At the center of the state’s growing measles outbreak, it’s business as usual

Listen to article • 0:00 min

The floats had been decorated, the public officials assembled, and now the parade was underway — a convoy of colorful trailers and pickup trucks rolling slowly through downtown.

Firetrucks passed grandmothers in lawn chairs and young children, squealing with delight as they fetched candy tossed by the fistful from passing floats.

It was Goose Day in Mifflin County — honoring an animal believed to bring good fortune and prosperity in the coming year — and everywhere you looked were geese: ceramic geese standing sentry on street corners, inflatable geese atop parade floats, goose meat soup over at the Square Cafe, $6.29 a cup.

But the day’s joyous tone belied a grim reality.

In the midst of the state’s deadliest measles outbreak in decades, Mifflin County — this rural enclave of 46,000 tucked into the rolling hills of the central Pennsylvania valley — had recently achieved a troubling distinction:

It now counts the highest rate of infection of any county in the state.

For weeks, the nation’s rapid spread of measles — once deemed eradicated in the U.S. thanks to the measles, mumps, and rubella vaccine — had been met with growing national alarm. Public health experts issued increasingly sober warnings. News outlets across the country published the latest case totals and measles-related deaths, in a kind of macabre box score.

Less than a mile and a half from where paradegoers gathered stood Geisinger Lewistown Hospital, where an 18-year-old Amish girl had been reportedly treated for the measles before ultimately succumbing to a rare complication of the infection last month. She was the state’s fourth measles-related death. A fifth and sixth, in Lancaster and Franklin Counties, soon followed.

Yet during a visit to Mifflin County earlier this month, and in conversations with area members of the Amish and non-Amish communities, there were few tangible signs of concern. No widespread panic. No state-held news conferences, like the one organized this summer in Lancaster County, to extoll the benefits of vaccination.

At the epicenter of the state’s outbreak, measles seems to have been largely met with a sort of shrugging detachment.

By locals outside of the Amish community, who largely see the outbreak as not their problem.

By elected officials, who have been reluctant to address publicly the community’s growing public health crisis.

Even by members of the Amish community themselves, who — hit disproportionately hard due to low rates of vaccination — have insisted that the virus is simply part of life.

As cases here continue a troubling rise, there seems to be, for many, little sense in fretting.

“My dad used to say, ‘Worry is from the devil,’” says Mose Yoder, a member of the local Amish community.

“We still have to do what we have to do.”

A community poised for trouble

Mifflin County is home to an estimated 5,500 Amish people, a community long leery of modern advances, at times including healthcare and vaccines. Mifflin County’s Amish communities tend to be more conservative and traditional than those living in Lancaster County, which has the highest total case counts in the state.

The county as a whole trends heavily Republican, a faction in which vaccine skepticism is higher. Seventh-grade measles vaccination rates in the county — which include both Amish and non-Amish students — sit at around 77%, among the lowest in the state. (Philadelphia County, by contrast, is at 97%.)

It remains unclear whether — and how far — the outbreak has extended beyond the Amish community to the county’s other residents.

But the outbreak has clearly spread widely among the area’s Amish.

Vaccination efforts in Mifflin are likely complicated by the local Amish communities’ attitudes around technologies and interaction with outsiders, said Steven Nolt, professor of history and Anabaptist studies and director of the Young Center for Anabaptist and Pietist Studies at Elizabethtown College.

“You can’t just say, ‘It’s the law of the land,’” says Helge Hartung, a physician at the Central Pennsylvania Clinic in Belleville, which treats a large number of Mifflin County Amish and has been working to vaccinate them. “That doesn’t work.”

Since July, 193 cases have been confirmed in Mifflin County, with 76 new cases reported in the last two weeks — more new cases than any county in the state over that period. Both numbers, experts say, are almost certainly significant undercounts.

Yet, during a visit to Mifflin County earlier this month, it seemed to largely be business as usual.

At the Sharp Shopper grocery store in Belleville, both horse-drawn buggies and late-model SUVs still fill the parking lot.

