Los Angeles emergency room nurse Sandra Younan spent the last year juggling long hours as she watched many patients struggle with the coronavirus and some die.

Then there were the patients who claimed the virus was fake or coughed in her face, ignoring mask rules. One man stormed out of the hospital after a positive COVID-19 test, refusing to believe it was accurate.

“You have patients that are literally dying, and then you have patients that are denying the disease,” she said. “You try to educate and you try to educate, but then you just hit a wall.”

Bogus claims about the virus, masks, and vaccines have exploded since COVID-19 was declared a global pandemic a year ago. Journalists, public health officials, and tech companies have tried to push back against the falsehoods, but much of the job of correcting misinformation has fallen to the world’s front-line medical workers.

In Germany, a video clip showing a nurse using an empty syringe while practicing vaccinations traveled widely online as purported evidence that COVID-19 is fake. Doctors in Afghanistan reported patients telling them COVID-19 was created by the U.S. and China to reduce the world population. In Bolivia, medical workers had to care for five people who ingested a toxic bleaching agent falsely touted as a COVID-19 cure.

Younan, 27, says her friends used to describe her as the “most chill person ever,” but now she deals with crushing anxiety.

“My life is being a nurse, so I don’t care if you’re really sick, you throw up on me, whatever,” Younan said. “But when you know what you’re doing is wrong, and I’m asking you repeatedly to please wear your mask to protect me, and you’re still not doing it, it’s like you have no regard for anybody but yourself. And that’s why this virus is spreading. It just makes you lose hope.”

Emily Scott, 36, who is based at a Seattle hospital, has worked around the world on medical missions and helped care for the first U.S. COVID-19 patient last year. She was selected because of her experience working in Sierra Leone during the 2014-2016 Ebola outbreak.

While many Americans were terrified of Ebola — a disease that isn’t nearly as contagious as the coronavirus and poses little threat in the U.S. — they aren’t nearly afraid enough of COVID-19, she said.

Scott blames a few factors: Ebola’s frightening symptoms, racism against Africans, and the politicization of COVID-19 by American elected officials.

“I felt so much safer in Sierra Leone during Ebola than I did at the beginning of this outbreak in the U.S.,” Scott said, because of how many people failed to heed social distancing and mask directives. “Things that are facts, and science, have become politicized.”

ER, nurse L’Erin Ogle has heard a litany of false claims about the virus while working at a hospital in the suburbs of Kansas City, Missouri. They include: The virus isn’t any worse than the flu. It’s caused by 5G wireless towersMasks won’t help and may hurt. Or, the most painful to her: The virus isn’t real, and doctors and nurses are engaged in a vast global conspiracy to hide the truth.

“It just feels so defeating, and it makes you a question: Why am I doing this?” said Ogle, 40.

Nurses are often the health care providers with the most patient contact, and patients frequently view nurses as more approachable, according to professor Maria Brann, an expert on health communication at Indiana University-Purdue University Indianapolis. That means nurses are more likely to encounter patients spreading misinformation, which gives them a special opportunity to intervene.

“Nurses have always been patient advocates, but this pandemic has thrown so much more at them,” Brann said. “It can definitely take a toll. This isn’t necessarily what they signed up for.”

In some cases, it’s nurses and other health care workers themselves spreading misinformation. And many nurses say they encounter falsehoods about the coronavirus vaccine in their own families.

For Brenda Olmos, 31, a nurse practitioner in Austin, Texas, who focuses on a geriatric and Hispanic patient population, it was a no-brainer to get the vaccine. But first, she had to debate her parents, who had heard unsubstantiated claims that the shot would cause infertility and Bell’s palsy on Spanish-language TV shows.

Olmos eventually convinced her parents to get the vaccine, too, but she worries about vaccine hesitancy in her community.

When she recently encountered an elderly patient with cancerous tumors, Olmos knew the growths had taken years to develop. But the man’s adult children who had recently gotten him the vaccine insisted that the two were connected.

“To them, it just seemed too coincidental,” Olmos said. “I just wanted them to not have that guilt.”

Olmos said the real problem with misinformation is not just bad actors spreading lies — it’s people believing false claims because they aren’t as comfortable navigating often complex medical findings.

“Low health literacy is the real pandemic,” she said. “As health care providers, we have a duty to serve the information in a way that’s palatable, and that’s easy to understand so that people don’t consume misinformation because they can’t digest the real data.”

When Texas Gov. Greg Abbott lifted the state’s mask mandate this month against the guidance of many scientists, nurse practitioner Guillermo Carnegie called the decision a “spit in the face.”

