Public health experts and health care providers say a recent wave of protests and unrest across the United States is a response to the kinds of inequities they see in their jobs on a daily basis.

More than 1,000 physicians, professors, public health experts and students studying medicine or public health, including some from the University of Washington and Washington State University, signed an open letter in support of the protests nationwide.

“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter states before explaining how systems of oppression lead to adverse health outcomes for Black people, indigenous people and people of color in the United States.

COVID-19 has disproportionately impacted Black Americans nationwide.

“Black people with COVID-19 are diagnosed later in the disease course and have a higher rate of hospitalization, mechanical ventilation, and death,” the letter says. “COVID-19 among Black patients is yet another lethal manifestation of white supremacy.”

Rachel Bender Ignacio, an assistant professor in the Division of Allergy and Infectious Diseases at UW, helped pen the letter , along with colleagues from institutions across the country.

Faith Price recently finished her master’s degree and on-campus work at WSU in Pullman. She is continuing her studies to complete a doctoral degree in prevention science.

She recently moved to Missoula to begin working as a public health worker at an urban Indian Health Center, focusing on substance use and suicide prevention.

Price said she signed the letter because in her research and experience, she knows that systemic racism is “a huge factor of health disparities.”

“It was something I felt really strongly about because I am a person of color and a health professional,” she said.

The letter places the nationwide protests against policy brutality sparked by the murder of George Floyd at the hands of Minneapolis police officers in context, noting that they do not condemn the protests as “risk for COVID-19 transmission.”

“Protests against systemic racism, which fosters the disproportionate burden of COVID-19 on Black communities and also perpetuates police violence, must be supported,” the letter says.

The letter outlines good practices for demonstrations, including wearing face coverings and maintaining 6 feet of space when possible, including such advice for law enforcement officials, not just protesters.

Price said she plans to attend a vigil that her daughter helped organize this weekend in Missoula, wearing a mask. She pointed to other measures people can take if they are not comfortable or cannot protest, like supporting local organizations or calling lawmakers.

“There’s ways you can support the cause without having to physically go out there,” she said.

The open letter also opposes law enforcement’s use of tear gas, smoke or other respiratory irritants, which could make the respiratory tract more susceptible to infection.

“What initially caught my attention were the concerns of tear gas and other irritants at a time when we don’t want people to be coughing and touching their faces,” said Hilary Godwin, dean of the UW School of Public Health, who personally signed the letter as well.

“And it’s not something that I’m generally in favor of anyway, but this was one of those moments where it was like, ‘Hey, that’s not OK.’ ”

Bender Ignacio points out that tear gas and pepper spray can have lasting and damaging effects to a person’s eyes, skin and respiratory tract.

“That’s why they are banned in international warfare. But we use them on civilians in our own cities?” Bender Ignacio wrote in an emailed statement.

A study of U.S. Army recruits completing basic training found that exposure to riot control agent o-chlorobenzylidene malononitrile, also called CS, led to a much higher risk of being diagnosed with acute respiratory illness, which resulted in many recruits going to the hospital and receiving treatment after exposure during their training.

Studies like this lead public health officials and providers to fear that the pandemic makes exposure to respiratory irritants even worse. COVID-19 is a respiratory virus, and its impacts on a person’s lungs can be severe, especially in at-risk people who are older or have underlying health conditions. Patients needing more emergent health care may require a ventilator to assist them in breathing.

Ultimately, the letter draws on parallels between the movements seen on streets nationwide and the pandemic playing out at the same time.

“These are related issues, and you can see with COVID that there are disparities and inequities, so it’s not an either/or, a protest or be safe from COVID,” Price said. “These are related issues and this is something that also needs attention.”

In Washington state, current but incomplete ethnicity data of COVID-19 cases show that the new virus is disproportionately impacting people of color statewide.

The state has identified the ethnicity of a person in 68% of COVID-19 cases. Of the cases in which ethnicity is recorded, 42% are Hispanic.

All cases of COVID-19 in nonwhite ethnicity groups make up 63% of the state’s total cases, despite white people making up 68% of the total state population.

“This is an opportunity to highlight that the inequities in terms of health outcomes we see in our country don’t have to do with anything inherent or biological with those groups,” Godwin said. “They have to do with the social constructs we’ve created in our society and injustices we continue to perpetuate in our society, so until we start dismantling those inequities, we won’t see the outcomes we want to see.”