At the Wednesday livestock auction and farmers market, a heavily attended weekly event, men in straw hats and suspenders commingle with guys in pickup trucks and novelty T-shirts (“My wife says I only have two faults: Don’t listen and something else.”).

In the small shops and restaurants of downtown Lewistown, patrons talk about the weather and the Eagles’ offense — but not the virus spreading rapidly through their county.

“I haven’t heard one customer talk about it,” says Deb Guard, who owns the Lemon & Lime craft shop in downtown Lewistown. “Seriously, not one.”

“I haven’t heard one customer talk about it. Seriously, not one.”

Deb Guard, owner of the Lemon and Lime craft shop in downtown Lewistown

Even the online rumblings that have been known to percolate here — politically infused back-and-forth about vaccine safety and efficacy — rarely spill into public, residents say.

Over at radio station WMRF-FM 95.7, just off the town square, morning host Rocco Pallotto routinely wrangles a chatty stable of listeners. “You ask them [whether] they like apple, pumpkin spice, or caramel better — oh, boy,” he says.

But when Pallotto put out a call recently to discuss news of the local measles outbreak, he didn’t receive anything in response.

“There’s just nothing there,” he says.

Asked about the rising cases, Amanda Haines, a home health aide and mother of two vaccinated sons from Lewistown, shrugged last week as she sipped coffee outside the East End Coffee Co.

As she put it: “I’m more worried about my kid [coming home with] lice.”

Among the Amish, little concern

In Belleville, home to many of Mifflin County’s Amish, it’s difficult to find anyone who hasn’t been touched by the current measles outbreak.

It reached Bennie Peachey’s family not long ago, leaving two of his five children — the 9- and the 7-year-old — bedridden, covered “head to toe” in rash.

The father himself has so far been spared — “unless I have it now,” said Peachey, a lithe man of 33, as he fussed with a tractor outside the family’s barn. If so, he noted, “It’s not too bad.”

The Amish have looked out for each other.

They know which neighboring farmhouses are grappling with the infection. They trade home remedies for mitigating the virus’ effects — blackberry juice and yarrow tea for hydration, sunglasses for a sensitivity to light. Some make a point not to bathe while ill, out of an unfounded fear it might push the virus deeper into the body.

“We want to take care,” said one Amish woman who declined to give her name. “But we feel that God is in control.”

A lack of information — both inside and outside the Amish community — has been an ongoing issue.

At least one local Amish newspaper — Die Botschaft — decided not to publish the infection totals and has opted not to wade into coverage of the outbreak, including any recommendations regarding the vaccine.

“We just don’t get into that stuff,“ says David Lapp, owner and editor of the Millersburg-based publication. ”It’s not really our focus, or our target.”

A spokesperson for the Pennsylvania Department of Health said last week that its efforts to curb the spread of the disease in Mifflin County include distributing “educational materials and … flyers about vaccine clinics.” The state is working with local healthcare providers to build trust on outreach and vaccination efforts.

State Secretary of Health Debra Bogen recently traveled to Mifflin County to meet with local healthcare providers, the spokesperson added, to ensure they “have the tools they need to continue to provide educational information and MMR vaccinations to the affected community.”

Local officials, however, have been reluctant to discuss a topic that has routinely devolved into politically infused rhetoric.

“We don’t think that we can add much to your inquiry,” Robert Postal, one of three Mifflin County commissioners, said in an email.

Some in Mifflin County have filled the void with rumor and innuendo, especially in the weeks following the 18-year-old’s death.

The county coroner, a Republican, posted a news release on Facebook saying the young woman died of acute disseminated encephalomyelitis, a rare and serious neurological complication of measles.

Yet the gossip that reached Randy Wilsoncroft, a local who runs a stand at the weekly Belleville auction and market, speculated erroneously the girl suffered from underlying health issues that had exacerbated her infection — even as her father described her, in a September interview with the Pittsburgh Post-Gazette, as “perfectly healthy.”

“I heard she had West Nile and Lyme disease,” Wilsoncroft said.

Back in medical school, when Katie Mascia learned about the measles, the lesson had the feeling of a long-ago relic.

