Trust,individualism,and the logics of care in middle America during the first year of the COVID-19 pandemic

Context and methods

In the first few months of the pandemic, Trump relegated power to implement public health measures to the states, which created confusion, fear, and stress among many people across red and blue states alike. Drew Altman (2020, n.p.) argued in the BMJ that “delegating primary responsibility to the states in a crisis” resulted in “the states and the American peoples split strikingly along partisan lines in their response to COVID-19, as if the country has both red and blue pandemics.” This was apparent to me as I made my way in June of 2020 from a locked down region around Washington, DC, to the largely business-as-usual region in rural northwest Iowa, where I grew up and my extended family resides. Throughout the course of the pandemic, Iowa's Republican governor Kim Reynolds embraced President Trump's COVID denialism and consistently parroted conservative politics (Pfannenstiel & Coltrain, 2020). Iowa exemplifies what happens when leadership emphasizes personal responsibility during a crisis as opposed to implementing policy (Molteni, 2020).

I use the case study of Okoboji to demonstrate what happens when national, state, and local leadership fails in leading a coordinated public health response in times of crisis. Iowa never enacted a formal “stay at home” order and many people's everyday lives were not drastically altered by the pandemic. There was strong local resistance to public health prevention when the summer tourist season began because the summer tourist season was a primary source of annual income for many residents. Many people make enough money during the summer to last the whole year and a summer without income threatened their family's livelihoods. But for some business owners, especially those with lots of money and power, it was more about profit margins and less about families or individuals. I quickly realized that the wealthy business owners in the community had a lot more power than public health officials, in part because of their informal networks not only with local county supervisors but also with state leadership, including the governor. By May, a number of restaurants, bars, marinas, golf clubs, and other summer activities opened up and few were enforcing public health protocols directed by the state and local authorities.

Such rugged individualism is not surprising; it's even inscribed on Iowa's state flag: “Our liberties we prize, and our rights we will maintain.” But it's as cultural as it is political. Economists have called the strong antigovernment sentiments in the American Midwest a “total frontier experience” that reveals a “primacy of personal goals over group goals and the regulation of behavior by personal attitudes rather than social norms” (Bazzi et al., 2020, p. 55). Midwestern historian Kristin Hoganson, (2019) describes agrarian markets as bound into an “us-versus-them mentality, a desire to dominate in a win-or-lose world” (p. 136). State representative John Wills, long an Okoboji resident and speaker pro tempore in Iowa's Congress, wrote an op-ed in the local paper at the end of April arguing that it was time to reopen the economy. He wrote, “We can fight COVID-19 by adding health precautions to protect ourselves and each other but also get people back to work and have Iowa thriving again” (Wills, 2020). Statements like “I don’t need the government,” “I don’t want the government to interfere in my life,” and “I don’t trust the government” are ubiquitous in the Iowa Great Lakes region and explain in part Republican Governor Kim Reynold's (in)actions to intervene in public health during the COVID-19 pandemic.

I arrived in Okoboji on June 6, 2020—in the middle of an outbreak: although there were only eight cases by Memorial Day, when I arrived a week later, there were 50 new cases. I was deeply engaged in the local public health response in part because my brother-in-law, Dr. Zachary Borus (Zach), was a local physician and the president and medical director of the Dickinson County Board of Health. Concerned about the outbreak, I put together a research proposal to conduct research on what caused the outbreak, where cases were concentrated, and how to stop it; this was swiftly reviewed and approved by the Institutional Review Board at Georgetown University (#00002592) and the Dickinson County Coronavirus Task Force.

I spent about 10 weeks conducting ethnographic research in and around the area. Since I grew up in the area, and my family has lived there for five generations, I relied largely on personal networks to begin speaking to people about their experiences living through and in relation to the pandemic. I reached out on Facebook, text, email, and on the street to everyone I knew. Although I initially was advising on potential public health interventions in the midst of the first large outbreak, over time I became fascinated by the ways in which people were thinking about COVID-19 in such drastically different ways when compared to my friends and colleagues in different parts of the United States, and even globally.

