Resistance to COVID-19 checks in anthropologist’s hometown

As the COVID-19 pandemic reached the American Midwest, Okoboji, a small rural community in Iowa, decided not to follow public health guidelines on masking and avoided physical distancing. When medical anthropologist Emily Mendenhall visited her hometown, the sight of unmasked people flocking to restaurants and bars alarmed, perplexed and intrigued her. Why did Okoboji reject public health advice even as his number of COVID-19 cases rose and deaths followed?

by Mendenhall Unmasked: COVID, the community and the case of Okoboji begins in 2020, before COVID-19 vaccines were available, and is primarily about the controversy around the use of masks. Okoboji is predominantly white and votes Republican. After a brief shutdown, the governor of Iowa left regulatory decisions about COVID-19 measures to local authorities. As COVID-19 has taken the US East Coast by storm, Okoboji and the Midwest have generally remained less impacted. When COVID-19 arrived in Okoboji, many of those infected were healthy young people who worked or spent time in tourist spots. At first, no one died. Mendenhall began anonymized interviews with community members, attended public meetings, and scanned the media, bringing an insider-outsider lens to her role as a participant observer. She was not neutral – she wore masks and mostly interviewed people outdoors.

Okoboji depends on visitors for its economic well-being. Masking and physical distancing have had financial consequences. Some residents were fatalistic about the risks of COVID-19, often linked to Christian beliefs. Some residents, often women, thought the masks were harmful, especially to children. Men were likely to invoke personal freedom as justification for remaining unmasked. One respondent claimed that some families “ran their children through Walmart when they had COVID-19 to infect others and build immunity in the community.”

What emerges is a lack of social solidarity beyond small circles of friendship. People saw it as everyone’s right to take care of themselves. Some lamented this position as a lack of attention, but they were not the majority. The author’s brother-in-law was a county health official and denied the internet rumours. But among the sources of misinformation are other doctors. His interviews show Mendenhall to be an attentive listener, probing and gently prompting. His approach humanizes people and successfully conveys that the decision to reject public health measures was not made by bad people.

Mendenhall considers how Okoboji’s trajectory, which she has no doubt resulted in preventable deaths, occurred at the intersection of racial identity and status. Most residents of Okoboji are white. Acknowledging Jonathan Metzl’s insights, she cites his argument that “deeply modern American conservatism demands that lower- and middle-class white Americans vote against their own biological interests as well as their own economic priorities.” Deprived of a status previously assured by whiteness, have the inhabitants of Okoboji regained dignity and autonomy in the resistance to public health measures? Did they see lethal consequences as acceptable trade-offs? During Mendenhall’s school years, agriculture supported most Okoboji families. By the time he graduated, farming had all but disappeared and income had become dependent on tourism and big box stores. But such musings are Mendenhall’s, and ideas about racial identity and contagion aren’t often addressed in interviews.

Partisanship in the acceptance of COVID-19 vaccines in the United States is well established, with surprisingly lower vaccination rates among white and Republican-voting people. Mortality follows political beliefs in a way that should be better understood. Prior to COVID-19, Bor and others showed that former US President Donald Trump was more likely to carry communities where life expectancy had stagnated or declined. Krieger and his colleagues analyzed COVID-19 deaths by U.S. congressional district and found that Republican-controlled areas had up to 25% higher COVID-19 death rates than Democratic-controlled areas. – Deaths were highest when the executive and legislative representatives were all Republicans, as in Okoboji.

Communities can collectively confront pandemics. In the 17th century, the English village of Eyam imposed a cordon sanitaire, successfully sparing its neighbors from the plague while losing over a quarter of its population. Some 250 years later, during the 1918 flu pandemic, Gunnison, a mining town in Colorado, USA, decided to isolate itself to avoid infection. Those who wished to leave could do so, so no one else could enter or return to the city. There were no deaths from influenza. In places like Okoboji in the 21st century, such community-wide action seems impossible to envision. From Mendenhall’s insightful book, we learn a few reasons why.

Unmasked: COVID, the community and the case of Okoboji Emily Mendenhall, Vanderbilt University Press, 2022 pp 312, US$28 95 ISBN 9780826504524

Further reading

  1. Beaumont, March 15, 2020.

    Eyam recalls the lessons of the 1665 battle against the plague.

    The Guardian. March 15, 2020;

  2. Bor, 2017.

    Divergent life expectancies and voting patterns in the 2016 US presidential election.

    Am J Public Health. 2017; 107: 1560-1562

  3. Carroll, March 1, 2020.

    Gunison, Colorado. The city that avoided the 1918 Spanish flu pandemic.

    The Guardian. March 1, 2020;

  4. Krieger et al., 2022.
    • Krieger N.
    • Testa C
    • Chen J.T.
    • Hanage WP
    • McGregor AJ

    Relationship between the political ideology of US federal and state officials and key outcomes of the COVID pandemic in the age of the vaccine: April 2021-March 2022.

    SSRN. 2022; ()

  5. Metzl, 2019.

    Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heart.

    Basic books,
    New York, NY2019

  6. Sparks et al., 2021.
    • Sparks G
    • Kirzinger A
    • Brodie M.

    KFF COVID-19 Vaccine Monitor: profile of the unvaccinated.

    Kaiser Family Foundation,

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