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Racism is a Public Health Crisis

ONA Supports Black Lives Matter


Racism in America is a public health crisis. There is a systemic racism problem in the healthcare system that excludes People of Color from receiving comprehensive, quality care. The results are evident: higher rates of chronic illness that are perpetuated and exacerbated by a health care system with an extensive history of racist practices. Current events have again revealed this public health crisis as People of Color experience a disproportionate mortality rate from COVID-19, police brutality, and are met with state sanctioned violence when protesting. 

When Black and Brown people protest systemic racism, the police employ draconian, violent tactics that are meant to intimidate and harm those standing up for social justice. Their lives are put in danger by the police using tear gas, rubber bullets, and batons and perpetuating the foundations of racist oppression in America. When white people armed with assault rifles and dressed in military style clothing storm and occupy government buildings the police refrain from these tactics and protect the health of the white occupiers. White people protesting in support of perpetuating white supremacist culture are protected by the police while People of Color are met with systematic, oppressive violence. 

The effects of racism in public health are realized in the COVID-19 mortality rates (Kirby, 2020. Yancy, 2020).  As of June 8, 2020, Black people make up 13% of the population yet account for 24% of COVID-19 deaths where race is known (The Covid Tracking Project, 2020). Hispanic communities face significantly higher rates of infection than their white counterparts in the same regions (Hooper, Nápoles, & Perez-Stable 2020). It is evident by recently released unemployment numbers that the economy is recovering for white people and communities of color are, once again, suffering economic hardships that exacerbate the public health crisis (Gonzalez, Karpman, Kenney, & Zuckerman, 2020). These disparities are not random occurrences but are the result of a society designed on white supremacist principles that are endemic in health care, law enforcement, and American financial institutions. Systemic racism is an insidious disease that perpetuates a public health crisis in America.

COVID-19 Pandemic Safety

Limiting face-to-face contact with others is the best way to reduce the spread of coronavirus disease 2019 (COVID-19). While people who are sick or know that they have COVID-19 should isolate at home, COVID-19 can be spread by people who do not have symptoms and do not know that they are infected (Centers for Disease Control and Prevention, 2020).   
 
That’s why it’s important for everyone to practice social distancing (staying at least 6 feet away from other people) and wear cloth face coverings in public settings. Cloth face coverings provide an extra layer to help prevent the respiratory droplets from traveling in the air and onto other people (Centers for Disease Control and Prevention, 2020). 

COVID-19 is transmitted via droplet in most cases, which means small droplets of fluid are spread from a person infected with the virus to those near them when they cough, sneeze, sing, or shout (Centers for Disease Control and Prevention, 2020). Studies from several health agencies across the world, show that that singing, and shouting can actually aerosolize the virus for up to three hours. Under normal circumstances, masking and covering a cough or sneeze will reduce the transmission of a droplet pathogen to an area of roughly 6 feet. Shouting and singing while transmitting droplet pathogens, will also aerosolize pathogens. There are few methods to contain pathogens that have been made small enough for aerosolized (airborne) pathogens, and these include N95 or better respirators that trap droplet and airborne pathogens. Cloth masks and surgical masks only contain droplet (large and wet) pathogens, but not the small and light pathogens created by shouting or singing (Centers for Disease Control and Prevention, 2020).

Testing for COVID-19 has been inadequate in every sense. COVID-19 affects everyone differently, but overall the numbers are startling. By most estimates, only 20% of infected individuals are identified by testing, which means that 80% of those infected are never identified (Li et al, 2020). While some infected persons may only experience mild symptoms, which includes everything from loss of smell to fever or cough, some experience no symptoms at all before affecting others. The CDC estimates that at least 1% of all infected persons never experience symptoms but are still spreading the virus (Wu and McGoogan, 2020).

There have been several incidences of individual infected persons infecting several dozen other people without their knowledge, these persons are known as “super spreaders” in epidemiology. One person in Washington state infected 52 others in a single evening of choir practice, leading to infections across six states and at least three initial deaths. One individual in Singapore, infected more than 800 people in dormitories and one asymptomatic person in Japan infected more than 80 people at an open-air music venue (Kupferschmidt, 2020). Several factories across the country, despite masking precautions have experienced large COVID-19 outbreaks, including 85 people associated with the Firestone Pacific Foods fruit plant (Hanson, 2020). These instances all show the danger of persons in close quarters being infected by those with minimal or no symptoms infecting others via forcefully expelling their lungs, similar to what happens when a person is in close quarters to another, especially when shouting or singing forcefully (Centers for Disease Control and Prevention, 2020).

