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  • Updated

Reed Anfinson with a copy of his Swift County Monitor-News (Associated Press photo by David Goldman)

The headline in the Swift County Monitor-News was perhaps alarming, but nothing unusual in a global pandemic: “Covid-19 cases straining rural clinics, hospitals, staff,” over a story in which health officials urged residents of the western Minnesota county, pop. 9,838, to protect themselves by getting vaccinated.

"But ask around Benson, stroll its three-block business district, and some would tell a different story,"


Tim Sullivan of The Associated Press. The 136-year-old weekly "is not telling the truth," they say. "The vaccine is untested, they say, dangerous. And some will go further: People, they’ll tell you, are being killed by Covid-19 vaccinations."

"One little town. Three thousand people. Two starkly different realities," Sullivan writes. "It’s another measure of how, in an America increasingly split by warring visions of itself, division doesn’t just play out on cable television, or in mayhem at the U.S. Capitol. It has seeped into the American fabric, all the way to Benson’s 12th Street, where two neighbors -- each in his own well-kept, century-old home -- can live in different worlds."

Sullivan continues, "In one house is Reed Anfinson, publisher, editor, photographer and reporter for the Monitor-News. Most weeks, he writes every story on the paper’s front page. He wrote that story on clinics struggling with Covid-19. He’s not the most popular man in the county. Lots of people disagree with his politics. He deals with the occasional veiled threat. Sometimes, he grudgingly worries about his safety. While his editorials lean left, he works hard to report the news straight. But in an America of competing visions, some here say he has taken sides."

One of Anfinson's neighbors (they still watch each other's homes when one's away) Lutheran Church pastor Jason Wolter, "who reads widely and measures his words carefully. He also suspects Democrats are using the coronavirus pandemic as a political tool, doubts President Joe Biden was legitimately elected and is certain that Covid-19 vaccines kill people. He hasn’t seen the death certificates and hasn’t contacted health authorities, but he’s sure the vaccine deaths occurred: 'I just know that I’m doing their funerals.' He’s also certain that information 'will never make it into the newspaper.'"

Anfinson, 67, told Sullivan, “The easy part is speaking truth to power. The hard part is speaking truth to your community. That can cost you advertisers. That can cost you subscribers.” The paper's circulation is 2,000.  He told Sullivan that he won’t consider following the example of some other rural publishers who have cut back on opinion pages or even eliminated them.

"He says it’s his duty to expose people to new ideas, even unpopular ideas like stricter gun control. The editorial page is, he says .the soul of a newspaper in a way. . . . I would be a traitor to the cause of journalism, of community newspapers. I would be cowardly.”

Sullivan's story is not just about a courageous rural newspaper, but about the fact that national politics are causing local divisions. But it's mainly about Reed Anfinson, and concludes with his wife Shelly, "a pro-life Republican who voted for Trump, at least the first time. It annoys her when news outlets talk down to conservatives. She worries that there are too few Republican journalists. . . . She is often torn between support for Reed and worries over subscriber loss. Still, she’s been pressing him to tone down the politics."

“It is a struggle,” she said. “I can tell these things to my business partner. It’s harder to tell them to my husband.”

Anfinson "mourns how some people see him as an enemy," Sullivan reports. "His newspaper should bind people together, he says. Instead, America and Benson are growing angrier. Contentious midterm elections loom."

“It’s kind of sad,” he told Sullivan. “But it would be foolish of me not to be aware of (my safety) with the sentiments out there.” Asked if he carries a weapon, he said he doesn't: “But I know where one is if I need it.”

Chart from; click on it to elnarge.

"With another coronavirus variant racing across the U.S., once again health authorities are urging people to mask up indoors. Yes, you’ve heard it all before," Maria Godoy reports for NPR. "But given how contagious Omicron is, experts say, it’s seriously time to upgrade to an N95 or similar high-filtration respirator when you’re in public indoor spaces.

“Cloth masks are not going to cut it with omicron,”

Linsey Marr

, a researcher at Virginia Tech who studies how viruses transmit in the air, told NPR.

Omicron "spreads at least three times faster than Delta," Godoy notes. "One person is infecting at least three others at a time on average, based on data from other countries."

Robert Wachter

, chair of the medicine at the University of California, San Francisco, told Godoy, “The kind of encounter that you could have had with prior versions of the virus that would have left you uninfected, there’s now a good chance you will get infected from it.”

Early research at the University of Hong Kong shows "Omicron

multiplies 70 times faster

inside human respiratory tract tissue than the delta variant does," NPR reports. "That study also found that Omicron reaches higher levels in respiratory tract tissue 48 hours after infection, compared with Delta."

Marr said, “That would suggest to me that maybe it reaches higher levels and then we spew out more [virus particles] if we’re infected,” Also, Omicron may be so contagious that it takes fewer viral particles to create an infection.

Also, "Virus particles from an infectious person can linger in the air indoors for minutes or even hours after they leave a room in some situations, says

Dr. Abraar Karan

, an infectious disease physician at Stanford University," Godoy reports.  Karan told her, “I think that people need to realize that transmission here can happen even when you’re not near somebody.”

