Whenever public health experts warn about the dangers of President Trump’s large political rallies, we are accused of hypocrisy: How come we condone Black Lives Matters protests but call out these rallies as potential superspreader events?

I understand where the criticism comes from. Both events can bring together many thousands, if not tens of thousands, of people. There’s limited physical distancing, with individuals often packed shoulder to shoulder for prolonged periods. There is the kind of chanting and shouting that causes attendees to expel aerosols and potentially transmit the coronavirus. In both settings, individuals come from other cities and states; if they are infected, they can seed the virus when they return to their communities.

But there is one key difference between social justice protests and Trump rallies: Those attending BLM protests by and large grasp the danger and are motivated to reduce their risk, while a large share of those attending Trump rallies deny that there is a danger at all.

I had a patient, a woman in her 60s with chronic medical conditions, who told me she followed covid-19 precautions to the point that she only left her house once a day to take a walk. She had all of her groceries delivered, and she didn’t even see her grandchildren because they attended day care. Yet she felt strongly that she needed take part in an anti-racism protest. She’d lost family members to police brutality, and she was willing to risk her life to show her commitment to the movement.

As her doctor, I couldn’t recommend that she participate in an activity that could compromise her health. But since she was going no matter what, it was my job to help her stay as safe as possible.

This is the public health concept of harm reduction. Protesting involves risk, but she could still substantially reduce that risk by being outdoors, wearing a mask, avoiding dense crowds, limiting her time there and not using public transportation. My patient chose a protest within walking distance of her house. She made sure to stay at the outer edge of the crowd, where she was able to maintain a six-foot distance from others most of the time.

These harm-reduction opportunities continue after an event ends and participants return to their homes. My patient lived alone, but at her protest, those who live with others were instructed to self-quarantine for at least five days and then get tested. During the protests, organizers followed public health guidance to educate participants about how to protect themselves and others. Many cities have helped by offering free testing for protesters.

Not everyone follows every guideline, of course, but overall, such harm-reduction practices appear to have worked. A research paper published by the National Bureau of Economic Research examined patterns of spread in more than 300 major cities and found “no evidence that net covid-19 case growth differentially rose following the onset of Black Lives Matter protests.”

Where are the harm-reduction practices at Trump’s rallies? The most recent events, in Nevada and Arizona, have been held indoors. Compared with those outdoors, indoor gatherings could increase the risk of transmission by 18 to 19 times. Many attendees appeared to not wear masks. Some rallygoers in Michigan called covid-19 a “fake pandemic” and spoke about mask-wearing as an infringement on their rights. Trump himself was not wearing a mask at the rallies. He used his platform to mock public health practices.

It seems reasonable, then, to worry that many attendees engage in other risky behaviors, such as hugging and shaking hands. Do they participate in higher-transmission activities before and after rallies, such as going to tightly packed bars and indoor restaurants? When they return to home, do they ignore guidance to self-quarantine and get tested?

And that’s the key difference between social justice protests and Trump’s political rallies. This is what public health experts should counter with when we come under fire for appearing to support one cause over the other. It’s not our job to judge why people are at an event, but it is our duty to explain — based on science — what makes one event higher-risk than another.

To be clear, from an epidemiological perspective, there shouldn’t be any mass gatherings during a pandemic. But let’s not engage in false equivalencies. The reason Trump’s rallies are more dangerous than social justice protests has nothing to do with the purpose of the gatherings and everything to do with the behavior of organizers and participants.

The distinction is this: Are attendees going in spite of the risk or in defiance of it?

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