You’re listening to a press conference from the Harvard T.H. Chan School of Public Health. With Natalia Linos, executive director of the Harvard FXB Center for Health and Human Rights. This call was recorded at 11:30 am Eastern Time on Tuesday, June 2.
Previous press conferences are linked at the bottom of this transcript.
NATALIA LINOS: A couple of opening remarks. The question of whether these two issues, the inequitable and unacceptable impact of COVID on communities of color is linked to the protests that we are seeing around the George Floyd murder is one that has come up a lot in the last few days. And I think it’s important to highlight that they’re both separate and of course, of course, very much linked. So they’re separate in the sense that the murder of George Floyd was an egregious act of injustice. And in any time that this could have happened, there should have been protest for the justice around, you know, justice for George Floyd.
The backdrop, though, that COVID has taken the lives of so many Americans, one hundred thousand Americans and disproportionately so black Americans, Hispanic Americans, Americans of color is important. And it’s important for the public health community to link the two to say that racism kills. Racism kills explicitly through police violence. It also kills indirectly in terms of what we’re seeing through COVID, what we’re seeing in terms of maternal mortality disparities, infant mortality disparities.
So talking about structural racism as the root cause and what the protesters are on the streets for is important. And framing that as a public health priority is also important. So I think I wanted to start by just saying that they are linked through the thread of that this country has allowed for racism to exist and to end up in the situation where we are. And there seems to be tremendous frustration, tremendous pain and possibly an opportunity to see the COVID response and the fact that COVID has laid bare these injustices as an opportunity to call for a very different future. And that is the optimist in me. And I’m open to questions and thinking through some of the connections with all of you today.
MODERATOR: Thank you, Dr. Linos. Do we have any questions?
Q: Yes. Thank you so much. I have a few questions. One of these, one of which is what does the current situation with the COVID that if and how the protests could affect – can we get the new wave? And second question is, what do you think about epidemiologists and doctors who don’t believe that COVID is more dangerous than regular flu?
NATALIA LINOS: Thanks so much for your questions. The first question around, you know, what is the status? So the U.S. has recorded over one hundred thousand deaths. There has been discussions of plateauing and also the conversation around reopening has begun. How to do that safely, how to start loosening some of the restrictions in different states. This is happening faster or slower. Many public health professionals feel that we still need to keep in place a lot of the measures because there is a big worry about the new wave.
Now, the question about how that links to the protests. That’s a tricky one, because obviously the protests are responding to a very immediate crisis, the murder of George Floyd and the need for people to voice that they share in calling for for justice, that they believe that this is a systemic issue. Protests have been happening across the country. Most of the protests seem to be well organized in terms of having masks and carrying hand sanitizers. And they’re happening outdoors.
But, of course, you know, there is in any situation this does pose some risks. But for many in the public health community who believe that racism is a fundamental risk to public health, some would agree that these protests are important for for calling for systemic change that will improve the health of every American. Your second question, I think I forgot it already. Sorry.
Q: I can repeat. OK. Yes. The second question was about epidemiologists and virologists who don’t believe that COVID is more dangerous because there is still – I was just recording the interview with one of the doctors from Russia who are from Russian Service. And they are still bothered that it’s, you know, as if it’s new flu virus, you know, seasonal virus and it’s not as dangerous.
NATALIA LINOS: So, I’m not an infectious disease expert, but I think everybody at the School of Public Health would agree that these are very different and COVID does pose a much bigger threat than the flu. And of course, with the flu, we do have a vaccine with COVID, we don’t. So I think that question would probably be better suited to someone who is a virologist, and I’m not. But that’s the general consensus, I think, is that we are in a very different situation, both because of the rate of transmission and also the fact that we don’t have treatment or vaccine, which makes it so much more lethal.
Q: Thank you.
MODERATOR: Next question.
