Three days before President Trump’s first indoor campaign rally during the coronavirus pandemic — at an arena in Tulsa in June — the director of the Tulsa Health Department marveled at the wave of abuse that was cresting in his direction.

“It’s been crazy since the announcement of the presidential rally,” Bruce Dart wrote to Lori Freeman, a colleague who led an association of local public health officials. “It’s amazing how people strike out against anyone who they assume is not supportive of the president instead of listening to our messaging around staying safe in this pandemic.”

“You’re doing a fabulous job,” Freeman wrote back. “Be strong (as will I).”

With the novel coronavirus raging, Trump has now restarted campaign rallies, bringing fresh controversy to new communities. Earlier this month, thousands of people, many without masks, crowded into an indoor manufacturing facility in Nevada to hear the president speak, defying a state directive to limit gatherings to 50 people. Nevada Gov. Steve Sisolak (D) called Trump’s actions “shameful, dangerous, and irresponsible.” The director of the state’s coronavirus response predicted a spike in cases because of the campaign event.

Tulsa’s experiences before and after the Trump rally show the difficulty that many communities face in balancing the desire to protect residents from the pandemic while catering to a president and Republican Party that have consistently cast doubt on and flouted health recommendations. Dart, a medical doctor and public health expert who has spent his career working for local governments, was one of the few city officials who publicly warned of the danger of an indoor rally. Those warnings earned him angry emails from Trump supporters about his health recommendations as well as those who said he didn’t do enough to stop Trump’s rally, according to emails obtained by The Washington Post through an open-records request.

Dart has since said the rally, as well as large protests that weekend, probably led to some coronavirus infections but has avoided going into detail. Some attendees have tested positive, including several campaign staff members and Secret Service agents, as well as Oklahoma Gov. Kevin Stitt (R) and former presidential candidate and pizza executive Herman Cain, although it is not known where they contracted the virus. Cain later died of covid-19, the disease the coronavirus causes.

The rally was not just a health concern for Tulsa. The highly publicized event attracted about 10,000 attendees, according to an estimate by the Tulsa World, including many from surrounding states. There were also crowds of protesters in Tulsa at that time.

“Unfortunately, I think spread occurred elsewhere from being in Tulsa that weekend,” Dart said in an interview.

After the Tulsa event, which attracted a smaller crowd than the Trump campaign expected, the president stopped holding indoor rallies. His appearances have predominantly taken place virtually or at outdoor venues. But the event in Las Vegas raises the possibility that Trump will revive the indoor rallies that were a mainstay of his 2016 campaign — again putting pressure on state and local officials.

Trump has defended his choice to hold indoor gatherings, telling the Las Vegas Review-Journal last week: “I’m on a stage, and it’s very far away.”

In Tulsa, the criticism of Dart and the health department did not end when Trump flew home from his rally at the 19,000-seat BOK Center. Dart and his department have been buffeted by subsequent political battles over his department’s recommendation that masks be required in public and that schools start virtually instead of in person.

“Wearing masks is harmful!” one resident wrote to Dart on July 14. “Why are you hell bent on forcing Tulsans to muzzle up?! We are not your serfs or guinea pigs!”

Dart has received threatening calls and emails from residents who “have not been pleased with the recommendations made by the health department,” said Reggie Ivey, the department’s chief operating officer.

Dart filed a police report about the threats, and the department reviewed security protocols, but no arrests were made, a health department spokesperson said.

“Unfortunately, during covid, I think we’ve seen the best of human nature, and we’ve seen the worst of human nature,” Dart said.

Distrust and anger toward local public health officials has sprung up in jurisdictions nationwide, including in many conservative areas. For a profession long seen as providing important if unglamorous work — restaurant inspections, immunizations — the scrutiny has added another layer of pressure on top of grueling hours and staffs stretched thin by the pandemic.

“This is a brutal time for them,” said Freeman, the chief executive of the National Association of County and City Health Officials. “They’ve always been so trusted in their community. And now so much of their advice is not trusted or [is] ignored.”

Freeman keeps a database of the more than 50 public health officials nationwide who have resigned, been fired or faced threats and intimidation because of their work during the pandemic.

