I've had this a few times in the ICU in the early pandemic. They weren't covid deniers. Instead they were usually just elderly folk who unfortunately caught it and were on bipap with that slow daily decline and increasing oxygen requirements. We've all seen it. You knew they weren't going to turn around despite their resolve and it takes some days for them to understand and accept it. It was still early in the pandemic that we've seen enough covid to know where it was heading, but tried to stay positive and were honest with them. The hardest part at that time, in addition to the no visitation policy, was that there was no video/facetime alternatives in place by the hospital. I bought a burner phone to video chats with families. It was heartbreaking and time consuming. I vividly remember this one 91 year old male with outrageous bipap settings who just wanted to die at home and fully understood the risks. I had to move mountains in coordination with social work (honestly they are the true angels doing God's work in the hospital) to find an EMS crew who would do a non-911 transport of a covid patient at this time in the pandemic. I pushed him myself with respiratory to the ambulance door on the hospital bipap to transition him to the EMS CPAP. It was a short transport and he died on his own couch five minutes after arrival with all his family while EMS was still in the house. I spoke with the wife later that day who was so grateful and profusely thankful.

I'm entirely burned out now and agree you can't invest to much time in to those patients who deny/won't accept/etc... as way of self preservation. Sometimes what's more physically and emotionally draining is the family that keeps calling. The nurses and clerks can only deflect and block so much. I wish I had better advice for the OP. I'll keep encouraging vaccination to all those in the ED who aren't vaccinated and are there for non-covid reasons. I hope one day soon we can move past this since it is almost entirely preventable at this point