With protests over the police killing of George Floyd spreading throughout the country, public health officials are concerned that these large gatherings could trigger another type of spread: an increase in COVID-19 cases. The demonstrations began on Tuesday in Minneapolis, where Floyd was killed, and as of Saturday, May 30th, have taken place in more than 30 cities around the United States, including New York City, Chicago, Detroit, Columbus, Dallas and Los Angeles — some of which have been hotspots for the virus. 

It has been nearly three months since the country started shutting down and restricting non-essential travel in an attempt to control the highly infectious virus. Without a vaccine or cure for COVID-19, public health measures like social distancing and wearing face masks in public have been our primary tool and containment strategy. And while some states have begun the process of reopening, most are still at the stage where large gatherings like protests are potentially dangerous — especially given the number of people who may have unknowingly already contracted the virus.

“Given the fact that there is likely a large group of individuals who are asymptomatic, and given that the activity — in this case, protesting — doesn’t lend itself to practicing social distancing, there are certainly concerns about COVID transmission,” Dr. Barun Mathema, assistant professor of epidemiology at the Columbia University Mailman School of Public Health tells Rolling Stone. “This is especially the case when there are altercations with law enforcement which, needless to say, are very troubling to see.”

According to  Dr. Amesh A. Adalja, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security, from a public health standpoint, a mass gathering is always going to be a concern when it comes to the spread of viruses like SAR-CoV-2. “The virus can take advantage of any kind of interaction — a protest or rock concert or whatever it might be — that facilitates the transmission,” he tells Rolling Stone

Of particular concern to Adalja is the yelling and shouting that goes on at protests, which he says creates more of the droplets through which the virus spreads. “It really is going to depend upon how socially distant these individuals are, but I do think we have to be worried about any kind of mass gathering spreading the virus in the era of COVID-19,” he says. “We know that the virus is going to be with us until there is a vaccine, and any type of social interaction where people are within six feet of each other is going to be an opportunity for the virus to infect others and spread between people.” 

Protesting during a pandemic presents additional challenges. For example, Dr. Elie Saade, an infectious disease specialist at University Hospitals and assistant professor of medicine at Case Western Reserve University in Cleveland, says that if a person is wearing a mask and is exposed to tear gas, the tear gas could get on the mask and cause skin irritation. If this happens, some may not be able to tolerate the additional discomfort caused by the mask, and may remove it, giving the virus more opportunities to spread.  “During the protests, people will be close together,” he tells Rolling Stone. “Plus, it’s a situation where you really can’t [predict] what’s going to happen. Things can be chaotic, so the priority of people may not be to wear a mask, but may be trying to run away or make a point, so that definitely increases the infection risk.” 

In April, various anti-lockdown protests took place in states like Wisconsin, Kentucky, North Carolina and Ohio, drawing attention and criticism for ignoring social distancing guidelines. Though headlines during that period indicated that the protests occurred at the same time the number of COVID cases in the state spiked, this isn’t evidence that the protests actually spread the virus. For that to have happened, the number of cases would have had to increase approximately 14 days after the protests. At this point, Adalja says that he hasn’t seen any data demonstrating that people who attended the reopening protests ended up contracting COVID-19 at higher rates. And while Mathema also is not aware of any definitive research linking anti-lockdown protests to a subsequent spike in COVID-19 infections, he says that there has been some anecdotal evidence of clusters of cases emerging in locations like Michigan, following protests. 

However, Mathema clarifies that it’s not possible to know whether these people would have tested positive for COVID-19 regardless of their attendance at the protests. “But I believe the thinking is that when you do have a critical mass of individuals, where some individuals could be asymptomatic or pre-symptomatic and shedding the organism, it’s a really nice environment from a pathogen’s perspective,” he says. “If you’re a pathogen, you would love to be in places like concerts or protests, where there are people who are excitable and close together.”

And though there also isn’t specific data on the proportion of people wearing personal protective equipment (PPE) and practicing social distancing at the reopening protests compared with the more recent demonstrations over police brutality, Mathema says that this weekend’s protestors appear to be better at wearing masks. “There was a considerable amount of concern among protesters and organizers about COVID, so I think a lot of community organizers did not go into this blind,” he says. “They knew what they were doing. And this was a risk that was, in a number of people’s minds, worth taking with appropriate protection, because the cause is very important.”

Additionally, in the current wave of protests, Saade says that existing racial health disparities could make things worse. “Unfortunately, African Americans are disproportionately affected by this pandemic, and are probably also disproportionately protesting,” he says. “So that’s another concern.”

If people do plan on attending protests, all three doctors recommend wearing masks and trying to maintain as much distance between other people as possible, given the circumstances. And while covering our faces is a way of stopping ourselves from potentially spreading the virus, Saade says that masks are also important for protecting ourselves in situations where there are large crowds. “The concern is really being close to people, and having their mucus or saliva coming onto our face,” he explains. “If you’re wearing a mask, the risk will be much less.” 

During his daily press briefing on Saturday, May 30th, New York Gov. Andrew Cuomo urged anyone attending protests to wear a mask. “You have a right to demonstrate, you have a right to protest, God bless America,” he said. “You don’t have a right to infect other people. You don’t have a right to act in a way that’s going to jeopardize public health…Demonstrate with a mask on. What’s the difference? I still do not get it.” 

And though a face mask covered in tear gas can cause skin irritation, Mathema says that another form of PPE may help protect you from both tear gas and the virus. “If you can wear goggles to protect your eyes, that would be a good idea,” he says. “Of course with tear gas, it also irritates the skin and makes it difficult to breathe. So even with goggles and masks, the simplest thing to do if there is tear gas is to move away from it.” In addition, Mathema recommends that those attending protests also bring heat-resistant gloves and water, and try to stay with their group.

Ultimately, Saade says that whether or not we’re in the midst of a pandemic, there are always physical safety risks associated with attending a protest or demonstration, and it’s up to people to weigh the risks and benefits of their participation. “COVID is another risk,” he says. “That doesn’t mean that we shouldn’t protest — it just means that we should take more precautions.”