Misinformation and denial about covid-19 and its vaccine have left Dr. Heather Walker and her colleagues in the emergency department at Excela Health Westmoreland Hospital feeling defeated. "No matter what you do, it’s not enough,” she said. "It’s exhausting for everyone.” It’s also perplexing for doctors. How can a patient be in disbelief over the coronavirus, pandemic and vaccine and yet trust doctors when it comes to a stroke, heart attack or broken leg? "You believe me as an expert in all those things,” she said. "Why don’t you believe me about the pandemic?” The same misinformation being believed by some patients nationally is prevalent at home, too, said Walker, the department’s assistant director. That includes concerns over government control, vaccines being poisoned or having the ability to alter someone’s genetic sequence, and the quick time frame in which vaccines were made available. In one instance, a man was being treated at the hospital for a cut and a nurse was preparing to give him a tetanus booster shot. The patient stopped the nurse and demanded to see the syringe so he could read what was on the label, worried the nurse had mixed the coronavirus or its vaccine in, Walker said. He wouldn’t back down. Vaccine refusal has been a similar trend at Allegheny Health Network. Some of the reasons to avoid the shot have been dumbfounding, health care workers said. "I’ve had patients look at me and say, ‘I’m not getting a shot. They’ll be able to track my every move,’ ” said Dr. Amy Crawford-Faucher, vice chair of AHN’s Primary Care Institute and medical director for telemedicine. Early on, health care workers heard a lot about microchipping from patients, but excuses have evolved. "I’ve had people tell me their friends ‘got magnetic’ from the vaccine,” Crawford-Faucher said. "I just listen and tell them I don’t see how that’s medically possible.” Many patients are concerned that the vaccine was developed too quickly. Others can’t give an exact reason; they just dig their heels in and refuse, she said. One patient even cited political ties. Some of those same people contracted covid-19 and became interested in taking monoclonal antibodies without proof of ingredients, Crawford-Faucher said. Some have requested ivermectin, the horse dewormer, despite there being no research to support its use in treating covid-19, she said. "These are belief systems at this point,” Crawford-Faucher said. "Unless you can build enough trust to break through, you can’t fix it with facts. It’s extremely frustrating. "At this point, people’s refusal to get vaccinated is harming other people and the economy.” Still others, despite being diagnosed with covid-19, will tell doctors "covid isn’t real” and demand further proof, Excela’s Walker said. "It’s alarming that now we’re many months into this pandemic and people still believe these crazy, crazy things,” Walker said. It’s typically working-age adults, those between 20 and 60, who express distrust, she said. "Yes, they do live here,” she said. Some eventually change their minds. After recovering from the coronavirus, they ask how to get vaccinated, Walker said. She said she encourages them to tell family and friends about their experience with the virus. The health system, like many across the country, has seen vaccinated patients with breakthrough infections, but they are not as sick as patients who haven’t received the vaccine. Most covid-19 patients hospitalized at any of Excela’s three hospitals are not vaccinated, spokeswoman Robin Jennings said. On Sept. 30, there were 55 covid patients — 91% had not been vaccinated, Jennings said. In September, 642 people tested positive for the virus through Excela’s testing, she said. Of those, 88% were not vaccinated. More than half of the positive cases involved people younger than 50, and 22% of the cases were in people younger than 18. ‘I hear that you’re scared’ It’s important not to shame or judge patients who have qualms about getting vaccinated, said Dr. Maya Ragavan, a physician who helps coordinate clinics across the region via the Pittsburgh Community Vaccine Collaborative. Instead, she’ll start conversations by saying things like, "I hear that you’re scared. I hear that you’re concerned. Let’s talk about that fear a little bit more. Let’s talk about what the side effects of covid vaccines are and how rare that is.” "I do emphasize that it’s getting more serious,” Ragavan said. "But making people feel bad is not going to convince them to get vaccinated. You can stress the urgency of it and the severity of it while also still being patient and understanding what their reasons are for it.” If a patient is willing to share, Ragavan tries to pinpoint the specific concern driving their hesitancy. Reasons can vary widely. "There are people who have really, really good questions about the vaccine. There are people who were saying they wanted to wait until there was more data,” Ragavan said. "For those people, we’re really trying to share the amount of research that’s been done and how safe and effective it is.” ‘Just come and learn’ Many people admit they simply "don’t understand how vaccines work, and they’ll hold onto their fears,” said Laura Duncan, senior administrator for the University of Pittsburgh’s Department of Medicine. She urged anyone with questions to attend a community-­based vaccine clinic — even if they have no intention of getting a vaccine or don’t feel ready. They want those who are vaccine-hesitant to get answers from reliable sources, which is why clinics have physicians, nurses and other experts on hand. "There’s no pressure to get the vaccine. Just come and learn,” Duncan said. "Then at least the conversation has started.” She recalled a recent instance in the East End when Dr. Steven Evans, clinical professor of surgery and director of community engagement for Pitt’s Department of Surgery, sat down and talked to a woman for about 45 minutes. He explained how the vaccine was created, how it works and why it’s safe. "Because he alleviated her fears, she left and came back and brought three generations of family — seven more family members,” Duncan said. Ragavan, who works at an Oakland-based primary care practice affiliated with UPMC Children’s Hospital of Pittsburgh, has met with teenagers who want to get vaccinated but whose parents don’t want them to, and vice versa. "There’s also a lot of questions about access. Some people want to get it at their primary care physician’s office. Some people want to get it at a school,” Ragavan said. "And it’s not just where can I get the vaccine, but how can I get the vaccine so if I have side effects I don’t have to miss a lot of work, so it’s not disruptive to my life?” Ragavan tries to use a combination of data and science-based evidence with relatable experiences, such as by sharing how she has been a participant in a Moderna clinical trial for the covid-19 vaccine. "Some people respond well to data, some respond well to stories,” she said, "and there is a certain level of trustworthiness that we as providers need to build up.”