LANCASTER, Pennsylvania — While most Americans are glued to their televisions and cellphones for the latest information on the coronavirus pandemic, the nation's Amish communities — tight-knit Christian farming families that live simply and reject most modern technology — present a challenge for elected and public health officials working to share information about the virus.
There were more than 340,000 Amish living in the U.S., in 2019, according to the Young Center at Elizabethtown College, which focuses on national Amish studies. They live primarily in states like Pennsylvania, Ohio and Illinois.
While it’s unclear how many Amish have been diagnosed with COVID-19, the illness caused by the coronavirus, there's evidence of positive cases in several counties where they live. Lancaster County in Pennsylvania, for example, has reported at least 596 cases (on par with some Philadelphia suburban counties), while Geauga County in Ohio has at least 47 cases and Douglas County in Illinois has 11 cases.
Pennsylvania, Ohio and Illinois are among those that have issued statewide stay-at-home orders, so the Amish are cut off more than usual from the outside world — meaning they aren’t receiving much news about the pandemic in real time. Typically, an Amish person might hear news on the radio if driven in a car by a so-called “English” (non-Amish) colleague, or hear updates from non-Amish co-workers or at farmers markets.
While churches and schools across Amish country have closed, the culture itself remains very social, with communities sometimes continuing with the kinds of large gatherings discouraged by state and local officials during the pandemic.
“In their culture, they look forward to those events, to going to church and having weddings,” Dr. Holmes Morton, who treats Amish patients in Belleville, Pennsylvania, told NBC News. He described a phone call he had with one of his regular patients who lives in an Amish community near Pittsburgh, where church services were still being held.
“It’s very hard on them as a culture, to accept the fact that it's dangerous to do that,” Morton said.
Morton’s office, the Central Pennsylvania Clinic, is offering testing to the Amish community for COVID-19 to boost awareness of the severity of the virus and the importance of prevention.
It’s a drive-through process, but with horse-and-buggy service for the Amish. WellSpan Health, a health care system in central Pennsylvania which works with the Amish, has been updating the community on the pandemic since mid-March, sending mailers to church deacons who often serve as disseminators of information.
“The real challenge is getting information out quickly, because they do not have access to the things that most of the rest of us would turn to quickly like social media, the internet and television,” Joanne Eshelman who, as WellSpan’s Director of Plain Community Relationships, said.
“We jokingly talk about the ‘Amish internet.’ Information spreads by word of mouth fairly quickly,” Dr. Keith Wright, the medical director of quality and innovation, said.
Wright says their health liaisons work to answer questions coming from the community about when to wear masks, when businesses can open again, and in what situation they should seek testing.
Because so many Amish and Mennonites — a similar community of “Plain” Christian farmers — are uninsured, WellSpan Health is waiving all out-of-pocket costs for anyone who needs COVID-19 testing or treatment during the coronavirus outbreak. The health center also provided a pattern for the Amish to sew their own masks; many families have made extra masks and are donating them back to the health care system as the state sees shortages in personal protective equipment.
One Amish death due to COVID-19, in Indiana, was reported by several physicians and liaisons this week. NBC News could not confirm the cause of death due to the federal health care privacy law.
An obituary for the deceased said that the funeral service will be private and for family only. That suggests an acceptance of social distancing measures, as Amish funerals can typically draw more than 400 people in Indiana.
Amish farmers markets and agricultural auctions have been permitted to continue as essential businesses, but attendance has decreased in recent weeks.
“It’s a strange sight to see the market so empty,” one Amish man at the Lancaster Central Market in Pennsylvania said, requesting anonymity due to privacy and religious concerns. Blankets covered at least half of the stands in the market, marking their temporary closures.
“The folks who are coming know what they want to buy, instead of wandering around like some do. So business has been cut in half, but luckily some people are willing to come down to the farm,” the man added.
Liaisons with the Amish community said that most communities are abiding by the stay-at-home orders.
Typically when driving through Lancaster County, the roads are sprinkled with horse and buggy carriages carrying Amish families through town. This week, a lone Amish woman riding her bicycle was spotted, passing a sign reading, “Dawn comes after darkness,” echoing a Bible verse.
The Penn State Extension, a branch of the university used to educate local communities regarding science and agriculture, normally works with the Plain sect communities -- it has distributed pamphlets to hang in Amish businesses that are still operating, with guidance and graphics depicting best practices.
The large Amish farming community receives publications like Lancaster farming where Leon Ressler, an agronomist with Penn State, publishes a weekly column, used now to provide updates on national guidance regarding the coronavirus.
Last week’s read in part, “Since we don’t yet have an approved treatment, social isolation practices to prevent the spread of the virus are critical to gaining ground in the efforts to control the virus,” pointing to guidance from the White House task force and the Centers for Disease Control and Prevention.
In Illinois, though, the Douglas County Health Department has worked over time to build a relationship with the Amish community, providing regular care and immunization clinics throughout the year.
“With that community, from the beginning, we just blanketed information about COVID-19,” department spokesperson Amanda Minor said. “Even if it’s the same information that comes from the CDC or the president, if it comes from us locally, it feels more trustworthy. We put it on our letterhead.”
Minor noted the Amish population she works with has done well abiding by the guidance to avoid gatherings of more than 10 people, especially with church services.
In Ohio, Amish schools closed the day after Gov. Mike DeWine gave the order statewide. Geauga County worked with the Amish school superintendent to strategize about safe alternatives to give out lesson plans, since the Amish don’t have access to the technology for remote learning.
The Amish community “is being very proactive in asking for partnership with Geauga Public Health,” Health Commissioner Thomas Quade said.
Quade described detailed communication with local bishops to request churches be closed throughout the month of April, along with efforts to create billboards depicting social distancing using items the county thought would be meaningful to the community, like a ladder and tape measure.
“Just like in the non-Amish community, there is room to improve, but there is a very good relationship between their leadership and the health department to assure communication is flowing in both directions,” Quade added.
Maura Barrett reported from Lancaster and Matt Wargo reported from Reading, Penn.