By Sara Shipley Hiles, Kaiser Health News

WASHINGTON, Mo. — In August, local officials in this small city an hour west of St. Louis voted against requiring residents to wear masks to prevent the spread of the coronavirus.

On Nov. 23, with COVID cases surging and the local hospital overflowing, the City Council brought a mask order back for another vote. As protesters marched outside, Councilman Nick Obermark, an electrician, was the sole member of the nonpartisan council to change his vote, causing the mandate to pass.

One of his many reasons? He has a child the same age as Washington Middle School student Peyton Baumgarth, 13, who on Halloween became the youngest person in Missouri to die of COVID complications.

“That hit pretty hard,” Obermark said later. Though the councilman doesn’t like wearing a mask, he said it’s worth it if we can keep one or two people from getting COVID-19.

Washington became the latest community to flip its stance on masks and other restrictions while the coronavirus ravages the country.

As America enters a dark winter without national directives to curb the pandemic, numerous cities, counties and states must decide: enact more restrictions now or leave people to their own will? Some in this tightknit city of 14,000 have discovered that the answer — and the key to changing hearts and minds — lies in how close and real the danger seems.

After a spate of nursing home fatalities early on in Franklin County, where Washington is located, two months this summer passed without a death from COVID. Some residents saw the virus as a big-city problem and rejected preventive measures.

Families attended weddings with hundreds of guests. Downtown merchants held “Thirsty Thursday,” with participants mingling over drinks. Even as officials at the city’s hospital urged COVID restrictions, 356 people signed a letter to the local paper vowing their opposition to being “forced to cover our mouths in public.”

Republican Missouri Gov. Mike Parson has declined to enact a statewide mask mandate. Franklin County Presiding County Commissioner Tim Brinker posted on Twitter July 29: “Franklin County MO. No mandates, low case counts, low to no hospitalizations. Logic! Keep hands clean, and if you don’t have the space, cover your face. We love Freedom and respect human life. Come to Franklin County and raise your children in God’s Country! #COVID.”

Embracing freedom and tradition is as expected here as following deer hunting season or attending the Washington Town & Country Fair. The city’s downtown, within view of the swirling brown Missouri River, is lined with historical red-brick buildings and quaint shops. The Missouri Meerschaum Co. still produces corn cob pipes on Front Street. Its motto: “Over 150 Years & Still Smokin’.”

In the months before the election, yards sprouted signs for President Donald Trump, who has downplayed the threat of COVID-19 since the start of the pandemic.

But the virus crept closer in September when 74-year-old Ralph Struckhoff died of the disease. The Missourian newspaper published a story describing him as a healthy man who had just done a day of construction work at his church before he fell ill. “Please wear a mask in memory of Ralph,” his widow, Jayne Struckhoff, wrote in a letter to the editor. “If this virus can take Ralph, it can take down anyone.”

Some locals began asking: What would it take for this town to change? University of Missouri health communication assistant professor Yerina Ranjit said many factors influence health decisions. For instance, she said, people usually follow health advice if they believe an illness is serious and that they are susceptible to it.

“That’s true with COVID as well,” she said. Older people are more likely to wear masks and social distance. But others might not wear masks if they think the virus wouldn’t make them very ill.

Symbolic threats, or things that people feel threaten their values, can also affect behavior. In a survey of U.S. adults yet to be published, Ranjit and her colleagues studied media viewing and found that the kind of information people are exposed to makes a real difference. Regardless of political affiliation, they found, Fox News viewers were more likely to think the pandemic threatens the American way of life, which made them less likely to wear masks. They were “buying into the idea that masks are against our identity,” she said. On the other hand, people watching MSNBC felt more afraid of the virus, which caused them to wear masks.

But in November, Mayor Sandy Lucy noticed that attitudes were evolving. That’s when residents heard about Peyton, the middle schooler, who declined rapidly and died days after being admitted to the hospital, his mother told KMOV. According to his obituary, he was known for his love of Pokémon Go, flag football and the St. Louis Blues. “He loved his puppies Yadi and Louie who be lost without their buddy,” it said. “He loved listening to music and singing in the school choir.”

“Suddenly there was a death of a 13-year-old,” Lucy said, “and you think, maybe this virus is more vicious than I give it credit for being.”

Peyton’s mother, Stephanie Franek, pleaded in a TV interview: “Wear a mask when you’re in public, wash your hands and know that COVID is real.”

Meanwhile, cases skyrocketed. Between the first and second mask votes, the total COVID count in Franklin County, with a population around 104,000, climbed from 728 to 4,594, and deaths rose from 19 to 75. In the week ending Nov. 23, 25% of COVID tests returned positive results.

Mercy Hospital Washington was running out of space. Hospital President Eric Eoloff tied rising hospitalizations and deaths to the absence of safety measures. “As a hospital administrator, I knew we would be on the receiving end of the choices not to wear the masks and not social distancing,” he said.

In a surprise move Nov. 19, the Franklin County Board of Commissioners enacted a mandatory mask order. Presiding Commissioner Brinker told The Missourian that he had spoken to local doctors and the St. Louis regional pandemic task force, and the numbers “speak for themselves.” Brinker did not respond to requests for comment for this story.

Although the order already applied to the city, the Washington City Council went further and approved its own mask rule four days later. Unlike the county order, which expires Dec. 20, the city’s mandate will stay in force based on metrics related to the new COVID case rate, hospital admissions and deaths.

Dozens of protesters wielded flags and signs against mandatory masking outside City Hall the evening of the vote. Ali and Duncan Whittington came with their 4-year-old daughter. “I’m here because I feel my freedom is being violated,” Ali Whittington said.

Councilman Obermark later said that he had lost a lot of sleep over his decision. “It wasn’t one thing,” he said. “It was several things that made me change my mind.”

The high positivity rate, the lack of capacity at the hospital. Knowing healthy people whom COVID “knocked down” for days. His wife having to quarantine. And Peyton’s death.

He said he knows masks aren’t a cure-all, but they could help reduce the spread until vaccines arrive.

“We tried nothing and it isn’t working,” he said, “so we have to try something.”