Q: Thank you for doing this. My question is in your position, as you try to get this message out, if you would, what are the complications with – it’s hard to put this into words. Could be the demonstrations under way now, could it be seen as being opportunistic to try to make the point that you’ve always been trying to make that racism and public health are connected? And the point is, is the right time? Is this an opportunity or do you have to be careful about how you deliver this message in the current climate?
NATALIA LINOS: So, my thinking is that we need to look at people in their daily experience. I think as public health professionals, we look at numbers and data and we say, you know, that African-Americans make up 13 percent of the US population, but 26 percent of the deaths. But, I mean, if we center it on that individual, an individual living in a community who has lost a parent or grandparent. And actually, what the data don’t often talk about is the fact that black and brown Americans are dying not only at higher rates, but at much younger ages. If we look just at the, you know, 30 to 50 year olds, the rates of of death are many, many fold higher, 7, 8, 9-fold higher. So you’re losing young Americans to COVID who are parents, who are your schoolteachers.
At the same time, that individual has lost their job, likely in a job that was not providing, you know, PPE. So I think talking about what COVID has uncovered in terms of the overlapping injustices, the injustice of just not having the same access to health care, but also being in a position where your daily life puts you at greater risk because you don’t have a car or there’s housing insecurity and you therefore can’t stay at home, or you don’t have the six hundred dollars it takes to stock up for three weeks of food so that you don’t need to be going into the grocery store.
So you have this reality that, you know, our country and the racism in this country has allowed for so many people of color to be at greater risk to COVID. And then you have this horrible graphic murder on TV where it’s just like the tip of the iceberg. You know, the injustice is so blatant and so daily. And so I think that it is not opportunistic. It is just time. It’s just time. And people are frustrated. And I think communities are hurting. I’ve been supporting the Poor People’s Campaign as part of their Health Justice Advisory Committee. And, you know, Reverend Barber has been talking, articulating these links across COVID, poverty, and now the murders as overlapping, interconnected. And, you know, he said we have to allow for these protests to play out if we really want to heal as a country.
And so that, you know, maybe that’s not the message that you expect from a public health advocate. But for public health advocates like myself, a social epidemiologist who looks at health, not just the absence of illness, but health, as you know, whether we are giving people an opportunity in terms of their housing and their employment rights and, you know, supporting low income workers, then it is all health and racism is a public health challenge. So I think the timing is the timing, because this murder happened now. And I don’t think people can wait because they’re overlapping injustices that they’re seeing daily.
Q: Is there, I don’t want to say checklist, but is there a list of steps that you and your colleagues feel that you could go to a committee hearing and sit down and testify and say this is what needs to be done? One, two, three, four.
NATALIA LINOS: In terms of the health equity dimension? Yes, I think there is. There is. And actually, you know, our center, the FXB Center for Health and Human Rights, has been talking about, for example, you know, we’ve talked a lot about PPE for essential workers, but essential workers then narrowly gets narrowed down to essential health care workers, so ensuring that our nurses, our doctors have masks. And that is critically important.
But as we open up, we need to ensure that also at the grocery stores or the people who are low income workers have masks, so thinking about their protection. You know, the health community has also talked a lot about expanding testing and treatment. But the social epidemiologists like myself would say, you know, when we open up, how are we shifting risk? For example, wealthy Americans in jobs where they can work from home will stay home even if the economy opens up. And it’s the low wage workers who don’t actually have a say or an opportunity to work from home, who will be having to go in. And what does that mean for our public transportation? Does it mean we need more busses more frequent so that they can have, you know, the distancing?
So it’s not that I have a list written out right now. But basically the approach is think about who has the means to follow the public health advice and who doesn’t. And then do something about filling that gap. And obviously, the you know, if you were to speak to someone at the School who does the, you know, contact tracing and does the work around making sure that we are testing enough people so that if there is an indication that we’re going into a second wave, we quickly isolate and ensure people have housing. That’s a different technical conversation. But there’s also the social conversation about how we set ourselves up.