Study participants were local residents of Dickinson County, which has a year-round population of around 17,000 people. This population balloons in the summer to around 100,000 people visiting the lakes for tourism or to occupy summer residences. Busy weekends, such as Independence Day celebrations, have attracted a half-million visitors. I interviewed mostly year-round residents and some summer residents, quickly assembling the project amidst the biggest outbreak in the town, as cases hiked from eight to 200 within one month (see Kenworthy et al., 2021; Koon et al., 2021). After the initial outbreak, I expanded the project to better understand people with different political affiliations, income, occupations, and beliefs. For this article, I draw from 86 formal interviews, hundreds of informal interviews and conversations, public forums of the school board, and observations of everyday life, such as social interactions in Walmart or observations of people conversing on the street. While my participant observation was conducted over the course of the first pandemic summer in Dickinson County, Iowa (which I often refer to by its colloquial term and the name of one of the small contingent towns, “Okoboji”), I continued the research until June 2021 over Zoom, following up with several interlocutors and closely following the local news reporting on public health measures. I employ quotes and vignettes from coding 81 formal in-depth 30–90 min ethnographic interviews with 86 community members, business owners, elected officials, public health practitioners, and healthcare providers; and 12 testimonials within two public discussions of the school board. Further data, including more code-driven analyses on this project in Okoboji, as well as companion sites I conducted with students in California, can be reviewed elsewhere (Dhanuka et al., 2023; Hariharan et al., 2022; Kenworthy et al., 2021; Koon et al., 2021; Mendenhall, 2022).

All but three of the people I interviewed self-identified as White, and residents of the town in which the study took place are mostly White (96%), conservative (two in three people voted for Donald Trump in 2020), and Christian (two-thirds, and most are Protestant or evangelical; DATA USA, 2020; Dickinson County, Iowa, 2020). Those declining to participate often referred a friend, neighbor, or colleague; however, some declined because they saw me as an outsider or perceived COVID to be too political to talk about. Most interviews were conducted over Zoom, although some were conducted in person, and always socially distanced on people's porches, yards, or in parks.

Twenty-eight of the 86 people I interviewed formally owned their own businesses. The rest worked in the hospital, schools, politics, non-profits, or health centers. Some worked multiple jobs or shift work at large national or regional stores, restaurants, cafés, gift shops, grocers, or manufacturing plants. Most people I spoke to were middle or upper middle class. About 12% described low wages, and one quarter earned very high wages. Three in four people I spoke to had completed college or more schooling. The rest had finished some college, technical school, or high school. I triangulate data for this article from participant observation, formal interviews, and everyday talk. As an insider/outsider—as I am from the community but do not live in the community—I have known (or known of) most of my interlocutors since childhood, although I met some people over the course of the research.

Jay: Middle ground

In July 2020 I spoke to a local metal worker who described himself as a libertarian and avid fan of the popular and controversial right-leaning political podcaster Joe Rogan. I begin with Jay in part to illustrate how important local leaders were for the public health effort and to exemplify the trust local leaders emboldened when state and national leadership faltered. In many ways, local leadership—in both public health and business—was much more powerful in determining how people perceived the pandemic and in which they devoted their time, energy, and concerns. Jay, and many others, described how important the weekly Facebook public health awareness videos of Zach describing the local risks, outbreaks, and concerns in Dickinson County were for him, in part because he was frustrated by the inconsistent messages conveyed by the national and state leadership. Jay was, however, reassured by the local public health leadership and perceived Zach and other local physicians as being committed to his well-being. However, my discussion with Jay revealed the tightrope many people walked between messaging around personal responsibility, wanting limited government in their lives, and wanting the pandemic to end. In everyday talk, people negotiated the social expectations of in-groups and out-groups that were forming in these early days of the pandemic.

Jay said, “I’m stuck in between a rock and a hard place because,” he took a deep breath. “I’m trying to find the right words to use here so it's not just like,” he paused again. “But like if this virus is that horrible and that deadly, why do I have to be tested to know that I have it? You know, if it's so bad! So those thoughts run through my head. Then 10 minutes later I’m getting out of my vehicle to walk into Walmart and I’ll put my mask on. Then again, I don’t know.”

I looked at him and asked, “So you feel like, if it is that bad, we shouldn’t need tests because you would just know that you have it?”

