Despite a new wave of COVID-19 cases across the country, President Donald Trump continues to hold frequent in-person rallies that bring together thousands of people with little regard for social distancing. His political events in Washington, D.C., already contributed to an outbreak among his aides and throughout the White House. Local public health officials and other commentators, including CNN’s Sanjay Gupta, have expressed concern that Trump’s political rallies could be fueling community spread of COVID-19. Dr. Anthony Fauci said that Trump’s decision to hold rallies without social distancing was “asking for trouble.”
At least 26 individual COVID-19 cases have been linked to participation in Trump rallies since June. New analysis by the Center for American Progress finds that about half of the president’s 22 campaign rallies held between June and September were followed by a county-level increase in COVID-19 cases, suggesting the events may have led to community spread. The analysis also finds that counties that had a lower COVID-19 incidence—a measure of new cases per capita—prior to the rally were more likely to have a visible increase in cases after the rally, perhaps because any uptick in cases was more likely to stand out against the pre-event level.
This column discusses how rallies without proper pandemic precautions may be endangering host communities; examines the trends in county-level case counts for cities that hosted rallies; and highlights instances in which local officials have traced cases to participation at Trump events.
Half of Trump’s rallies were followed by an increase in cases in the county
Public health experts have voiced concern that Trump’s rallies pose a risk not only to participants themselves but also to others in the communities in which they are held. Due to concerns about COVID-19, the Trump team suspended rallies in March. It then held two indoor rallies in June and again halted in-person events as the United States approached its second peak of COVID-19 cases. Trump resumed rallies in mid-August, appearing at multiple large events per week. In total, Trump held nearly two dozen rallies between June and September.
Attendees at rallies—including those held in Pennsylvania, Florida, and North Carolina—tend not wear masks or socially distance, even after Trump himself contracted the virus. In addition, the majority of these events have been in violation of local or state restrictions on gatherings to limit the spread of COVID-19. Most Trump rallies during the pandemic have been outdoors in airplane hangars, which may have helped mitigate transmission relative to indoor settings.
To examine whether Trump’s rallies were associated with heightened cases, the authors used county-level data on COVID-19 positive cases from The New York Times. For each of the 22 rallies Trump held between June and September, the authors looked at a chart of daily new cases and the seven-day moving average of new cases during the 21 days before and after the rally. The full set of charts is available at the end of this column as an appendix.
In 11 instances, there was a post-event increase above the pre-event trend, with an increase defined as either new case counts rising up following a pre-event decrease or plateau or new case counts accelerating above a steady, pre-event increase. The authors found unambiguous increases after rallies in Mankato, Minnesota; Bemidji, Minnesota; Henderson, Nevada; Londonderry, New Hampshire; Swanton, Ohio; Middletown, Pennsylvania; Old Forge, Pennsylvania; and Newport News, Virginia. The increase in the county case count trend was more subtle after the rallies in Vandalia, Ohio; Latrobe, Pennsylvania; and Oshkosh, Wisconsin.
In the other 11 instances, the number of new cases in the local area appeared consistent with the pre-event trend or declined after the rally. This category included rallies in Phoenix, Arizona; Yuma, Arizona; Jacksonville, Florida; Freeland, Michigan; Duluth, Minnesota; Minden, Nevada; Fayetteville, North Carolina; Winston-Salem, North Carolina; Tulsa, Oklahoma; Pittsburgh, Pennsylvania; and Mosinee, Wisconsin. Although case counts soared in Mosinee after the rally, the sharp increase that occurred prior to the rally and the next day would have been due to infections prior to the event.
A post-event increase was more common in counties that started with lower levels of COVID-19. Splitting the 22 events in two groups based on their level of per capita new case incidence in the days up to and including the rally, the authors found that only 3 of the 11 communities (27 percent) with higher pre-event incidence (19 new cases per day per 100,000 population) saw an increase. Among the communities with lower pre-event incidence (5.8 new cases per day per 100,000 population), 8 of the 11 counties (73 percent) had an increase in new COVID-19 cases following a rally.
One reason for this difference may be that a case spike from a one-time event is more visible in areas with low-baseline incidence, while an outbreak in areas with higher incidence might not stand out against other variation in case counts. Another difference between the groups—which might make detecting an increase in spread more difficult in the high-incidence counties—was county size. Counties in the high-incidence group were larger, with an average population of nearly 1 million, compared with about 320,000 in the low-incidence group.
CAP’s findings are similar to those of other recent analyses of Trump rallies. One published in Stat that found “[s]pikes in Covid-19 cases occurred in seven of the 14 cities and townships where these rallies were held.” Separately, USA Today found that “COVID-19 cases grew at a faster rate than before after at least five” of Trump’s campaign rallies. While none of these analyses are causal, community-level rises in cases are not the only indication that rallies may spread COVID-19: Public health authorities have linked individual cases to Trump rallies through contact tracing.
