WEBVTT - Protests in a Pandemic 0:00:15.396 --> 0:00:21.996 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.036 --> 0:00:25.196 where we explore the stories behind the stories in the news. 0:00:25.716 --> 0:00:30.276 I'm Noah Feldman. After months of lockdown, people are beginning 0:00:30.356 --> 0:00:33.476 to come out of their houses. Many are coming out 0:00:33.516 --> 0:00:36.436 to protest. The death of George Floyd has set off 0:00:36.476 --> 0:00:40.116 demonstrations across the country. Protests in the midst of a 0:00:40.156 --> 0:00:46.996 pandemic raise unprecedented and unclear questions about both science and ethics. Crucially, 0:00:47.076 --> 0:00:51.236 they center on the question of transmission outdoors. How does 0:00:51.276 --> 0:00:54.356 the CSARS cove two virus move outdoors and how do 0:00:54.396 --> 0:00:59.196 the circumstances of protest affect that transmission. To analyze these 0:00:59.196 --> 0:01:03.236 pressing questions, we are joined today by doctor Menisha Jutani. 0:01:03.956 --> 0:01:07.756 Doctor Jutani is an Associate Professor of medicine specializing in 0:01:07.836 --> 0:01:11.436 infectious disease at the Yale School of Medicine. She's also 0:01:11.516 --> 0:01:14.956 an attending physician at the Yale New Haven Hospital, where 0:01:14.996 --> 0:01:19.596 she's been instrumental in leading the infectious disease efforts. Addressing 0:01:19.796 --> 0:01:25.556 COVID nineteen Minsha, thank you so much for being here. 0:01:25.796 --> 0:01:30.156 You've been following the question of how the stars covy 0:01:30.236 --> 0:01:35.796 two virus spreads very closely, and then in the middle 0:01:35.996 --> 0:01:38.996 of the scientific effort to make sense of this very 0:01:39.076 --> 0:01:44.596 very important question, we suddenly were faced with the protests 0:01:44.676 --> 0:01:47.316 about the death of George Floyd, and we're in a 0:01:47.476 --> 0:01:51.636 completely new universe where the question of transmission is being 0:01:51.676 --> 0:01:54.956 filtered through a new form of social interaction that it 0:01:54.996 --> 0:01:58.956 hadn't occurred on this scale previously. It's sort of like 0:01:59.036 --> 0:02:04.076 an advanced course transmission with ethical dimensions as well as 0:02:04.076 --> 0:02:07.276 scientific dimensions. I want to start by asking you about 0:02:07.316 --> 0:02:11.796 the scientific dimension. What do we know about outdoor transmission 0:02:12.316 --> 0:02:16.516 of this virus? To begin with, science on outdoor transmission 0:02:16.836 --> 0:02:20.676 is still evolving. What we know so far is that 0:02:21.116 --> 0:02:26.156 in series of outbreaks that have been identified from China 0:02:26.356 --> 0:02:29.556 to start and other areas of the world, including Japan, 0:02:30.276 --> 0:02:35.356 it appears that most transmission is occurring indoors, when people 0:02:35.436 --> 0:02:39.716 are face to face and spending more than ten minutes 0:02:39.796 --> 0:02:42.516 of time, let's say, talking to each other. This is 0:02:42.556 --> 0:02:45.956 the highest risk of exposure. Now, what we've seen happen 0:02:46.676 --> 0:02:50.916 is that families and the household setting is probably the 0:02:51.036 --> 0:02:54.596 number one way that this virus is transmitted. Part of 0:02:54.596 --> 0:02:57.316 that is because that's where people have been stuck. People 0:02:57.316 --> 0:03:00.636 who got infected were at home and they were with 0:03:00.676 --> 0:03:03.636 each other, and so they went on to infect each other. 0:03:03.676 --> 0:03:05.996 And people buy and large have not been wearing masks 0:03:06.076 --> 0:03:09.276 in their own homes. The next way that we saw 0:03:09.356 --> 0:03:12.676 that this virus was transmitted, probably in highest proportion, is 0:03:12.716 --> 0:03:16.356 in transportation settings. Again, this makes sense that people are 0:03:16.556 --> 0:03:19.036 on a train for prolonged period of time. Let's say 0:03:19.076 --> 0:03:22.036 you're taking an hour ride from the suburbs of New 0:03:22.116 --> 0:03:25.036 York City into New York City or Boston or other 0:03:25.076 --> 0:03:28.716 big cities of the like. If you're in a setting 0:03:28.796 --> 0:03:30.396 where you are with a group of people for a 0:03:30.436 --> 0:03:33.156 prolonged period of time, potentially sitting side by side, face 0:03:33.196 --> 0:03:37.116 to face, maybe you cough, maybe you're talking on your phone, 0:03:37.636 --> 0:03:41.996 and the person next to you is getting that transmission 0:03:42.116 --> 0:03:45.036 of virus that This is the second, probably most common 0:03:45.036 --> 0:03:48.156 way people have been infected. So getting to the outdoors. 