“Right,” Jay replied. “And then again I know that it can lay basically dormant in your system and you’re carrying it and you can have absolutely zero effects from it. But then you know it could kill my grandma in days.”

Nodding, I said, “Exactly.”

Jay continued, “You know, you get information like that and you’re going back and forth and it's just really hard and I think a lot of the reason it's hard for me is because of the political differences. Can you really trust anyone in our government to tell us the truth? So I just go by the hospital guidelines.” He paused and explained further, “You know and then I was listening to our governor speak the other day at her press conference and, while watching her Facebook videos, I would read the comments. There were people begging for a shut down and then the next comment would be someone saying, ‘Don’t you dare shut us down, we’ll be just fine.’ You know whatever. And it's like,” he paused again. “They’re so far apart, you know. ‘I voted for you and I guarantee I’ll vote you out because you won’t shut our state down.’ And then the other people are like ‘I didn’t vote for you, and now I’m going to because you didn’t shut our state down.’”

I said, “And it feels so divided that it's not like there's a middle ground.”

But Jay disagreed. “There absolutely is middle ground but there is absolutely no way in my opinion for it to be reached because people have put up such big walls that there's just no way to even hear the other side.”

In-groups

Social psychologist Jonathan Haidt (2012) argues in The Righteous Mind that there are six moral values that drive political divisions. These values emerge across contexts: care/harm, fairness/cheating, loyalty/betrayal, authority/ subversion, sanctity/degradation, and liberty/oppression. Haidt argues, “political parties and interest groups strive to make their concerns become current triggers of your moral modules. To get your vote, your money, or your time, they must activate at least one of your moral foundations” (Haidt, 2012, p. 156; also see Haidt, 2001).

A good example of getting your vote through a moral value is by promoting the idea of caring. Caring Is both innate and learned, and this is exemplified by caring for our young. Caring diverges somewhat when we move to political parties, sports teams, universities, and rock bands but maintains similar characteristics. Haidt says bumper stickers are the clearest in-group badges. Haidt provides two examples. On the one hand, a liberal “Save Darfur” sticker begs the reader to “protect innocent victims.” The conservative “Wounded Warrior” sticker emphasizes those who have “sacrificed for the group” (Haidt, 2012, pp. 157–158).

The loyalty construct was tested during the coronavirus crisis in 2020. I found that the idea of loyalty to the president became imbued in the mask debate. This can be understood by people not wanting “outsiders” (i.e., liberals) to tell them what to do. In some ways, scientists were associated with liberals during the coronavirus response and therefore refuted by the right. The need to form groups is inherent in human history, where we have for centuries built “cohesive coalitions” to create a society we imagine (Haidt, 2012, p. 163).

These group factions were solidified further during the 2020 election cycle, which mirrored public health recommendations (like masking). When you wore a mask, you were going against the group. In many ways, people promoted in-group fidelity (that is, unmasking) through shame. In Okoboji, people wanted the freedom to unmask, while often wielding shame when anyone did the opposite of what they believed. But shame works in both directions. In other parts of the country, people used shame to ensure that their neighbors would mask.

Shame is a powerful social tool (see Brewis & Wutich, 2019). As a feeling of humiliation or distress caused by a perception of foolishness or wrongdoing, shame shapes how people think about engaging with others. Shaming is not always visible; but masks are. People wielded shame about masking and unmasking throughout the summer around the country, causing the choices people make about whether or not to put on masks when they leave their homes to be calculated and in many cases linked to fear they may be judged. Shaming can also be subtler, such as the tilt of a head, the scooting away of a chair, a laugh, or a stern look of disappointment (refer to more extensive discussions of shame in Kenworthy et al., 2021; Mendenhall, 2022).

Masking at Walmart

Issues like masks accumulate larger symbolic or moral meanings in ways that rendered conversations about the effects of national and state coronavirus policies ever-more difficult, demonstrating the extremes to which in-groups and out-groups become imbued in both everyday life and national political discussions. Jonathan Metzl (2019) argued in his book Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland that liberals are slow to realize how “Trump supporters were willing to put their own lives on the line in support of their political beliefs” (p. 5). Focusing on contentious issues of gun-control, health care, and school funding cuts, Metzl described how “frameworks of white racial resentment shaped debates about, and attitudes toward, various public policies and acts of legislation” (p. 8). For example, he provides the example of a woman who held on so tightly to her gun rights that she actually shot herself in the face while playing with her gun when her boyfriend drove off the road. She died by accidental suicide. In some ways, American practices of unmasking demonstrated a similar type of stubbornness. With the pandemic occurring amid the 2020 election, unmasking strongly aligned with President Trump's rhetoric of normalcy and downplaying of the severity of national outbreaks throughout the summer (Paz, 2020).