Godoy says, "Given all this, you want a mask that means business when it comes to blocking viral particles. Unlike cloth masks, N95, KN95 and


respirators are all made out of material with an electrostatic charge." That “pulls these particles in as they’re floating around and prevents you from inhaling those particles,” Karan told her. “And that really is key.”

Surgical masks also have an electrostatic charge, but they tend to fit loosely, "A snug fit — with no gaps around nose, cheeks or chin — 'really makes a big difference,' says Marr, who has studied mask efficacy," Godoy reports.

"KN95s tend to be a bit more comfortable than N95s, but counterfeits continue to be a problem. For safer shopping, check out a site like

Project N95

, a nonprofit that helps consumers find legitimate personal protective equipment. Or check the CDC’s site for advice on

how to spot a counterfeit

and a list of

trusted sources for surgical N95s

. For maximum protection, make sure your N95 fits snugly as well, creating a seal around your mouth and nose. The CDC explains

what makes a good fit

and how to test that

yours is sealing well.


  • Updated

Rural Virginia couple Everett and Kristin Jiles got Covid-19 in July, but only she was vaccinated. After he had a much harder time recovering, the conservative Christian couple became crusaders for vaccination. Here, they talk about their story. (Assn. of American Medical Colleges video)

"Many people in rural and conservative areas remain frustratingly resistant to vaccination, challenging public health officials to come up with more convincing — and sensitive — approaches to promoting greater vaccine uptake," Beth Howard


for the Association of American Medical Colleges. "It’s not enough to refute misinformation, experts say. To reach the vaccine-hesitant, public-health officials urge a combination of approaches, from connecting with local physicians to having respectful conversations."

The problem is persistent. A recent University of Pittsburgh study shows that, although overall vaccine confidence rates have increased nationwide since Covid-19 vaccines became available early this year, the same percentage of people who strongly opposed vaccination in January felt the same way in May. Even after adjusting for factors like age, sex, race, employment status and education, people in very rural counties were 23 percent more likely to be vaccine-hesitant than urbanites.

Partisanship is also strongly correlated with attitudes toward coronavirus vaccination. "People in counties with the highest support for former President Donald Trump in the 2020 presidential election were 44% more likely to be vaccine-hesitant," Howard reports. "Those living in a state with a Republican governor were 34% more likely to be hesitant than people living in a state with a Democratic governor."

Rural emergency medicine doctor Edwin Leap, who grew up in West Virginia, told Howard that the pandemic has exposed cultural rifts that go back generations. Because of that, mandates won't work, he said: "People in rural America are a culture. They tend to be fiercely independent. . . . The very last way you’ll get them to comply is by telling them they better do what’s right. They’re not going to have you tell them what to do."

Health and communications experts suggest the following approaches to increase coronavirus vaccination rates in rural areas:
  • Just provide the facts. Rural Americans resist mandates because they want to make their own decisions. So providing unbiased, basic information that will help them make an informed decision is the way to go.
  • Leave politics at the door. The coronavirus has been deeply politicized, so it's important to avoid saying anything even remotely political in discussion vaccination. One expert told Howard that, if the subject of politics comes up, the best way to respond is something along the lines of "This virus does not care who you are or what you believe." That removes the discussion from politics and enables you to address the other person's concerns.
  • Team up with community influencers. Rural Americans trust local health-care professionals much more than outsiders, so they're more likely to listen to fact-based vaccine recommendations from a community doctor, nurse, pharmacist or community health worker.
  • Don't refute false claims about the vaccines. By bringing up misinformation, even if you do so to disprove it, you end up reinforcing the belief in the person's mind. So don't repeat falsehoods when providing vaccine information. "For instance, if someone says that vaccines give you Covid-19, you don’t have to say they don’t give you Covid-19," Howard reports. "Instead, provide an answer that addresses the vaccine’s overall safety — why and how they’re safe."
  • Treat people with care and respect. Regardless of what someone believes, take their concerns seriously and treat them with respect. Don't talk down to people or make them feel judged or shamed.
  • Be prepared to play the long game. It will likely take more than one conversation to change someone's mind about vaccination. When you're wrapping up a discussion about vaccination, "give them a call to action, such as offering additional resources to learn about the efficacy of the vaccine and inviting them to come back and talk about it more so that you can answer any other questions," Howard reports.

  • Updated

On Monday, Dec. 6, The Rural Blog excerpted an NPR story headlined, "

A county's vote for Trump is predictive of its Covid-19 vaccination rate, and more generally of its death rate

." It was accompanied by two plotter charts on which the vaccination and death rate of each county were on the vertical axis and its percentage of vote for Trump on the horizontal axis. We used one county as an example, to show how local news media could give their audiences a sense of their place in the phenomenon.