0:03:48.876 --> 0:03:53.436 Outdoors has been the lowest risk identified mechanism of transmission. 0:03:54.036 --> 0:03:56.516 So in one series that was looked at, there was 0:03:56.516 --> 0:03:59.436 only one person that was clearly identified to risk of 0:03:59.556 --> 0:04:03.116 outdoor transmission. Most transmission events that have been able to 0:04:03.156 --> 0:04:06.156 be tracked have been to some sort of indoor setting, 0:04:06.436 --> 0:04:12.316 which gives us additional confidence that the outdoors is likely 0:04:12.636 --> 0:04:17.596 a much lower risk place where people can get COVID nineteen. 0:04:18.116 --> 0:04:20.556 I was very affected by the Wuhan study that you 0:04:20.596 --> 0:04:23.676 were just describing, where by my reading of the study 0:04:23.676 --> 0:04:25.476 and correct me if I get it wrong. They looked 0:04:25.476 --> 0:04:29.436 at seventy five hundred individual cases, and only one of 0:04:29.476 --> 0:04:32.996 those cases could they show definitively had been transmitted outdoors. 0:04:33.476 --> 0:04:35.636 I had recognized it's only one study. I recognize it 0:04:35.676 --> 0:04:38.476 was the winter, and that most people also may have 0:04:38.516 --> 0:04:40.556 been under lockdown, so that may be the reason it 0:04:40.596 --> 0:04:43.116 was such a small number. I did have an instinctive 0:04:43.156 --> 0:04:46.396 reaction to that, thinking, wow, it must be pretty difficult 0:04:46.476 --> 0:04:50.156 to transmit the virus outdoors. Why what is it about 0:04:50.196 --> 0:04:52.716 being outdoors that has this effect? I mean, the most 0:04:52.716 --> 0:04:54.436 obvious thing to me is a layers and is there's 0:04:54.436 --> 0:04:56.636 a whole lot of air outdoors. I think there are 0:04:56.636 --> 0:05:00.396 several factors. Number One, most of the time when people 0:05:00.436 --> 0:05:03.436 are outdoors, they tend to be further apart from each other. 0:05:03.596 --> 0:05:08.396 Not always. There are certain contexts like the recent rallies 0:05:08.396 --> 0:05:13.356 and protests, when people are in closer proximity to each other. However, 0:05:13.756 --> 0:05:16.476 a lot of times if people are even if they 0:05:16.516 --> 0:05:19.956 are going to public pools or they are going in 0:05:20.036 --> 0:05:24.516 a park or they're watching an outdoor concert, they tend 0:05:24.556 --> 0:05:28.796 to be a little bit further apart. Secondly, as you mentioned, 0:05:28.916 --> 0:05:31.796 the air is blowing, and that may be part of 0:05:31.836 --> 0:05:36.876 the reason that this infection cannot perpetuate as much in 0:05:36.916 --> 0:05:40.396 the outdoor setting. People have postulated that while maybe win 0:05:40.516 --> 0:05:42.876 could make it worse, that you have aerosols that are 0:05:42.876 --> 0:05:45.396 in the air and it can blow from one person 0:05:45.476 --> 0:05:47.956 on the end of a field to another person on 0:05:47.996 --> 0:05:51.076 the other end of the field. Although in theory that 0:05:51.236 --> 0:05:54.596 is possible, I think from what we've seen so far, 0:05:55.156 --> 0:05:58.436 I suspect that the science will be able to show 0:05:58.516 --> 0:06:02.076 us over time that droplets that are generated through coughing 0:06:02.196 --> 0:06:04.476 or talking or singing, or all the activities that we 0:06:04.556 --> 0:06:08.876 know through human projection of voice that occur that win 0:06:09.236 --> 0:06:13.076 an air and just sort of the natural barriers that come, 0:06:13.116 --> 0:06:15.916 whether it bay trees or leaves or benches or other 0:06:15.956 --> 0:06:18.436 things that get in the way of these droplets along 0:06:18.476 --> 0:06:21.716 the way, maybe more likely to break up those droplets 0:06:21.876 --> 0:06:25.716 and make the particles less likely infectious or non infectious 0:06:25.716 --> 0:06:30.316 at all. Turning to the protests, What were the circumstantial 0:06:30.356 --> 0:06:34.476 events or what have been so far that would potentially 0:06:35.076 --> 0:06:38.116 change this calculus, again on the scientific not the ethical level. 