A massive motorcycle rally rumbles into South Dakota. Attendees should stay outside, health experts say.

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Bikers and motorcycle enthusiasts have descended on South Dakota's Black Hills for the annual Sturgis Motorcycle Rally, again raising concerns that COVID-19 will rapidly spread among the hundreds-of-thousands expected at the event.

Last year's rally drew widespread criticism, as maskless attendees gathered en masse, even as most in-person events were canceled around the country. This year, vaccines have made more gatherings possible — but Sturgis still stands out.

Some recent large-scale events, including the music festival Lollapalooza, have required attendees to show proof of vaccination or a negative COVID-19 test and to wear a mask. Because the nation is currently battling growing cases as the highly transmissible delta variant circulates, even those precautions have been called insufficient.

But health precautions at Sturgis are optional.

Sturgis officials said the rally offers attendees access to coronavirus tests, face masks and hand sanitizer stations, in addition to doses of the Johnson & Johnson COVID-19 vaccine, according to The New York Times. And the city has also allowed rallygoers to drink on public property, with the hope of preventing indoor crowding.

More: Lollapalooza a 'recipe for disaster,' experts warn. Should more music festivals be canceled amid COVID-19?

There are no testing or vaccine requirements to attend.

Jody Perewitz, the rally's ceremonial grand marshal, said she was “ecstatic" to see how many people came for the opening ceremony on Friday. Motorcycles stretched for blocks as crowds strolled Main Street, the heart of the rally.

Some experts say it's a recipe for a super-spreader event. Last year's was traced to 649 virus cases across the country, but some estimates are far higher. In Minnesota, 86 COVID-19 cases were detected in the state, resulting in four hospitalizations and one death, and linked to the rally, according to a report published by the Centers for Disease Control and Prevention in November 2020.

Michael T. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said this year's Sturgis rally could result in a fresh wave of infections.

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“People often associate with Sturgis being outdoors on the bike,” Osterholm told CNN. “That makes it hard to imagine why there would be an increased risk of potential COVID transmission, but it's what is done in Sturgis – it's indoors, in the bars, it's in the tattoo parlors. It's in all the inside activities that really put people at increased risk.”

Motorcycles fill the streets of Sturgis, S.D. on Friday, Aug. 6, 2021 as the Sturgis Motorcycle Rally began.
Motorcycles fill the streets of Sturgis, S.D. on Friday, Aug. 6, 2021 as the Sturgis Motorcycle Rally began.

Stefan Baral, a physician epidemiologist and associate professor from the Johns Hopkins School of Public Health, said while there's an overall lower risk of COVID-19 infection at this year's rally, due mainly to the public's access to vaccinations and coronavirus testing, the risk goes up as people head indoors.

“There’ll be lots of people there that only engage in the outdoor activities, which I think are probably very low-risk,” Baral told USA TODAY. “And then there’ll be lots of folks that engage in indoor activities, including in bars and in people’s homes and those things, which probably are likely (to) have higher risks of transmission associated with them.”

The Sturgis Motorcycle Rally has a solid track record when it comes to large turnouts. Average rally attendance each year has totaled about 485,000 rallygoers for the past two decades. Despite the social limitations of the coronavirus pandemic, last year’s rally brought in roughly 460,000 attendees. 700,000 people are expected to attend this year’s rally – the 81st iteration of the event.

“The rally is a behemoth, and you cannot stop it,” Carol Fellner, a local who worried that this year's event would cause a fresh outbreak of cases, said. “I feel absolutely powerless.”

Republican Gov. Kristi Noem has given the rally her blessing and will appear in a charity ride. The event is a boon for tourism, powering over $800 million in sales, according to the state Department of Tourism.

The state's Department of Health said the rally can be conducted safely.

“Anytime you have a large group of people come together there are risks, but with the proper precautions and mitigation practices, it can be done safely,” Daniel Bucheli, director of communications at the South Dakota Department of Health, wrote in an email to USA TODAY.

Despite the growing threat of the highly contagious delta variant, which now accounts for more than 93% of COVID-19 cases in the U.S., Bucheli said recent advances in public health knowledge separate this year's gathering from last year's.

“We’ve come a long way since this time last year in what we know about COVID-19, with widely available testing and COVID-19 vaccines available to the public,” Bucheli said. “We encourage all those attending to continue observing mitigation risk strategies and make the choice to get vaccinated to protect themselves and others.”

More: South Dakota dismisses 'elite class of so-called experts,' carries on with state fair after Sturgis rally fueled COVID-19 surge

Only about 46% of adults in the county that hosts Sturgis are fully vaccinated, according to the CDC, compared with 60.6% nationwide. Vaccination rates were similarly low in the five counties where most 2020 rallygoers hailed from, according to an analysis of cellphone data from the Center for New Data.

This summer's Sturgis rally takes place against a backdrop of summer blowouts in the U.S., as large gatherings – state fairs, music festivals and conventions – begin to make a comeback. Many have left a trail of infections in their wake.

A small COVID-19 cluster emerged from the Southern Baptist Convention in Nashville, Tennessee, which drew more than 15,000 attendees in June. Wisconsin health officials said nearly 500 coronavirus cases may be linked to crowds that attended Milwaukee Bucks games or gathered outside the NBA team’s arena.

“I understand how people want to move on from this pandemic — God knows I want to — but the reality is you can’t ignore it,” Osterholm said. "You can’t just tell the virus you’re done with it.”

Baral said the Sturgis rally offers "an incredible opportunity" to target and reach people who may have previously been vaccine hesitant, potentially creating "ambassador[s] of vaccination" when these individuals return to their respective communities after the event.

“To me, Sturgis represents an amazing opportunity because you have a lot of folks getting together that may not have, in their own settings, ever thought about vaccination,” Baral said. “And here you can really think about creative ways and fun ways and engaging and empowering ways, using local champions and whatnot, to encourage vaccination.”

The Sturgis Motorcycle Rally runs through Aug. 15 and will also feature musical performances from artists such as Kid Rock, Stone Temple Pilots and ZZ Top.

Contributing: Stephen Groves, The Associated Press; Joe Sneve, Argus Leader

This article originally appeared on USA TODAY: Sturgis Motorcycle Rally 2021: South Dakota event raises COVID fears