Protests raise fear of covid-19 spread

Jenn McCullough emerges from the voting booth Tuesday in Philadelphia as Pennsylvania, eight other states and the District of Columbia held primaries overshadowed by curfews and coronavirus worries. More photos at arkansasonline.com/63election/.
(AP/Matt Rourke)
Jenn McCullough emerges from the voting booth Tuesday in Philadelphia as Pennsylvania, eight other states and the District of Columbia held primaries overshadowed by curfews and coronavirus worries. More photos at arkansasonline.com/63election/.
(AP/Matt Rourke)

PROVIDENCE, R.I. -- As demonstrators flood streets across America to decry the killing of George Floyd, public health experts fear that the close proximity of protesters and their failures in many cases to wear masks, along with police using tear gas, will fuel new transmissions of the coronavirus.

Many of the protests broke out in places where the virus is still circulating widely in the population. In fact, an Associated Press review found that demonstrations have taken place in every one of the 25 U.S. communities with the highest concentrations of new cases. Some have seen major protests over multiple days, including Minneapolis-St. Paul, Chicago, Los Angeles and Washington, D.C.

The protests have come just as communities across the nation loosen restrictions on businesses and public life that have helped slow the spread of the virus, deepening concern that the two factors taken together will create a national resurgence in cases.

"As a nation, we have to be concerned about a rebound," Washington Mayor Muriel Bowser warned after days of protests rocked the nation's capital. New York Gov. Andrew Cuomo bemoaned the crowds, saying hundreds of people could potentially have been infected, undoing months of social distancing.

A fresh outbreak in the places where protesters gathered could lead to reinstituting shutdowns.

The AP's review focused on large metropolitan counties -- the central counties within metropolitan areas with more than 1 million people -- that showed the highest rates of new cases per capita over the past 14 days.

While case numbers and deaths have been trending down in several of the cities where the largest protests have occurred, the number of people in those places infected with the virus -- and with the ability to spread it -- remains high. And in some of the communities, such as Minneapolis, the number of people hospitalized with covid-19 has been rising.

Floyd died May 25 after a Minneapolis police officer pressed a knee into his neck for several minutes, even as he pleaded that he couldn't breathe. The officer has been arrested and charged. Minneapolis has been ground zero for the sprawling protests, which have crossed the Mississippi River into neighboring St. Paul.

The unrest has coincided with "the very worst days of the pandemic so far" in the Twin Cities metropolitan area, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"Our ICU bed care is at its all-time high and is really on the edge," he said.

Experts point out that other factors associated with protests could accelerate the spread of the virus. For instance, tear gas can cause people to cough and sneeze, as can the smoke from fires set by people bent on destruction. And both prompt protesters to remove their masks.

Crowding protesters who have been arrested into jail cells can also increase the risk of contagion.

Protesters and police shouting at one another nose-to-nose also is raising alarms.

PARTISAN FEARS

Dr. David Eisenman, director of the Center for Public Health and Disasters at the UCLA Fielding School of Public Health, said he feared that partisan forces will accuse cities of bringing fresh cases on themselves.

"I'm actually more worried about how, if those spikes occur, how that information will be weaponized against the notion of protests," he said.

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Eisenman called protesting an "essential activity" that's possible to practice with reduced risk.

Dr. Leana Wen, an emergency physician and public health professor at George Washington University, said the hospitalizations from coronavirus in the Washington metropolitan area have been on the decline but she knows that could change.

Wen was the health commissioner for Baltimore during the 2015 uprising after the death of Freddie Gray in police custody, and said many health clinics were closed and pharmacies burned down, making it difficult for people in disadvantaged communities to access health care.

It's a concern for her now, too.

"You will have compounded health issues that go beyond covid-19," she said.

Public health experts said it will take two to three weeks to know whether the protests cause a surge in coronavirus cases. And even then, they can't definitively tie it to the demonstrations.

The unrest is happening in tandem with the reopening of gyms, hair salons, restaurants, parks and beaches. It also comes on the heels of the Memorial Day weekend, when many people attended large gatherings, so experts already were bracing for a case increase, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University.

In Los Angeles, barbershops and in-person dining were allowed to resume last weekend, just as protests descended into destruction and more than 1,000 people were arrested.

Nearly 10,000 new cases have been reported in Los Angeles County in the past week.

