The rural fight against COVID

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From drive-through clinics to house visits, rural county health departments and nonprofits are using a mix of approaches to get shots in arms.

Efforts to safeguard rural populations from COVID-19 infection have needed to evolve since the pandemic struck the region last year. Myriad factors, including vaccine hesitancy and general challenges of vaccinating rural populations, have prompted rural county health departments and nonprofits to change tactics to protect these populations.

“We’ve kind of responded (to) meet what the needs on the ground are,” says Paul Pettit, director of the Genesee and Orleans County Health Departments. “It’s really evolved over time.” 

That evolution has produced a range of efforts to dispense coronavirus vaccines in the counties surrounding Monroe, from mass vaccinations to those conducted in individual residents’ homes. 

Such measures have resulted in more than 1,000 vaccinations in a single day.

In the eight counties of the region around Monroe, the percentages of residents 12 years old and older who have received at least one dose of a vaccine range from 73.7 percent (Ontario) to 53.9 percent (Wyoming), the Finger Lakes COVID-19 Vaccine Hub reports. In some parts of Wyoming County, barely one-third of the population has received even a single vaccine dose. By comparison, the rate in Monroe County is 75.9 percent—and in some parts of the county, more than 90 percent have received at least one dose. All areas have high COVID transmission rates, as determined by the Centers for Disease Control and Prevention.

Percentage of population (12+) with at least one dose of vaccine as of Oct. 13, 2021.
Source: Finger Lakes COVID-19 Vaccine Hub

COVID immunity can be gained naturally, through contracting and surviving the disease, or by being vaccinated against it. Researchers aren’t sure what percentage of a community must be immunized against the virus to prevent its spread, but Anthony Fauci M.D., director of the National Institute of Allergy and Infectious Diseases, has said that that number could be as high as 85 percent.

While public health officials continue to combat the spread of the original coronavirus strain, the Delta variant this summer became a key concern.

“We’re continuing to watch potential new variants spin up,” Pettit says. “We’re going to have to continue to respond to those as they come along.”

The Genesee and Orleans County health departments, which function as “GO Health,” began vaccinating people in very large numbers at Genesee Community College’s Batavia campus and the Ridgeway Volunteer Fire Co.’s firehall in Medina in late February. 

“We had a month or so of really robust, full clinics where we did over 1,000 (per day),” Pettit says. 

Business was so brisk that GO Health’s staff didn’t bother to remove their equipment between vaccination days. 

Ontario County Public Health began doing mass drive-through vaccination clinics on the Hopewell campus of the county’s highway department in January.

“We’ve vaccinated thousands of people quickly and safely while seated in their cars,” says Kate Ott, Deputy public health director. “Our drive-through clinics have been very successful.”

Hitting a wall

In late April, GO Health’s mass vaccination program hit what Pettit calls a “wall.”

“We were going full-full-full, all the clinics were filling up,” he says. “All of a sudden, demand dropped right off.”

Pettit blames the precipitous decline on the limited pool of Orleans and Genesee residents who were willing to be vaccinated against COVID.

“We kind of reached the point where I think the strong majority of folks at that time (who wanted to) had gotten vaccinated,” he says.

GO Health responded by shifting from mass vaccinations to what Pettit called a “mobile vaccine road show.” That show began visiting parts of Genesee and Orleans counties that had low vaccination rates.

“We did a very proactive engagement, offering vaccination clinics on business sites for employees, their friends and families and public, as businesses desired,” Pettit says.

GO Health also headed out to other types of sites. Six Flags Darien Lake, Genesee County’s huge amusement park and resort, invited the agency to host two vaccination clinics for employees and others just prior to opening in May. Those who received at least one shot of a vaccine were given two free passes to the park. Altogether, about 150 people were vaccinated at the clinics.

Ontario County Public Health also found new sites at which to dispense coronavirus vaccines. Its vaccination crews have given out shots on the campus of Hobart and William Smith Colleges, Finger Lakes Racing and Gaming in Farmington, Geneva’s Mount Olive Missionary Baptist Church and a number of other sites.

“We vaccinated about 700 individuals at the Mt. Olive Baptist Church,” Ott says. “We’ll be eternally grateful for the wonderful people there who opened their church, provided education/vaccine promotion during their church services and volunteered on (the) six clinic days.”

Kate Ott

The Birdhouse Brewing Co. in Honeoye in June gave a free beer to anyone who came in to be vaccinated. Ten people got their shots. 

Though most of Ontario County Public Health’s large-scale coronavirus vaccinations went off without a problem, small groups of people who were opposed to the vaccination efforts appeared at three sites to picket for a day. Ontario County sheriff’s deputies were on hand and the protesters were orderly, but those giving out the shots were a little nervous.

“Reports of violence in other areas of the country make us all a little nervous about being out in public administering vaccine,” Ott says.

At this point, the number of people seeking their first and second shots of COVID vaccines has fallen so low that Ontario County Public Health now gives the injections one day a week in its offices. That has not necessarily given the department’s staff a breather. It began giving mass vaccinations of booster shots on Sept. 29. One week, it gave close to 400 injections.  

In addition to holding such events, Ott’s department partners with the Ontario County Office for the Aging to help those who can’t make it to vaccination sites get the shots if desired.

