US healthcare workers march against racism despite the risks


PROTESTING IN THE CORONAVIRUS PANDEMIC

US healthcare workers march against racism despite the risks
Across the US, healthcare workers are risking exposure to one public health threat to speak out
against another. Bryn Nelson explores what it means for healthcare workers when two public health
agendas collide

Bryn Nelson science journalist

Shortly before noon on 5 June 2020, dozens of
healthcare workers in blue scrubs and facemasks,
some wearing white coats, walked across the street
from the University of Washington Medical Center in
Seattle to a small grassy expanse bisected by a
sidewalk and benches. There, more than 100 people
on their lunch break kept their distance from one
another and knelt for 8 minutes and 46 seconds.

The extended moment of silence represented the
exact length of time that a Minneapolis police officer
knelt on the neck of George Floyd, an unarmed black
man, on 25 May. Floyd’s death in police custody,
documented in part by a bystander’s video in which
Floyd repeatedly said, “I can’t breathe,” sparked
weeks of riots, protests, and demonstrations against
racism and police violence that rippled out to all 50
US states and multiple countries around the world.

For many healthcare workers, protesting one form of
systemic racism and violence amid a viral pandemic
that has disproportionately hit some of the same
minority communities has become a tricky three-point
balancing act involving their own health, the health
of their patients, and the health of society.

The day after the tribute at the University of
Washington Medical Center, a separate protest march
drew thousands of chanting healthcare workers and
their supporters to downtown Seattle. Other rallies
crisscrossed the city, blocking major thoroughfares.
And then, shortly after midnight on 7 June, police
clashed with shouting demonstrators in a
neighbourhood known for its political activism, amid
a cloud of tear gas, pepper spray, and “flashbang”
grenades.

A growing group of doctors, nurses, researchers, and
other healthcare workers in Seattle and across the
US have been facing pushback from critics
questioning whether health officials should be
encouraging mass demonstrations as covid-19 rages.
Their answer: racism and police brutality are also
public health emergencies with long term
consequences. They have written public letters,
launched petition drives, and organised marches
throughout the US.

Estell Williams, assistant professor of general surgery
at the University of Washington, organised the 6 June
rally in Seattle with her husband, Edwin Lindo, a
lecturer in the university’s department of family
medicine. Racism, they said, should be thought of as
a powerful disease that can kill just as covid-19 does.

“The ultimate goal of these protests is to improve our
community, and we are being mindful and safe and
recognise that there’s still an ongoing pandemic, and
we want to preserve life,” Williams said. But, for her
family and others in the black community, she added,
stress due to racism and police violence can increase
the risk of chronic illness, which in turn can increase
the susceptibility to covid-19.

“Decrying racism and police violence as a public
health crisis is the crux and intention of what took
place on Saturday,” Lindo said.

What’s the risk?
Some supportive healthcare workers have chosen not
to march themselves, because of the risk of
contracting the virus in often tightly packed outdoor
protests and rallies where shouting, singing, and
chanting could help disperse viral particles.

Trevor Bedford, a computational biologist at Seattle’s
Fred Hutchinson Cancer Research Center, posted his
educated guess of how the protests and police
response might increase the number of new covid-19
infections, sparking an online debate about the
trade-offs and whether it was possible or even helpful
to make such forecasts.1 The calculations have been
complicated by long lags between exposure and case
identification, spiking case numbers in several states
that have loosened social distancing mandates, and
flat or declining numbers so far in Seattle, New York,
Minneapolis, and several other cities with massive
anti-racism protests since the end of May.2

Multiple observers have pointed out that the
anti-racism movement has embraced protective
facemasks, both as protection from covid-19 and as
a symbol of how many minority communities have
been left unprotected and vulnerable. Facemasks
emblazoned with slogans such as “Black Lives
Matter” and “I Can’t Breathe” have popped up around
the country, and fliers for multiple marches in Seattle
have emphasised mask wearing and social
distancing, though the latter is often harder in
practice.

Sherise Epstein, a resident physician at the University
of Washington and education chair for the UW
Network of Underrepresented Residents and Fellows,
helped organise the 5 June show of solidarity at the
medical centre. It was one of at least five held at
medical campuses across the city that day.