Yet I noticed beliefs about masks were not clearly divided between right and left, wealthy and poor, religious and agnostic (Koon et al., 2021). Many people were ardent supporters of President Trump while still advocating for masking and social distancing. Some conservatives were frontline workers at businesses that required masks and were relieved to have reliable masks to protect them. Others were in constant protest against being told to wear any mask at all. Some dangled their masks below their nose when their employer required them, in protest.

The most contested space in town, where maskers and unmaskers walked shoulder to shoulder, was Walmart. Walmart was the only place many people said they would mask. It was also the only place where there was national policy mandating that people must mask.

I found people across town grappled with Walmart after the corporation instated a mask mandate in mid-July (Smith & de la Rosa, 2020). Jay, for example, always put a mask on at Walmart. In contrast, a local politician told me he decisively avoided Walmart because he, as part of the GOP, would not be seen wearing a mask in public.

Everyone mentioned Walmart in my interviews. It was a place where some people refused to go (on policy) but everyone would slip into (by necessity). Walking through the store, we ran into people double masked with gloves and worried looks. The next beat we saw a man wearing a red flagship Make America Great Again hat with his mask around his chin.

What was striking about the anti-masking stance that so many people upheld was a simultaneous belief that if you were vulnerable, then you should stay home (Christensen, 2022). Many people I interviewed—who often unmasked—balanced worry about someone they loved becoming infected and the perceived harm of masking (Hariharan et al., 2022). One mother described how her daughter had a respiratory condition so she was concerned both with what might happen if her child developed COVID-19, and the conspiracy theory around CO₂ harming her daughter's lungs from wearing a mask all day. (Even though this conspiracy theory was widely debunked, it continued to spin; see Khazan, 2020.)

Yet, many people found masking to be very frustrating in part because science was in-the-making, constantly changing on what people should do, where, and for how long (Jacobs & Ohinmaa, 2020). I spoke to one tradesman whose wife worked in a hospital and was frustrated by the quick pace of changes to mask recommendations and the lack of available personal protective equipment (PPE) for her to wear at work. On the one hand, part of his frustration was related to his uncertainty of what to do. His frustration was a classic case of sense-making where people make sense of their reality by interpreting the narratives they gathered from the media, politicians, and organizational leaders who mediated their everyday realities (and risks) (Langley, 2021; also known as frames, see Koon et al., 2021). On the other hand, he was frustrated by her inability to protect herself at work, which was inherently a structural problem (even when it was disguised as an individual one); the PPE shortage during that time was linked to the Trump administration shutting down the strategic national stockpile of PPE in 2018. In the end, concerned for her safety during a time of great uncertainty, he bought every mask he could find at regional home improvement stores and stuffed them in the back of his truck.

Trade-offs

I spoke with a number of business owners who were taking COVID-19 precautions very seriously and described in detail how science and CDC guidelines influenced their decisions. None of these businesses completely shut down. Instead, nearly every business serving the public was working by appointment only or regulating how many people could enter their store at once. For example, an athletic studio offered only online or outside classes for many weeks; later they opened with limited capacity indoors. A small gift shop required masks and provided them free-of-charge at the door. Many of these business owners were concerned with their patrons feeling safe.

Some of these business owners were beyond frustrated by what they saw other business owners and community members doing throughout the pandemic. For example, I spoke with a business owner, who I will call Merin, who was deeply rattled by the community's resistance to masking. For her, the anti-mask stance was moral as opposed to political. When I asked what people can do to prevent coronavirus, Merin provided the most lucid moral argument I had heard:

Well, I think of course, masks. Unfortunately, it's a statement in itself. It's a statement to wear a mask to protect or assist with someone else's wellbeing. And to choose not to do that is much more of a statement about who you are than what your political opinions align with. So, to me, it's more of a character type of, I guess that's a personal opinion, because if you’re unwilling to care for someone else's wellbeing, then I take offense to that. Because that's what it is. You’re helping others, for other community persons. You’re not protecting you. But other people around you.

