Indoors, yelling and packed crowds: Experts sound alarm ahead of Trump's Tulsa rally amid coronavirus

As President Donald Trump pushes ahead with an upcoming rally in Oklahoma, multiple health experts told ABC News they fear the event with a packed, yelling crowd in an indoor arena could supercharge the spread of the coronavirus in an area that's already seeing cases on the rise.

In interviews with ABC News, a half dozen epidemiologists and public health experts raised concerns about the planned gathering set in Tulsa for an 19,000-seat arena and another 9,000-seat overflow space. They said the event has all the necessary ingredients to become an event that could endanger Tulsans and the president’s supporters who travel to Tulsa from across the region.

“This seems like a terrible idea,” said Dr. Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania’s School of Nursing. “I would be saying that if it was Joe Biden’s rally, I’d be saying it if a dog catcher candidate was holding a rally.”

Trump has downplayed the severity of the outbreak in Tulsa, even as local health officials have publicly pleaded with the campaign to reschedule the event. White House and campaign sources have described the rally, Trump’s first since March 2, as the “2020 campaign kickoff.”

Facing mounting blowback over resuming rallies, the president has dug in, claiming the media "had no Covid problem with the Rioters & Looters destroying Democrat run cities" and arguing critics were trying to "Covid Shame us on our big Rallies," despite new outlets also covering the health risks that protesters have been taking while demonstrating for racial justice across the country.

Experts have publicly said they are wary of gatherings of protesters as well, but some told ABC News that the nature of the Trump rallies, from their indoor setting to the yelling to the distance from which people travel to be there, have them particularly on edge.

Trump campaign spokesperson Erin Perrine told ABC News the campaign "takes the health and safety of rally-goers seriously and is taking precautions to make the rally safe" including checking the temperatures of attendees and providing them with face masks and hand sanitizer.

Perrine's statement did not address social distancing, and campaign sources told ABC News there's currently no plan to implement distancing measures for attendees at the rally.

Dr. Lena Wen, an emergency physician and public health professor at George Washington University, said she worries about the event's consequences.

"I’m really very concerned about this event being a super-spreader-type event where there will be potentially many people coming out of this who were exposed and could become sick from COVID-19," said Wen, who also previously served as Baltimore's Health Commissioner.

CDC warns against group gatherings, older Americans especially vulnerable

The Centers for Disease Control and Prevention's definition of the highest risk gatherings -- “large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area" -- accurately describes the average Trump rally.

The typical Trump campaign event features tens of thousands of people crowded together outdoors, and then inside the venue, for several hours. Blaring music from the campaign playlist makes it difficult to hear anyone who isn’t shouting. And it’s not uncommon for supporters to travel several hours to the venue to support the president.

According to the White House’s non-binding plan for reopening states, large gatherings should only take place under the third phase of reopening in states and regions with “no evidence of a rebound,” “robust” testing and two weeks of declining positive COVID-19 cases.

Oklahoma began moving forward with their Phase 3 of reopening on June 1, but new cases in the state have been on the rise in recent days. Just Monday the Tulsa Health Department reported the county's highest single day count, at 89 new cases, bringing the total confirmed cases in the city to 1,653.

Texas, which borders the state to the south, has recently seen a significant increase in cases amid reopening. And Dallas, a four-hour car ride from Tulsa, has emerged as a new hot spot, with Dallas County recording a record number of COVID-19 hospitalizations and cases in recent days.

“I think it’s an honor for Tulsa to have a sitting president want to come and visit our community, but not during a pandemic,” Dr. Bruce Dart, the director of the Tulsa Health Department, told the local news outlet Tulsa World. “I’m concerned about our ability to protect anyone who attends a large, indoor event, and I’m also concerned about our ability to ensure the president stays safe as well.”

Tulsa still has a “Safer-at-Home” order in place, urging all residents over 65-years-old and any with underlying medical conditions to only leave their homes for essential work, medical appointments and grocery shopping.

The president’s rallies often attract many senior citizens who are among the most vulnerable to the coronavirus and considered to be at high-risk for severe illness from COVID-19, according to the CDC.

“Our strategy will continue to protect senior citizens and other vulnerable populations,” the president said at a White House coronavirus press briefing back in April while urging states to begin reopening. Vice President Mike Pence and Dr. Deborah Birx, the White House coronavirus response coordinator, have also warned about the more vulnerable gathering in large groups.

However, campaign sources told ABC News there are no plans to restrict senior citizens from attending Saturday’s rally.

The state's health commissioner Tuesday urged those in "vulnerable population" groups, "to include being of the age of 65 and older," to not attend large-scale events, rather encouraging them to "please stay home."

The rally in Tulsa is just one of several the president has teased in other states like Florida, Texas and Arizona -- events that could also be at odds with the guidance from local health officials grappling with coronavirus in their communities.

'Outside versus inside certainly does make a difference'

Dr. Anthony Fauci, the nation’s top infectious disease expert, told ABC News last week that his advice for those who want to attend Trump’s campaign rallies is the same for anti-Trump protesters -- any large group is “a danger” and “risky.” Fauci said if a person insists on going, they should wear a mask, especially when they are yelling or chanting, he said.