Q: Thank you.
MODERATOR: Dr. Linos, I had a quick question. So one of the things that’s been coming in quite often is a concern about protesters going into the street and the possibility of spreading the virus among each other that way. Do you know – have you come up with any alternatives to protests in the street? Do you have any suggestions of what people could do other than going out and congregating together in large numbers?
NATALIA LINOS: So, some protesters could consider doing driving. I mean, it’s not great for the environment, but if you’re in your car, that’s one way you could do a procession. And they’ve done that in smaller numbers. And there’s also, you know, I do think that we need to talk about harm reduction within the concept of you are going to go out into the street, what can you do? So the types of things you can do is make sure you have a mask and have extra masks. And I know that a lot of the protests that have taken place, the organizers did have extra masks for people. So everybody should be wearing a mask. Instead of yelling and chanting, you could use, you know, because that, sort of, you have droplets coming out, you could use drums and signs and music and recorded messages rather than, you know, so the protesters themselves could be doing it in silence. Bring your own water bottles so you’re not sharing food or water.
There are ways to think about basically reducing the risk. You know, standing at a distance. But, you know, people are going to be taking a risk. And that decision, whether they should be going out on the streets or thinking differently is not one that I think I can speak to. But if you’re going to be going out on the streets, organizers can think through ways to reduce risk for the participants.
MODERATOR: Thank you. And I had another quick question. So one of the the hot spots in Massachusetts has been Chelsea, Mass. And one of the things that people have been saying is that it’s such a densely populated area, and that’s one of the reasons that the virus has been spreading so quickly through Chelsea. Chelsea is densely populated, but Somerville, Mass, which is on the other side of the river, has an even denser population. Can you talk about why those two towns have such different outcomes, even though Somerville has an even greater population density?
NATALIA LINOS: Sure. And I think if everybody on the call hasn’t seen the work by Nancy Krieger and Jarvis Chen, they did some interesting analysis. And density wasn’t the dimension that they looked at, they looked at overcrowding. And by that they mean within a household. So if you are, you know, living in a small space, like a one bedroom with a mother, a grandmother, a child, and there’s an intergenerational dimension there, as well as you’re low income and you have to work one or two jobs, your exposure is not just because your neighborhood is densely populated. It is because there’s overcrowding, because you’re poor and an essential worker, you may not have access to a private car.
So, I think the big difference when you’re looking at dynamics geographically is to look at overlapping challenges. And that’s what the great paper by Nancy Krieger at the School of Public Health has done is looking at things like, you know, percentage of essential workers, percentage of low income families, percentage of overcrowding in the households, and all of these issues overlap to create risk. So I think, you know, as a social epidemiologist, our interest is around, you know, how do we mitigate the risk for those who are at heightened risk because of their occupation, because of their housing circumstances, et cetera.
And, you know, there are mitigation measures. You can ensure that people have paid sick leave so they’re not going to work when they’re sick and therefore bringing, you know, creating an environment where their colleagues, who probably also come from similar, you know, less affluent backgrounds are taking home, you know, the virus. So, you know, there’s it’s not unexpected. We know this from other epidemics, too. And we should have been better prepared. We should have had a specific health equity approach to COVID. Dr. Bassett and I wrote a piece in The Washington Post on March 2, I think, when there was the first death. And we said that unless these kind of deep-rooted inequities are are taken seriously, the US could have the worst epidemic among all wealthy countries. And it’s proven to be true.
And it is both because of these deep-rooted inequities that are overlaid by a structure that is racist. But also this lack of trust in public institutions, in government, the sort of alternative facts. I mean, I think there is a lot at play here that goes beyond just our social structures. But also people don’t want to be left at home and they’re angry and frustrated. And, you know, as we’ve seen with the protests of people who want us to open up, they hope that if we just pretend that the disease, you know, that COVID isn’t here, that we can just go back to normal. But there is no going back to normal, really.