Social distancing has proven remarkably effective in reducing the spread of COVID-19. Epidemiological research has shown that COVID-19 initially spread with an R0 or “R-naught” of 2.6, which means that each infected individual spreads the infection to 2.6 other people on average (Javis et al, 2020). Social distancing measures across the world, have shown that the R0 can be reduced to 0.62, which will lead to an eventual eradication of the pathogen if maintained (Delmater et al, 2020).

Protesting in close quarters may be vitally important to the future of our democracy but presents serious risks to the immediate well-being of our population. While Oregon has fared better than most states, we are still experiencing a 3.6% mortality rate for the minimally confirmed cases in our state (Oregon Health Authority, 2020). Those at highest risk for serious illness and death are persons with autoimmune diseases and the elderly, including 59% of Oregon’s infected being over the age of 40. Those under 40, account for 41% of Oregon’s infected people and even children are not immune to complications and many have died from multi-system inflammatory syndrome in children (Oregon Health Authority, 2020).

Violence, Racism, and Public Health

The concept of violence as a public health issue has emerged nationally, and globally, over the last few decades, although communities of color have known this for hundreds of years.  As the incidence of death related to infectious disease has declined, death from violence has risen in the rankings of causes of death (CDC. 2009). Furthermore, the rates of deaths related to violence among communities of color has increased significantly, especially in African Americans. In the 1979 Surgeon General’s Report, Healthy People, the significance of violence on public health was highlighted and a call for methods to control stress and violent behavior identified as one of the priority areas for improving health of American communities. Violence directly impacts the well-being of communities. In fact, Hospital emergency departments treat more than 1.7 million assault victims per year in the U.S. (Wen & Goodwin, 2016). People of color, and particularly Black Americans are at significantly greater risk of suffering from violence. Particularly, police brutality and racial profiling have been identified as adversely impacting the health of Black Americans (Aland, McAlpine, McCreedy, & Hardeman, 2017). 

Police brutality has taken many forms and has often resulted in fatalities. The Black Lives Matter movement was only the most recent social movement emerging in response to the murdering of Black Americans at the hands of police – this has happened before. In addition to death, other health outcomes have been identified, among Blacks as direct results of police violence: adverse psychological responses that increase morbidity (effects of teargas, physical injuries from batons, clubs, and rubber bullets, etc.) racist public reactions that increase stress and stress disorders, incarcerations that cause family and financial strain (Alang, McAlpine, Hardeman, & McCreedy, 2017). Currently, in Oregon, the police in many cities have used such tactics during the Black Lives Matter protests. Many injuries have been sustained heightening the awareness of the impact of police violence on our communities. This is a continuation of a long history of trauma and violence that have characterized race relations in the United States since it’s beginning. These traumas are long-lasting and inter-generational.  

ONA does not support the use of chemical irritants such as tear gas or pepper spray as a means of crowd control, and especially does not condone using chemical irritants during a public health crisis.  Historically, these types of irritants have been used by law enforcement officers to suppress civil unrest, and in more recent years the use of tear gas has increased (Rothenberg, Achanta, Svendsen, & Jordt, 2016).  The 1925 Geneva Protocol even prohibits the use of these types of chemical weapons in warfare, yet in the United States our police officers are still being trained to use asphyxiating gases on our own people.   

The two types of chemical compounds used most frequently by law agencies for means of crowd control are 2-chlorobenzalmalonitrile (CS) and oleoresin capsicum (OC). CS is the most frequently used compound; while the effects of low concentrations of CS are considered temporary, the National Academy of Sciences still does not consider any amount to be a safe concentration (Harr et. al., 2017).  OC, on the other hand, is highly concentrated and derived from the active ingredients in hot peppers; the volume and concentration of each spray with this particular chemical compound varies widely because the potency of OC is not only dependent upon the concentration within a solvent, but also on the strength of the capsicum extracted (Harr et. al. 2017).  This is a major cause for concern when these asphyxiating chemicals are being used on people over short periods of time and often in places where it’s difficult to break free from the crowd, resulting in various injuries. 

Tear gas agents have been known to cause lung damage, ocular injuries, and complications for those with chronic conditions (Rothenberg, Achanta, Svendsen, & Jordt, 2016).  Several studies have shown tear gas to have a high potential for misuse, causing unnecessary injuries and even deaths (Harr et. al., 2017).  Chemical irritants can cause individuals to cough, sneeze, and gasp for air; this all produces a lot of mucous (NPR, 2020).  Fast forward to the current state of affairs, where there are mass demonstrations fighting for equality across the country, law enforcement attempting to crowd control by utilizing tear gas, the highly contagious COVID-19 virus which is spread through the air via droplets, and you’ve got the perfect recipe for disaster.

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