0:06:38.196 --> 0:06:41.756 So if your tear gased, is that likely to cause 0:06:41.796 --> 0:06:45.396 you to aerosolize? I mean, you cry, you cough, maybe 0:06:45.436 --> 0:06:47.956 you sneeze. I don't think crying is an aerosolizing event, 0:06:48.036 --> 0:06:57.556 but the others are right. Certainly the coughing, chanting, screaming, talking, loudly, singing, 0:06:57.996 --> 0:07:02.676 these are all very clearly aerosol generating events. Now, I 0:07:02.716 --> 0:07:05.916 would say there's some protests I've seen where people are 0:07:05.916 --> 0:07:10.276 not wearing masks, but by and large I have visualized 0:07:10.396 --> 0:07:14.556 even firsthand, is that almost everybody is wearing a mask, 0:07:15.076 --> 0:07:19.916 and that is certainly good. However, the thing that we 0:07:19.996 --> 0:07:24.396 don't know is that the outdoor data that has been 0:07:24.396 --> 0:07:27.956 collected so far, at least in the one case that 0:07:27.996 --> 0:07:30.396 you described in that study that we talked about again, 0:07:30.556 --> 0:07:33.236 was a person talking face to face with somebody else. 0:07:34.116 --> 0:07:36.756 If we have a setting where there are a lot 0:07:36.836 --> 0:07:40.996 of people who are together and you have multiple aerosol 0:07:41.076 --> 0:07:46.236 generating events happening all at once, will the risk go up? 0:07:46.316 --> 0:07:48.596 We just don't know the answer to that. We are 0:07:48.676 --> 0:07:52.436 living in a real life, real time natural experiment. That 0:07:52.596 --> 0:07:55.956 is what's going on right now, and only the facts 0:07:55.996 --> 0:07:58.156 are going to show us what happens. And I don't 0:07:58.156 --> 0:08:02.756 think it's necessarily in the next week or two, because 0:08:03.436 --> 0:08:07.356 in my calculus, in the next couple of weeks, it 0:08:07.436 --> 0:08:12.876 might be that some people will have asymptomatic infection, that 0:08:12.956 --> 0:08:16.476 some people will have mild cases of infection, may or 0:08:16.516 --> 0:08:19.756 may not go to get tested, but it depends what 0:08:19.796 --> 0:08:23.116 they go and do after that. Are they going back 0:08:23.196 --> 0:08:28.876 to individual units where if they did get infected, potentially 0:08:28.916 --> 0:08:33.276 they're staying quarantining or not engaging as much in public 0:08:33.396 --> 0:08:38.076 life as maybe they were months ago, And if they 0:08:38.116 --> 0:08:40.836 did get infected, maybe that'll be the end and that'll 0:08:40.956 --> 0:08:44.636 self terminate the cascade of infection versus people who are 0:08:44.676 --> 0:08:49.276 going home to maybe multigenerational homes where a month from now, 0:08:49.756 --> 0:08:51.356 not just a week or two from now, but a 0:08:51.396 --> 0:08:54.436 month from now, we now see people who are older 0:08:54.596 --> 0:08:58.676 and debilitated or have multiple other chronic conditions now coming 0:08:58.716 --> 0:09:03.396 to the hospital and getting a spike in hospitalizations at 0:09:03.436 --> 0:09:06.036 that point. So I think that's what we are living 0:09:06.036 --> 0:09:08.116 with and we just have to wait and see what happens. 0:09:08.156 --> 0:09:10.876 Now you set something that actually makes me think the 0:09:10.916 --> 0:09:12.356 science is going to be a lot harder than I 0:09:12.396 --> 0:09:14.636 had originally imagine it would be, for the following reason. 