MODERATOR: Thank you. Next question.
Q: Do you worry about the potential that these protests will worsen the racial disparities we’re already seeing with COVID-19? And as a follow question, could you talk a little bit about what we could be doing better in certain neighborhoods, certain urban areas, to better control the the pandemic? And, you know, sort of as we look ahead, you know, how might cities or how should cities be reacting right now?
NATALIA LINOS: Thanks for that question. And, you know, vis-a-vis the first part of whether these protests will disproportionately, you know, if they are, it’s hard to say. You know, I don’t have a clear answer. I would say that there is a disproportionate number of people protesting who are people of color, although there are a lot of white Americans also standing side by side, which is great for our democracy, but maybe from a public health perspective, you do worry that they’re putting themselves at risk and hopefully not transmitting the risk back home. As I mentioned earlier, the fact that these are happening outside, that people are taking measures, wearing masks, is a positive one.
But I do think that, you know, when we take a step back and say if we were to really see a result of these protests in changing the structures and, you know, reducing the racism, that would have a benefit that far outweighs the risk. But in the short term, I don’t have an answer for you. I think it’s a challenging question. And I think it is, you know, a question not for public health experts. It’s also for those of us who believe in, you know, the right to protest and democracy and what that means for our country. So it’s challenging as a public health expert to be put in that situation to weigh or outweigh the benefits.
So I prefer not to be conclusive, but to say that if you’re going to protest, take measures to reduce your risk. If you’re living with an elderly grandparent and you can go stay with friends after you’ve been at a protest, that’s probably a good step. So there are a lot of things that we can practically do. Now, the bigger picture question of what cities should be doing, I think there’s a lot the cities can be doing. I think there’s a lot, you know, the discussion and it’s interesting because these protests are happening at the same time as many states and cities are opening back up. You know, even in Boston where we are, you know, hairdressers and manicures, you know, they’re opening up. So even if we see an increase, you know, some may say it’s because of the protests.
But realistically, it’s probably because of the economy opening back up. It’s not because of the protests or not alone. There could be an interplay. So thinking through the strategy of how we reopen and who is is most at risk while we reopen is critical. I think the public health community believes that it’s too soon. It’s too soon to open barbershops. It’s too soon to be, you know, in close settings. But it might not be too soon to be having outdoor, you know, six feet apart activities so that you can interact with, you know, one close friend or one, you know, the social isolation piece does have a toll, too. But cities can do a lot to ensure that employers and small businesses aren’t, you know, aren’t left, aren’t going under because of this. I mean, it’s cities, but obviously state-level funding, federal funding, there has to be coordination across all levels.
Cities are doing a lot of innovative things like making pedestrian roads, you know, cutting down traffic so that pedestrians can go and be outdoors and exercise, but not have to be overcrowded on the sidewalk. Some school settings are doing some interesting innovations around bringing a very small number of students into the classroom, those with special needs who can’t really be on Zoom learning but connecting through the teachers with students who don’t have special needs by Zoom and those who do have being in a classroom, three students really spread apart. So there is a lot of innovation, there’s a lot of thought going in and I think the guiding principle has to be who is most at risk in terms of age demographics, who doesn’t have the means to follow any guidance and how do we fill that gap as policymakers?
Q: Thank you.
MODERATOR: Dr. Linos, you’ve touched on a couple of the health inequities that have been fueling the high COVID infection rate or disease rate among black and brown people. Could you just kind of summarize those really quickly? What do you see as the biggest issue for the increased vulnerability of these populations? And is there anything we can do in the meantime immediately to rectify those differences?
NATALIA LINOS: Yeah, that’s very important to stress that these inequities don’t represent any sort of biological reason. There is no biological reason for why we should be seeing these. So the reasons why we’re seeing them is because of social reasons and inequitable distribution of risk for some communities, because, you know, a lot of us who are social epidemiologists would say the root cause is structural racism. But there are also other overlain issues, the fact that the U.S. does not guarantee sick leave, you know, like weaker employment.