Protesters, including militia-style groups, have held rallies in opposition to stay-at-home orders and business closures. Early in the pandemic, the top public health official in Georgia was given an armed guard after threats were made against her. One health director in rural Colorado has had her car vandalized twice since the pandemic began, the Colorado Sun reported.

“I’ve never seen this rapid loss of experienced expertise, leadership, at a time that we need it most, in the thick of a worldwide pandemic,” Freeman said. “It’s very demoralizing.”

In the days ahead of Trump’s June 20 rally, increasingly agitated emails poured into Dart’s inbox from people who said he should cancel Trump’s event. If he didn’t, many said, he would have blood on his hands.

“Do you want this on your conscience the rest of your life,” one person wrote to Dart the day before the rally. “Just for a job?” A doctor from Long Island, N.Y., wrote that Dart had a “moral responsibility” to demand that the mayor cancel the event or he would be “complicit.”

“This is truly a matter of life and death for many people,” wrote one person who described herself as a Tulsa resident for more than 65 years. “The thought of our community being used as a guinea pig experiment is very disheartening.”

Not everyone was worried. One Tulsa County resident wrote to warn Dart not to insert himself in politics: “Trump supporters pay your salary just as much, if not more, than Trump haters.”

At the time of the rally, Tulsa Mayor G.T. Bynum, a Republican, chose to let Trump proceed even though coronavirus cases had been spiking in the weeks leading up to the event and despite Dart’s recommendation that it be postponed until a safer time. At a news conference before the event, Bynum described the issue as out of his hands, saying that the venue manager had “sole discretion” on whether to hold the event and that “it’s not my decision to make.”

Bynum did not respond to a request for comment.

In July, while discussing a measure to require future large gatherings to have a coronavirus safety plan approved by the health department, Bynum suggested that he wouldn’t want a repeat of Trump’s rally.

“Am trying to avoid a future situation in which, just to pull an example out of the air, the BOK Center books a rally for 19,000 people without a requirement for a safety plan being on the books as a local regulation,” Bynum wrote to Dart and other health department officials in July.

Dart’s email correspondence also shows that ASM Global, the company that manages the BOK Center arena, did have a plan to keep attendees a safe distance apart. In addition to having 400 hand sanitizer stations, 47,800 gloves, and 34,960 disinfectant wipes, the plan submitted to the health department before the rally said the venue would “decommission every other fixed seat to limit seating capacity,” in the arena’s interior bowl. On the day of the event, members of Trump’s campaign removed thousands of “Do not sit here, please” stickers, and the crowd sat shoulder to shoulder.

“I support your efforts to recommend additional public safety requirements for events within the BOK Center facility,” Dart wrote to the arena management after reviewing the safety plan. “From a public health perspective, I have shared my concerns about the inherent risks of all large gatherings at this time.”

In July, Bynum, on Dart’s recommendation, proposed an ordinance requiring adults to wear masks in public places. Dart had earlier expressed that such ordinances are a tough sell to the public — and that Trump was one reason.

“It’s going to be hard to require masks in Oklahoma as political as the issue is with the president and governor refusing to wear masks,” he wrote to Dale Bratzler, a medical doctor who is the chief coronavirus officer at the University of Oklahoma.

The city council ultimately voted 7-to-2 to approve the ordinance.

George Monks, president of the Oklahoma State Health Association, credited Dart and the health department with “brave leadership through a really challenging time,” adding that “there’s a lot of misinformation and fear.” Mask ordinances have saved lives and allowed businesses to stay open, he said.

Although no known coronavirus cases have been definitively linked to the rally, cases spread in Tulsa at a greater rate after the event. The seven-day rolling average, which stood at 112.1 cases on the day of the rally, peaked at 253.9 cases by July 29, before declining to 129 cases as of Sept. 17, the most recent data available from the Tulsa Health Department. Tulsa has had 152 deaths related to covid-19, more than double the number when Trump held his event.

Although the health department does contact tracing on all coronavirus cases in the county, including those linked to the Trump rally, it does not make public those findings because it is often hard to isolate where a person contracted the virus, department officials said.

“The bottom line — and this continues, it was true then, and it continues to be true — when people come together in large groups, transmission occurs,” Dart added. “It’s best not to have large gatherings.”