"The Amish in Wayne County are part of the Greater Holmes County Area Settlement, which has the largest population of Amish in Ohio (36,955 in 2020). Traditionally, the Amish limit engagement with the government, the non-Amish health care system, and modern medicine, except in acute events that affect the wider community, such as a 2014 measles outbreak in an Ohio Amish community, and prefer an herbal or natural approach to well-being.
The high SARS-CoV-2 positivity rates from the May 20 testing clinic and findings from the interviews highlighted the extent and probable reasons for community transmission and served to increase participants’ awareness of COVID-19. After the testing clinic, an additional 39 persons from the community received tests by June 28, after experiencing COVID-19–compatible symptoms or having close contact with a person with COVID-19. Among the 39 persons whose specimens were tested, 25 (67%) received positive test results, suggesting ongoing community transmission.
Amish communities emphasize strong social connections and communal activities. The importance of religious and social gatherings and communal fellowship among the Amish has challenged efforts to prevent infection during the COVID-19 pandemic. Six religious and social gatherings were reported in this community; such gatherings have been shown to lead to SARS-CoV-2 outbreaks. To help limit transmission within other Amish communities, public health officials recommended five strategies to local health departments. First, health departments should continue to build trusting relationships with Amish community institutions and leaders. Second, health education materials should be provided through local networks. The Amish rarely use electronic communication; however, well-established Amish media networks (newspapers and radio stations), local Amish steering committees (serving as liaisons to various government levels), and Amish- and non-Amish–owned businesses with Amish employees can help share COVID-19 prevention messages. Third, messages using culturally acceptable language emphasizing protection of family and community might help persuade community members to apply these strategies. Fourth, access to testing services needs to be timely and convenient, with active support from community leaders. Fifth, health departments and the community should continually share information and concerns about mitigation strategies and barriers to their use. Establishing points of contact within communities might allow health department staff members to promptly share updated or new information."
