The worst of the pandemic is hitting Elkhart County, Indiana, just days before the election. The number of new coronavirus cases is exploding. Positive test rates are three times the national average. Local hospitals are running low on beds, their doctors and nurses exhausted.
Yet Elkhart’s public health leaders and politicians know exactly what needs to be done – how to slow the virus and break the chains of transmission. They did it with success during a smaller outbreak this summer.
But they also know that’s not going to happen now.
“There’s no help coming before the election,” said Lydia Mertz, the county’s health officer, calling the current situation “extremely alarming.”
“I think right now some elected officials are just looking to get through the first weeks of November before they do anything unpopular,” said Dan Nafziger, chief medical officer at Goshen Hospital, referring to the restrictions seen in the state earlier this year that he believes are needed again.
“Without a doubt the election is a factor,” said Mike Yoder, a Republican county commissioner.
The pandemic has become politics. And on the eve of a contentious national election, with cases of the novel coronavirus surging in many parts of the country, places like Elkhart County – where President Donald Trump is popular – feel they are being left alone to face outbreaks spiraling out of control. Trump has long disparaged efforts to fight the virus, clashing at times with his own public health officials. On Sunday, White House Chief of Staff Mark Meadows reinforced the president’s message, saying during a CNN interview, “We’re not going to control the pandemic.”
The result, according to officials in Elkhart County, is that state and federal authorities in recent weeks have showed little interest in helping them push for the tougher measures needed to control the pandemic – a change from earlier this year, when they worked together on encouraging mask-wearing or limiting public gatherings. And local officials worry they lack the authority or support to go it alone.
“I’ve talked with the mayor, county officials and corresponded with the Indiana State Health Department and the governor, and I’ve asked them to make stronger interventions,” said Rebecca Stoltzfus, president of Goshen College, who is part of the county’s coronavirus fight. “There’s not been much of a response.”
The business community, too, has noticed the lack of action, said Levon Johnson, president of the Greater Elkhart Chamber of Commerce.
“Unfortunately, politics has gotten in the way of the common-sense things that need to be done,” said Johnson.
A spokeswoman for Indiana Gov. Eric Holcomb, a Republican, referred questions from The Washington Post to the state health department. A statement from the state health agency said cities and counties are free to impose, “ANY additional health emergency restriction they determine necessary to control the spread of the virus.” The agency said it has provided advice and funding for testing clinics and education campaigns in Elkhart and across the state.
Elkhart County is rural and conservative, home to 200,000 people, 150 miles north of Indianapolis and best known for a manufacturing base that makes it part of the “RV Capital of the World.” A Democrat hasn’t been elected to county office in years. Trump won nearly 57% of the vote here in 2016.
And the area is accustomed to serving as a stage for presidential politics. Barack Obama, when he was president, visited the county in 2009 to highlight how much work was needed to get the economy back on track. He returned in 2016 to showcase the nation’s progress. Two years later, Trump held a campaign rally in Elkhart, proclaiming, “America is respected again.”
At first, Trump’s antipathy toward public health efforts didn’t matter much in Elkhart County. The coronavirus arrived later in most of the Midwest than the country’s coastal cities. Still, Indiana’s governor issued a “stay-at-home” order by late March. Schools went online.
Many businesses shut down for at least a couple of weeks – including the RV industry. That caused Elkhart County’s unemployment rate to jump from under 3% to nearly 29% in April. It fell to 6.1% by August as the economy reopened, guided by a five-stage plan from Holcomb.
Still, in June, Elkhart saw its first big surge in infections. The county landed on a national hot spot watch list. Disease detectives from the Centers for Disease Control and Prevention were dispatched with state health officials’ help to study the outbreak. (They investigated for a month and delivered a final report to the county only last week. The report didn’t include any revelatory findings and was of little help with the current outbreak because it was so dated, health officials said.)
But even before the CDC arrived, Mertz, the county health officer, pushed for a countywide mask mandate. It took effect July 1, nearly a month before the governor enacted a statewide mask mandate.
Elkhart County also was helped by statewide limits on public gatherings at the time. Bars and movie theaters were closed. Restaurant tables needed to be spaced out.
