Across the US, two public health crises — one new and one ages old — have merged into a devastating tandem. Systemic racism undergirds COVID-19 health disparities and the plague of police violence, both of which kill Black Americans at disproportionately high rates.

As protesters have taken to the streets to march against police brutality and to remember George Floyd, Breonna Taylor, and other unarmed Black people who have died at the hands of law enforcement officers, the COVID-19 pandemic has continued plowing its destructive path. The US passed 100,000 coronavirus deaths at the end of May, and in some states like California, the daily number of new coronavirus cases is persistently trending up.

Black people make up 6% of California’s population but represent 10% of deaths from COVID-19, according to data from the California Department of Public Health. And now some health experts worry that the protests will accelerate the spread of the novel coronavirus, further burdening communities of color.

“The same broad-sweeping structural racism that enables police brutality against Black Americans is also responsible for higher mortality among Black Americans with COVID-19,” Maimuna Majumder, PhD, a computational epidemiologist at Harvard Medical School, told Brian Resnick in Vox. “We can’t compare these two tragedies directly — but they both are public health crises that are operating at immense scales.”

Recognizing Racism as a Public Health Issue

Medical and public health groups have spoken out in recent days to condemn police violence and call for racism to be recognized and addressed as a public health issue.

“Racism is detrimental to health in all its forms,” American Medical Association board chair Jesse M. Ehrenfeld, MD, MPH, and President Patrice A. Harris, MD, MA, wrote in a joint statement. “The disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency.”

The American Academy of Pediatrics (AAP) wrote on Twitter, “Racism is a public health issue. The AAP condemns violence, especially when perpetrated by authorities, and calls for a deep examination of how to improve the role of policing. Systemic violence requires systemic response.”

And Georges C. Benjamin, MD, executive director of the American Public Health Association, called for racism to be dismantled “through brutally honest conversations, policy changes, and practices.”

Black Men and Women Face Greatest Risk

Research supports the idea that racism, which is a major driver of lethal and nonlethal police brutality, should be treated as a public health issue. A 2019 study (PDF) published in the Proceedings of the National Academy of Sciences quantified Americans’ risk of being killed by police use of force and found that “risk is highest for Black men, who (at current levels of risk) face about a 1 in 1,000 chance of being killed by police over the life course.”

In comparison, white men have approximately a 1 in 2,500 chance of being killed by police over the life course, and Latino men a 1 in 1,900 chance. Women are far less likely than men to be killed by police. Their lifetime risk is about 1 in 33,000, compared to 1 in 2,000 for men, but when women are stratified by race, Black women face the highest risk over the life course.

In an interview with Vox’s P. R. Lockhart, Frank Edwards, PhD, the study’s lead author and assistant professor at the Rutgers School of Criminal Justice, said the negative effects of a police killing extend far beyond the lives taken. “There’s been great research finding that when an unarmed African American man is killed in a state, there is an increase in symptoms of depression among African Americans in that state following the shooting,” Edwards said. “When a white unarmed man is killed in a state, there’s no similar increase in depressive symptoms among white residents.”

Furthermore, research shows that having negative encounters with the police is associated with higher levels of medical mistrust — a particularly devastating consequence in the middle of a pandemic that necessitates prompt medical care and testing. “We found that when people have a negative encounter with the police, such as the police cursing at them or shoving them, that they are less likely to think medical institutions have their best interests,” said Sirry Alang, PhD, the study’s lead author and assistant professor at Lehigh University, in a press release from the university.

The Risk of Taking to the Streets

For months, Americans have mostly stayed at home to curb the spread of the coronavirus. But nationwide protests sparked by the horrifying death of George Floyd have brought many Americans onto the streets in demonstration against police violence and systemic racism.

Protesters have gathered in cities and towns across the nation and around the world. In these crowded surroundings, where physical distancing is difficult, many demonstrators have been wearing face coverings. Some experts say that it is possible to protest safely. The California Department of Public Health released guidelines for safer protesting, including wearing face coverings at all times and using in-car protests. However, many experts are concerned that street protests could accelerate the spread of the coronavirus.

It’s a catch-22. “How do you choose between two tragedies?” asked Kimi Watkins-Tartt, director of the Alameda County Public Health Department, in an interview with the San Francisco Chronicle. “Being in this pandemic is a tragedy. And that man losing his life is a tragedy, and people are hurting and that’s a tragedy. And as a public health leader, I can’t choose — I can’t say which one is more important.”

Marjaan Sirdar, a longtime community organizer in Minneapolis, has been participating in the protests in his hometown, and he has reservations. “I’m deeply concerned about the spread of COVID-19 in this community,” he told Jasmine Aguilera in TIME. “I’m deeply concerned that we will not have warriors to continue this struggle a month from now because we will lose them to the disease.”

Compounding these public health concerns are reports that coronavirus testing sites across the country have been closed because of safety concerns amid the protests. For instance, the California county hit hardest by the coronavirus, Los Angeles, closed its free testing locations on May 30 and reopened just two sites on June 1, Colleen Shalby reported in the Los Angeles Times. Shuttering or reducing the hours of testing sites could severely hamper efforts to test widely and track people who have been exposed to the virus.

Still, many health experts are balancing the risk of transmission with the need for public demonstrations against unacceptable social injustices. “The fact that people are out there protesting, despite the risks of COVID-19, tells you that the fear of police brutality, racism, is much more terrifying,” Jaime Slaughter-Acey, PhD, an epidemiologist at the University of Minnesota, told Resnick.

A Call to Action

“All of us have a role to play in addressing this deadly strain of racism and inaction — in our communities and in the nation as a whole,” CHCF president and CEO Sandra R. Hernández, MD, wrote in a blog post. “Whether it’s police killings or the disproportionate deaths from COVID-19, no one should tolerate a system that diminishes the value of Black lives.”

What is on your antiracism reading list? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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