An indoor area in crammed with more than 19,000 fans. Standing shoulder to shoulder. Shouting their approval. For more than an hour. And many without masks.
President Donald Trump's decision to return to the campaign trail by holding a rally Saturday night in the Tulsa, Oklahoma – his first in more than three months – in the middle of the coronavirus pandemic has health experts fearful that the gathering could turn into ground zero for a "super spreader" event.
And that doesn't include the thousands of supporters, protesters and law enforcement officers expected to congregate outside the venue, most in close proximity to one another and for extended periods of time. Or the musical acts and high-profile surrogates intended to give the event a festival feel.
Many will come from around the country and return to their homes when it's over.
"Let me be clear: Anyone trying to attend a large-scale gathering will face an increased risk of becoming infected with COVID-19," Bruce Dart, executive director of the Tulsa Health Department, told reporters Wednesday. "I know so many people are over COVID, but COVID is not over. It's transmitting very efficiently in our community."
The rally is being held even as the Centers for Disease Control labels as the highest risk any large in-person gathering "where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area."
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he had no plans to attend the rally.
“I’m in a high-risk category. Personally, I would not. Of course not," the 79-year-old doctor told the Daily Beast, adding that when it came to Trump’s rallies, “outside is better than inside, no crowd is better than crowd” and “crowd is better than big crowd.”
The Trump campaign is holding the rally even as the pandemic shows no sign of slowing. The number of cases nationwide is approaching 2.2 million, and deaths have surpassed 118,000, according to Johns Hopkins.
Sun Belt states such as Florida, Texas and Arizona are reporting record case increases.
Professional and college sports have been largely shut down for months, following the advice of medical experts who say even limited exposure to a virus with no vaccine can be fatal. The BOK Center has canceled or postponed more than a dozen events, including concerts, since March, including the last month of the minor league Tulsa Oilers hockey team.
Tulsa is seeing its highest spike in coronavirus cases. The number of new cases reached a high of 120 Wednesday, up from 35 at the beginning of the month. The trend mirrors a spike in Oklahoma.
"Why would you hold a political rally in a hot zone?," tweeted Jonathan Reimer, professor of medicine and surgery at The George Washington University School of Medicine & Health Sciences in Washington.
The Trump campaign said it will check attendees temperature as they come in, provide hand sanitizer and issue masks but not require they be worn. Tickets to the rally come with a liability waiver that says the campaign or other parties associated with the event cannot be held liable for exposure to the coronavirus.
In an interview with CNN Wednesday, House Speaker Nancy Pelosi, D-Calif., called the president's rally "an ego trip" that would "endanger" people's health.
But the president's supporters say no such criticism was leveled by Democrats when protesters gathered in cities across the country to demonstrate over the death of George Floyd and other victims of police brutality.
Trump told the Wall Street Journal in an interview published Thursday that some attendees may catch the virus, adding “it’s a very small percentage.”
Asked if he would be fine with Ivanka Trump, his eldest daughter, sitting in the crowded audience inside the arena, he said he would.
“First all she’s young,” he said, adding that elderly Americans were more likely to become severely ill or die from the disease. Hart, the Tulsa health director, said cases among the youngest residents are rising as well.
Oklahoma Gov. Kevin Stitt told Trump on Thursday his state is prepared to host the rally.
"We're so excited to have you," Stitt, a Republican, told the president during a White House event focused on reopening the economy. "Oklahoma’s ready for your visit."
On Thursday, the BOK Center asked the Trump campaign for a written plan "detailing the steps the event will institute for health and safety, including those related to social distancing."
Campaign Spokesman Tim Murtaugh said the request was being reviewed.
"We take safety seriously, which is why we’re doing temperature checks for everyone attending, and providing masks and hand sanitizer," he said. "This will be a Trump rally, which means a big, boisterous, excited crowd."
Regardless of what precautions the campaign takes, the facility will provide personal protective gear to event staff, periodically clean and disinfect the arena during the rally, and install plexiglass partitions at all concessions stands.
Health experts say the biggest danger of the Trump rally is not that the BOK Center can hold 19,199 people but that the virus is so easily transmitted in an enclosed space.
“Group size doesn’t make that much of a difference anymore,” said Kent Smetters, faculty director of the Penn Wharton Budget Model. “You can have a large group these days as long as you have masks, it’s outdoors and you have some reasonable distance away.”
Air circulation is one of the key ingredients to prevent virus transmission, Smetter said. It disperses the virus faster and more effectively than air conditioning or an open window, so people are less likely to inhale a high concentration.
The more virus you inhale, the more likely you’ll get sick.
“It’s not just inhaling a single cell of the virus, it’s how much you’re inhaling that actually matters a lot,” he said.
The Penn Wharton Budget Model found behavioral changes such as mask-wearing, social distancing and whether the activities are outdoors or indoors had more impact on transmission than sheer group size, according to an analysis by John Ricco, the senior analyst at Penn Wharton Budget Model.
More: World struggles to stop the spread of coronavirus
In March, an encounter index of 5, which is considered a large group of people close to one another, would result in one person infecting at least five other people. However, in June, the model predicted that one person infected only 1.3 other people at the same encounter index.
That suggests people are able to get together in large groups and reduce transmission risk by gathering outdoors and wearing masks, Smetter said.
A study published in the New England Journal of Medicine in May also found that the airborne droplets produced when someone speaks increase in frequency as the volume increases.
Experts believe that means Trump's rally could pose a higher risk of infection because most people will be screaming or chanting during Trump's rally.
