Protesters meet police during marches in Seattle in late May.
Just a couple weeks ago, it would have been the stuff of public health professionals' nightmares: Thousands of people clustered together amid a pandemic, chanting, shouting, and, after police hit them with tear gas, coughing.
But that was before Minneapolis police officers killed George Floyd, and before the week of protests against police violence and institutional racism that have erupted in Seattle and across the nation.
Since then, local public health professionals and leaders have supported the protests, both tacitly and explicitly, despite the increased risks of new coronavirus outbreaks and despite the protests violating their own guidelines.
Infectious disease experts at the University of Washington wrote a letter, that ultimately circulated nationally and drew more than 1,200 signatures, saying that protests against systemic racism "must be supported."
They wrote that the protests, even amid the pandemic, are "vital to the national public health and to the threatened health specifically of Black people in the United States."
Public Health -- Seattle & King County, as it applied for a variance to the state's reopening plan which would allow outdoor gatherings of no more than five people, also offered tacit support to the protests, which have drawn thousands to gather together.
And Gov. Jay Inslee, who for months has been both pleading with and ordering people to stay home to slow the spread of the virus, has had a different message with regard to the protests. Instead of asking people to stay home, he's asked that they wear masks and try to keep some distance amid the crowds.
"I'm very hopeful people will remain committed both to justice in our society and survival against COVID-19," Inslee said Wednesday. "We ought to be able to do both at the same time."
Inslee and others have noted that the protests are outside and there's a growing consensus that transmission of the virus is significantly less likely outdoors.
Dr. Jared Baeten, vice dean of the UW's School of Public Health, was one of dozens of UW faculty, medical students and staff to sign the letter calling for support for the protests, despite the risks of gatherings.
Baeten said that COVID-19 and structural racism are both epidemics and both public health emergencies, and both need to be addressed simultaneously.
"Of course there is tension but these are two epidemics that are layered on each other," Baeten said, citing higher infection and death rates among people of color.
Baeten said he was expecting spikes in infection rates, but pointed to the broader pattern of increased economic and social activity, not just the protests.
"If we see spikes, which we will," Baeten said, "it is not solely because of the protests."
Jennifer Balkus, an assistant professor of epidemiology at UW and another signatory, said it was a risk to gather and recognized the concern of a spike in infections. But, she said, institutional racism is "a public health crisis that's been with us for decades."
"Despite the fact that we're in a pandemic, it's critical to be talking about these issues and acting on these issues and speaking out and people gathering for protests are an important way to effect change," Balkus said.
But as epidemiologists and public health experts are supporting the protests, the local branch of Black Lives Matter is being far more cautious.
Black Lives Matter Seattle-King County, which said it has not been involved in planning the protests, published a protest safety guide for those that do participate.
"Do not underestimate how dangerous the virus is. At the time of this writing, it has killed more than 100,000 people in the United States," the guide says. "Situations where people are shouting or singing can spread more of the virus into the air."
"Ultimately, we decided that the situation is too dangerous for us to encourage greater attendance at these in-person protests," said Marlon Brown, a board member of Black Lives Matter Seattle-King County. "While we have not led or organized direct protests at this time, we understand why people are marching for Black lives. We see you. We hear you. We appreciate you."
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said the sheer number of personal exposures in some places could push infections beyond what contact tracers at local health departments can handle.
"A mass gathering is a mass gathering," Adalja said. "When people are socially interacting and unable to social distance, shouting, and being sprayed with agents that caused them to cough, it is a simple biological fact the transmission events are going to occur."
King County on Wednesday applied to move forward in reopening segments of the economy that have been shut down to stem the spread of the virus. The county still has not met all the criteria to move to Phase 2 of reopening, but is asking to go to a "modified Phase 1." If the application is approved, social gatherings would be "allowed outdoors only with five or fewer people outside the household."
Of course, the protests that have flooded downtown Seattle for the last week have already violated that standard many times over. But the county's public health department, after months of pleading with people to stay home, seemed to give its blessing to the protests.
"We can't let COVID-19 distract us from our resolve," wrote Patty Hayes, the department's director. "Let us join together in King County and show how it is possible to break down the historical institutional racism that affects our communities every day."
The health department published its own guide of questions and answers about protests. It is less stringent than what Black Lives Matter advised. It urges people to wear masks, try to stay six feet apart, carry hand sanitizer and stay home if they feel sick. It neither encourages nor discourages people from attending.
"The violence against black and brown bodies is the antithesis of the right to health," Sharon Bogan, a spokeswoman for Public Health -- Seattle & King County, wrote in an email. "The impact of systemic racism has been, and continues to drive health inequities."