She went on to explain that the pandemic experience, in a context where few people heeded public health recommendations, radically transformed how she perceived her community: “It has changed my perspective even driving down the road now,” Merin explained. “Because I’m viewing humans differently as to how they are caring about other people. And so, if they have so little disregard for other people, how are they going to be driving the fastest vehicle, you know? I have all of these other mind-boggling perspectives on human nature that have stemmed from this. That I feel we have strayed so far from the general moral of what it is to be human, and what it is to live in a community to take care of one another.”

Dutch philosopher Annemarie Mol (2008) has argued that instead of a logic of choice, we should think about these circumstances as involving a logic of care. Situating within a logic of care imbues the decision with greater meaning where decisions around risk for an individual or community must involve aspects of caring for people—truly seeing their needs, complexity, and feelings. Caring is something that grows out of mutual knowledge and engagement in promoting good health and whole lives (as opposed to decisions chosen moment to moment without a history or community of people). Although Mol speaks about caring within clinical contexts, there is relevance to community contexts where logics of care determine people's actions, especially when those actions have serious implications for others. In this way, people were not making a choice to mask or not: they were demonstrating their motivation to care (or not) for others.

Merin went on to explain her theory of why and how people navigated these decisions: “I think power. And it is having that sense of power to make that decision. And if you are a person that needs that sense of power then you don’t have that power somewhere else in your life.” Merin's comment speaks to the broader way that the politics of resentment have played out among the White working class in America, where people exert power somewhere in their life where they can when they feel powerless in other parts of their lives (Fukuyama, 2018). As Francis Fukuyama (2018) explained in his book Identity, “the economic inequalities arising from the last fifty or so years of globalization are a major factor explaining contemporary politics, economic grievances become much more acute when they are attached to feelings of indignity and disrespect” (pp. 10–11). In this way, people who resist masks but repeatedly miss work because they become sick or are exposed to coronavirus (and possibly become financially crippled) exemplify the politics of resentment in American society that enabled the rise of Donald Trump.

This framing closely aligns with Metzl's (2019) argument in Dying of Whiteness, where he argues that “deeply modern-day American backlash conservatism demands that lower- and middle-class White Americans vote against their own biological self-interests as well as their own economic priorities” (p. 52). “At least what I’m seeing here, I don’t like to generalize different groups,” Merin told me. “But I think, at least what I witness in the store, there is a lot of masculine energy in people who don’t like to wear masks. So, it is a lack of grounding, and lack of connection with who they are. There is just something they can utilize to feel powerful.”

Merin suggests that these acts of mask-defiance illuminate an outward expression of power and control over an unfamiliar threat. In northwest Iowa, men hold on tight to traditional gender roles where they are largely expected to be bread winners. It may be that men feel their identities threatened by financial loss to the pandemic. Could these idealized norms play out in shaming masks and throwing their energy into the economy? Metzl (2019) similarly argues that

according to evolutionary biology, these men responded in predictable ways [when their masculinity felt threatened]—by smoking, fighting, drinking, pumping iron, driving too fast, or other modes of chest-beating that restored a sensation of order but also increased their blood pressures and shortened their collective life spans. (p. 52)

Logic of care

Many people navigated what to do about COVID-19 by enacting a logic of choice, meaning they felt unmasking was a right. However, most I spoke to unlocked a personal logic of care through which they navigated these decisions, often describing how fear about themselves or others close to them who demonstrated some vulnerability affected where they went, whether they masked, and how they interacted with others in one context or another (Ali, 2020).

Mol (2008) argues that a logic of care “is not preoccupied with our will, and with what we may opt for, but concentrates on what we do” (p. 7). One interlocutor described this type of logic with regard to masking: although she did not perceive herself to be high-risk for moderate or severe COVID-19, and rarely wore a mask to protect herself, when she was around someone who was high risk, she put a mask on. She also described putting on a mask among those who were fearful, or who felt very strongly about others wearing a mask. She described very clearly adapting to the collective fear when it made sense to do so, even while caring differently for herself when she perceived it was comfortable and safe.

