We're About to Learn a Lot About Just How Contagious Coronavirus Is
The protests present an elevated risk, but how elevated?
|Andrew Egger||Jun 5, 2020||26||52|
Here’s the good news: Two weeks from now, we’ll know a lot more about how easily COVID-19 spreads outdoors than we do right now.
After a week of mammoth crowds clustering in cities across the nation to protest the death of Minneapolis resident George Floyd at the hands of police, many have asked the obvious question: Hey, aren’t we still in the middle of a pandemic? After two months of shutdown managed to slow the advance of the coronavirus—but not to beat it back—a sudden deluge of crowds have led to understandable fears of a resurgence.
Epidemiologists agree: While there are things protesters can do to cut down transmission in a crowd, primarily by masking and doing their best to maintain social distancing, it’s undeniable that they present an elevated risk. How elevated? Time will tell.
When America and the world battened down the hatches to brace against the pandemic back in March, the details of the coronavirus’s transmission remained largely a mystery. Discouraging early reports that it was more contagious than the flu, coupled with the dizzying feeling as testing efforts got underway that the disease was breaking out everywhere in America at once, all contributed to a nationwide sense of omnipresent danger. Anybody you passed at the store or in the street might have the virus, and if you got too close for an instant you’d probably get it too.
In the months since, we’ve learned some encouraging things on this front. Scientists are still not quite sure about the coronavirus’s minimum infectious dose—how many viral particles it takes, in other words, to allow the disease to establish a beachhead in the body. But the risk of outdoor transmission in particular appears to be lower than many had initially feared.
A few prominent national events have lent this hypothesis weight. On April 7, Wisconsin, having stalemated politically on finding a COVID-safe alternative to a statewide election, went ahead and had the election as previously planned. Virus-skittish poll volunteers canceled en masse, forcing many polling places to close; in Madison, voters were forced to wait in line for hours before casting their ballots. COVID-watchers braced for the worst. But the dreaded spike in cases never came; of the more than 400,000 Wisconsinites who voted in person that day, only a bare handful contracted the virus as a result.
Another, smaller-scale example took place over Memorial Day weekend, when spring-crazy Missourians descended en masse on the Lake of the Ozarks to party. Photos and video of hundreds of people partying cheek-by-jowl in and around an outdoor pool and bar went instantly viral on social media, drawing horror-struck reactions across the country. But Missouri public health officials reported Wednesday that the crowds had not led to any new reported COVID-19 cases.
All that is encouraging. But the simple reality is that neither the Wisconsin voters nor the Missouri partiers have been anything close to the kind of nationwide stress test for outdoor transmission that the Floyd protests present. The rationale behind the slow, tiered economic reopening begun over the last month was that, by creeping slowly and cautiously back in contact with one another and keeping a close eye on the state of the pandemic all the while, we could figure out how much we could get away with without taking on too much new risk. By contrast, the protests represent a trial by fire, with potentially catastrophic downsides if it turns out that the virus can transmit just fine in a thronging, yelling, chanting crowd.
“This is an important issue, and clearly people have First Amendment rights to speak, march, protest, that have to be respected,” Dr. Chris Beyrer, an epidemiologist at Johns Hopkins, told The Dispatch. “That said, there are real concerns over ongoing spread, and the potential for new outbreaks of COVID-19, if people protesting don’t, or can’t, follow necessary precautions.”
Beyrer brought up one possibly worrisome counterexample to the trend of outdoor transmission being uncommon: “Analysis of the outbreak in Spain was shown to have been markedly increased by the decision of the Spanish authorities to allow a march of some 150,000 people to go ahead” on International Women’s Day, when COVID transmission was first ramping up in Spain. “But those marches,” he pointed out, “were not masked or practicing social distancing guidelines.”
“For protests, mask wearing may be the single most important issue—since people will be shouting, chanting, speaking, all of which are now known to be activities that can effectively spread COVID-19,” Beyrer went on. “Older people and those with underlying conditions should be urged not to participate, and younger people living with such persons should also be urged to exercise caution.”
A large number of protesters and marchers have been following exactly those guidelines. But many have not—either going maskless altogether or pulling the mask down to be better understood when the shouting starts. This is worrisome, given that the utility of masking is not to prevent yourself from becoming infected, but to prevent yourself from infecting others. An asymptomatic COVID carrier who doesn’t mask up can present a danger to everyone around him, whether they themselves are masked or not.
“Will protests contribute to a spike in new COVID cases?” is, of course, not the same question as, “Should protests be taking place?” Earlier this week, hundreds of doctors, medical students, and public health experts signed an open letter throwing their support behind the protests, stating that “white supremacy is a lethal public health issue that predates and contributes to COVID-19.”
“To the extent possible, we support the application of … public health best practices during demonstrations that call attention to the pervasive lethal force of white supremacy,” the letter reads. “However, as public health advocates, we do not condemn these gatherings as risky for COVID-19 transmission. We support them as vital to the national public health and to the threatened health specifically of Black people in the United States.”
The signatories also point out that it isn’t just protesters whose acts have increased the risk of transmission. Law enforcement actions to contain the protests raise that risk too—both by holding arrested prisoners “in confined spaces, including jails or police vans” and by employing irritants like tear gas “which could increase risk for COVID-19 by making the respiratory tract more susceptible to infection, exacerbating existing inflammation, and inducing coughing.”
“We encourage good public health practices, but recognizing that racism is a major element in COVID-19, we also support protesters’ work to call attention to and dismantle structural racism,” Dr. Megan Ranney, an emergency physician who teaches at Brown University, told The Dispatch. “Many of us are also highlighting that the highest risk of infection is not to protesters who are outside, but to those who are jailed.”
From a public health standpoint, of course, it ultimately doesn’t matter who is to blame for increased risk factors—the trouble is just the existence of increased risk at all. A virus doesn’t care whether it’s setting up shop in the lungs of a cop or a protester. All we can really do is wait and see—and hope that the virus is even less capable of traversing the great outdoors than we’d thought.
Declan Garvey contributed to this report.
Photograph by Maria Chourdari/NurPhoto/Getty Images.