The U.S. has 3,243 counties and county equivalents, so the dots on that pair of plotter charts are two fuzzy clouds, not clear trend patterns. Readers, especially rural ones, want to know how their county relates to other counties in their state, especially those close to them. We now know that is possible, through state-by-state graphs created by web designer Charles Gaba, who put them into the public domain by publishing them on Twitter; here are the vaccination graphs.; here are the death graphs.

Above and below are two examples. In those giving data for states with lots of counties, such as Kentucky (below), some counties may be difficult to discern. But counties' data are easily available. To enlarge or download either image, click on it.

  • Updated

Screenshot of interactive plotter graphs shows how a higher vote for Donald Trump in 2020 correlates with a lower Covid-19 vaccination rate (left) and a higher Covid-19 death rate. In this example, Jackson County, Kentucky, which went 89% for Trump, follows trendlines created by the averages. For a larger image, click on it; for the interactive database, click here.

"Since May 2021, people living in counties that voted heavily for Donald Trump during the last presidential election have been nearly three times as likely to die from Covid-19 as those who live in areas that went for now-President Biden," Daniel Wood and Geoff Brumfiel report for NPR

Overall Covid-19 death rates were 2.7 times higher in counties where at least 60% of the votes went for Trump, and the higher the vote share for Trump, the higher the Covid death count. Recently, Covid-related deaths in the reddest counties were 5.5 times higher than the bluest counties, Wood and Brumfiel report. The data start in May since that's when vaccinations became widely available. 

"The trend was robust, even when controlling for age, which is the primary demographic risk," NPR reports. "The data also reveal a major contributing factor to the death-rate difference: The higher the vote share for Trump, the lower the vaccination rate. The analysis only looked at the geographic location of Covid-19 deaths. The exact political views of each person taken by the disease remains unknowable. But the strength of the association, combined with polling information about vaccination, strongly suggests that Republicans are being disproportionately affected."

Republicans are the largest demographic group of unvaccinated Americans, and Kaiser Family Foundation polling shows that they're highly likely to mistrust official information sources and be exposed to misinformation. Foundation Vice President Liz Hamel said political affiliation is now the strongest indicator of vaccination: "If I wanted to guess if somebody was vaccinated or not and I could only know one thing about them, I would probably ask what their party affiliation is."

"It was not always this way," NPR reports. "Earlier in the pandemic, many different groups expressed hesitancy toward getting vaccinated. African Americans, younger Americans and rural Americans all had significant portions of their demographic that resisted vaccination. But over time, the vaccination rates in those demographics have risen, while the rate of Republican vaccination . . . has flatlined at just 59%, according to the latest numbers from Kaiser . . . 91% of Democrats are vaccinated."

  • Updated

New coronavirus infections, in ranges by county, Oct. 17-23
Map by The Daily Yonder; click the image to enlarge it or click here for the interactive version.

New coronavirus infections in rural counties continued declining during the week of Oct. 17-23, but Covid-19 deaths rose nearly 20 percent. The rural new-infection rate was still 78% higher than the metro rate, and the weekly death rate was 120% higher. "Rural counties reported nearly 30% of the Covid-related deaths in the United States, even though they constitute only 14% of the U.S. population," Tim Murphy and Tim Marema


for The Daily Yonder.

Rural counties saw 2,980 new Covid-19-related deaths, compared to metro counties' 8,302, Murphy and Marema report. The five states with the highest numbers of rural new infection were, in descending order, Ohio, Michigan, Wisconsin, Pennsylvania, and Kentucky. The five states with the highest rural new infection rates were, in descending order, Alaska, Wyoming, Montana, North Dakota, and Idaho.

Click here for more charts, regional analysis, and county-level interactive maps from the Yonder.

  • Updated

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

Though health officials have warned the public that ivermectin doesn't treat Covid-19, many are still taking the anti-parasitic, and reports of ivermectin poisoning are on the rise. Read more here.

Coronavirus-vaccine injury claims are mounting, but there is little meaningful legal recourse for those who say they've been harmed. "More than 1,300 Covid vaccine-related injury claims are now pending before an obscure government tribunal, which to date has decided only two such cases, one involving swelling of the tongue and throat following the jab, the other alleging long-lasting, severe shoulder pain," Jenna Greene reports for Reuters. "In both instances, the government, which requires claimants to prove their injuries are “the direct result” of a Covid-19 vaccine, denied compensation. It’s a steep burden of proof. Lawyers tell me the vaccine is so new that there’s virtually no definitive research on injury causation to cite."

Thousands of workers are opting to get fired rather than get vaccinated.

Read more here


Some epidemiologists say the novel coronavirus is here to stay; much like the influenza virus, it will mutate and continue to infect people. But they note that the coronavirus is not the same thing as Covid-19: Covid-19 is the disease some people develop after being infected with the coronavirus, much like HIV sometimes evolves into AIDS. So, though the coronavirus will likely be around for a long time, the extreme illness associated with it won't be, as long as people stay up on their vaccinations. Read more here.

A recent poll found that nearly 40% of rural Iowans surveyed are struggling with mental health amid the pandemic. The findings are likely true elsewhere. Read more here.