“It was almost like a historical lecture — like, ‘Oh, yeah, this is what measles looked like back in our grandparents’ age,’” said Mascia, now director of clinical services at the Central Pennsylvania Clinic in Belleville. “I never expected to see a measles case when I graduated from medical school, that’s for sure.”

Ever since the first patients began showing up this summer with coughs and fever, she and other local healthcare workers now find themselves on the front lines of responding to an outbreak that has sickened more than 1,200 people statewide.

“I never expected to see a measles case when I graduated from medical school, that’s for sure.”

Katie Mascia, director of clinical services at the Central Pennsylvania Clinic in Belleville

Though most people recover from measles without incident, nearly one in five infections reported in Pennsylvania has resulted in hospitalization. In the worst cases, patients arrive struggling to breathe, or must be life-flighted out of Lewistown to larger facilities across the state. Measles-positive mothers in the state have passed the virus on to their newborns, who are sometimes born with rashes and at risk for other severe diseases. Two Lancaster County infants with confirmed cases have died.

In the sterile corridors of the county’s clinics and hospitals, patient stoicism can quickly turn to panic.

“I see fear,” says Alexander Haines, an inpatient nursing manager at Geisinger Lewistown Hospital, which has treated 72 measles cases to date. “I see a lot of fear.”

At the Central Pennsylvania Clinic, physicians have done their best to pierce an often staunch reluctance to a vaccine that has proved 97% effective at preventing the infection.

The Amish people who spoke with The Inquirer this month shared a range of opinions that varied widely — sometimes within a single home. Some called the decision not to vaccinate a religious one. Some expressed concern that the side effects of the shots could be greater than the infection itself. Others have received one shot of the MMR vaccine, offering strong protection, but not a second, which experts recommend.

“It’s a personal decision,” says Aaron B. Kanagy, a father of eight in Belleville, who contracted the measles as a child, which means he should now have immunity to further illness.

Amid the current outbreak, vaccine resistance might be waning.

In August and September alone, healthcare providers in Mifflin County administered nearly 800 MMR vaccinations, according to figures provided by the state — a significant jump from the 50 to 75 vaccinations typically administered each month.

Last month, meanwhile, the Central Pennsylvania Clinic, which largely treats members of the local Amish and Mennonite communities, held a vaccination clinic locally. Originally, only 15 people signed up to be inoculated. By the time the event was held — just a few days after the death of the 18-year-old on Sept. 11 — 73 people arrived to receive a shot, Mascia said.

Still, a wide swath of the area’s Amish — and many other residents — likely remain vulnerable to an airborne disease known to infect nine of 10 unvaccinated people exposed to it.

Sitting inside the Belleville clinic, Mascia described the “heartbreak” of the ongoing spread, one that — with cold-and-flu season fast approaching — she fears could pose new challenges, including fewer available hospital beds.

As she spoke, the clinic’s executive director appeared in the doorway.

“A van with a big 6 on it just pulled in,” the woman reported.

Mascia glanced out an office window, watched as an out-of-town TV news truck eased into a parking spot.

“We’re very popular lately,” she said.

On a vast plot of Belleville land, inside a simple farmhouse, is a small, dark bedroom where the Kanagy family keeps its ill.

When the 12-year-old, Lizzie, first contracted the virus last month, the family — Aaron and Katie Kanagy and their eight children — did their best to keep their daughter quarantined even as they braced for a household barrage.

By early October, the twins — Lomie and Lena, both 8 years old — hadn’t been feeling well, though they were still on their feet. At the height of the 12-year-old’s illness, Aaron Jr., 7, spent hours at his sister’s bedside, fetching her glasses of water and regaling her with tales from the school day.

“I’m pretty much expecting it,” says Katie Kanagy.

The Kanagys, like many of the area’s Amish, are old enough to remember the region’s last significant measles outbreak, in the late 1980s, when the infection roiled the Amish community and at least three of the 10 Amish schools across Lawrence and Mercer Counties were temporarily shuttered.

But they made it through that OK, they insist.

This time will be no different.

If the infection is coming, Aaron Kanagy said one recent afternoon, as he looked out over the family’s 63 acres of farmland, he would prefer it come soon.

“Then,” he said, “it would be done.”