0:09:15.316 --> 0:09:18.796 If we could see a result in two weeks, let's say, 0:09:19.396 --> 0:09:23.316 then I think a good statistician looking at national data 0:09:23.356 --> 0:09:27.356 and matching where people live to where there were protests 0:09:27.396 --> 0:09:31.316 of different sizes, could begin to draw an association and 0:09:31.396 --> 0:09:34.916 interpret the natural experiment that you describe. But if it's 0:09:34.916 --> 0:09:37.876 going to take a month, I'm concerned that there's going 0:09:37.916 --> 0:09:40.436 to be the possibility again, just from an analytic perspective, 0:09:40.956 --> 0:09:46.196 of a conflation between the fact of the protests and 0:09:46.556 --> 0:09:49.436 the fact that so many places across the United States 0:09:49.756 --> 0:09:52.956 are gradually opening up and began to do so at 0:09:52.996 --> 0:09:56.436 almost exactly the same time that the protests began, namely 0:09:56.476 --> 0:09:58.876 the very end of May and the beginning of June. 0:09:59.356 --> 0:10:03.196 And if that's the case, maybe a very very skilled 0:10:03.236 --> 0:10:07.156 statistician could begin to pluck out data from the noise. 0:10:07.636 --> 0:10:09.036 But it actually sounds to me like it's going to 0:10:09.076 --> 0:10:11.076 be really hard to do if it's going to take 0:10:11.116 --> 0:10:14.196 a month. That is my exact same concern. I have 0:10:14.276 --> 0:10:17.276 a feeling that it's going to be very very difficult 0:10:18.036 --> 0:10:21.916 to sort that out when you're looking at broad strokes. 0:10:23.036 --> 0:10:27.836 What you could do is look at specific, smaller subsets 0:10:27.876 --> 0:10:31.676 of the population and smaller groups. One thought I've had, 0:10:31.716 --> 0:10:34.716 for example, is that there are many physicians that have 0:10:34.836 --> 0:10:38.436 also been protesting. On Friday, there was a large movement 0:10:38.516 --> 0:10:42.116 for white coats for Black Lives, and there were many 0:10:42.156 --> 0:10:45.836 physicians who were out there. Now, if these physicians have 0:10:45.996 --> 0:10:50.036 been using Personal Protective Equipment PPE in the hospital, and 0:10:50.076 --> 0:10:53.516 we've seen that when you use PPE, the risk of 0:10:53.556 --> 0:10:57.156 transmission is quite low. In fact, we know that the 0:10:57.236 --> 0:11:00.716 PPE works. That's what our first experiment has shown us 0:11:01.036 --> 0:11:03.876 that in fact, we can be protected as healthcare providers 0:11:03.916 --> 0:11:06.676 if we use it. So the question is if these 0:11:06.716 --> 0:11:13.116 people are used masks in protests, if they are using 0:11:13.156 --> 0:11:17.556 PPE in the hospital, and maybe are re engaging in 0:11:17.636 --> 0:11:21.076 society a little bit. With some of the loosening of 0:11:21.116 --> 0:11:25.916 restrictions that have happened in certain areas, you might be 0:11:25.996 --> 0:11:28.356 able to say, well, okay, if these people are getting 0:11:28.356 --> 0:11:31.076 screened and tested maybe on a more regular basis, because 0:11:31.116 --> 0:11:33.476 that's also part of what we're doing. Do we see 0:11:33.476 --> 0:11:36.596 associations with people who went to a protest versus those 0:11:36.636 --> 0:11:39.076 who did not. That's a very defined group of people 0:11:39.156 --> 0:11:42.196 where maybe you might be able to get at that question. 0:11:42.556 --> 0:11:45.556 But if we just look at sort of the epidemiologic 0:11:46.156 --> 0:11:48.716 way that we might look at some of these questions, 0:11:48.756 --> 0:11:51.036 I think exactly what you highlighted is going to be 0:11:51.156 --> 0:11:54.676 very difficult to tease out. So there's the potential for 0:11:54.756 --> 0:11:58.516 challenge in that. I like your experiment idea to look 0:11:58.556 --> 0:12:00.796 at medical professionals who went to the protest, but I 0:12:00.836 --> 0:12:03.436 can immediately think of a confound which is that they're 0:12:03.436 --> 0:12:07.236 going to be disproportionately likely to use PPE correctly and 0:12:07.356 --> 0:12:09.836 to maintain social distance at the protest tests because they 0:12:09.836 --> 0:12:12.716 are medical professionals. So you might be able to make 0:12:12.716 --> 0:12:15.436 a comparison between them and other medical professionals, but that 0:12:15.476 --> 0:12:18.436 won't necessarily give you any external validity for trying to 0:12:18.436 --> 0:12:20.676 figure out what that means for the rest of us. 0:12:20.716 --> 0:12:23.196 When