Passionate protesters, fueled by centuries of racism, are taking to the streets and trying to do so responsibly: wearing masks and physically distancing. Still, the COVID-19 pandemic rages on, and local governments should start acting like it: health authorities should bring free, voluntary, curbside COVID testing and mask distribution to protesters; crowds should be given space and time to assemble, and crowding peaceful protesters into wagons and jails should cease.
The confluence of the two greatest crises of our time is here. It's been well known among health equity and civil rights activists for decades that marginalized communities, especially black and brown, have long suffered tremendous health disparities due to structural racism and other social injustices. COVID and racism have already killed too many people. Protesting need not have more dire public health consequences.
The HIV/AIDS epidemic taught us that testing is a cornerstone of effective public health interventions. Bringing testing directly to the people has precedent and works. New York City has the capacity: on Friday, Mayor DiBlasio announced that mobile testing will come to hardest-hit communities. That's not enough. The highest risk NYC community right now may be the protesters-- countless people are gathering and social distancing is often aspirational; masks are not freely available.
There are challenges to testing, but that's no reason not to do it. People exposed that day would not yet test positive, but protests have been going on for almost two weeks. Asymptomatic carriers would learn their status and be empowered to adjust their behavior — at the protests and to where they return. Testing at protest hubs like Barclays, Union Square, and across the city and country (as they've done in Louisville, Kentucky, where Breonna Taylor was murdered) gives people the opportunity to be tested regularly they would have repeated exposures with each protest.
Nobody yet knows how risky outdoor gatherings with masked participants are. Testing and tracing in this setting could enable epidemiologists, governments, and organizers to approach this question and mitigate possible outbreaks, informing reopening strategies across the country and world.
Public health authorities have long been dispensing free condoms to curb HIV/AIDS and other sexually transmitted infections and could do the same with face masks and hand sanitizer. Many city health departments have a supply that is prioritized for healthcare workers, but states could allocate more. (This would not be an issue if the federal government would finally invoke the Defense Production Act). N.Y. officials have already announced that masks and sanitizer will be handed out when subways resume full service — why not distribute them now? People are rightfully putting their lives on the line to show up for racial justice; local authorities should empower them to protest "safe(r)," as we say in harm reduction.
Some may be wary of sharing their identity and sensitive information with testers, as was the case with HIV/AIDS testing. This concern is understandable, as modern medicine and public health institutions have deeply racist (and classist, xenophobic, sexist, queerphobic..) roots. Yet, people should have a choice. Many would likely test on-site because they wouldn't have to take time away from protesting and other life responsibilities to seek testing out. It will raze barriers to testing in this potentially high-risk setting and possibly curb other hyper-local epidemics, such as seen in meat-packing plants, jails, and nursing homes, where people come home and unintentionally infect everyone around them. The benefit of reducing transmission could have a massive impact in places where protests are large and ongoing.
Beyond the obvious direct public health benefits, a public health presence at protests could also be symbolic of local government supporting civil rights (and against state-sponsored brutality) while still raising awareness of ongoing and severe health risks during the pandemic and doing something about it. Health workers' presence might even deescalate tensions between protesters and police, discouraging tear gas, rubber bullets, assaults, arrests, and other abuses of power.
What's clear is that this violent policing captured on camera by protesters and reporters, such as "kettling" people in tight spaces, prolonged jailing of peaceful protesters in close quarters, and attacking protest medics, is only increasing known COVID risk factors.
Leaders in New York and elsewhere have responded to the protests with increased policing and curfews, but what if we approached these mass gatherings as an opportunity for anti-racist public health support? Governor Cuomo has repeatedly implored people to get tested and wear masks. The logical thing is to bring testing and masks directly to the people. A functioning democracy should want people to be speaking out and showing up (and remaining healthy enough to vote). Let's enable them to show up safer.
Margo Simon, M.D., is a family doctor and psychiatrist specializing in homelessness, integrated care, and addiction and is on faculty at Albert Einstein College of Medicine.