Why tracing coronavirus cases from the Black Lives Matter protests could be nearly impossible

• People have been marching through the streets around the globe for two weeks, protesting police brutality and inequality.
• Many public health experts, doctors, and nurses have shown up to protest too, saying protecting human lives is their job.
• But healthcare workers are still worried that the close contact between people at these gatherings could prompt new coronavirus outbreaks, and that contact tracing the gatherings to stop the virus' spread could prove to be nearly impossible.

Oklahoma State linebacker Amen Ogbongbemiga probably had the coronavirus when he joined thousands of other people in protesting police violence against Black people. He just didn't know it yet.

Shortly after attending a recent Tulsa protest, the football player tested positive for COVID-19, the disease caused by the virus.

"Please, if you are going to protest, take care of yourself and stay safe," Ogbongbemiga tweeted on June 2nd.

Per Oklahoma State University protocol, Ogbongbemiga was quarantined on campus after his test. He added in a followup tweet the next day that he had protected himself while protesting, presumably by wearing a mask.

Ogbongbemiga's case is one that experts and policy makers fear will be repeated in the coming weeks, as people protest in crowds in reaction to the police killings of George Floyd, Breonna Taylor, and others.

The odds of catching the coronavirus at one of these protests is still an open question, and doctors, nurses, and public health experts across the US have stressed that fighting for human rights shouldn't take a backseat to coronavirus worries.

But if there are coronavirus outbreaks that emerge as a result of protesting in the days and weeks to come, figuring out who to contact, and how to contact them — to warn them they may be ill and putting others at risk of infection — could prove to be nearly impossible.

Contact tracing is incredibly difficult work

Many epidemiologists have said that the risk of coronavirus infection at outdoor protests, as long as people are wearing masks and keeping a safe distance from others, may be small.

But contact tracers — the people tasked with tracing and stopping disease outbreaks in their tracks — are still worried that there could be potential for coronavirus spread.

One big worry is that many people coming down with the coronavirus are at their most infectious right before they know they're sick, meaning they might not stay home on their most contagious days.

"From my perspective, [it's] certainly [concerning] any time there's gatherings of people, mass gatherings, such as these protests,"John Henry, a COVID-19 contact tracer at the Columbus Health Department, told reporters on a conference call last Thursday.

The job of a contact tracer is to retrace the steps that someone with COVID-19 took while they were sick in order to determine who else they may have infected, and alert those people to quarantine. Ideally, tracing work stops outbreaks before they spiral out of control in a community, but there are nowhere near enough contact tracers in the US to trace back every coronavirus infection right now.

Contact tracers usually look at who was in close contact with a patient (living or working alongside them), taking into consideration if they were within six feet of someone for more than 10 to 20 minutes. At a protest attended by thousands, where people are often close to one another for extended periods of time, it would be almost impossible to track infections this way.

"Potential exposure in a protest setting is a challenge for contract tracing," Jen Horney, founding director of the University of Delaware's epidemiology program, told Insider. "Public health authorities are likely limited to notifying those potentially exposed through the media, and other public postings."

Unlike concerts or sporting events, there are no records of ticket purchases that could be used to inform people who attended a protest that they had been potentially exposed.

Ogbongbemiga's Tuesday tweet may have been the best possible PSA for his fellow Tulsans, letting them know they may have been exposed to his infection. While it's possible that Ogbongbemiga didn't infect many protesters, if he spread his illness to anyone else at all, it's too soon to know for sure one way or the other.

"One of the things that we all need to recognize is that outdoors is far, far safer than indoors — in one study, the risk of spread outdoors is 19 times less than indoors," former CDC Director Tom Frieden told WCBS last week.

Still, there have been cases of outdoor super-spreader events, including one coronavirus outbreak at an Italian soccer stadium in mid-February, which helped seed that country's deadly wave of infections.

People, and especially people of color, may have privacy concerns about contact tracing

Contact tracing the coronavirus was already a challenge, even before these protests started. Calling people up who may not feel sick and telling them to lock themselves in the house for two weeks straight is no easy task, especially with so many Americans out of a job.

"There's a genuine and justifiable mistrust of both government and the healthcare field, among many people of color," Henry said, adding that the current pandemic — which is also disproportionately killing Black and brown people — only compounds this rickety relationship.

"People have been out of work for months, they're frustrated, and now they're getting contacted by the health department, saying they need to self quarantine for 14 days," he said. "Definitely have had people hang up on me, definitely have had obscenities hurled my way."

Henry said that over the past several weeks, he's developed "a certain finesse when talking to people," which allows him to better engage contacts to follow "very strict guidelines about a 14 day quarantine" at home. It's similar to how other contact tracers describe the job.

"People are upset," Jenine Clements, a contact tracer in Michigan previously told Insider. "People have had to deal with death."

"I use my interviewing skills by, first, coming to them where they are," she said. "You know, 'Oh, thank you so much for sharing that with me, can you tell me more about that?'"

Police have made 'contact tracing' sound more threatening than it is

But even the most effective and communicative contact tracers may now be fighting an uphill battle with the public, especially in Minneapolis.

At a press conference in the first weekend of June, Minnesota Public Safety Commissioner John Harrington used the term "contact tracing" incorrectly to describe police surveillance of protesters at demonstrations there.

"We've begun doing — almost very similar to our COVID [work] — it's contact tracing," Harrington said. "We're building that information network, building that intel effort, so we can link these folks together."

Many pointed out that he misused the term, but the damage may have already been done, as protesters may no longer want to comply with a "contact tracing" public health system they might (wrongly) suspect could give police information leading to prosecution or detainment.

"In this current environment, which has enhanced or brought forth a mistrust of governmental authority, it might make them disinclined to speak with anyone in government," William Schaffner, an infectious diseases expert at Vanderbilt University, told US News and World Report of the Minneapolis mix up.

Henry said there's one obvious long-term solution to combat the issue of community mistrust.

"I think universal health coverage would go a long way in leveling the playing field, in terms of access to essential health services, and rebuilding the trust between communities of color and the healthcare field," he said.