we went to the protests, I totally agree, and 0:12:23.436 --> 0:12:27.596 I'll speak as a protester myself. I stood on the 0:12:27.716 --> 0:12:34.036 way periphery and I did not go near chanting crowds 0:12:34.436 --> 0:12:38.756 myself because I felt that that was a safer way 0:12:38.876 --> 0:12:42.676 given what I know, without having to necessarily be right 0:12:42.796 --> 0:12:45.756 in the middle of the protest. We'll be back in 0:12:45.756 --> 0:12:57.636 a moment. So I'm fascinated when you talk about your 0:12:57.676 --> 0:13:01.996 own experience at the protests that, notwithstanding your very clear 0:13:02.036 --> 0:13:05.996 analysis that the data suggests that risks of transmission outdoor 0:13:06.116 --> 0:13:11.236 are actually arguably pretty low, that nevertheless, were concerned enough 0:13:12.036 --> 0:13:14.996 about chanting and singing to stay on the periphery and 0:13:15.036 --> 0:13:18.196 to avoid loudly chanting protesters. And I want to ask you, 0:13:18.316 --> 0:13:21.716 I guess a personal question. Is that because you on 0:13:21.836 --> 0:13:24.796 the whole or a person who likes to make assurance 0:13:24.836 --> 0:13:28.076 double shore and be safe, or was that your assessment 0:13:28.116 --> 0:13:31.836 that rationally speaking, everybody in the crowd actually should have 0:13:31.916 --> 0:13:34.876 not chanted very loudly and not sung and stated a 0:13:34.876 --> 0:13:36.676 greater distance from each other. Did you have an instinct 0:13:36.716 --> 0:13:39.156 to want to warn everybody else about this too, Yes, 0:13:39.316 --> 0:13:41.396 I did have an instinct to want to do that. 0:13:41.596 --> 0:13:43.876 But I know also that people are entitled to their 0:13:43.996 --> 0:13:47.236 right to do what they feel is appropriate in the 0:13:47.276 --> 0:13:50.196 moment in time that we're in. And I'm not going 0:13:50.196 --> 0:13:55.116 to deny that I would have liked to participate in 0:13:55.156 --> 0:13:58.796 that way myself, but as a public health measure for 0:13:58.956 --> 0:14:03.836 myself if I am asymptomatically infected, I didn't want to 0:14:03.876 --> 0:14:07.556 put others at risk. And so there is a way 0:14:07.596 --> 0:14:12.356 to show civil disobedience and to show protests even in silence, 0:14:13.156 --> 0:14:15.916 and I felt that I was able to do that 0:14:15.956 --> 0:14:18.756 in a way that was comfortable for me. But I 0:14:18.796 --> 0:14:22.196 also understand people are in a very difficult position right 0:14:22.196 --> 0:14:24.436 now and are entitled to do what they feel is 0:14:24.556 --> 0:14:29.156 right for them. But I have encouraged people to try 0:14:29.676 --> 0:14:36.716 to maintain distance, not scream, shout, or saying or chant, 0:14:37.476 --> 0:14:40.476 as a way to protect themselves and protect others because 0:14:40.516 --> 0:14:44.276 I do fundamentally believe that the outdoors is so much 0:14:44.316 --> 0:14:49.676 safer than anything indoors, So protesting outside I think can 0:14:49.716 --> 0:14:53.436 be done in a low risk environment. I cannot say 0:14:53.476 --> 0:14:56.316 that it's no risk. I tell people all the time, 0:14:56.396 --> 0:14:59.836 if you're a very anxious person and you are worried 0:14:59.836 --> 0:15:03.436 about risk, you should just stay home and stay indoors. However, 0:15:03.516 --> 0:15:06.276 if you are trying to engage in a way that 0:15:06.356 --> 0:15:09.836 feels comfortable to you and in a way that at 0:15:09.836 --> 0:15:13.476 the moment we think is the safest what I've described, 0:15:13.516 --> 0:15:17.956 which is to try to exhibit silence, wear a mask, 0:15:18.396 --> 0:15:24.676 keep distance, and still protest. That is what I would 0:15:25.116 --> 0:15:29.836 advocate for. I think that people will be seen and 0:15:29.996 --> 0:15:34.116 heard even in silence. One of the really complex ethical 0:15:34.156 --> 0:15:36.436 issues that you've already alluded to, but I want to 0:15:36.436 --> 0:15:39.676 ask you more about, is the question of medical professionals 0:15:39.676 --> 0:15:43.796 white coats protesting in their white coats. White coats for 0:15:43.876 --> 0:15:47.076 black lives