More than two dozen COVID-19 cases linked to rally participation
In several communities, public health officials have linked COVID-19 cases to Trump rally attendance. At least 26 individual cases have been linked to Trump rallies held between the months of June and September, according to various news reports. In many of these cases, officials were unable to determine whether the case acquired the infection at a rally or was already positive for COVID-19 when they attended the event.
In addition, some local public health authorities have pointed to Trump rallies as a reason for an increase in community spread. Compared to the county-level data on COVID-19, some events with confirmed rally-linked cases were not followed by a clear increase in case counts. Conversely, for some instances where cases rose dramatically after an event the authors did not find news reports about cases among rally participants.
The following Trump rallies have been tied to individual cases of COVID-19 among staff or participants:
- Tulsa, Oklahoma (June 20): Two Trump campaign staff and one journalist who attended the indoor event tested positive, as did multiple campaign staff who were not present for the rally itself. Former Republican presidential candidate Herman Cain was in attendance; he tested positive for the virus nine days later and was hospitalized. He died from COVID-19 on July 30. Tulsa City health officials say the rally “more than likely” contributed to a case spike in the area 2 to 3 weeks later, although data for Tulsa County show that case counts were increasing beforehand and leveled off after.
- Oshkosh, Wisconsin (August 17): One attendee of the rally tested positive, but that individual had also attended other events.
- Freeland, Michigan (September 10): The Michigan health department said one attendee of the Freeland rally tested positive for COVID-19 but was unaware of any associated “outbreak.”
- Minden (September 12) and Henderson, Nevada (September 13): A Nevada official said in late September that one COVID-19 case reported a “connection to a political rally.” The rally in Henderson was inside an industrial warehouse and had more than 5,000 attendees, violating the Nevada’s ban on gatherings of more than 50 people, as well as its mask mandate. The owner of the venue, Xtreme Manufacturing, was later fined $3,000 by the city of Henderson for the violation.
- Bemidji, Minnesota (September 18): Rally attendance was about 2,000 people, well over the state ban on outdoor gatherings of 250 people or more. Local officials linked 16 cases to the rally, including four among protesters. One case required hospitalization.
- Duluth, Minnesota (September 30): Three cases have been tied to the rally attended by thousands. The Duluth rally was one of several political events the president attended in-person between the White House ceremony for Supreme Court nominee Amy Coney Barrett—a super-spreader event—and his announcement of his positive test.
Despite sparse mask-wearing and lack of social distancing, other Trump campaign events have generated no reports of cases. For example, Virginia health officials have not linked any COVID-19 cases to the September 25 rally held in Newport News, even though the number of daily new cases had been falling in the city of Newport News before the rally and rose in the 21 days after. In New Jersey, Gov. Phil Murphy (D) said there are no known cases or outbreaks linked to Trump’s fundraiser in Bedminster, which Trump and his staff held the day the president announced his positive test.
The full extent of COVID-19 spread from rallies is unknown
While data suggest that the Trump rallies are often followed by increased community spread of the coronavirus, multiple factors prevent a definitive, causal connection. First, cases may have risen for reasons independent of the political events. For example, Tulsa was already emerging as a regional hotspot for the virus prior to the Trump event. In addition, many of the late summer rallies coincide with other factors driving up cases, including school reopenings, the cooler weather sending people indoors, and “pandemic fatigue” with social distancing and other precautions.
Second, the lack of effective contact tracing in much of the country hampers linkages between individual cases and the source of infection. When contact tracers lack information on whom positive cases have interacted with and when, it is difficult, if not impossible, to determine how they may have contracted the virus and how it spread. A prominent example of this challenge was the outbreak in the White House, in which Trump administration officials declined to fully cooperate with contact tracers from the District of Columbia Department of Health and the federal Centers for Disease Control and Prevention.
Third, the authors examined case counts but did not have county-level data on testing or positive test rates. It could be that in the days after a rally, as after other mass gatherings, residents in the community are more likely to get tested for COVID-19 at the urging of state and local governments, which enables the detection of more cases than would otherwise be found.
Lastly, one factor that could prevent a stronger association between rallies and cases is that the authors examined only the county in which the rally took place. Events featuring the president likely attracted participants across multiple counties in each region. If the coronavirus was transmitted at an event, cases would be dispersed back to attendees’ home counties in the days following.
The Trump administration has flouted public health guidance throughout the pandemic, and the president’s choice to continue holding large rallies is no exception. Trump’s political events have regularly violated state and local restrictions on gatherings. Both his White House and his campaign have fostered a culture that discourages commonsense mask-wearing and social distancing. By downplaying the severity and contagiousness of the virus—even after being hospitalized with the virus himself—and gathering tightly packed crowds in the nation’s COVID-19 hot spots, Trump jeopardizes the health of the very people who turn out to support him.
Thomas Waldrop is a policy analyst for Health Policy at the Center for American Progress. Emily Gee is the health economist for Health Policy at the Center.