As the Covid-19 public health emergency comes to a close, a new book tells the story of its impact on rural healthcare providers in their voices.

Masks, Misinformation, and Making Do: Appalachian Health-Care Workers and the COVID-19 Pandemic is a selection of essays written by the people who experienced it, said the book’s editor Wendy Welch.

The book, published by Ohio University Press, presents the pandemic experience through rural voices and looks at how the virus polarized communities. It also grapples with the spread of misinformation that turned some residents against the healthcare providers who cared for them.

“During the pandemic, there was so much politicization of information, and so much deliberate intent to misinform,” Welch, who also serves as the executive director for the Southwest Virginia Graduate Medical Education Consortium, said in an interview with the Deesmealz.

“In my line of work I'm talking to medical professionals all the time and they were as demoralized by the difficulties they were seeing as they were in trying to make their patients understand that they were fighting the disease. Doctors expect to fight disease. They don't expect to fight patients... It just wasn't right. It wasn't right in every sense of the word.”

Welch said she wanted to provide a record of what healthcare providers went through as they dealt with the pandemic. The book looks at the onset of the coronavirus, its impact on the human body and its spread. It also describes how healthcare changed as a result – the explosion of telemedicine, the impact social distancing had on medical education, and the exposure of the disparities in rural healthcare it revealed.

Through personal experiences, the book takes readers inside what was happening in rural healthcare settings, Welch said. From the search for lifesaving equipment to the burden Covid placed on rural patients already dealing with a myriad of health concerns, the articles paint a picture of life inside rural hospitals during the pandemic. And the book looks at how some residents ignored public-health mandates because they believed the misinformation they heard – that Covid was a hoax and nothing more than a cold.

In some cases, healthcare workers talk about battling both the virus and patients. Convinced doctors and nurses were trying to kill them, some patients lashed out and threatened physical violence against those trying to save them.

“One (article) is about a Black nurse and her experience with Black patients basically asking ‘If we come to this hospital, are they going to kill us?'” Welch said. “The conspiracy theories and the misinformation... in some communities gave them a legitimate reason to be afraid... The nurse told me that she probably saved more lives on Facebook after her shift than she did in the Covid ward.”

Problems with misinformation in rural communities, said Beth O’Conner, one of the book's contributors, stem from decades of neglect toward rural healthcare.

“From a national policy perspective, rural health has been undermined since really the ’60s,” she said. “People (in rural areas) don’t have access to a primary care provider, which means their only option is to believe what their aunt told them that they saw on the internet... because they don’t have a trustworthy person they can turn to. We end up believing what information is presented to us, and then... without a trusted source for information, the void gets filled somehow and not necessarily in a way that we would want it to be.”

But misinformation is not something new, she said.

“That’s certainly been happening since the dawn of time, really, if people didn’t have the information they needed to make proper decisions,” she said.

In recent years, she said, internet misinformation and the backlash against vaccines led to a rise in children getting whooping cough and polio – diseases she said children should not be getting.

O’Conner, executive director for the Virginia Rural Health Association, said fixing misinformation's spread in the future lies in ensuring residents in rural communities have access to affordable health care.

For Welch, the book is a record of what happened, as well as a road map for dealing with other public health emergencies in the future.

“This is a snapshot of what happened, but it's also a cautionary tale and a warning... for avoiding what will happen next time because the cracks and the foundations of society are so evident now,” she said.

Fixing it means rural healthcare providers need to learn how to communicate with patients in a way that understands where patients got their information, instead of writing those fears off, she said.

“They (patients) were fed a bunch of hooey and fear about the vaccine being the mark of the beast,” Welch said. “The problem comes when somebody says that's a bunch of hooey and they mean believing in the mark of the beast in the first place. The healthcare provider at that moment has a very important job not to say, ‘Wow, you believe in the mark of the beast? Boy - are you dumb’ but to say, ‘I know what you're afraid of and here's why you don't need to be afraid of it.’”

The book, released in November 2022, was recently one of a few selected to be open access – meaning that the information it presented was deemed important enough to be available for free to scholars around the world. Welch said the inclusion of the book has special meaning because it was written about rural healthcare providers, by rural healthcare providers.

“They only select so many books, and this is a rural book,” she said. “It just feels, at last, like our voices got to be the ones that told our story.”

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