I spoke to two mothers who worked in the wellness industry who made me think about what logics of care meant in this community. One mom said,

I think people that are maybe in education or science or medical field right now, are just seeing things differently than the rest of us are. […] Because what I’m seeing is, I don’t even know anyone very close to me that has tested positive. I know of people. And of those people that I know most of them have recovered in a couple of days. […] I personally don’t have reasons to be fearful.

“I just feel that there is not enough logic going on,” she replied. “There are the rules: they don’t make sense. Six feet is such a stupid number. I think you know being out in the fresh air,” she paused and shook her head. “I don’t know how that got all tangled up with this. Why people wear a mask when you are out and about when you are away from people? I just feel like things have gotten messed up.” I nodded as she spoke, because I found the shifting recommendations confusing myself. Throughout the pandemic many people spoke of how shifting policies affected trust in public health leadership and confusion amongst each other (Glenn et al., 2020).

In some cases, logics of choice had severe consequences. There was a small minority of families who identified as “anti-vax” who were steadfast in their mask refusals and promoted the idea of “building immunity” through infection of themselves and others. This was exemplified by a mother of four who told her COVID-positive children to run through Walmart to infect others, indicating that this would build immunity in the community; a local physician who aggressively promoted conspiracy theories and treatments like Ivermectin and hyperbaric therapy for COVID-19; and a father who went to a bar to get infected with COVID-19, only to become concerned when a family member was infected by him and became very ill. These individuals, and many others, repeated the mantra: “I don’t fear the virus because I believe in God.” It was this religious fervor that often centered this “magical thinking” about coronavirus (Lévi-Strauss, 1966), where true believers would survive due to God's grace.

Fear was a contested emotion throughout the summer: some people were so fearful they would not leave their house while others I spoke to were very clear that they did not fear coronavirus because “He will protect me.” This use of language in many ways reflects an insider status, synergizing a strong faith, clear political position, and the confidence to go on with daily life without fear. However, the salience of fear demonstrated how people grappled with the biological reality of risk and vulnerability for an unknown virus while trying to put on a brave face due to their social networks and religious or political beliefs (thereby solidifying their allegiance to their in-group).

Others described how the realities of companies putting profits before people made them face their fears even when they might not have wanted to (Blustein & Guarina, 2020). A small business owner explained that many factories were “not observing any time off for quarantine” and “putting profit before employee health.” She emphasized how this was happening in Dickinson County, and that it was even worse in the meatpacking plants in Storm Lake—a town 60 miles away that was known for its flourishing ethnic and racial diversity, left-leaning politics, and burgeoning population. She implored that businesses were more concerned with profits than their workers, which was unregulated by the federal, state, or local government, and therefore felt no obligation to follow local public health guidelines.

I spoke to a technician at Polaris, a local company that makes motorcycles, snowmobiles, and all-terrain vehicles, who said over the “past couple months they have done stuff to keep people at a distance. But some areas you can’t.” I asked if they wore masks on the factory line. The technician said, “Some people are required to wear a mask. But I just kind of float around so I don’t wear a mask.” A classmate who works as a security guard told me,

I refuse to live in fear. If something is going to happen, it is going to happen and there is not a damn thing I can do about it. I can go in wearing a mask but that doesn’t mean that I still won’t contract the damn thing.

This form of fatalism was something that I found emerge as a quiet hum within many conservative interlocutors. I asked a local therapist if many people expressed fear associated with getting sick from COVID-19; she said that it was uncommon. The local therapist explained,

There is not a high level of fear in my opinion overall of COVID [in Okoboji]. There is just not. There are some, like I said, there is a high level of fear related to it [because of their personal risk or the risk of a loved one]. But overall, I’m not seeing that. I really thought that when I offered Telehealth versus in office, that it would be a much higher percentage that would stay Telehealth. I was shocked [when nobody chose telehealth].

The therapist went on, “I hate to bring politics things into it, but I think it is more of a conservative thing. I think people here tend to—not all people, but a lot—tend to hold on to the belief they don’t want government telling them what to do. And so to be told like we are required to wear a mask doesn’t feel good to a lot of people.”