The Amish and COVID-19: It's complicated

KIDRON  The signs posted outside of Lehman's Hardware store make it clear: "No mask, no entry."

Inside, both customers and employees are in compliance.

Well, almost everyone. As a pair of young Amish men entered to browse last week, they were approached by an employee because they weren't wearing masks.

"You have to wear a mask; it's a state law," the worker said.

Slightly startled, the young men wordlessly took the masks she handed them and put them on. But it wasn't long before they had them in hand again, prompting the store to announce over the intercom that masks must be worn.

Religious and cultural beliefs

It's a common issue in the heart of Ohio's Amish country, specifically in Wayne and Holmes counties — the Amish are largely reluctant to masks. For them, it's a matter of religious and cultural beliefs, including a healthy suspicion of others and government, experts say.

"There's an association between wearing them and fear," said Dr. Cory Anderson, a National Institutes of Health-sponsored researcher in population health at Pennsylvania State University. "As a people, they have a value orientation toward minimizing problems. They try to portray that all is at peace and rest. They're willing to make masks — they're not necessarily willing to wear them." 

Anderson is a member of the Amish-Mennonite community living in Holmes County and founding publisher of the Journal of Amish and Plain Anabaptist Studies. Co-author of a report published in Social Science and Medicine, Anderson said the Amish response to coronavirus has been a focal point of his most recent research.

He said numerous factors must be examined when it comes to why so many Amish have been against following COVID-19 policies such as wearing face masks.

He added that it's difficult to document.

"I've been in the process of systematically collecting sources from Amish newspapers to get a sense," he said. "It can be a little difficult to distill. Anecdotally, if you come into Wayne or Holmes County, you will find very little compliance. Why is that? I guess there are two levels to the question.

"On the one hand, in Holmes and Wayne, where 50% of the population in Holmes is Amish or Mennonite, we look at a dynamic that transcends this particular religion and ethnic group, and look at the community as a whole. Even among the non-Amish population here, there is quite a bit of agreement to disregard the approach to masking and social-distancing. There is something going on at a community level."

Business factor

Anderson added that Holmes and Wayne counties have strong business cultures that emphasize hands-off deregulation and autonomy.

"It's very characteristically libertarian here, not in the political party sense, but that mentality is here," Anderson said. "Part of that probably is due to the Amish and Mennonite theology."

Religious persecution in Europe in the 1700s prompted an Amish and Mennonite migration to America.

"There's this narrative within the culture of a history of persecution at the hand of outsiders, especially the state," he said. "It creates this suspicion of outsiders coming in and telling us what to do."

Spread

In May, the U.S. Centers for Disease Control & Prevention reported an outbreak of COVID-19 among Ohio's Amish community in Wayne County — home to one of America's largest Amish settlements. Neighboring Holmes County also has a large population, with more than 30,000 Amish spread across the two rural counties.

One of the factors cited in the report is that the Amish community's emphasis on communal living was a factor in the spread.

Around Kidron, few people want to address the issue — even those wearing masks.

Lehman's store manager Chris Hess said the business is vigilant about its mask policy, adding that people comply "for the most part."

"We follow the state recommendations for the protection of our employees and customers," he said. "Some people do get confused. And we have asked some people to leave."

Hess said Lehman's, which attracts both Amish and non-Amish customers, has had their policy in place since the fall.

"Customers have been more compliant than in the past," he said. 

Way of life

University of Missouri Professor Caroline Brock spent 18 months in Wooster doing research on the Amish way of life.

"With the Amish in general there is a lot of diversity of response on issues based on geography, settlement differences etcetera, so it is challenging to make blanketed statements," she said.

"I think they are influenced to some degree by their rural neighbors so issues with lack of compliance issues that may carry over from what we know about rural English folks. Lots of rural people are not complying that go well beyond the Amish. They don’t always get on board right away with a changing public policy environment, especially one based on guidelines that shift as we learn more in terms of the science beyond COVID."

Anderson said another dynamic is the region's tourism and wood-based manufacturing industries.

"When it comes to policy, they're very much self-regulating," he said.

Uneven public policy

Anderson said initially uneven public policies only increase skepticism among the Amish.

"Right at the beginning of the pandemic there was fairly strong compliance," he said. "Most Amish and Mennonites in Holmes and Wayne were willing to work with authorities. This was especially apparent, as they were willing to close businesses and church services. That's phenomenal. Strangers telling you to stop having church cuts at the very heart of who they are. It was really amazing they were willing to do that."

Anderson cited a New York Times article published in April about how the Amish rallied to make masks. But enthusiasm faded, he said, as the issue of mandatory masking and social distancing came to the forefront.

"The Amish have a very localized power structure," Anderson explained. "You can find at any church, there's some issue of tension of over what will or won't be allowed. Opinions over how we should do things spread very quickly especially when something new comes around. When opinion leaders swing their weight in terms of a new issue. If an opinion is for or against a change, you see it."

Why then, did the opinion swing so heavily against it?

"There's no one answer that applies to every individual," Anderson said. "But there are some major themes: They never had a chance to develop a sense of ownership over these practices. They want to make sure their way of doing it is 'Our way of doing it.'"