is sometimes the slogan that's used, and that's 0:15:47.116 --> 0:15:51.676 raised an ethical question about the consequences not just for them, 0:15:51.836 --> 0:15:55.876 but for everybody of engaging in protest in a situation 0:15:55.916 --> 0:15:59.436 where there is at least a possibility of transmission. Karl Bergstrom, 0:15:59.476 --> 0:16:01.876 the epidemiologist and statistician whom we've had on the show, 0:16:02.436 --> 0:16:06.836 has been posting, not without a lot of opposition, on Twitter, 0:16:06.916 --> 0:16:09.556 that he wants to remind people that you're not only 0:16:09.636 --> 0:16:14.156 carrying risk for yourself in a situation of epidemic, but 0:16:14.236 --> 0:16:17.236 you're actually imposing an externality. You're creating a risk for 0:16:17.316 --> 0:16:21.596 other people if you're engaged in risky behavior with respect 0:16:21.676 --> 0:16:26.436 to transmission. How do you think about that concern? In healthcare, 0:16:27.756 --> 0:16:31.756 there has been systemic racism for a long time. I've 0:16:31.796 --> 0:16:39.916 spoken to students, residents, fellows, attending physicians who have experienced 0:16:40.716 --> 0:16:46.236 racism in their careers for decades as a South Asian American, 0:16:46.476 --> 0:16:51.196 as a woman of Indian descent, I've had many comments myself. 0:16:51.876 --> 0:16:56.796 I've been called Gandhi as a young person in a 0:16:57.076 --> 0:17:00.756 mall on nine to eleven. My husband, who's also of 0:17:00.796 --> 0:17:04.556 Indian descent. We lived in New York City and our doorman, 0:17:04.636 --> 0:17:08.636 who saw us every single day, wouldn't allow him in 0:17:08.676 --> 0:17:11.356 the building and told us to go back to where 0:17:11.396 --> 0:17:16.556 we came from. I believe that as a healthcare professional 0:17:17.196 --> 0:17:22.356 to stand up for patience and providers that have experienced 0:17:22.396 --> 0:17:25.516 this kind of racism in their lives, and as a 0:17:25.556 --> 0:17:30.156 medical educator to say, if I'm a bystander and see 0:17:30.236 --> 0:17:32.956 something that's wrong, I'm not going to stand for it, 0:17:33.196 --> 0:17:36.196 and I'm going to stand up for somebody who maybe 0:17:36.516 --> 0:17:39.316 is having a hard time speaking on behalf of themselves. 0:17:40.596 --> 0:17:43.276 I want to make a point to say that I 0:17:43.316 --> 0:17:45.676 will do that, and I'm going to stand on the 0:17:45.716 --> 0:17:48.876 side of what I think is right. And this is 0:17:48.876 --> 0:17:53.196 a critical juncture in our country. And as much as 0:17:53.236 --> 0:17:56.316 I'm on the side of protecting people from COVID nineteen, 0:17:57.316 --> 0:17:59.796 there is a confluence of events that is happening right 0:17:59.796 --> 0:18:03.116 now and we have to recognize what is going on. 0:18:03.916 --> 0:18:07.956 And so I have struggled with this myself. As you mentioned, 0:18:08.636 --> 0:18:11.756 how can I go about and express what I think 0:18:11.836 --> 0:18:16.036 is an equally important message to get out there at 0:18:16.036 --> 0:18:20.356 the same time as trying to prevent a potential huge 0:18:20.396 --> 0:18:23.756 second wave. The way that I see that being able 0:18:23.796 --> 0:18:28.356 to happen is I went to one protest. I went 0:18:28.436 --> 0:18:32.116 in my white coat. I showed people around them that 0:18:32.316 --> 0:18:35.796 should something happen, I am a white coat. I am 0:18:35.836 --> 0:18:38.716 ready to help those that might be in need. But 0:18:39.156 --> 0:18:41.356 I'm going to stay on the periphery because that's what 0:18:41.396 --> 0:18:43.476 I'm comfortable with. I don't want to put other people 0:18:43.516 --> 0:18:45.716 at risk, and I don't want to be at risk 0:18:46.076 --> 0:18:48.716 because I need to keep doing my job. I need 0:18:48.716 --> 0:18:52.316 to continue being able to be a physician taking care 0:18:52.316 --> 0:18:57.356 of patients, and continue being an educator, educating trainees and 0:18:57.556 --> 0:19:01.796 educating the public. So I think there is a conflict here, 0:19:01.836 --> 0:19:03.316 but at the end of the day, we all are 0:19:03.436 --> 0:19:05.516 human beings and we all have to stand on the 0:19:05.556 --> 0:19:08.636 side of what we think is right. In this moment, 0:19:09.476 --> 0:19:12.476 when I hear the phrase systemic racism in the context 0:19:12.516 --> 0:19:15.516 of health outcomes, I tend to think of the long 0:19:15.716 --> 0:19:19.796 range consequences of slavery and segregation in the United States 0:19:19.836 --> 0:19:24.476 and economic inequality, primarily for African Americans, and the consequences 0:19:24.476 --> 0:19:28.196 that that has had for the health of African American people. 