Emergency rooms are now swamped with seriously ill patients, often those whose chronic conditions have become more serious after months of treatment delays. That's straining capacity at hospitals already inundated with Covid-19 patients. Read more here.

  • Updated

A nurse in a Louisiana Covid ward (AP photo by Gary Hebert)

Requiring all health-care workers to be vaccinated against the coronavirus could worsen chronic staffing shortages at rural hospitals, because rural areas have low vaccination rates and many health-care workers have yet to be vaccinated.

The latest look at this issue comes from Aallyah Wright of Stateline, who notes, "In the broadest sense, President Joe Biden’s vaccine requirement for the more than 17 million U.S. health care workers will alleviate the strain on all health centers and clinics by boosting the country’s overall vaccination rate. . . . But the story may be more complicated in rural America, where resistance to the vaccine remains strongest."

Wright quotes rural hospital leaders who worry that the mandate will make the labor shortage so bad in some hospitals that they will have to close. "Dr. Randy Tobler, CEO and director of women’s services at Scotland County Hospital in rural Memphis, Missouri, said his hospital will abide by Biden’s mandate, but some staff members have told him they will quit rather than get vaccinated."

Brock Slabach, chief operations officer for the National Rural Health Association, told Wright, “I've talked with administrators of hospitals that have estimated anywhere from 3 percent to as much as 20 percent of their workforce may have to quit their jobs if they're required to have the vaccine as a condition of their employment. In a rural hospital, that could be two, maybe three nurses, which could cripple their ability to meet the demands of patient care.”

The Centers for Medicare and Medicaid Services hasn’t said when workers will have to meet the requirement, and there are other reasons for uncertainty. "At least 22 states plus the District of Columbia announced that state health care workers—or, in some cases, all health care workers—would need to be vaccinated or regularly tested,

according to

the nonprofit National Academy for State Health Policy," Wright notes. "But six states—Arkansas, Georgia, Indiana, Montana, Tennessee and Texas—have approved laws or have executive orders from their governors prohibiting vaccine mandates as a condition for employment. Hospital leaders say the conflicting guidance makes it difficult to know how they should proceed, though experts assert that federal law

will supersede

any conflicting state law or executive order."

The uncertainty adds to the stress of the pandemic, now in its 20th month. Some hospitals have "cut back, delayed or eliminated services such as elective surgeries, labor and delivery, and other inpatient care," Wright notes. "Nurses and other health care employees have worked double shifts, and many rural hospitals have had to create makeshift intensive-care units."

  • Updated

Public-health agencies, especially in rural areas, have been chronically underfunded for years. A new data analysis reveals just how underfunded and understaffed such agencies are: State and local health departments nationwide need to add 80,000 full-time employees to reach adequate staffing levels, according to the analysis conducted by the nonprofit de Beaumont Foundation and the Public Health National Center for Innovations. That would be an increase of nearly 80 percent.

"Adding those employees would allow health departments nationwide to better deliver services like immunizations and preventive health measures—but not to prepare for or respond to emergencies, including outbreaks and pandemics," Kate Queram


for Route Fifty. "The analysis does not recommend hiring specific types of employees, nor does it estimate the cost of adding 80,000 positions—a scope that’s narrow by design, said Brian Castrucci, president and CEO of the de Beaumont Foundation, which advocates for public health. It’s meant simply to provide a snapshot of staffing levels at state and local health departments, similar to the

health professional shortage areas

identified by the federal Health Resources and Services Administration."

From 2008 to 2019, the number of full-time employees at local and county public-health departments fell by 16%, and state health agencies lost nearly 10% of employees from 2012 to 2019, according to nonprofit Trust for America's Health. "Federal funding for public health preparedness and response programs decreased by nearly $40 million between the 2019 to 2020 fiscal years, and overall funding for those programs has been cut in half over the past decade,"Queram reports. "Those cuts became particularly noticeable in the early months of 2020, following a year of continuous public health issues—including outbreaks of measles and hepatitis A, a mysterious vaping-related illness, prolonged debates about the effectiveness of vaccines and historically high levels of sexually transmitted infections—that were then overshadowed by an emerging pandemic of a then-unknown virus."

It could be difficult to hire more public health officials even if the funding is available; many workers have quit amid the stress of the pandemic compounded by public animosity toward coronavirus vaccination—especially in rural areas.

  • Updated

Pastor Lewis (Photo by Jessica Tezak for Kaiser Health News)

In rural Eastern Kentucky, keeping hospitals from being overwhelmed by Covid-19, the flu and other illnesses this winter may depend on rural churches helping vaccination campaigns, Sarah Varney


for Kaiser Health News.

Varney writes mainly from "Leslie County, in the foothills of the rugged Pine Mountain ridge that anchors the state's eastern coalfield," where "public health workers are trying to outsmart the fantastical tales spread on Facebook about the Covid-19 vaccines, while also helping residents overcome the everyday hurdles of financial hardship and isolation."