But perhaps most importantly, the politics of taking action were less divisive. While Elkhart endured protests to the government’s pandemic response, like those seen in Michigan and Pennsylvania, most residents remained open to doing what they could to slow transmission.
“People were still in a place where they were willing to listen and it worked. We saw the cases come down. We actually did get it under control,” said Michelle Bache, an emergency room doctor and executive at Elkhart General Hospital.
Now, the county is facing a much more dangerous outbreak.
The daily average case count is 37% higher now than during the summer surge. The positivity rate for coronavirus tests is 50% higher.
New coronavirus cases skyrocketed 40% in just one week this month, to nearly 750 cases, said Mertz at a recent county health board meeting. Deaths are on track to double this month. And local hospitals are struggling to handle the crush of hospitalizations.
The difference now is that Indiana has been almost completely reopened since late September. While a statewide mask mandate remains, bars have reopened. Limits on restaurants have been loosened. Students are in classrooms. Public and private gatherings of up to 250 people are allowed.
With the relaxed rules, Melanie Sizemore noticed a change.
Signs at stores reminding people to wear masks and social distance began to disappear. She saw fewer people wearing masks at the grocery store. She heard about more weekend events featuring hundreds of people.
“The governor opening up the state helped people think covid is gone, not as bad as it was,” said Sizemore, who leads the maternal child health program at the county health department and serves as the agency’s spokeswoman.
She took calls from residents who insisted the pandemic was a hoax. She listened as they complained that masks didn’t work or the death rate was exaggerated.
“We’re in a bad place right now,” Sizemore said. “But how do you explain that to people who don’t believe it’s a problem?”
The county health department has tried to fight back. It published a list of best practices to avoid getting sick. It produced new public service announcements for its Facebook page. It’s planning new radio ads. Public health officials have been calling local companies and churches, reminding them of the importance of face masks and social distancing. But they are running up against rumors and misinformation, often spread by commentators echoing Trump’s own lines casting doubt on the pandemic.
“We just haven’t found the way yet to convince people that these preventive measures are things they’re going to have to do,” Mertz said.
Mertz, the county health officer, said she has listened to the state health agency’s suggestions and followed its recommendation guidelines.
“But it’s not changing things for us,” Mertz said.
Elkhart County needs to place new limits on all public gatherings, Mertz said. That would mean going back from the state reopening plan’s Stage 5 to Stage 3. She could take this action by herself because it’s a public health emergency, but she doubted it would work.
“People are well aware of the fact that anything I do I have no enforcement for,” Mertz said. “They know.”
The county also sometimes needs to defer to the state for enforcement. People flooded the county health department with complaints about a lack of protective equipment or social distancing at work, but they were told to contact the Indiana Occupational Safety and Health Administration, according to health officials. Complaints about bars go to a different state agency.
Indiana has received more than 4,000 complaints about coronavirus-related workplace safety, more than three times the number of all workplace complaints in a normal year, according to the state’s OSHA. Complaints are followed up with a letter asking for more details, a state OSHA spokeswoman said in a statement, with the state conducting 17 on-site inspections – less than 1% of all complaints. All of the investigations are still ongoing.
There is evidence in Elkhart County that public health measures can work. The area’s schools and colleges reopened at the end of the summer. And they have successfully contained the virus by requiring face masks and enforcing social distancing.
Nafziger, who has witnessed the outbreak’s strain at Goshen Hospital, where he’s an infectious-disease doctor, said the lack of response from many politicians – from the White House on down – doesn’t make sense to him. Supporters of Trump might doubt the pandemic, but getting it under control would seem to be the best way to ensure he gets reelected.
“I don’t get it,” Nafziger said. “It’s only going to get worse.”
Yoder, the Republican commissioner, said the political landscape has made its hard to fight the outbreak. He worried the county doesn’t have the resources to enforce new mandates. He admitted he doesn’t know what to do about bars, short of shutting them down.
“We need people to become more cautious. We need to send a signal that this serious. But how do you send that signal?” he said.
He worried people were losing faith that the outbreak could be contained.
But Yoder won’t be on the county commission much longer. He lost his Republican primary earlier this year.
Soon, the decisions about what to do about the outbreak will be someone else’s problem.