or “Were you at a mass gathering?” That should raise the clinician’s suspicion that the illness might be COVID-19, even if they have not been around a “documented” case.

Q: What are the potential effects of tear gas on the lungs of protesters who may have COVID-19?

A: Any kind of respiratory irritant is going to make things worse. But the issue with tear gas is probably that it makes people cough, and if you have COVID-19 and you’re coughing, you’re more likely to spread it than if you are not coughing. That’s the main issue, but any kind of respiratory irritant would increase the symptoms. You shouldn’t be protesting if you are sick — if you have any symptoms, you should not necessarily be exposing yourself to others. Or, you should be wearing a mask, for sure, if you have symptoms or if you actually are a diagnosed case of novel coronavirus and you’re out anyway. That’s a different issue. But we know that any respiratory tract irritant is going to make symptoms worse, it’s going to make you cough more, and it may also make you more susceptible to acquiring it, if you’ve got irritation of your respiratory tract.