Two public health emergencies have collided in the United States: the Covid-19 pandemic, and the epidemic of police violence against people of color, particularly black Americans.

As social unrest spurred by the police killing of George Floyd sweeps America, public health officials and government departments are grappling with the fear that demonstrators and police risk accelerating the spread of the coronavirus, which also disproportionately affects minority communities.

“This is the worst possible thing that could happen,” said Dr Howard Markel, director of the Center for the History of Medicine at the University of Michigan and an expert on pandemics. “It’s hard to know how many of those people are asymptomatic carriers, and that’s really scary.”

Several factors could contribute to the spread, including lack of social distancing, limitations of masks, and police tactics such as use of teargas and arrests.

At the same time, the threat of infection is unlikely to deter demonstrators desperate for social change. In some cases, the rate of black men killed by police rivals that posed by serious infectious disease. 

“Protests are life-saving for black people in this country,” said Dr Rhea Boyd, pediatrician and masters of public health in minority health policy. “Even though being in the streets increases your risk,” of Covid-19 infection, “we all know that risk exists anyway.” 

1 in 1000 Black men and boys will be killed by police in their lifetime.

1 in 1000 is also the mortality rate of measles, a risk deemed so deadly, it has near constant public health surveillance and prevention.

That we don’t treat police violence the same is a form of racism.

While Covid-19 has killed more than 100,000 Americas in just a few months, past studies have found one in 1,000 black men in American are expected to die by police violence in their lifetimes. That is roughly equal to the rate which measles kills children

The coronavirus represents an especially contagious and deadly disease.

Compared with past coronavirus outbreaks, Covid-19 is spread much more easily among people who show no symptoms, known as asymptomatic carriers. The virus is especially contagious, because of how it is shed from the upper respiratory tract – or the part of the body used to chant, cry and cough. Although death rates vary across countries, they remain high.

Protesters or police shouting at the top of their lungs could spread viral droplets for which masks are a weak barrier. Holding hands could also spread contagion. Corralling protesters together makes social distancing impossible. And thousands of people circulating together make contact tracing all but impossible. 

Protests have also shut down testing sites in some cities and states, including in Los Angeles, Philadelphia and Jacksonville, Florida, Politico reported.

At the same time, police tactics threaten to accelerate the spread of Covid-19. The use of teargas and pepper sprays are a public health nightmare. Both cause incessant coughing. Oil-based pepper sprays cause tears, mucus and saliva to pour from the eyes, nose and mouth. 

Teargas and pepper spray “would be the last agent I would use during this time period, for that reason,” said Markel. “You amplify the possibility of spread.” 

Quickly jailing protesters also holds unknown infection control risks, given the heavy presence of the virus in jails and prisons.

Nina Fefferman is a professor at the University of Tennessee Knoxville, and a mathematical epidemiologist. At the beginning of the Covid-19 pandemic, her work focused on projecting the impact of mass incarceration on the spread of the virus. Because communities of color are disproportionately jailed, they were also most likely to be affected by outbreaks in jails and prisons. 

Protesters sent to jail for short periods in the current unrest are “temporarily increasing the number and also social diversity caught up in the criminal justice system, introducing them into a jail population, and then releasing them,” said Fefferman. “None of it is good – but all of it is unusual.” 

Four days of protest in Las Vegas provides an example of how this plays out on-the-ground. A local court ordinance asked police to release people charged with misdemeanors, rather than bring them into jail, to slow the spread of Covid-19. Instead, police working protests in Las Vegas have arrested at least 338 people over the course of the demonstrations, and have used teargas and pepper balls to disperse crowds.

Fefferman developed a model used by the American Civil Liberties Union that found reducing mass incarceration could save 100,000 lives – including 76,000 lives among the broader community – because it would reduce the rate of infected corrections officers and accused who return to the community after exposure to the coronavirus. 

At the same time, Covid-19 has already taken a devastating and disproportionate toll on black Americans, because of a laundry list of state policies. Black Americans are less likely to have paid sick leave, less likely to live in states with public health insurance safety nets and are overrepresented among essential workers

“African Americans already suffer from chronic under-treated and untreated illness within our healthcare system, that denies them care at every level,” Boyd said.

Researchers from the US Centers for Disease Control and Prevention have argued, as recently as 2017, that anti-discrimination laws in employment, housing, education and healthcare result in enormous gains in life expectancy for Americans of color – when they are enforced. That provides powerful reasons to keep protesting for police reform, even in the face of a pandemic.

Demonstrations that led to civil rights in the American south provide one salient example of the health benefits of fighting for minority rights. In the 1960s, the American south segregated hospitals. However, they were forced to integrate after a court ruled white segregationists could not deny treatment to black Americans.

Researchers found over six years from the time of the change, that the rate of black infants dying from pneumonia and diarrhea dropped by 40% while the rate of infant death among whites remained the same. Researchers now estimate between 1965 and 2002, the change saved 38,600 black lives. 

Protests of the past, which “came on the backs of black bodies that were murdered in the streets”, have secured protections Boyd said, “not just for black people – for women, for LGBTQ folks, for everybody in this country who ever needed a civil liberty”.

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