IN DEPTH -- A look at vaccination resistance in Appalachia and the toll on the nurses trying to help neighbors

The pandemic had hit late but hard in the Appalachian highlands — the mountainous region that includes Southwest Virginia and Northeast Tennessee — and over the winter many of its victims had ended up on ventilators tended by Boucher and her fellow nurses at Johnston Memorial Hospital.

They were enduring the traumas known to ICU workers across the world: days filled with death, nights ruined by dreams in which they found themselves at infected patients’ bedsides without masks. But they were also enduring a trauma that many doctors and nurses elsewhere were not: the suspicion and derision of those they risked their lives to protect.

Conspiracy theories about the pandemic and lies recited on social media — or at White House news conferences — had penetrated deep into their community. When refrigerated trailers were brought in to relieve local hospitals’ overflowing morgues, people said they were stage props. Agitated and unmasked relatives stood outside the ICU insisting that their intubated relatives only had the flu. Many believed the doctors and nurses hailed elsewhere for their sacrifices were conspiring to make money by falsifying covid-19 diagnoses.

Boucher and her colleagues were pained by those attacks — and infuriated by them. Unlike their exhaustion, that anger rarely showed on their faces, but it was often there: as they scrolled Facebook to see local ministers saying God was greater than any virus, or stood in line with unmasked grocery shoppers who joked loudly about the covid hoax....

The post-traumatic stress experienced by nurses and doctors during the pandemic has been compared to what soldiers suffer. But in places still rife with covid denial — often rural, conservative and devoted to former president Donald Trump — there is a difference: It is like having fought in a war that many believe never took place.  ...