So the types of categories I think, that we can think about include what work looks like for low income workers. Does it, you know, do people have access to paid sick leave? Do they have an ability to work from home? And it’s a disproportionate number of wealthier and whiter Americans who have the privilege to work from home. So the fact that your employer requires you to go in, whether you’re working in a meat packing sort of context or at a post office or at a grocery store, your job is putting you at risk because you’re face to face with people who are coming in, you know, and you have no idea what their status is. The second risk is obviously in this country, there is a disproportionate number of black and brown Americans incarcerated. And we know that prisons and jails have had a tremendously high rate of COVID. There has been advocacy around and that is to the solutions part.
There has been advocacy around ensuring that people are not in jail because they can’t pay bail, because that puts them at an unacceptable risk for basically not having money to pay bail. So there’s been efforts around that. I think at the School of Public Health and in our Center, we think about homelessness too, communities that, you know, you say stay at home, but for homeless individuals or survivors of violence, including intimate partner violence. We need alternatives because staying home isn’t an option. And then, of course, the washing hands guidance in parts of Navajo Nation and parts of this country where there isn’t running water is not – we can’t take it for granted, even some of those guidelines. So I think the biggest the biggest kind of vector or the biggest reason why we see these disparities is because of the inequitable work experience, like people’s jobs, essential workers who basically have no protection, and then they bring it home. But, of course, there’s also the deaths in the nursing homes, and that’s different because that’s mostly white, mostly older. But I haven’t touched on that. So if there’s a follow up, please.
MODERATOR: That’s great. Thank you. I did get an e-mail question in. So this might again overlap a little bit with what you said already, but he would like to know how public officials should adjust the reopening plans in light of the demonstrations where large groups of protesters and law enforcement officials are congregating together for hours at a time. Should they postpone everything for two or three weeks to see if positive cases and hospitalizations rise? How should the protests affect re-opening plans?
NATALIA LINOS: That’s an interesting question, and I hadn’t actually thought about it. But I think the suggestion of the journalists is actually a good one in the sense that if we think – everything that we’ve been doing around reopening has to do with our capacity in our hospitals, right. The whole notion of flattening the curve is that if there is a spike, we need to make sure that our hospitals are able to take in that burden and treat. And so reopening, the plan at least in Massachusetts is around, you know, looking at the data, if there’s an increase, we don’t continue. So if we do believe that the protests will increase – we don’t know to what extent, but it may increase a little bit, it may increase a lot, it may not increase at all – the most cautious response would be to wait. Let’s wait a few weeks and allow that this was an unexpected, you know, dimension to the conversation. So I do think that that is a wise recommendation to take into account this new variable in terms of will our hospitals have enough beds?
The bigger question really, though, around reopening is have we ramped up our testing? Are we ready to reopen safely in the sense of everything that should have been done during the two, three months that we’ve been shut down? I don’t think, I think most public health professionals would agree that we are not actually there yet. We don’t have, you know, the CDC, not the CDC, the you know, the box it in the notion of the former CDC head, Dr. Frieden, of, you know, do we have enough tests? Do we have enough people on the ground who can do the contact tracing, who can ensure that if someone is identified that they have a home to stay in? So I think the bigger question is not about the protest. It’s just like, are we ready? And many would say no. And the protests probably suggests that we should delay it even a bit longer because of the uncertainty.
MODERATOR: Thank you. Looks like that may be all we have for questions today. Did you have any other final comments you’d like to make for today?
NATALIA LINOS: No. I thank you all for paying attention to health inequities and to raising that as an issue. I think that is important. It’s important from a public health perspective. It’s also important for the conversation we’re having with the media and the press. Thank you for participating.
This concludes the June 2 press conference.
Michael Mina, assistant professor of epidemiology (June 1, 2020)
Bill Hanage, associate professor of epidemiology (May 29, 2020)