The region matches what national polls show tend to be the most adamant anti-vaccine part of the U.S. population, citing "tends to be disproportionately white, rural, evangelical Christian and politically conservative," The New York Times



"Local health agencies have been eager to enroll churches in the all-hands-on-deck vaccination effort," Varney reports. "Some church leaders have refrained from encouraging vaccination, afraid of offending congregants in a state where mistrust of government intrusion runs deep." But not Billy Joe Lewis, pastor of the Full Gospel Church of Jesus Christ on Cutshin Creek, which drains much of the county.

"We've still got to use common sense," Lewis told Varney. "Anything that can ward off suffering and death, I think, is a wonderful thing."

He has seen both. "In recent weeks, Lewis held a funeral service for a 53-year-old unvaccinated former coal miner, suspended Sunday services after more members fell ill and, with a heavy heart, canceled Homecoming — a cherished yearly gathering of area churches that marks the fall foliage with a celebration of the gospel and shared faith," Varney writes.

Another big obstacle to vaccination is "the specter of coercion" in a region "where government directives have been met with derision," Varney reports, quoting Louisa nursing-home owner David McKenzie: "We do not like to be shoved. We resent it, and we shove back."

"They're fearful of 'The Man'," McKenzie told Varney. "The Man could be your employer, it could be the government, it could be a newspaper reporter." And there's another kind of fear, Varney reports, paraphrasing and quoting McKenzie: "People who boasted about refusing the vaccines cannot change their minds, or 'They'll look like they're weak, or they caved to The Man'."

  • Updated

Stateline chart, based on Centers for Disease Control and Prevention data

Some states with large rural populations got off to a fast start getting their residents vaccinated, but recently "have hit a wall," reports Stateline, a service of the Pew Charitable Trusts.

"Those less populous states outhustled bigger ones using innovative distribution schemes such as flying vaccines on small airplanes to remote areas, tapping into existing rural health systems and eschewing the county-by-county model that slowed larger states’ distribution," Elaine Povich


., noting Alaska and West Virginia. "The plummet is a combination of the unsustainability of early distribution methods and less demand for vaccines among the remaining, largely rural population, experts say."

Jennifer Tolbert, state health reform director for the Kaiser Family Foundation, told Povich, “More recently, what you are coming up against are ideological issues in more conservative states. Vaccines are available, but absent mandates and requirements for people to get vaccinated, if there is hesitation or reluctance in large sectors of the population, the vaccines are going to plateau.”

William Galston, a senior governance-studies fellow at the Brookings Institution, a nonpartisan think tank, "noted that white people without a college degree, who generally make up more of the vaccine-resistant U.S. population, are a higher share of the rural population." He told Povich, “I won’t say demography is destiny, but when you are looking at vaccines, it’s way up there.”

The wall is also political. Several research reports have noted the negative correlation between states' vaccination rates and their percentage of vote for Donald Trump last year. Here's one graph, from The Washington Post:

  • Updated

University of Iowa College of Public Health graph, adapted by The Rural Blog

Rural deaths from Covid-19 have spiked to the point that the latest rural death rate is twice that of the overall rate in metropolitan areas,

according to a report

 from the Rural Policy Research Institute.

Fred Ullrich and Keith Mueller of the College of Public Health at the University of Iowa tracked Covid-19 mortality rates from the beginning of the pandemic and found that counties outside metro areas began showing higher rates in June, with a wider separation beginning in August.

Over the course of the pandemic, the non-metro mortality rate, 231 deaths per 100,000 residents, has been only moderately higher than the metro rate, 195 per 100,000, Ullrich and Miller report.

The researchers also tracked the rates in micropolitan areas, which are outside metros but have cities with populations between 10,000 and 50,000. Their death rates were usually about the same as those in rural areas until last month, when the rural rate clearly exceeded it.

Ullrich and Mueller's report also tracks the rate of new cases since the start of the pandemic. It shows that on Sept. 15, the seven-day average of new cases in metro areas was 43.3 per 100,000 residents, and in non-metro areas (rural and micropolitan) it was 66.8 per 100,000.

The overall non-metro vaccination rate is 41.4 percent, while the metro rate is 53.3%.

  • Updated

By Al Cross

Director, Institute for Rural Journalism and Community Issues, University of Kentucky

Millions of Americans say they have decided not to get vaccinated to protect themselves, their families and their neighbors from the coronavirus, but polling and anecdotal evidence show that some will change their minds. News media have a role to play in that, especially in rural America, where vaccination rates are lower than the rest of the nation, sometimes dangerously lower.

Few vaccine-hesitant or -resistant people are likely to be persuaded by a news story or editorial urging vaccination, but it's important to keep delivering facts about the vaccines, because social media are awash with misinformation about them. And there's another way to promote the shots: lead by example.

That's what Alan Gibson, editor and publisher of the Clinton County News in Albany, Kentucky, did this week. On the back page of the newspaper is a "house ad" telling readers that the paper's entire staff of five is vaccinated and urging readers to do likewise.

