The Protest Wave: COVID-19, Perceptions of Science, and Mass Events
As you know, our nation is the midst of a convulsion of protest over the killing of George Floyd. City streets have been filled with protesters, riots have broken out in some areas and police have clashed with civilians, arresting some 20,000 of them as of this writing. As you also know, this is happening at a time when our nation is still in the throes of the COVID-19 pandemic. While the pandemic has improved from its awful peak in April, we are still detecting about 20,000 new cases a day and losing about a thousand Americans a day.
The combination of these two events has naturally created concern over whether the protests will result in a sudden and explosive spread of the virus, reversing the halting progress we’ve made over the last two months. And it has also drawn comparisons to the much smaller protests against stay-at-home orders that start appearing in mid-to-late April, against which many public health experts inveighed.
On Friday, a group of health professionals1 published an open letter addressing the issue. The letter, which you can read at the link, declares its support for the anti-racism protests. It also draws a distinction between the anti-racism protests and the anti-lockdown protests, describing the former as being “rooted in white nationalism”. It argues that the anti-racism protests should be encouraged, despite the risk, while the anti-lockdown protests should not. It goes on to describe ways that to minimize the risk of a viral outbreak from the protests, such as wearing masks, not arresting people, not using tear gas, etc.
The letter has created a mini-tempest in a teapot. Those who have been long skeptical of stay-at-home orders have proclaimed that this shows the entire thing was a fraud, a scam to seize control of people’s lives, wreck the economy and undermine the presidency of Donald Trump. For weeks, we have been told that mass gatherings — even for church services — were incredibly dangerous. But the minute a mass event occurred whose politics overlapped those of public health experts, all the danger was waved away. Having a funeral would kill grandma; having a massive march was fine. Even those who are not of a conspiratorial bent see this as hypocritical.
Let’s dig into this a bit.
A Moving Target
First of all, we need to keep in mind that we’re not comparing apples to apples. When the anti-lockdown protests got going in mid-April, we knew even less about COVID-19 than we do now. It was unclear, for example, whether incidental contact could spread the virus. We now we believe that incidental contact is low risk (although not zero) while prolonged contact, particularly indoors, is high-risk. So riding an elevator that someone who has COVID-19 rode an hour ago will probably not get you sick. But sitting down to lunch and having them breath in your face for 15 minutes is high risk2. So, in hindsight, while the anti-lockdown protests were risky, they were not quite as dangerous as we thought.
Moreover, the situation has changed. When the anti-lockdown protests erupted, we were losing 3000 people a day and ICUs in some cities were overwhelmed. Since then, the death toll has fallen to under a thousand a day and the ICU crisis, while still going, is not quite as dire.
So, all things being equal, it would be defensible to say that protests in April were dangerous while protests in June are not.
However…things are not equal. There is another factor that differentiates the anti-lockdown protests from the anti-racism ones: size. The current protest are gigantic, whereas the anti-lockdown protests were small. That substantially alters the calculation of risk. Because the risk of the virus spreading grows exponentially with the size of the crowd3. This is why gatherings of 10 or fewer people are being permitted while larger gatherings are prohibited. As more people are involved, the risk skyrockets.
Let’s go back to the 1918 pandemic, to which our current situation is the most comparable. On September 28, 1918, the city of Philadelphia had a Liberty Loans Parade involving more than 200,000 people. The result was one of the most lethal flu outbreaks in the entire pandemic. Something like 50,000 people got sick and 12,000 died. Within a week, the hospitals were overwhelmed and the city completely shut down.
Are we facing something similar now, only in cities all over the country?
Deaths on the Back of An Envelope
Here’s the thing: I don’t know the answer to that question. No one does. Because as much as we’ve learned about the virus, there is much we still don’t know, such as how well it spreads in warm sunny conditions. There are reasons to believe it spreads less rapidly outside, but massive outbreaks in India and Brazil argue that weather alone is not protective enough.
To give an example of the uncertainty here: we currently have about a million people with active infections of the virus in the United States. But that’s confirmed test results, so the real number is probably more like five million, based on the number of deaths. Most of those are too sick to go to a rally but some fraction are either asymptomatic or pre-symptomatic. Let’s say that about a million people, or about one-in-300 Americans, have the virus, are contagious, but don’t know it. And that’s probably a bit optimistic when we talk about the protests since the infection rate tends to be much higher in cities than suburban or rural areas.
How many protesters are out there? Let’s say a million. That means about 3000 people are out at protests able to spread the virus.
