Public Health Experts are Embarrassing Themselves

While the current protests are certainly well-meaning and anger over police violence and racism justified, claiming that the protests' positive effects on public health will exceed the harms from the spread of coronavirus is an assertion of faith, not science.

For several months, epidemiologists have been warning about the dangers of coronavirus spread from large gatherings, including large outdoor gatherings. Much has been made, in particular, of the cautionary example of a big war bond rally held in Philadelphia in September 1918. Philadelphia's failure to cancel that rally as the flu epidemic hit is said to be responsible for thousands of additional deaths; St. Louis, which canceled its planned rally, suffered many fewer flu deaths. The Philadelphia rally attracted some 200,000 people, far fewer than have attended the recent protests (though, to my knowledge, no individual protest rally has attracted that many people).

Yet epidemiologists and other public health gurus have been overwhelmingly reluctant to criticize the loosening of public health restrictions on public gatherings to accommodate the current large public protests. Some, including hundreds who signed a public letter to that effect, have explicitly supported them. In doing so, some of the latter group have blatantly contradicted their own prior public statements on the dangers of public gatherings.

One Ivy League epidemiologist, for example, claimed that President Trump was putting "millions" of people in danger of contracting the virus by encouraging reopening rallies. This was, purportedly, Trump's "arguably most dangerous act" in a series of corona-related actions that amounted to the equivalent of "genocide."

That was in late April. By early June, much larger outdoor protests were somehow a significantly lower public health threat, with the same epidemiologist asserting that "The new infections that may be generated by protests pale in comparison to the larger drivers of the epidemic in the U.S…." What happened to the the "millions" of people that were put at risk by reopening rallies, and encouraging such rallies being especially dangerous?

That said, everyone seems to acknowledge that the protests will cause more, perhaps many more, Covid-19 cases and deaths. Public health types, in general, believe their mission is to focus on public health above all else, so they obviously need to explain why the protests are nevertheless justified from a public health perspective, or, for more moderate figures, why they are reluctant to be critical of the failure of authorities to crack down the protests in the name of public health.

The basic rationale they have provided is that protests against racism and state violence are different from other activities they have criticized and sought to have banned in the name of public health because racism and state violence are also public health problems. On the extreme pro-protest side, public health experts have argued that the damage from racism is so great that the rallies will have a more positive effect on public health than any harm caused by the spread of coronavirus. Even more sober analysts who have been sounding alarm about (but usually without much criticizing, much less calling for a shutdown of) the protests have felt obliged to pay lip service to such concerns, acknowledging, for example, that concerns about the spread of coronavirus must be balanced against the fact that "racism and state sponsored violence are critical public health issues."

It's not that public health folks are wrong that racism and police brutality have significant public health consequences; while coronavirus has the potential to kill hundreds of thousands in a short period of time, over the long-term racism and state violence can cause even greater harm.

But here's the thing: while it's understandable that people want to take to the streets to protest racism and state violence, there is no epidemiological or other scientific evidence that such protests will have positive public health effects by spurring positive social and political change. Any scientist or public health expert who suggests otherwise is engaging in political and sociological speculation that is not only beyond their expertise, but that really beyond anyone's expertise. But it's worse when such speculation purports to be scientific, from experts whose credibility is crucial for containing the current and future pandemics.

Will the protests raise public consciousness about the pernicious effects of racism? Surely, and that will likely have positive effects. But beyond that, things are very uncertain. Will violence/rioting continue and cause a "reactionary" backlash? Will reforms advocated by protesters, such as those encompassed by the slogan "Defund the Police," actually be enacted? If enacted, will they have positive effects on public health, or will they lead to a surge in violent criminal activity, itself a huge threat to public health and wellbeing?–it wasn't that long ago that violent crime rates were triple what they are now, with tens of thousands more people killed and injured each year. What will be the effect of social disorder on the economic health of big cities in general, and the poorer neighborhoods within them in particular, and what effect will that have on public health and wellbeing?

The public health folks who are comparing the negative Covid-related health effects of the rallies to the health effects of racism and police violence are committing a fundamental methodological error. On the one side, there is a real public health problem of coronavirus, and we know, based on what the experts have been telling us since March, that large public gatherings will likely kill a large but indeterminate number of people.

On the other side, racism harms people's well-being, and state violence directly harms their health. However, and this is key, no one has any idea what overall effect the protests (and any attendant violence) will have on racism and state violence, even whether it will be positive or negative.

When public health experts express implicit or explicit belief that political rallies and protests will lead to desirable social and political outcomes, they are not engaging in science, they are not relying on public health research, they are relying on something akin to faith.

In short, the situation we are faced with is that large pubic rallies will almost certainly kill and injure many Americans through Covid spread, and we don't have the slightest non-speculative idea as to whether the protests will have a positive effect on public health, much less whether any such positive effects will outweigh the health harms from virus spread.

To the extent public health experts claim to be relying on their expertise, rather than faith as political activists or fortune-tellers, there is only one plausible "public health" answer to having large, public protests: based on what we can actually measure and predict, they are a significant net threat to public health. How authorities should balance that threat against the public's undeniable right to protest, and the possibility that banning or limiting such protests would iteslf cause civil unrest with public health consequences, is a separate question.