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 , causing the mandate to pass.

One of his many reasons? He has a child the same age as Washington Middle School student , 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, 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 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 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 . The city’s downtown, within view of the swirling brown Missouri River, is lined with historical red-brick buildings and quaint shops. The . 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 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 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 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, . According to his obituary, he was 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 : “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 in Franklin County, with a population around , 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 . Presiding Commissioner Brinker 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 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.”

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“Hardly anyone wears masks here,” observed Bob Harrison, visiting with his wife, Etta Harrison, from Olathe, Kansas, outside Kansas City. “People are sort of like, here, it’s a vacation resort, and they don’t have to worry about it.”

As summer approaches, tourist destinations from Cape Cod to Yellowstone National Park face looming questions over how to reopen tourism-dependent economies while balancing risks from the coronavirus. At the Lake of the Ozarks, a 54,000-acre reservoir thrust into the spotlight over Memorial Day party photos, the answer seems to be: We’re open for business.

Many residents and visitors at the lake remain relatively unperturbed about the virus and the national outrage over at Backwater Jacks and other Lake of the Ozarks bars over the holiday weekend. Even after reports surfaced recently that one for COVID-19 and potentially could have infected hundreds of others in the Midwest, some still look on the sunny side.

“It was a good thing,” said Larry Clark, who was selling coffee at a farmers market stand. “It showed we can open up. … It’s not something that should control our lives.”

His wife, Kat Clark, said people have been eager to get out of the house and don’t want to be told what they can’t do. “It’s just the nature of freedom lovers,” she said.

Just two stalls over, vendor Kathy Peironnet had another view of the infamous partiers. “I have a name for people who do things like that: covidiots,” said Peironnet, who wore a mask while selling art and jewelry at her booth.

Since May 3, retail businesses of various sizes are allowed to reopen as long as they limit occupants to 10% or 25% of a building’s capacity. Restaurants must seat no more than 10 people at a table. At all times, the new order says, people should practice social distancing of at least 6 feet.

The Lake of the Ozarks region opened up cautiously at first. Camden County, Missouri, which houses much of the lake, has recorded from COVID-19 as of June 5, a rate of 80.76 per 100,000 people. For comparison, the city of St. Louis — where many lake visitors live — has a case rate more than seven times higher. But if out-of-towners did contract the coronavirus in Camden, they would take it, and their case counts, back to their home counties.

“In terms of total cases, the lake area has been very minimal,” said Nathan Bechtold, editor-in-chief of , a news outlet that covers the lake lifestyle. “By early to mid-May, it seemed like business was picking up. By the time we hit Memorial Day, I think everyone had a sense, economically speaking, we may be making up for lost time.”

Some out-of-towners who own area vacation homes came to the lake in March and April to ride out social isolation lockdowns. Then, as the holiday neared, demand skyrocketed as visitors from surrounding cities and states booked their getaways. Some boat dealers reported record-breaking sales. On Memorial Day weekend, the population of Camden County swelled from its typical 50,000 residents to hundreds of thousands of visitors, Bechtold estimated.

“There was pent-up demand regionally to get out, to get in the sunshine,” Bechtold said.

Russell Burdette, owner of , a property management company, said his company sold out for the Memorial Day weekend for the first time ever.

Viral video showed customers crammed at local swim-up pool bars over the holiday weekend. Geospatial data analytics platform Tectonix published an showing that customers at Backwater Jacks traveled to and from St. Louis, Kansas City, Omaha, Iowa, Illinois and other locations for the holiday weekend. issued a travel advisory and the asked anyone who attended the crowded parties to self-quarantine for 14 days. In an interview on CNN, Dr. , director of the National Institute of Allergy and Infectious Diseases, called the party scene “tempting fate and asking for trouble.”

No covid concerns at the lake of the ozarks😳

— Scott Pasmore (@scottpasmoretv)

Late last month, the Camden County Health Department issued a saying a Boone County resident had tested positive for COVID-19 after being at the lake Memorial Day weekend. The person visited Backwater Jacks, Shady Gators, the Lazy Gators pool and Buffalo Wild Wings and “was likely incubating illness and possibly infectious at the time of the visit,” the statement said.

In response to the backlash, Backwater Jacks posted saying that “no laws were broken” and “customers should have the freedom to choose” whether to visit. Hundreds posted supportive comments to social media.

But not everyone was a fan.

“I thought it was stupid,” said Etta Harrison, the woman visiting from Olathe, who is also a retired nurse. “But these are young people and they want to have fun.”

On that recent Saturday, she and her husband wore masks after eating lunch in the cafe at the local market, which had installed a hand-washing station outside.

Kathy Turner, an Osage Beach resident watching her daughter’s dance recital on an outdoor stage, said people make “bad choices” everywhere, but she wasn’t too worried about visitors bringing the virus to town.

Bechtold, the LakeExpo editor, said many people felt the national media sensationalized the story. He said lakeside pools might have held a few thousand people, but hundreds of thousands were at the lake, most of them acting responsibly. “The pictures of the pools,” he said, “were not a very fair and complete representation of what happened here last weekend.”

In the end, the negative Memorial Day party publicity will end up being positive for the lake, predicted Burdette, the vacation property manager. He envisions a busy summer as Midwesterners rethink faraway vacation plans and look for closer destinations where they can spend time outdoors — boating, fishing and grilling.

Burdette said he wouldn’t have gotten into the pool shown in the viral video. “On the other hand, we are a tourist community, and if people act responsibly, there are plenty of things to do here,” he said. “We have plenty of room for people to social distance.”

Fauci, in the , cautioned against making quick conclusions. Some people are asymptomatic carriers, testing still isn’t widespread, and the virus takes time to incubate. published in March in the journal Annals of Internal Medicine said virtually all who develop symptoms of COVID-19 do so within 11.5 days.

Fauci said “people who were out there frolicking” should not be overconfident if cases don’t rise immediately. “The effect of spreading is not going to be seen for two, three or maybe even more weeks,” he said. “That’s the reason why we encourage people … to take a careful look at the guidelines and to the best extent possible, to follow them.”

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).