0:19:28.556 --> 0:19:33.636 And the COVID nineteen epidemic is a perfect instantiation of this, 0:19:33.716 --> 0:19:36.676 and that's the reason that African Americans seem to be 0:19:36.716 --> 0:19:40.356 around three times more likely to die of COVID than 0:19:40.436 --> 0:19:43.236 white people. That's a question of the effects of that 0:19:43.316 --> 0:19:46.076 kind of systemic racism. And so I think for those 0:19:46.116 --> 0:19:51.596 who have expressed trepidation around the protests, one of the 0:19:51.596 --> 0:19:55.036 things that they've been saying is African Americans might be 0:19:55.076 --> 0:19:58.116 disproportionately likely to be protesting in Black Lives Matter, and 0:19:58.236 --> 0:20:02.836 African Americans are disproportionately likely to be contracting and becoming 0:20:02.876 --> 0:20:05.676 ill from the disease. And here, I guess what I'm 0:20:05.676 --> 0:20:09.436 wondering is is it your instinct that the risk of 0:20:09.476 --> 0:20:13.756 transmission aren't so great in protests as to make this 0:20:14.036 --> 0:20:17.836 as pressing a dilemma as some people would like to 0:20:17.876 --> 0:20:20.316 make it out to be. I think that's a difficult 0:20:20.796 --> 0:20:23.876 call on a question. And the reason I say that 0:20:24.076 --> 0:20:30.356 is because I'm extremely concerned about outbreaks to come, particularly 0:20:30.436 --> 0:20:35.036 in communities where the current prevalence of infection is still 0:20:35.116 --> 0:20:39.876 high and rising. So there are many communities where protests 0:20:39.876 --> 0:20:44.836 are happening where the incidence of infection is quite low 0:20:45.116 --> 0:20:49.356 or getting even lower, and so I'm less concerned in 0:20:49.476 --> 0:20:54.436 those communities, but still extremely concerned. But I also fully 0:20:54.596 --> 0:20:59.516 respect the need to protest right now, and everybody has 0:20:59.556 --> 0:21:01.956 to take the risks that they think are appropriate for them. 0:21:02.156 --> 0:21:05.476 But from my vantage point, if you wear a mask, 0:21:05.836 --> 0:21:08.476 if you try to prevent touching your face, if you 0:21:08.556 --> 0:21:11.596 watch your and try to protect yourself and others by 0:21:11.636 --> 0:21:16.196 not screaming, shouting, or yelling while maintaining distance, I think 0:21:16.236 --> 0:21:20.916 you can still have an equally effective protest. And I 0:21:21.076 --> 0:21:22.996 know that that is hard to do. I know what 0:21:23.036 --> 0:21:28.436 I'm asking for is almost impossible, and that maybe I'll 0:21:28.476 --> 0:21:31.996 convince a few others to protest in that way, but 0:21:32.116 --> 0:21:34.956 that the majority of people won't want to do that, 0:21:35.236 --> 0:21:38.716 And I understand that, and I respect that decision, but 0:21:38.836 --> 0:21:42.836 I do feel that the risk that you're potentially putting 0:21:42.836 --> 0:21:47.636 others too, and you yourself are putting yourself at is 0:21:47.956 --> 0:21:52.276 potentially significant. I fully acknowledge that the outdoors is better, 0:21:52.716 --> 0:21:56.276 But we don't have the science of riots and protests 0:21:56.596 --> 0:22:01.036 to say that we can extrapolate the data we have 0:22:01.116 --> 0:22:03.556 so far to these settings. I don't think is accurate, 0:22:03.916 --> 0:22:06.556 and so I think as an infectious disease doctor, as 0:22:06.596 --> 0:22:08.836 an epidemiologist, I'm going to be on the side of 0:22:08.836 --> 0:22:12.116 cause I'm going to be on the side of putting 0:22:12.316 --> 0:22:17.116 into place the measures that can most likely result in 0:22:17.156 --> 0:22:21.956 the least number of infections, not no infections. I'm not 0:22:22.036 --> 0:22:26.396 expecting that, I'm just expecting to reduce the number. Fast 0:22:26.476 --> 0:22:30.276 forward a month. Imagine, just for the sake of argument, 0:22:30.436 --> 0:22:35.236 that we haven't seen a substantial spike in cases correlated 0:22:35.316 --> 0:22:38.276 in any way, shape or form with the locations of protests. 