Anderson added that the Amish have fads and fashions like any group. 

"The Amish want very much to own what they're doing," he said. "There's also a fear that if they accept an external way, it's going to disrupt the power structure of the local pecking order."

Change in dress

Anderson stressed that Amish dress is nuanced and that individual attention is not welcome or encouraged.

"A mask is a huge change in appearance," he said. "There's a follow-up fear that if they accept what an outside entity says, it also justifies that power to intervene in their lives, and 'We don't know what they're gonna do.'"

There's deep cultural resistance to masks, Anderson said.

"There's an association between wearing them and fear," he said. "As a people, they have a value orientation toward minimizing problems. They try to portray that all is at peace and rest. They're willing to make masks — they're not necessarily willing to wear them." 

Positivity rates?

Though cases are rampant in every Ohio county, Anderson said the rates would be much higher in Holmes and Wayne were some Amish not resistant to testing.

"There's a fear that 'If I get tested and positive, what are they going to make me do?'" he said.

Aultman Hospital spokesman Jason Clevenger said Aultman's Amish Services program is designed specifically to coordinate and streamline care in the Amish community.

"COVID-19 has presented many challenges across Ohio, including the rural Amish community," he said. "Aultman’s designated Amish coordinator maintains routine communication with the Amish elders to address their needs and concerns and help them navigate care as needed."

Part of that includes translation services to ensure patients understand their plan of care and transportation to and from Aultman facilities for patients and their families in partnership with Pomerene Hospital in Millersburg.

"In addition, housing services are available for Amish family members when a loved one is hospitalized," Clevenger said. "In Wayne and Holmes counties, Aultman Orrville Hospital has actively worked with Wooster Community Hospital and local health departments to provide swabbing when outbreaks are identified in the Amish community and provide access to rural health clinics."

Anderson said the Amish may not be aware of the scale of the pandemic because they don't avail themselves of much technology. However, they do keep up with some news, primarily through local and regional newspapers aimed at their communities.

"They don't consume as much media as we do, probably because they want to protect themselves from the outside hype," he said. "While work crews are going to other cities, most people are homebodies and are not seeing what's going in other parts of the state."

Working Amish

At the P. Graham Dunn Co. in Dalton, about half of its 225-person workforce is Amish.

Anthony Burdette, vice president of marketing, said they adhere to regulations set for factories, which include employees wearing masks when warranted.

P. Graham Dunn manufactures home furnishing and decorative accessories. They also have retail stores, including one in Canton, which opened last year.

"In the factory, we're following every single government guideline we're given," Burdette said. "The rules and regulations for a factory-workplace environment say that if employees are 6 feet apart, masks are required. The minute an employee leaves their work station, the mask goes back on."

Burdette said the company did do some training, and its human resources director and safety coordinator reinforce the guidelines.

"With the rise in cases in the fall, we did that more frequently," he said. "People got a little comfortable over the summer."

Burdette said many of their factory employees are young Amish women 16 to 22, who want to work before getting married. 

He said the company does all it can to ensure that protocols are not violated.

"People need to work; they want that paycheck," he said. "We provide a healthy environment so they can do it in a healthy way, and feel safe doing so."

Alternative medicine

According to Anderson's research and the CDC report, the Amish tend to turn to alternative medicine more than other religious groups.

"They are doing more folk medicine than normal because they're treating the symptoms," he said. "Onions and garlic are standard home remedies being used, though some have been going to the hospital."

Spiritual healing, Anderson said, also is a big factor.

"It's mainly prayer, and having a strong faith in resigning loved ones being over to the will of God," he said. It's a yield 'to what God wants for me.' It's a little bit fatalistic."

Asked what outside agencies can do to better reach them, Anderson said the agencies should work directly with local institutions.

"There have been cases where getting the Amish to wear masks has been successful," he said. "You have to connect with local authorities and a variety of institutions.

Anderson said another thing policy officials can do is remind the Amish of their own theology.

"Romans 13 talks about submitting to governing authorities," he said. :So does 2 Peter 1. Reminding the Amish to work with the government when the government isn't persecuting them is reminding them of their own commitment."

One good example of cooperation, Anderson said, is the East Holmes School District.

"They decided on masking in the classrooms," he said. "Most Amish go to their own schools, but there are some who go to one of the four public schools. They succeeded in getting all the kids to wear masks, and they lost hardly any kids. The principal has personal relationships with those families. When it's people they know and like and appreciate, they will cooperate."

Amish and the vaccine

As for a COVID vaccine, Anderson said there's a sizable percentage of Amish who have traditionally resisted vaccination. 

"I imagine when it comes out, it probably will be the same way," he said. "The New Leaf Clinic in Mount Eaton, a genetic clinic that deals with the Amish community, just completed a study that found that Amish acceptance rates of vaccines have declined since 2010."

Anderson said that although the Amish are cloistered, what they do still impacts the wider community.

"The Amish are one of the fastest-growing populations in the country; the average family has seven kids," he said. "Public health is going to be increasingly important as they continue to interact with more and more with non-Amish populations through tourism and manufacturing."

To read the CDC's May report, visit https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a2.htm?s_cid=mm6945a2_w.