Those are back-of-the-envelope calculations. But I did them to set up the real point. How infectious are these potential spreaders? R0 or the basic reproduction number, is the expected number of new people that a sick person will infect. The higher R is, the more infectious. The R of COVID-19 is estimated to be about 3. But that varies quite a bit. A huge amount of the infections have come from super-spreader events where an asymptomatic person at a mass event infects dozens of people4. Moreover, R is affected by many factors. Our social distancing and shut-downs have brought it down to about 1, which is why the pandemic has stabilized. But we simply don’t have enough information to know what R is for these protests. How many people are wearing masks? How good are they about wearing them? Are they shouting and therefore propelling infectious droplets at high speed? And how is this affected by weather and being outside? How many are being arrested and being put in jails, which are some of the highest-risk areas of the United States?
And it’s not just the protesters who are at risk. If some of them get infected, they will take that infection home. And they may be in situations where — because of work or housing circumstances — they simply can’t “self-isolate” for two weeks if they get sick.
If the R is something like 2, two weeks of protests might result in 12-24,000 new infections, which is barely a blip on our current rate. But if it’s more like 4, it’s more like 50-200,000. If those people take it home, we could be looking at hundreds of thousands of new infections and thousands of deaths.5
That is the possibility that has real public health experts worried. It may not get that bad. Maybe the warm weather and what few precautions are being taken could prevent a catastrophe. We may — and I pray hard that we do — barely see a blip in the infection curve. But we can’t pretend that we’re not risking a potential catastrophe.
And this is the first failure of the much-hyped letter. You can judge yourself, but to my ears, it badly downplays the risks involved in the protests. “As public health advocates, we do not condemn these gatherings as risky for COVID-19 transmission” is an incredibly irresponsible thing to say. Because a mass gathering is a huge risk to public health. There is simply no two ways about it.
Maybe you think it’s worth it. The letter points out, quite correctly, that racism has a very real cost in lives and health for minorities. Noah Smith makes the case that if it seriously cuts down police violence, more lives may be saved in the long run. But you have to be honest about the risks being taken. You have to give people information about the very concrete and real risks protests are courting so that they may weigh this against the potential and even more uncertain benefits that the protests may create. By highlighting the worthiness of the cause first and blithely skating past the substantial risks involved, this letter does a disservice to our country, to public health and to the protesters themselves, who deserve to know the risks involved.
Now contrast the tone of this letter against this thread from Nicholas Christakis or this interview with Anthony Fauci. Both acknowledge the validity of the cause. Both acknowledge the fundamental right of people to protest. But both talk seriously about the risk of triggering a second wave just when we’ve got the first somewhat under control. Neither downplays the risk because they support the overall goals.
The Hithertos and the Whyfores
If it were just the tone of the letter that bothered me, I might not have written a 2000-word post on it. But the letter goes farther than that and, in doing so, seriously undermines public health.
One of the more maddening things about the anti-lockdown protests was their casual dismissal of them by many Left Wing voices. We were told that people wanted to kill grandma so they could go to Fuddrucker’s or get a haircut. But that wasn’t the case. The protests were mainly from people who saw their businesses collapsing and their jobs vanishing. And, as they correctly pointed out, this wasn’t just a matter of money. Being unemployed is one of the worst things that can happen to someone’s health. The stress and deprivation can have measurable impacts on health and lifespan, especially in a country where insurance is linked to employment. Poverty kills too. And yet the reality of plunging millions of Americans into it was cavalierly dismissed as a necessary tradeoff for the gain in public health. While I agreed with that assessment in the end, as did the vast majority of Americans, I also thought the protesters had a very real and valid point.
Ultimately, I agree that the anti-lockdown protests were misguided. The mobility data shows that people began staying home long before government stay-at-home orders were issued. As it turned out, no one wanted to risk death to get a burger or see the latest Hollywood film (and with the quality of film Hollywood is making these days, who can blame them?). Moreover, we noted at the time that, in the 1918 pandemic, cities that locked down faster and tighter saw more robust economic recoveries, a theory seemingly confirmed by the unexpectedly strong jobs report for May.
But I still supported the right of the protesters to speak. Because the right to protest can not be conditioned on whether someone is right or wrong. Or whether they are wise or foolish. Or whether their cause is just or unjust. The right petition for redress of grievances is universal. “Stupid but Constitutional” is not just for laws.
To the conspiracy theorists, however, the objections to anti-lockdown protests weren’t just concern about the risk involved. They were evidence that the COVID crisis was being used an excuse to seize power over the American people6. This was about oppression and control, and they were the freedom fighters standing between us and this encroachment on our economic and personal freedom.
And that’s where the letter makes its second error. It plays rights into the hands of this infuriating narrative.
This should not be confused with a permissive stance on all gatherings, particularly protests against stay-home orders. Those actions not only oppose public health interventions, but are also rooted in white nationalism and run contrary to respect for Black lives.
This is one of the most irresponsible things I’ve read during this entire crisis. First of all, to dismiss the anti-lockdown protests as white nationalism is absurd. Yes, there were some white nationalists involved. But about one in five Americans opposed the lockdown. And they didn’t oppose them because of some nebulous and unclear connection to white supremacy; they did so because they saw the economy being wrecked for what they felt were poor reasons. I think they were wrong. But they were not so wrong that you can just shout “white supremacy” like Michael Scott declaring bankruptcy and dismiss everything they said.