“I was disgusted,” said Carnegie, 34, of Temple, Texas. “This governor, and different people, they act like, ‘Oh, we’re proud of our front-line workers, we support them.’ But then they do something like that, and it taxes the medical field tremendously.”

Brian Southwell, who started a program at Duke University School of Medicine to train medical professionals how to talk to misinformed patients, said providers should view the patient confiding in them as an opportunity.

“That patient trusts you enough to raise that information with you,” Southwell said. “And so that’s a good thing, even if you disagree with it.”

He said medical workers should resist going into “academic argumentation mode” and instead find out why patients hold certain beliefs — and whether they might be open to other ideas.

That act of listening is imperative to building trust, according to Dr. Seema Yasmin, a physician, journalist, and Stanford University professor who studies medical misinformation.

“Put down your pen, put down your notebook and listen,” Yasmin said.

One year ago, workers across the United States learned they'd been divided into two categories: those who would work from home, and those who would have to keep showing up to workplaces where they risked exposure to Covid-19.

Matt Valentin was among the latter, and in the months that followed, the Starbucks cafe where he worked in Monroe, Michigan became an increasingly anxiety-ridden environment.

"From my perspective, it went from 'get these drinks and orders done as fast as possible to 'do all of that, and try not to bring a deadly virus home to your vulnerable family,'" the 21-year-old said in an interview.

As Americans mark the one-year anniversary of the beginning of the pandemic that transformed how business is done in the world's largest economy, those whose jobs required them to show up to work as the virus raged told AFP of a year of fear and uncertainty.

"It seemed like it went from zero to 100 in a matter of days," said Julie Mann, a midwife at a Boston-area hospital.

"We didn't have (personal protective equipment), we didn't have testing. We didn't know who was infected, we didn't know if our colleagues were infected."

- Divided workforce -

Tens of millions of people lost their jobs after US states closed or restricted businesses as the pandemic intensified in March 2020.

Among those who stayed employed, the division between those who could work from home and those who couldn't become one of the first of many inequalities widened by the pandemic.

A study from the University of California, San Francisco found that working-age adults in the state experienced a 22 percent overall increase in mortality during the pandemic, with larger jumps seen in industries like agriculture, transportation, and others where in-person labor is common.

Racial and ethnic minorities are more likely to hold risky positions. The Urban Institute think tank found that more than half of Black, Hispanic, and Native American workers do their jobs in-person, compared to 41 percent of white workers.

"It's just the patterns that are baked into our society in terms of who we value and who we don't, and how we pay people," Lisa Dubay, a senior fellow at the Urban Institute, said of the findings.

- 'A spacesuit look' -

At Mount Auburn Hospital in Cambridge, Massachusetts, where the 44-year-old Mann works, the pandemic began with a terrifying two-week period where protective gear was needed yet was in short supply, forcing staff to take unheard-of steps like reusing or jury-rigging equipment.

Something like normalcy returned once those shortages were resolved and Covid-19 testing became widespread, but Mann had to wear a gown, mask, and glasses during visits with patients -- a "spacesuit look" she tried to soften by attaching a family photo to her scrubs to give the interactions a bit of the intimacy they once had.

A thornier problem was how to take care of mothers who were Covid-19 positive, particularly in the days after giving birth.

"If you want zero risks, then you isolate fully from the baby and the baby isn't with you," she said. "No mom that I know of chose to do that."

- Mask wars -

The Starbucks where Valentin works part-time while studying for his college degree also faced trouble with masks, but in his conservative county the issue was not supplied but suspicion.

"Even to this day, we have people walking in with no mask, or barely trying to keep it on. They'll walk in and say, 'Oh, I forgot to wear one,' which we all obviously don't believe because it's been over a year," Valentin said.

Some customers would take one of the free masks on offer, wear it improperly, or rip it off before leaving the store. Entire families would make no effort to mask up.

One time, a maskless customer screamed at Valentin's co-workers that they "can't control him," shouting expletives until the staff called the police.

"To react that way over something so minimal is still shocking to me, but these are the kinds of people we get to encounter every day since last March (or) April," he said.

- Wait for vaccines -

Two of Valentin's co-workers came down with Covid-19 after the store temporarily closed early in the pandemic, but it managed to avoid further infections even when the country's outbreak was at its worst.

Despite an entire year of tense in-person shifts, Valentin expects he will have to wait for weeks to be eligible for his vaccine.

"I'm very frustrated that my line of work that was once considered 'essential' has been put on the backburner," he said.

In the meantime, Mann, like many healthcare workers, has already been vaccinated.

Despite the relief that brought, she can't forget the disaster of the past year, when the United States saw the world's worst Covid-19 outbreak, leaving more than 530,000 people dead.

We are "not as great as we think we are," Mann said, "and it's been humbling."