0:22:38.476 --> 0:22:41.596 Imagine a best case scenario. Would you then think that 0:22:41.636 --> 0:22:45.996 it would be plausible for public health officials to say, Okay, 0:22:45.996 --> 0:22:50.076 it's the summer, the beach is really pretty safe because 0:22:50.116 --> 0:22:52.276 it's not as extreme as a protest, and there's no 0:22:52.316 --> 0:22:57.956 tear gas there, and pools are outdoors and therefore reduced 0:22:57.996 --> 0:23:02.276 transmissions substantially, and outdoor restaurants should be opened, and we 0:23:02.276 --> 0:23:05.676 should basically treat the summer while we can as before 0:23:05.676 --> 0:23:07.756 the fall comes and we are all indoors in high 0:23:07.756 --> 0:23:11.156 transmission environments, again as an opportunity to get out there 0:23:11.156 --> 0:23:14.196 and live a little bit of life. Can you imagine 0:23:14.196 --> 0:23:16.356 a scenario like that, and if the data doesn't spike 0:23:16.436 --> 0:23:19.316 by then, do you think you would be comfortable making 0:23:19.316 --> 0:23:22.476 recommendations like that. I think I might. I think you know, 0:23:22.516 --> 0:23:25.916 I'd like to see where we go. But I think 0:23:26.316 --> 0:23:30.076 in an ideal best case scenario, if that's the case, 0:23:30.996 --> 0:23:34.676 I think I would listen to your local public health 0:23:34.716 --> 0:23:39.196 officials and governors and people making regulations for your local 0:23:39.276 --> 0:23:41.636 districts because every area is going to be a little 0:23:41.676 --> 0:23:46.036 bit different, and the nuance and reasoning in different areas 0:23:46.076 --> 0:23:49.236 are going to be different. But for me personally, if 0:23:49.276 --> 0:23:52.436 we see that, I'll feel even better about what I 0:23:52.516 --> 0:23:56.396 recommend people to do in terms of the outdoors. But again, 0:23:57.316 --> 0:24:00.076 what I've seen is that most of these places people 0:24:00.116 --> 0:24:03.156 have been wearing masks. So if you're going to be 0:24:03.236 --> 0:24:05.836 up close and personal with somebody, I'm not going to 0:24:05.876 --> 0:24:08.156 tell you to take your mask off. I'm going to 0:24:08.236 --> 0:24:10.676 say keep your mouth gone, which is hard in the 0:24:10.716 --> 0:24:13.756 summer and being outdoors and all that. But if you're 0:24:13.796 --> 0:24:16.796 on the beach, and you're spread out and you have 0:24:16.876 --> 0:24:19.076 your mask off and you're not necessarily getting all on 0:24:19.116 --> 0:24:23.156 top of other people. I will absolutely feel comfort with that. 0:24:23.276 --> 0:24:25.476 I think I would say again, it's not a no 0:24:25.676 --> 0:24:30.396 risk situation, it's an extremely low risk situation. I hope 0:24:30.396 --> 0:24:32.996 that we end up there. I really do, because I 0:24:33.036 --> 0:24:39.356 am concerned about December January February, our typical flu season spike, 0:24:39.836 --> 0:24:44.356 and to have the mental health of the American people 0:24:44.916 --> 0:24:47.876 be in a place where they're ready for our next 0:24:47.916 --> 0:24:51.956 typical flu season, to have had time where they got 0:24:51.996 --> 0:24:56.036 outside and reengaged with friends and family and had some 0:24:56.116 --> 0:25:00.836 time to be able to maybe reduce the anxiety, fear, 0:25:01.156 --> 0:25:06.156 and preoccupation with getting infected. It would be a great 0:25:06.396 --> 0:25:08.756 way to give people a little bit of a release 0:25:09.236 --> 0:25:12.836 before going into the next season. But I think, as 0:25:13.076 --> 0:25:16.276 you've kind of alluded to, none of these things are 0:25:16.316 --> 0:25:19.636 going to be all or none, light on, light off. 0:25:20.396 --> 0:25:22.836