What Protesting May Mean For COVID-19 Transmission

A potential increase in cases will depend on your location - This has been the theme, mission, and email signature of the moment since the novel coronavirus (COVID-19) was declared a pandemic in March. Social distancing mandates are a crucial part of staying safe and preventing disease transmission.

But in the wake of George Floyd's death on March 25, thousands are marching, protesting, and rallying together—making social distancing safety measures difficult to maintain in these situations.

"We know there is a risk [for COVID-19 exposure]. But racial violence is also a public health emergency," Cherise Rohr-Allegrini, PhD, MPH, an epidemiologist and San Antonio director of The Immunization Partnership, told Verywell.

The racial violence Rohr-Allegrini refers to is harm at the hands of law enforcement. A study of emergency department data from 2001 to 2014 found that Black people were treated for injuries inflicted by police, security guards, or other legal authorities almost five times more frequently than white people. The study data focused on people ages 15 through 34. According to The Guardian, in 2016, Black people were twice as likely as white people as likely to be killed by law enforcement.

Standing up to that systemic racism can't wait until the pandemic is over, according to Rohr-Allegrini, who attended a San Antonio protest on May 30. "So we work to reduce the risk and make it as safe as possible," she said. "Masks aren't perfect, but they help."

Masks, however, are only one aspect of COVID-19 prevention. Without the ability to maintain at least 6 feet of distance from other protestors, there's potential for disease transmission. At a U.S. House of Representatives subcommittee hearing on June 4, CDC director Robert R. Redfield, MD, said protests may be "seeding events" for COVID-19.

"Those individuals that have partaken in these peaceful protests or have been out protesting, and particularly if they're in metropolitan areas that really haven't controlled the outbreak.. we really want those individuals to highly consider being evaluated and get tested," he said.

What This Means For You

If you're going to a protest, wear a mask like the cloth facial coverings or bandanas recommended by the Centers for Disease Control and Prevention (CDC). N95 respirators and surgical masks should still be reserved for healthcare workers and first responders.

Will COVID-19 Cases Surge Because of Protests?

From a national level, the CDC is monitoring demonstrations and how they might increase COVID-19 transmission. The incubation period of the virus can take up to 14 days.

"It is too early to know what, if any, effect these events will have on the federal COVID-19 response," CDC spokesperson Kristen Nordlund said in a June 7 statement reported by CNN. "Every local situation is different. State and local officials will make decisions to protect public health and safety based on circumstances on the ground."

Locally, many cities are preparing for an increase by making testing more widely available.

In Minnesota, where Floyd was killed and where protests began on May 26, the state Department of Health is offering COVID-19 testing to anyone who participated in a protest or demonstration, as well as anyone who lives in a community impacted by a large event. The tests will be offered throughout the month of June at community sites in Minneapolis and St. Paul. The tests are free and also do not require insurance, and patients do not need to have COVID-19 symptoms to receive one.

Boston,6 Seattle,7 and New York8 are among other cities offering free COVID-19 tests to protestors.

In a news conference on May 30, New York Governor Andrew Cuomo outlined a plan for New York City's hospitals to share resources to prepare for a spike in cases ahead of the city's June 8 phase 1 of reopening, which followed a week of protests.

"We learned painful lessons with our hospital system," Cuomo said. "If we have a problem, we need all of those hospitals to work together. We can shift patients, we can share resources, that kind of coordination."

Why Protests May Increase the Risk of Transmission

"We know that being in close contact indoors increases transmission risk," Rohr-Allegrini said. "While being outside doesn't remove risk, it does decrease it."

When you're outside, air is constantly moving, and it's harder for pathogens like SARS-CoV-2, which causes COVID-19, to recirculate.

However, several aspects of protests and demonstrations still leave participants at risk.

Close Proximity

"We know that when people gather in groups, it increases the chance of spreading COVID-19 within those groups," Chidinma Chima-Melton, MD, an assistant clinical professor of pulmonary and critical care medicine at the David Geffen School of Medicine at UCLA, told Verywell via email. "It is absolutely important to demonstrate against systemic racism. But when large groups of people are not social distancing and talking loudly and singing, we can expect an increase in the transmission of the virus."

Shouting

Shouting can propel respiratory droplets, which are major drivers of COVID-19 spread. The New York City Department of Health recommends using noisemakers, drums, and written signs to make yourself heard.

Tear Gas

Crowd control measures like tear gas may both increase COVID-19 transmission and potentially aggravate symptoms.

"Tear gas makes it hard to breathe because it contains a substance—usually 2-chlorobenzalmalononitrile (CS)—that irritates and injures the lining of the airways," Chima-Melton said. "Since it damages the cells that line the airways and serve as natural barriers to infection, it allows easier entry of the virus into the body, increasing the chance of acquiring COVID-19."

Chima-Melton said tear gas can also result in increased sputum production and coughing, which increase the respiratory droplets responsible for COVID-19 transmission.

For people already considered high-risk for COVID-19, tear gas exacerbates the problem.

"Asthma and other respiratory conditions can make someone more susceptible to COVID-19 infection since they already have underlying inflammation in their airways, and tear gas exposure can further worsen this risk," Chima-Melton said.

What Should You Do If You've Been to a Protest?

If you've participated in a protest, get tested for COVID-19 and limit close interaction with people afterward.

"After protesting—or if you are worried about potential exposure—you can get testing within three to seven days to detect asymptomatic infection," Chima-Melton said. "However, this risk needs to be weighed against the availability of testing [in your area]. It may make more sense to self-quarantine for 14 days or to get a test on the last day of your protest activity. Certainly, if you are symptomatic, you should always seek out a test and stay at home."

Once you're home, it's important to isolate yourself.

"Quarantining after potential exposure COVID-19 is the only way to make sure you do not inadvertently transmit the virus while asymptomatic," Chima-Melton said. "If you live with high-risk people, you may want to be especially careful and consider other ways of making your voice heard rather than protesting in large groups."