As a healthcare provider who had seen the
consequences of personal protective equipment

1the bmj | BMJ 2020;369:m2460 | doi: 10.1136/bmj.m2460

FEATURE

Seattle, WA, USA

bdnelson@nasw.org

Cite this as: BMJ 2020;369:m2460

http://dx.doi.org/10.1136/bmj.m2460

Published: 19 June 2020

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https://crossmark.crossref.org/dialog/?doi=10.1136/bmj.m2460&domain=pdf&date_stamp=19-06-2020
mailto:bdnelson@nasw.org
http://dx.doi.org/10.1136/bmj.m2460
http://www.bmj.com/


shortages and the devastating impact of covid-19, especially on
black and indigenous people of colour, Epstein said her personal
decision to protest, participate in large gatherings, and even start
facilitating them was difficult. But she also saw how racism and
institutionalised oppression were integrally tied to the
disproportionate health impacts on the same minority groups. “I
think the gravity of the social movement outweighs the other
pressures so much more,” she said.

One medic’s answer
On that same Friday afternoon, volunteer Devin Speak helped
organise a makeshift station of free snacks, bottled water, and
medical supplies for protesters in front of Vermillion, an art gallery
and bar in the neighbourhood that’s been home to the loudest
protests. Speak said he was emphasising infection control measures
such as washing the surfaces of donated items, encouraging frequent
hand washing by volunteers, and distributing free facemasks and
hand sanitiser.

Speak, who received medical training during a stint in the Coast
Guard, had volunteered at a hospital morgue during New York’s
crest of covid-19 cases. “When I was working in Brooklyn, almost
every single body I handled was black or Latino, and that was
directly a product of systemic health and wealth disparities,” he
said.

He’d like to see facemasks cast as not only protection but also a
symbolic part of the movement against the health effects of systemic
racism. People he encountered accepted the message he and other
volunteers spelled out on posters in the main protest zone. During
rallies against stay-at-home orders and business closures, in
contrast, many protesters pointedly refused to wear masks and
harassed others who did.

Multiple health experts contend that the risk of covid-19 has been
heightened by police tactics such as the widespread use of tear gas
and pepper spray to disperse crowds3 and mass arrests in which
protesters are confined together in central holding stations. Beyond
their potential to inflame and damage airways, tear-inducing
chemicals can cause forceful coughing and sneezing, a runny nose,
heavy mucous production, and irritated eyes—all of which can ease
the spread of covid-19.

On 5 June, Seattle’s mayor and police chief pledged to impose a 30
day moratorium on tear gas for crowd control. But just after midnight
two days later, the police used tear gas, pepper spray, and flashbang
grenades to disperse protesters, citing “life safety” concerns after
protesters allegedly threw bottles and rocks and pointed lasers at
officers’ eyes.

Speak, who wore an N95 mask and gloves for protection while
volunteering his services, recalled rinsing protesters’ eyes with
saline solution after tear gas enveloped the Capitol Hill protest zone
late on 7 June. As he did so, three or four of the protesters coughed,
spat, and dripped mucous on him as a result of their symptoms. “It
was all over my leg and my hands, so I was really concerned about
that,” he said.

Despite the risks, protest organisers say healthcare workers have
joined the movement in droves. “There has been a huge outpouring
of support,” Williams said. And the continued protests and rallies
around the city have been largely peaceful since the Seattle police
removed barricades and temporarily vacated a precinct on 8 June.

“Historically, healthcare workers have focused on care within the
four walls of the hospital or clinic,” Lindo said. “And now I think
they’re seeing the impact that is required and the change that’s

required outside of it to make sure that our patients are safe when
they go home.”

Competing interests: I have read and understood BMJ policy on declaration of interests and have no
relevant interests to declare.

1 Trevor Bedford on Twitter. https://twitter.com/trvrb/status/1269783996109488130?s=20.
2 Coronavirus in the US. Latest map and case count. New York Times 17 Jun 2020.

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html.
3 Seo H. Tear gas during COVID-19 is a public health disaster. Popular Science 8 Jun 2020.

https://www.popsci.com/story/health/tear-gas-coronavirus/.

This article is made freely available for use in accordance with BMJ's website terms and conditions for
the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download
and print the article for any lawful, non-commercial purpose (including text and data mining) provided
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the bmj | BMJ 2020;369:m2460 | doi: 10.1136/bmj.m24602

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https://twitter.com/trvrb/status/1269783996109488130?s=20
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
https://www.popsci.com/story/health/tear-gas-coronavirus/
http://www.bmj.com/