Republicans and the president’s supporters have accused public health experts of a double standard, saying that many encouraged the protests and gatherings against racism and police brutality following the murder of George Floyd in police custody.

But a big difference between the protest rallies and Trump’s campaign event is the venue, experts said. They told ABC News that indoor events are generally considered more dangerous than mass gatherings outdoors, even if the same safety precautions are taken.

“Outside versus inside certainly does make a difference,” said Wen, of George Washington University.

The novel coronavirus is thought to be spread most easily via respiratory droplets that can live in the air and on surfaces. An asymptomatic or pre-symptomatic attendee could easily spread the virus to others through the Bank of Oklahoma Center, known as the BOK Center, as attendees sing, shout, clap and move through the building to their seats and to use the bathroom over the course of several hours.

CDC investigations have found that the coronavirus can spread rapidly at events like birthday parties, choir practices, and multi-day church events -- gatherings that involve large groups of people congregating indoors for extended periods of time.

Oklahoma Gov. Kevin Stitt, a Republican, said on Monday that he had asked the White House to potentially consider an outdoor venue for the rally, according to The Associated Press.

Though the campaign stressed the safety measures they're taking for the rally, including the face masks, the measures are less rigorous than those put in place for a recent Trump fundraiser in Dallas, where attendees were tested for coronavirus, and could also be undermined by a lack of enforcement.

Wearing masks won’t be a requirement at the rally, according to campaign sources.

“The presence of a mask there isn’t going to do anything until somebody actually puts it on and keeps it on,” said Dr. Nasia Safdar, the medical director of infection control and prevention at the University of Wisconsin-Madison.

But even if masks are worn, Dr. Deborah Birx, the White House coronavirus response coordinator, has warned about their effectiveness coupled with shouting.

“It does worry me because not everyone was in a mask and some people were shouting and we don’t know the efficacy of masks with shouting,” Birx said when addressing questions from governors about the protests, according to an audio recording of a call with governors obtained by ABC News.

Dr. Rebecca Fisher, an assistant professor of epidemiology and biostatistics and Texas A&M University, said that the typical fabric mask is “not designed to trap viruses,” and that screaming and cheering could “force those actual virus particles” through the barriers.

There are also no plans at this time to keep the president further away from his supporters during the event, as he typically remains 20 feet away, sources familiar with the planning said.

Travelers from out of town

Another complication? Supporters traveling to attend from neighboring states, a point Trump’s team often boasts about.

The Trump campaign has also launched a Facebook ad blitz targeting nearby states, urging supporters to attend the event in Tulsa. “Trump asked us to invite YOU to his campaign rally in TULSA, OKLAHOMA. Last chance: Seats are going fast!" one set of ads running in nearby states including Kansas, Missouri, Arkansas and Arizona reads.

Some hospitals are now seeing a record number of patients on ventilators nearly a month after reopening, as Arizona, to the southwest, is experiencing a sharp uptick in cases.

The CDC said that travel increases the chances of contracting and spreading COVID-19.

"We don’t know if one type of travel is safer than others; however, airports, bus stations, train stations, and rest stops are all places travelers can be exposed to the virus in the air and on surfaces," guidance on their website reads.

Wen said one of her concerns is that "people attend this event and then go back to their communities, and they could become affected at the event and spread the illness to where they came from."

Mayor is anxious, but won't stop Trump from coming

While the state of Oklahoma and specifically the city of Tulsa are not operating under any mandatory restrictions on large public gatherings, the city does have a “Safer-at-Home” order in place for residents over 65 and people with underlying medical conditions.

"We encourage residents and visitors to follow public health guidelines," Leanne Stephens, a spokeswoman for the Tulsa Health Department, told ABC News on Friday, noting that they included wearing cloth masks in public, social distancing, and hand-washing.

The Mayor of Tulsa said on Tuesday that while he does have anxiety about being the host city for a packed arena, he will not attempt to block the president from coming.

“Do I share anxiety about having a full house at the BOK Center? Of course. As someone who is cautious by nature, I don’t like to be the first to try anything. I would have loved some other city to have proven the safety of such an event already,” Mayor GT Bynum wrote in a Facebook post.

“We continue to recommend to anyone leaving your home -- to go to work, to the store, to church, or to any event -- that you wear a mask when in public and wash your hands frequently. If you don’t feel well, stay home. If you have a compromised immune system, stay home. Each person knows best how to manage your individual risk,” he added.

Attending at your own risk

Though the president has publicly targeted what he called the "fake news" for "Covid Shaming" him over the event, the Trump campaign appears aware of the potential danger.

Those looking to attend the rally, must also agree not to sue the campaign if they contract coronavirus, according to a disclaimer on the event’s signup page.

"By attending the Rally, you and any guests voluntarily assume all risks related to exposure to COVID-19 and agree not to hold Donald J. Trump for President, Inc.; BOK Center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury," the disclaimer reads.

Trump's rally will be the first in the BOK Center in over three months. Other events have been postponed or canceled through July amid the pandemic -- out of safety concerns.

“In an abundance of caution our box office will be closed until further notice,” the arena’s pre-recorded voice system says when reached by phone on Tuesday. “The health and safety of our guests and employees is our highest priority."