More to the point, arguing that someone’s ability to protest should be conditional on what they are protesting about is deeply destructive. If enacted into law, either de jure or de facto, it is also blatantly unconstitutional viewpoint discrimination.7
The letter then goes on to claim that this elevation of one viewpoint over another is not political but scientific. That because racism has a very real and measurable impact on the health and lifespan of minorities, that makes the anti-racism protests permissible in a way that the anti-lockdown protests are not.
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.
I can not imagine anything better designed to feed the narrative the the stay-at-home orders are more about advancing left wing politics than public health. Those who believed that the lockdowns were about oppression and control are gleeful, pointing at this letter and saying, “See! See?!” Tucker Carlson had an unhinged voraciously-watched monologue proclaiming that the lockdowns were “a front for tyrants to inflict their personal neuroses and their desire for control” on the country. By claiming that the riskiness of a public protest should be analyzed based not on the danger to public health but upon the cause being advanced, this letter undermines the public trust in health experts, giving the country the impression that our response to a virus should be conditional on the politics surrounding it.
The reason we have gotten as much control of the virus as we have is not because of lockdown orders or MSNBC broadcasts or Twitter hashtags. It’s because the public has demonstrated an astonishing trust in public health experts. Millions of Americans have sacrificed their lifestyles, lost jobs, sewed masks and avoided public functions because they believed that they would save lives. And they did! Despite numerous mistakes made by those in higher office, we’ve brought the rate of new infections and deaths down substantially. That has happened because, for all of the noise, the vast majority of Americans have done the right thing.
But that trust in experts is delicate. If the public ever gets the impression that this is not about saving lives but about politics, it will be a catastrophe. The public will not care about nuanced arguments about the lethal impact of racism on the lives of minorities. All they will hear is that the cause of public health must bend to the political inclinations of the health experts. Thomas Chatterton Williams says it well:
What are we to make of such whiplash-inducing messaging? Merely pointing out the inconsistency in such a polarized landscape feels like an act of heresy. But “‘Your gatherings are a threat, mine aren’t,’ is fundamentally illogical, no matter who says it or for what reason,” as the author of The Death of Expertise, Tom Nichols, put it. “We’ve been told for months to stay as isolated as humanely possible,” Suzy Khimm, an NBC reporter covering Covid-19, noted, but “some of the same public officials and epidemiologists are [now] saying it’s OK to go to mass gatherings – but only certain ones.”
Public health experts – as well as many mainstream commentators, plenty of whom in the beginning of the pandemic were already incoherent about the importance of face masks and stay-at-home orders – have hemorrhaged credibility and authority. This is not merely a short-term problem; it will constitute a crisis of trust going forward, when it may be all the more urgent to convince skeptical masses to submit to an unproven vaccine or to another round of crushing stay-at-home orders. Will anyone still listen?
Viruses don’t care about politics. They don’t care if a cause is just or if it is foolish. They don’t care about the long history of racism and the profound impact that has on today’s America. All they care about is infecting new bodies. This is why the real public health experts I referenced above have been much plainer in their language. Again…maybe the risk is worth it. But the American people deserve…the American people have earned some straight talk about the risk that is being taken.
It is not the place of scientists, including me, to tell people whether the risk of spreading COVID-19 is worth what they hope to gain with a public protest. Or rather, it is not our place to express our opinion on that and cloak it in the language of science. All we can do, as far as the science goes, is provide the best information we have. To educate people about the risks they are taking and the ways they can mitigate them. It is the place of scientists to be honest about the risks, to not get into the weeds of the merits of this or that protest and to, above all, never give the impression that our opinions are swayed by politics.
By proclaiming the anti-lockdown protests to be a menace to public health but dismissing concerns about the anti-racism protests, the people who signed that letter have done a disservice. They have played right into the hands of those skeptical of stay-at-home orders. They have allowed politics to get injected into a debate that is ultimately about science. They have taken sides. And we will all pay for that.
- Many of them students or interns.
- Of particular relevance was an incident where dozens of members of a choir were infected during a practice despite social distancing.
- Nerd note: Actually, it grows “superlinearly” which means the risk grows faster than the crowd does, but not quite exponentially.
- This is why small events are low risk, but large events are high risk. We’re limiting the number of people a super-spreader can infect.
- Trevor Bredford, who knows this stuff way better than I do, does a similar calculation and gets about 200-1100 extra deaths per day.
- Although what exactly was going to be done with this power was a bit of a mystery.
- Bill De Blasio, who seems to be on a mission to find every possible way he can be wrong about COVID, is one of the politicians who has endorsed this idea.