“We contacted the folks, found out which vaccine they were interested in, and then visited the home and administered it,” Ott says. 

She says home vaccinations are a “heavy lift” for her department, which has only 12 nurses on its staff. Despite that, it has vaccinated 140 county residents in their homes.

As fruitful as efforts to vaccinate people can be, they may not bring in those who hesitate to get the shots, or refuse to accept COVID vaccines outright. 

Understanding reluctance 

No single factor has been found to determine the reasons for such views. A recent U. S. Census Bureau Household Pulse Survey found that concern about vaccines’ side effects and mistrust of the drugs themselves respectively led 52 and 36 percent of the unvaccinated participants to refuse the injections. Roughly 25 percent did not trust the government, or thought they did not need to be vaccinated.

Seeking to shed more light on the problem of vaccine hesitancy, Common Ground Health interviewed over 260 residents of the Finger Lakes region this spring.

“We looked to get a great cross section of our different populations across the region to understand what their feelings were about the vaccine,” says Dina Faticone, the nonprofit agency’s chief program officer. “Did they plan on getting the vaccine? Why, or why not?”

Details of the survey’s results are unavailable, but Faticone was able to present a number of the themes that emerged from the interviews of those in rural areas. Some of the interviewees thought that COVID vaccines could cause harm because of unknown side effects, or because the drugs were created for ulterior motives.

“It will cause harm, things like population control or sterilization,” Faticone says, describing some respondents’ beliefs.

Those who were generally in good health sometimes did not feel the need to get vaccinated.

“Even if they got COVID, they felt very confident that their own strong system would be able to fight COVID, and they really wouldn’t get that sick,” Faticone says.

Others were reluctant to get vaccinated without additional information about the drugs used or their side effects, and did not trust information that came from outside their communities. 

“In the rural areas, what we heard was that their local primary care physicians and their pharmacists were trusted sources of information,” Faticone says. “We even heard that the fire chief and the fire department … were people that they really trusted.”

Efforts to spread accurate information

In response to that lack of trust, Common Ground Health has hired 20 “resident ambassadors” to carry information about coronavirus vaccines to their communities and encourage residents to get their shots. While most of them work in Monroe County, three are on the ground in the Finger Lakes region.

Dina Faticone

“If they were part of a church, they did a lot of their education within their church congregation, but also started to get more out into the community,” Faticone says.

Ambassadors have also attended farmers’ markets and other events in rural communities. 

“One community, there wasn’t a lot of attendance at the farmers’ market,” Faticone says. “(The ambassadors) were able to pivot, and walk down main street and talk to business owners (and) leave educational materials in those businesses.”

Faticone did not know how successful Common Ground Health’s ambassadors have been at actually getting people to accept the COVID vaccination.

“They reached over 14,000 individuals between April 1 and Sept. 30,” Faticone says. “It is difficult to prove causation, but we do have data that shows some of these places that we have focused on early on have started to improve their rates (of vaccination).”

Other organizations also have given vaccine outreach a personal touch. 

Human Service Development, a small firm based in Corning, has seven full- and part-time outreach workers traveling around the Finger Lakes region to dispense information on COVID vaccines, and help people get their shots. 

“They come from the communities in which they serve,” says Betsy Hull, HSD’s vice president for development.

The firm’s outreach workers have visited farmers’ markets, jazz festivals, local companies and even a balloon festival. One-on-one contacts have generally been the most fruitful for the workers, who try to at least give brochures or other information to those they approach.

“If we can get that into their hands initially, it will give food for thought,” Hull says. “The next time they see us at another event, they might ask us a question. It might take two or three touches before they’re willing to get vaccinated.”

Huff didn’t know how many of the people HSD’s outreach workers have spoken to about coronavirus vaccinations have received the shots. Funds from the federal American Rescue Plan finances the firm’s efforts.

Gloria Cuevas, one of Hull’s part-time outreach workers, uses a friendly approach.

“I talk to everyone,” she says. “I like to help people.”

Since she became one of HSD’s part-time outreach workers in late August, Cuevas has focused her attention on helping the area’s Latino residents and migrant laborers get vaccinated.

“The advantage for me is being bilingual,” says the Puerto Rican-born Geneva resident. “It helps a lot for some people (who) have a language barrier to communicate and answer their questions.”

Cuevas’s outgoing nature and the various jobs she’s have made her well known among Latinos in the community. While working for Geneva General Hospital’s emergency department and in patient account services, she often translated for those who spoke only Spanish. Though she’s left that position, Cuevas has continued to volunteer, helping members of the Latino community with translation services, providing rides to important appointments, and taking on other tasks. She also works part-time as a driver for a local medical transportation service. 

In all of her roles, Cuevas works to inform people of the value of COVID vaccination, and helps them get their shots. While driving an individual to a local drug store to purchase medication, she asked her charge whether he’d been vaccinated. When she learned that he wasn’t vaccinated, she helped him get the shot.

Cuevas also has gone to local farms to help migrant workers sign up for COVID vaccinations. Though she says that she has helped roughly 10 people schedule vaccinations in a given week, Cuevas does not know how many of those people have actually gotten the shots, but that doesn’t stop her from reaching out to those who have not been vaccinated.

“I am glad I am helping the community fight this together,” she says.

Mike Costanza is a Rochester Beacon contributing writer.

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