Hundreds of people also were arrested in Chicago, where Cook County has had among the highest per capita rates of new cases of any large county in the nation, with 283 new cases per 100,000 population in the past two weeks.

"The absolute number of cases is still high. We feel good about the fact that we've established a decreasing incidence, but we have a ways to go," said Dr. Ronald Hershow the director of the Division of Epidemiology and Biostatistics at the University of Illinois-Chicago.

Hershow and others noted that the racial disparities laid bare by the coronavirus -- with communities of color bearing a disproportionate burden of infections and deaths -- overlap with the issues being protested on streets across America and around the globe.

"Racism kills," Hershow said. "Sometimes that's direct, as in the case of George Floyd. And sometimes it's through a virus like covid-19."

DEATHS ABOVE NORMAL

In other news, New York and New Jersey have had more than 44,000 deaths above normal from mid-March to May, according to an analysis of data from the U.S. Centers for Disease Control and Prevention. While covid-19 is the leading cause of those extra deaths, more people have also died from other causes like heart disease, diabetes and Alzheimer's disease in recent weeks than for the same period in previous years.

Public health experts have said many of the additional deaths from other causes may be undercounts or misdiagnoses of covid-19, or otherwise indirectly linked to the pandemic.

The two states together account for more than 40% of the official coronavirus death toll in the United States.

According to the CDC, about 30,500 deaths were directly attributed to covid-19 from March 15 to May 2, the period for which the most recent comprehensive data is available. About half of those deaths were in New York City alone.

But more deaths have also been caused by conditions that are common comorbidities with covid-19.

Heart disease -- the leading cause of death in the United States -- saw a large surge in excess deaths over the same time. In New York City, deaths from heart disease were nearly three times the normal amount.

About 800 deaths above normal have been attributed to diabetes. Research has shown that people with diabetes and heart disease are particularly vulnerable if they contract covid-19.

It's also possible that some patients with chronic illnesses, like heart disease and diabetes, may have chosen to stay home rather than risk exposure to the coronavirus by going to the hospital. Many doctors have reported a decrease in hospital visits for heart attack and stroke.

"If I had diabetes, and it was barely manageable, and I had some episode that may normally require me to get urgent care ... do I want to stay home and manage my diabetes, or do I want to go into a hospital and potentially contract covid?" said Melody Goodman, a biostatistics professor at New York University.

LATER FLU SPIKE

The pandemic's strain on the health care system is also forcing some to delay or forgo treatment for illnesses not related to covid-19.

Some deaths attributed to the flu, pneumonia and other respiratory diseases might have actually been caused by covid-19, especially earlier in the pandemic, when coronavirus tests were hard to get, Goodman said. Chest X-rays from the virus and pneumonia look especially similar, for example.

The CDC data shows that flu deaths peaking much later than normal this season. Usually, the peak is in January and February; this year, deaths attributed to the flu spiked in March and April, around the same time as the peak of the coronavirus pandemic.

photo

Demonstrators pause to kneel Tuesday in Washington as they march peacefully in close ranks to protest the death of George Floyd. Large demonstrations in large metropolitan areas are raising fears of fresh outbreaks of the coronavirus.
(AP/Alex Brandon)

"As you look at mortality rates as you move through February into March, anything documented as flu, you have to wonder is it truly viral-tested flu or just people thinking it was flu when maybe that was all covid?" said Thomas McGinn, author of a study about clinical characteristics of covid-19 patients in the New York City area.

Deaths from Alzheimer's disease, a common cause of death among senior citizens, were more than 60% above normal during the same time period.

"I imagine that the care for people with Alzheimer's is being complicated by the epidemic, particularly given that this has ripped through certain nursing homes, and that could be affecting the level of care that's being given," said Robert Anderson, chief of the mortality statistics branch at the CDC's National Center for Health Statistics.

Deaths from other causes -- including Parkinson's disease, dementia and coronaviruses other than covid-19 -- are more than 25% above normal for this time. Deaths that are pending investigation are also included.

The CDC will ask states if some of the generic coronavirus deaths are indeed covid-19, Anderson said.

Information for this article was contributed by Michelle R. Smith and Nicky Forster of The Associated Press; and by Denise Lu of The New York Times.

A Section on 06/03/2020

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