Gibson told me he got the idea from the Kentucky Chamber of Commerce's "

Covid Stops Here

" campaign, which provides signs that businesses can download and print to display their level of vaccination, and lets them post their logos to do likewise.

Gibson knew his staff was fully vaccinated. "I thought, we should promote this," he said. Why? "We're one of the hardest-hit counties in the nation but we're one of the slowest to get vaccinated." And he thought it would be better to persuade by example than to lecture: "Do as I do, you know? I'm tired of arguing with people, because the arguments aren’t valid." He said it's worth the effort "if just one or two people look at it and say, 'I need to go ahead and do this.'"

Clinton County (Wikipedia map)
Gibson could be called a beacon in a wilderness. Only two other newspapers have their logos posted on the Kentucky Chamber site, and they're in the state's most highly vaccinated counties: The State Journal of Frankfort, in Franklin County, and The Woodford Sun, in Versailles; 79% and 77% of the adjoining Bluegrass counties' vaccine-eligible residents, respectively, are fully vaccinated. In Clinton County, it's only 38%.

What are you doing to promote vaccination? In addition to editing and publishing The Rural Blog, I do likewise with Kentucky Health News, which sends a weekly update to Kentucky editors. A few weeks ago, I told them, "There is no more immediately pressing public interest in this country than persuading people to get vaccinated, and local medical professionals and news media are more trusted than those at state and national levels. Please do your part. It's a slog, but if the heroes of public health can do it, so can we."

The White House will tell federal agencies today to begin preparing to shut down, as prospects for an agreement in Congress to keep funding the government remain cloudy, The Washington Post


. A shutdown would have an impact on rural America, from Agriculture Department programs to national parks and most other federal functions, including response to the pandemic.

"Administration officials stress the request is in line with traditional procedures seven days ahead of a shutdown and not a commentary on the likelihood of a congressional deal," the Post reports. "Democrats and Republicans have made clear they intend to fund the government before its funding expires on Sept. 30, but time is running out and lawmakers are aiming to resolve an enormous set of tasks to in a matter of weeks."

Bill Hoagland, a senior vice president at the Bipartisan Policy Center and former Republican staff director for the Senate Budget Committee, warned that parts of the Centers for Disease Control and Prevention and the National Institutes of Health would close in a shutdown, the Post reports: "Hoagland said a very brief shutdown may occur but said he doubted it would go on for 'any length of time'." But he also said, “This would be the first shutdown during a declaration of national emergency. In the midst of an ongoing pandemic and non-resolved issues related to the delta virus, to have a shutdown of some of the major federal agencies would add unbelievable complications to our ability to recover.”

  • Updated

Rural residents who watched television news from stations in the top 25 TV markets last year were more likely to follow precautions against catching the coronavirus, 

a study


“For some rural residents, their local news often focuses on urban communities with issues quite different from their own,” wrote Eunji Kim, Michael Shepherd and Joshua Clinton in the Proceedings of the National Academy of Sciences.

To measure viewers' compliance with recommended precautions, they studied mobility data from Cuebiq in 771 rural counties in the first week of April 2020, when American were advised to stay home. They also surveyed 9,081 residents from 705 of the counties about their efforts to social distance, their media consumption, and their concerns about Covid-19.

They found that rural residents who watched local news from a top-25 market were more likely to social distance than those outside of a top-100 market. Rural residents in top-25 markets were also more likely to say they wore a mask outside during the period studied, and more likely to stay home, except for trips to buy food. However, political ideology was a stronger predictor of behavior.

  • Updated

Unvaccinated respondents were polled between June 9 and July 6, 2021. Covid States Project chart; click the image to enlarge it.

A new report from The Covid States Project examines reasons why people do or don't get coronavirus vaccinations, with a heavy emphasis on why unvaccinated people remain so.

From April through July, researchers surveyed nearly 21,000 people in all 50 states and Washington, D.C., collecting open-ended and multiple-choice responses. Though the polling doesn't differentiate rural/urban differences, rural residents are among the most likely to resist coronavirus vaccination.

Pollsters asked respondents why they would or wouldn't get vaccinated against the coronavirus. Among those who gave reasons why they wouldn't get vaccinated, the most common answer (35%) was "perception of risk," the belief that vaccines pose a health risk. Another 24% said they were uncertain about the risks of the vaccines, particularly because they are new, and the perception that they were developed too quickly and/or not tested enough. Some 15% said it was lack of trust in institutions (such as public-health agencies or news stories) that say the vaccines are safe, and 12% said they don't believe Covid-19 poses a major risk to them. Only 3% said life constraints (transportation or job difficulties) have kept them from being vaccinated, and 1% said it was a fear of needles. About 9% listed other reasons such as religious beliefs, constitutional rights, and general opposition to all vaccines.

