Community outbreaks of Covid-19 often emerge after Trump’s campaign rallies

In mid-May I sat in the backyard of my family’s home garbed in graduation regalia and, via Zoom, joined my medical school classmates to read these words of the Hippocratic oath: “that into whatsoever house I shall enter, it shall be for the good of the sick.”

When President Trump held a mass campaign rally in Newport News, where I now work, at the end of September, he did so against the explicit warning of local public health officials. He was entering this community — our house — not for the good of the sick but to promote himself. The gathering may have brought sickness to the community. As a new physician, I find that deeply disturbing.

As the death toll of Covid-19 heads toward 220,000 in the United States alone, more deaths than in any other country in the world, the president, who is currently convalescing from Covid-19 himself, has spent the past several months crisscrossing a pandemic-ravaged country in his bid for reelection. The crowds he draws are fertile breeding grounds for transmission of SARS-CoV-2, the virus that causes Covid-19, followed by community outbreaks.

The president has repeatedly held these gatherings not only in defiance of public health guidelines, but seemingly to spite them: downplaying the threat of the virus, eschewing basic public health principles such as wearing face coverings and packing his supporters shoulder to shoulder for political optics. Several early campaign events were indoors, such as in Tulsa, where there was a reported surge in cases afterwards. Former presidential candidate Herman Cain, who was co-chair of Black Voices for Trump and who attended the Tulsa rally without wearing a mask, tested positive for Covid-19 two days after the rally and died less than two weeks later.

Earlier this year, my colleague Usnish Majumdar joined a different kind of mass gathering: a Black Lives Matter protest in the streets of New York City with thousands of people. In stark contrast to the behavior encouraged at Trump’s rallies, protesters not only wore masks but often carried extra face coverings for themselves and others. These good-faith attempts to adhere to public health guidelines paid off. No surge in Covid-19 cases was observed following these protests.

Concerned about the impact of Trump’s campaign rallies, Majumdar and I compiled county-based data of new coronavirus cases from each of his general election campaign rallies between Tulsa in late June and Newport News in late September. We looked at case numbers for the 14 days before and after each event to see if any patterns of community outbreaks emerged. We chose 14 days to consider the longest incubation periods, given the median onset from exposure to time of symptoms for Covid-19 is about three to five days.

This may be an imperfect measurement. Some rally-goers travel to these events from other counties and go back home afterward, possibly contributing to community outbreaks elsewhere. And community outbreaks may, of course, be due to other events — correlation does not equal causation. But these data offer a metric to quantify the damage from a public health hazard. Any signal of community spread would likely originate closer to the epicenter of these events.

What we found was sobering yet not surprising. Spikes in Covid-19 cases occurred in seven of the 14 cities and townships where these rallies were held: Tulsa; Phoenix; Old Forge, Penn.; Bemidji, Minn.; Mankato, Minn.; Oshkosh, Wis.; and Weston, Wis.

Now, less than two weeks after his Covid-19 diagnosis, the president is again holding large campaign rallies. That’s a mistake if he cares about the health of his constituents, the well-being of our communities, and frontline health care workers. He should instead suspend campaign activities that promote transmission of Covid-19. He should listen to doctors, the same professionals who treated him when he fell ill, urging him not to endanger the public health.

Campaigning in a safe and responsible fashion is possible: Former Vice President Joe Biden has held small-scale events with masking and social distancing requirements strictly enforced, and is leaning heavily on virtual events. He was ridiculed by the president for his mask-wearing and modest event attendance (sometimes in purposefully near-empty rooms) as a source of weakness. As a health care professional, however, I see this commitment to safety as a display of compassion and strength.

While it’s too early to tell if there will be a surge in cases in Newport News, I worry that some of my patients might suffer collateral damage from attending a reckless campaign event. When the president promotes maskless mass gatherings during a pandemic, I worry that some of my patients might emulate this behavior, putting their lives — and the lives of those around them — at risk. How do I explain the terrible irony to my Covid-19 patients that we allow the president to put on gatherings of thousands of people in our communities, yet they must die alone without the comfort of their own families?

Zach Nayer is transitional-year resident at Riverside Regional Medical Center in Newport News, Va., and an incoming ophthalmology resident at Columbia University in New York. Usnish Majumdar, a fourth-year medical student at the Icahn School of Medicine and product manager for the Mount Sinai Health System in New York City, collaborated on the analyses.