Conditions in Indian Country are ripe for a rapid spread of the coronavirus. Rates of infection among Navajos is a major concern.
The Lummi Tribal Health Center in Washington state is bracing for the deadly coronavirus. (Jovelle Tamayo/For The Washington Post)
Originally written for the Washington Post
April 4, 2020 at 11:35 a.m. MST
At the Navajo Nation that crosses three western states, 321 people were infected as of Saturday, an increase of 51 cases in a single day with 13 fatalities, the most in Indian Country. Police started issuing citations to anyone who violates a stay-at-home order.
The coronavirus is ravaging the United States, but experts say more than 5 million people who identify as American Indian and Alaskan Native are especially vulnerable.
“When you look at the health disparities in Indian Country — high rates of diabetes, cancer, heart disease, asthma and then you combine that with the overcrowded housing situation where you have a lot of people in homes with an elder population who may be exposed or carriers — this could be like a wildfire on a reservation and get out of control in a heartbeat,” said Kevin Allis, chief executive of the National Congress of American Indians.
“We could get wiped out,” Allis said.
The Lummi Nation couldn’t quickly get federal stimulus funding that had been allocated to tribes to buy protective gear for health workers. (Jovelle Tamayo/For The Washington Post)
Medical staff at the Lummi Tribal Health Center wears masks amid the coronavirus pandemic. (Jovelle Tamayo/For The Washington Post)
About half of Native Americans live on reservations mainly in the West, Midwest and South, according to the National Congress of American Indians. They live in small homes, where the virus can easily spread through families. Houses often lack electricity and running water so washing hands is more challenging, health experts at Johns Hopkins University said.
American Indians have a dark history with infectious disease, dating back hundreds of years. In the last century, the 1918 flu struck the group four times harder than the general population, according to a 2014 study published in American Indian Quarterly. At least 3,200 died, including 72 of 80 residents at the Inupiat village of Brevig Mission, Alaska, according to the National Institutes of Health.
Tribes “suffered hideously,” the study said, citing reports from the time. “The Navajos’ situation of 1918-19 was an almost perfect storm.” Considering the conditions that made them vulnerable, the researchers said, “it is remarkable not that so many of them were lost but that so many survived.”
“We have very limited data right now because of lack of surveillance systems, but we are hearing disproportionate level of severity of health impacts from coronavirus, a higher need for intubation and ICU-level care and more severe stress,” said Laura Hammitt, an associate professor of the Johns Hopkins Bloomberg School of Public Health, which works with the Navajo Nation.
Nez watched in frustration as the virus spread through the population of 350,000 Navajos. As infections more than tripled from 71 to about 270 in just over a week, he said the Navajo couldn’t quickly get federal funding for American Indians allocated by Congress in early March because he had to apply for it through the Centers for Disease Control and Prevention. Nez said money should have come directly to the tribe so he could quickly buy protective gear for health workers.
From California to New York, tribal presidents and chiefs expressed similar frustration. When the economy shut down last month, so did the casinos and tourism that funded their way of life. Tribal gaming operations are the 13th largest employer in the United States, with a workforce of about 640,000.
Joe Kalt, a professor and co-director of the Harvard University Project on American Indian Economic Development, said tribes’ casino revenue is going to “get hammered.”
“Just like a county or city collecting taxes, tribes use their casino revenue to provide for their citizens and the travel and tourism industries are going to take a direct, immediate hit,” Kalt said.
Derek Kawakone, a Native American student adviser at Ferndale High School and Vista Middle, and two of his children, pose for a portrait outside Lummi Bay Market on March 31. Kawakone’s wife and children are members of the Lummi Nation. (Jovelle Tamayo/For The Washington Post)
The Cherokee Nation in Oklahoma closed its 10 casinos and hotel operations more than two weeks ago and sent home its 4,000 workers with full pay and benefits. The Cherokee are losing $40 million per month, Hoskin said.
The tribe promised to pay the employees through the middle of April, but “it’s unreasonable to think we can do this for periods of months and months,” Hoskin said. The federal government has to step in to prevent a catastrophe, he said. “We expect the U.S. government to understand that if a tribe has its entire revenue base ripped out from underneath it from a pandemic, they ought to be made whole.”
A third stimulus package passed by Congress on March 27 included $10 billion for American Indians but allocating the funds could take weeks, Allis said.
“If we were to be infected or have an outbreak of 10 or more people that’s going to be overwhelming for IHS here, and they’re going to be unable to handle that,” Bear Runner said.
Which is why so many tribes are walling off the outside world.
The Lummi Fitness Center, left, was converted into a field hospital for coronavirus patients. A hospital bed at the Lummi Fitness Center, right. The blankets on the beds, donated by the Lhaq’temish Foundation, are from the tribe’s annual Paddle to Lummi event. (Jovelle Tamayo/For The Washington Post)
The Chippewa Cree in northern Montana erected checkpoints at the borders to block anyone who didn’t belong. The Crow and Northern Cheyenne in that state ordered curfews.
“We’re trying to limit the amount of travel coming and going and to educate people that aren’t aware of the dangers,” Bear Runner said on March 27. “Right now, none of our tribal members have it.”
No tribe has been more proactive than the Lummi. As early as Jan. 22, when there were only a handful of confirmed cases in the United States, clinic physicians on the reservation started ordering medical supplies, including test kits.
On March 3, the clinic declared a public health emergency. It started testing early, confirming the reservation’s first infection on March 12 — a worker on the reservation who lived in Seattle and wasn’t a tribal member. By March 27, the Lummi Tribal Health Clinic had conducted more than a third of the 330 tests in surrounding Whatcom County, despite having only two percent of its population.
Eighteen people have tested positive for the coronavirus at the clinic, so far with no fatalities. A tribal elder at a nearby nursing home experiencing an outbreak died in early March.
A handwritten sign reads, “Families are sacred,” on the Lummi reservation in Bellingham, Wash. (Jovelle Tamayo/For The Washington Post)
Tribal leadership attribute the low infection to dogged prevention efforts put in place before similar measures by Washington Gov. Jay Inslee (D).
It took time because defenses against the coronavirus — separating elders and children — are offensive to the Indian way of life.
“Social distancing is at odds with the Cherokee culture,” Hoskin said. “It probably feels to people like we’re saying break up the family, but literally going to see elderly grandparents is putting them in peril. It goes against the natural inclination of Cherokee Nation.”
American Indian attachment to family is tighter than the general population and isn’t easily discouraged, said Allison Barlow, director of the Johns Hopkins Center for American Indian Health.
“It’s such a strong reverence for elders, but it’s also terrifying,” she said. “Elders have a different meaning from other communities. They are the speakers of the native language. The meaning of this virus in tribal communities is incredibly traumatizing.”
