'Hit us at our core': Vulnerable Navajo Nation fears a second COVID-19 wave
NBC NEWS | By Kenzi Abou-Sabe, Cynthia McFadden and Didi Martinez | Aug. 3 2020
When the largest Indian reservation in the U.S. was hit by a surge of COVID-19 cases in April and May, it took weeks for federal aid to arrive. By the time it did, Navajo Nation had already begun to flatten its curve, but the virus had exacted a heavy toll.
“It hit our relatives. It hit people that we knew and love and respected,” area resident Crystal Kee said. “And it has hit us at our core.”
With more deaths per capita than any U.S. state, community members say virtually everyone on the reservation knows someone who has been personally affected by the virus.
The coronavirus was so devastating on Navajo Nation in part, experts say, because of severely lacking infrastructure on the reservation. An estimated 30 percent of homes don’t have running water, and over half of Navajo communities lack broadband access. Compounding the problem, a lack of healthy food options — there are just 13 grocery stores on land the size of West Virginia — overcrowded housing and high rates of heart disease, diabetes and obesity created a perfect storm for calamity in a pandemic.
Now, officials and community members want to use some of the $714 million in federal aid they received to prevent a public health crisis of this scale from ever happening again, but two major obstacles stand in their way: onerous regulation that makes construction on tribal land near impossible and a looming deadline that mandates the money be spent by Dec. 30. If the money tribal governments received from the CARES Act isn’t spent by the end of the year, tribes risk having to send it back.
“Don't get me wrong, we are going to get PPEs, but if $714 million is there, we should be able to improve our economy and our communities with that money for the long term,” said Navajo Nation President Jonathan Nez.
Nez wants to spend the money on expanding access to running water and electricity and providing broadband access and more affordable housing on the reservation — in effect addressing the infrastructure gaps that experts said contributed to COVID-19’s deadliness there.
“This money is to combat, yes, the immediate needs of COVID-19, but also for the future. We have no cure. There's no vaccine. So how do we prepare for the future?” Nez said. “If we can get running water to our citizens, it will help push COVID-19 off our nation, and any future virus.”
The stakes are particularly high, experts say, because even though Navajo Nation has had success in containing its COVID-19 outbreak, the states that surround the reservation have experienced surges of coronavirus cases in recent weeks. At one point, Arizona’s infection rate — when adjusted for population size — was the highest in the world.
Cases on Navajo Nation peaked in May, with an average of 104 new cases per day. By July, that number dropped by half to about 48 new cases reported each day. In all, about 9,000 of the roughly 172,000 Navajo members living on and around the reservation have tested positive and more than 450 have died from the virus.
Local officials say Navajo Nation’s success in flattening the curve has been largely due to three things: widespread adherence to mask-wearing and social distancing, one of the strictest stay-at-home curfews in the country and an aggressive testing regime.
But even the most stringent measures could prove ineffective amid spiking cases in Navajo Nation’s neighbors: Utah, New Mexico and Arizona. Cross-border travel is frequent, and it’s not uncommon for people to live on the reservation but work in a border town.
“I watch the Arizona predictive models and New Mexico predictive models, including Texas and Colorado, every day, several times a day, because of the big effect it has on us,” said Dr. Loretta Christensen, chief medical officer for the Navajo Nation at the federal government's Indian Health Service.
Of particular concern is the nation’s intensive care capacity. According to Christensen, Navajo Nation health facilities currently have roughly 40 ICU beds.
During the first surge of cases in April and May, Navajo health centers were able to transfer the most critical patients to ICUs in neighboring cities like Phoenix, Flagstaff and Albuquerque. That ability was critical to their success in managing hospital capacity and caring for patients, Christensen said. Now, as those cities deal with their own surges, that may no longer be an option.
“I will be totally honest: It will be a huge challenge to manage that volume of patients in our facilities,” Christensen said. “Do I believe our staff can do it? Yes, they've risen way above all levels of performance, and they've been innovative and adaptive and strong.”
Complicating the risk is the fact that thus far, COVID-19 has proven particularly deadly for Native Americans. They have the highest rates of hospitalization from the virus of any racial group in the U.S., according to Centers for Disease Control and Prevention data.
“This isn't a matter of race, but a matter of institutional racism that has made people at higher susceptibility for infectious diseases and kept them at higher susceptibility for many, many years,” said Dr. Laura Hammitt, director of infectious disease programs at the Johns Hopkins Center for American Indian Health at the Bloomberg School of Public Health.
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