Here are some of the report's other findings:
  • 67% of respondents said they had already had at least one vaccine dose, 15% said they were willing to get vaccinated, and 18% said they weren't willing to get vaccinated.
  • Lack of trust in institutions that oversee and vouch for vaccines' safety underlies many concerns about coronavirus vaccines.
  • Trust in institutions is strongly associated with vaccination at the individual and state levels.
  • Overall, 45% said in June that they trust the news media to do the right thing to best handle the current coronavirus outbreak. Only social-media companies, at 33%, scored lower. Hospitals and doctors were the most-trusted segment, at 92%. The pollsters did not ask respondents to specify what they meant by "news media" or to differentiate among different news sources.
  • 13% of vaccinated respondents said they trusted the news media "a lot" and 38% said "some".
  • 6% of unvaccinated respondents said they trusted the news media "a lot" and 24% said "some".
  • From April to June, trust levels for all institutions and people declined modestly.
The Covid States Project is a joint effort of Harvard, Northeastern, Northwestern, and Rutgers universities. It receives support from the National Science Foundation, the Knight Foundation, the Russell Sage Foundation, the Peter G. Peterson Foundation, and Amazon.

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"President Biden announced sweeping new coronavirus vaccine mandates Thursday designed to affect tens of millions of Americans, ordering all businesses with more than 100 employees to require their workers to be immunized or face weekly testing," The Washington Post


. "Biden also said that he would require most health-care facilities that accept Medicare or Medicaid funding to vaccinate their employees, which the White House believes will cover 50,000 locations." That includes outpatient facilities like dialysis clinics and home health agencies.

Biden will also require vaccinations—with no exceptions for regular testing among the unvaccinated—for employees of Head Start programs, Defense Department contractors, and federally operated Native American schools. "The White House estimates that the policy will affect about 80 million workers, or two-thirds of the country’s workforce. Businesses that ignore the mandate could face up to $14,000 per violation," the Post reports.

The new mandates will likely have a large impact in rural America, especially among large rural employers such as manufacturers, meatpackers, and Walmart, and hospitals. Rural health-care facilities are more likely to rely on Medicare and Medicaid for reimbursement, and many are already on the brink of bankruptcy. The new mandate will affect about one in three workers in Maine, the most rural state by population.

The announcement drew immediate criticism from many, including some Republican governors, The Associated Press reports. Wyoming Gov. Mark Gordon has asked his attorney general to fight the mandate when it is put into effect, and Missouri Gov. Mike Parson is considering a special legislative session to challenge the mandate. Biden called such governors "cavalier" with the health of children and of their communities for resisting the mandates.

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Pew Research Center chart; click on it to enlarge.

Social media is a notorious source of misinformation about the pandemic and vaccines. That adds significance to a new Pew Research Center survey showing that nearly 40 percent of Americans say social media is an important source for coronavirus vaccine news. Pew conducted the survey from July 26 to Aug. 8. Here's some of what they found:

  • Women and younger Americans are more likely than men and older Americans to say they get coronavirus vaccine news and information on social media; younger Americans and women are more likely to be on social media in the first place.
  • About half of the respondents said they get news and information about vaccines from social media: 30% said they get "some" and 18% said they get "a lot."
  • The other 51% say they've gotten little or no vaccine news or information from social media.
  • Though half the respondents get at least some vaccine news from social media, only a few (6%) believe it's the best way.
  • Another 33% said it's an important way, 29% said it's not an important way, and 31% said they don't get any vaccine news on social media.
  • Respondents who say social media is an important source of vaccine information are more likely to regularly rely on social media for news in general.
  • Only 4% of respondents said they regularly get general news from Snapchat, and 11% said the same about Instagram. But 85% of people who regularly get news from those platforms say they get a lot or some information about the vaccine there too.
  • 31% of respondents said they regularly get general news from Facebook, and 82% of that group say they're getting vaccine news there too.

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Cartoon by Nick Anderson
Demand is surging nationwide for ivermectin, an anti-parasitic drug typically used for livestock, based on unsubstantiated claims that it can help Covid-19 patients. How bad is it? A Las Vegas-area feed store is requiring customers to show a picture of themselves with their horse before they can buy it, and the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Institutes of Health have warned against using it to treat Covid-19.

This didn't start with ivermectin. It's largely a function of trust, or lack of it: in government, in science, and in the "elites" believed to control both. When Donald Trump, whom supporters saw as an outsider, cast doubt on top scientists from the beginning of the pandemic, it set the stage for supporters to doubt them when vaccines were released. Trump also advocated for untested Covid therapeutics such as hydroxychloroquine and publicly floated the notion of injecting disinfectants into the body to "clean" the lungs. Some followers listened; hydroxychloroquine prescriptions shot up 900% in 2020, leading to shortages for patients with autoimmune disease. And the day after Trump retweeted a viral video from America's Frontline Doctors claiming hydroxychloroquine cured Covid-19, poison-control centers in many states saw a significant rise in calls from people who had ingested bleach, Lysol and other household cleaners.

Part of the appeal of HCQ and ivermectin is that both drugs have already been FDA-approved and have been long in use to fight other human diseases. Ivermectin is used to treat parasites in animals and humans, but has a long history of being promoted as a panacea for everything from AIDS to autism. Last summer it became popular in Latin America and India for Covid treatment, mostly because doctors didn't have access to a vaccine and believed an experimental treatment was better than nothing.

