Four consecutive days of nationwide protests, with protesters numbering in the tens of thousands in some cities — some masked, some not — have health experts and state and city leaders worried about a spike in new COVID-19 cases in the next two weeks.

It's too soon to say if mass gatherings of people in cities across all 50 states will have a noticeable impact on the country's already grim coronavirus statistics. And some experts have been cautiously optimistic in the last month or so about the limitations of the virus's ability to spread in outdoor settings. But there has been plenty of discussion already in the media about the protests of the last several days turning into super-spreading events like those that have been recorded in other countries. (A February 19 soccer match in Milan, Italy that was attended by 40,000 people is seen as one such event.)

Los Angeles Mayor Eric Garcetti spoke on Saturday about protests becoming super-spreading events, but that did little to quell rioting and unrest there that spilled over into Monday. As the New York Times reports, multiple governors and mayors, both Democrats and Republicans, have expressed similar fears of a spike coming in two weeks thanks to these protests — though in contrast to events like the Italian soccer match, protesters are mostly well aware of social distancing guidelines and many have been masked.

Atlanta Mayor Keisha Lance Bottoms outright told protesters there to "go get a COVID test this week," and on Monday a Chicago public health official instructed everyone who attended weekend protests there to self-quarantine for 14 days.

But the mostly young base of protesters isn't likely to heed these warnings as much as their parents or older protest peers might — especially given how few young people have ended up with serious cases of COVID-19 overall. There is, however, an increased possibility that these protests could lead to more asymptomatic cases that are unknowingly transmitted to older or more vulnerable relatives and friends of the protesters.

That's what former FDA commissioner Dr. Scott Gottlieb spoke about on CBS's "Face the Nation" on Sunday, saying the protests would likely lead to new "chains of transmission." He pointed to the discrepancies in social distancing between the poor and more economically stable, in particular the reliance on public transportation. "Stopping the pandemic is going to depend on our ability to take care of our most medically and socially vulnerable,” Gottlieb said. “We absolutely need to resolve these underlying problems to eliminate the risk of pandemic spreading of the epidemic."

Medical historian Dr. Howard Markel tells the Times that he sees a potential echo of the bond parades like this one in Philadelphia, selling bonds to help the WWI war effort, which were seen as super-spreading events during the 1918 flu pandemic. And he dismisses the idea that the outdoor nature of protests makes them safe.

"Yes, the protests are outside, but they are all really close to each other, and in those cases, being outside doesn’t protect you nearly as much,” Dr. Markel says. "Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering."

Those of us who have not doubted the science behind shelter-in-place orders were quick to judge all the Americans — albeit far fewer than we saw protest over the weekend — who were out protesting at state houses several weeks ago to push for the reopening of the economy. Similar to these cries of caution, multiple pundits discussed how those protests (which seemed largely but not entirely unmasked) would lead to mass infections, and that has not yet been shown to be the case.

In the Bay Area, officials have not been so quick to warn against protesting, recognizing that much of the pent-up rage coming out in these demonstrations is as much connected to the pandemic and its impacts on people of color as it is about the death of George Floyd.

"How do you choose between two tragedies? You can’t,” says Alameda County Public Health Director Kimi Watkins-Tartt, speaking to the Chronicle. “Being in this pandemic is a tragedy. And that man losing his life is a tragedy, and people are hurting and that’s a tragedy. And as a public health leader, I can’t choose — I can’t say which one is more important. They’re all important. And so, I just — everyone be careful. Try to be as safe as possible."

UCSF infectious disease expert George Rutherford tells the Chronicle that he's hopeful that "masks will be the key," and the widespread mask orders around the country will prevent these protests from proving to be deadly disease vectors.

"Maybe we’ll be able to dodge a bullet," he says.

Photo: Matt Charnock/SFist