But the science is inconclusive at best, and leading scientific bodies have said so. The studies ivermectin fans often cite are either far too limited in scale to draw conclusions (which the studies' authors acknowledged), or say ivermectin only shows a therapeutic effect at toxic doses, or are ethically suspect. One study was yanked from a peer-reviewed journal almost immediately because the paper contained unsubstantiated claims and promoted the authors' own ivermectin treatment.

In some cases, courts have forced hospitals to allow Covid-19 patients receive ivermectin. Why not just let them take it? It's not necessarily safe, for one thing: Some people are experiencing violent diarrhea and other side effects from taking it, especially those using the over-the-counter version meant for animals. And putting one's faith in ivermectin may dissuade people from seeking other experimental but approved treatments for Covid-19, such as monoclonal antibodies.

UPDATE: Greg Sargent of The Washington Post explains "How right-wing media and social isolation lead people to eat horse paste," which tastes awful.

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Misinformation about coronavirus vaccines is widespread, partly because many holdouts don't trust the government or large, mainstream news-media sources for information. For better or worse, that means people are most influenced through friends, family and social media, whose algorithms often turn platforms into echo chambers that boost even extreme opinions.

A report from Facebook showed that, from January through March, an article casting doubt on coronavirus vaccines was its highest-performing link, and a site boosting vaccine misinformation was one of its most-visited pages. The company shelved that report for fear of public blowback; the Biden administration has criticized Facebook for allowing such misinformation to flourish.

Some state and local health departments, adopting an "if you can't beat 'em" philosophy, are seeking to boost vaccination rates among the under-40 crowd by paying social-media influencers to post pro-vax content on Facebook, TikTok and Facebook, Kate Queram reports for Route Fifty.

Some influencers live a little closer to home, though: faith leaders, medical professionals, friends and family also have some sway over vaccine skeptics, though they acknowledge often it's difficult to make headway.

Public-health officials have voiced hope that more religious leaders would encourage their congregations to get vaccinated, particularly among white evangelicals, some of the most resistant. But Southern pastors Politico interviewed said they didn't want to bring up such a divisive subject and risk alienating their flock.

In southeastern Kentucky, where vaccination rates are low and infection rates are high, health-care workers say they're trying to fight misinformation without being too confrontational, writes Jamie Lucke for Kentucky Health News.

For example, Dr. Shelley Bundy Stanko, chief medical officer at CHI Saint Joseph London and medical director of the Laurel County Health Department, said she's frustrated by how politicized vaccination has become, and said she works hard to reassure patients that it's safe and necessary. A few patients are willing to listen, but many (probably the majority) are "sort of shutting down and not absorbing the information," she told Lucke. Stanko said she continues trying to reach patients non-judgmentally, because "confrontation does not help." Instead, she urges people to research facts instead of relying on neighbors, social media, or television.

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House (Berea College photo)
In a 1,634-word article for The Atlantic, Appalachian writer Silas House explores the resistance to masking to fight the coronavirus. He begins by recalling his grandmother's stories of sacrifice during the Great Depression and World War II, and his parents' help for the less fortunate, and the lessons he learned from them.

"I was taught to sacrifice my own comfort for the good of others, whether it be by volunteering my seat to elders in a crowded waiting room, letting a pregnant woman go in front of me in the grocery line, or giving half of my sandwich to a hungry classmate," House writes. "Sacrificing for the common good was something most of us were taught when I was growing up. Just a few decades later, I’m seeing people in my hometown, and all over the country, thinking only of themselves. They’re not just unwilling to make sacrifices for others during a pandemic; they’re angry about being asked to."

House's object example is Kentucky Gov. Andy Beshear's mask mandate for schools, and he goes beyond his usual craft to commit journalism, interviewing upset parents and Science Hill Independent Schools Supt. Jimmy Dyehouse, who called Beshear a "liberal lunatic" in a message to parents. "He said that many studies had proved that masks were ineffective," House reports. "He didn’t cite any sources, but at least 49 scientific studies go against his claims."

Conversing with parents on Facebook, "Two of them said that their children broke down in tears at the news of having to go to school in a mask," House reports. "Others say the masks hamper social life, hinder education by being a distraction, and keep students from understanding their teachers. Several told me the masks are making kids sick because they are breathing in the same carbon dioxide repeatedly, a claim that has been widely debunked."

After noting recent statements of U.S. Sen. Rand Paul and Rep. Thomas Massie of Kentucky, House says his grandmother "would have been disgusted by the politicization of a virus that has now killed more than 620,000 Americans. . . . Maybe too few people today understand the necessity of putting aside one’s own comforts to help others. Perhaps our sense of community has suffered in the digital age. It seems to me, however, that most of the blame should go to politicians who care more about stirring up fear to defeat their opponents than they do about people’s lives or the economy. And I blame anyone who intentionally spreads misinformation to further their own agenda."

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