The coronavirus is exacerbating vulnerabilities Native communities already face

Lack of clean water and overcrowding leave Indian Country open to a “perfect storm” of health and economic crises during the pandemic.

In Kayenta, Arizona — the northwest corner of the Navajo Nation — the streets are eerily quiet. Famous landmarks like Antelope Canyon and Monument Valley are empty. Flea markets that are normally bustling hubs of commerce in this remote area are now closed. But for those living in and around Kayenta, there is still water to haul, wood to chop, and sheep to herd at home.

The town of 5,189 is taking stricter measures for social distancing since 18 cases of Covid-19, the disease caused by the novel coronavirus, were confirmed over the past two weeks. On Saturday, Navajo Nation President Jonathan Nez issued a stay-at-home order, prohibiting residents of the country’s largest Indian reservation — spanning 27,413 square miles from Arizona to Utah to New Mexico — from leaving their homes unless it is for food or medicine. Tribal police are already patrolling grocery store parking lots, enforcing social distancing and purchasing limits while children shop for their elders who wait in the car.

The Navajo Nation isn’t the only Indian community to feel the impact of the coronavirus. The first person in Oklahoma to die from Covid-19 complications was a 55-year-old citizen of the Cherokee Nation. A Northern Arapaho tribal member on the Wind River Indian Reservation in Wyoming tested positive on Saturday and the tribe has declared a state of emergency for the reservation that spans over 2.2 million acres. Last weekend, Minnesota Lieutenant Governor Peggy Flanagan, of the White Earth Band of Ojibwe, lost her brother to Covid-19 after he was already battling a cancer diagnosis.

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Natives living in urban areas like Salt Lake City, Seattle, and San Jose are contracting the virus in high numbers as well. According to the National Council on Urban Indian Health, “The Urban Indian Organizations located in Seattle, Washington, is projecting a monthly loss of $734,922 during this pandemic,” meaning the urban health clinics are dipping into their limited noncoronavirus-related funding to cope with the pandemic.

As of March 23, there are 35 confirmed cases in the Indian Health System, the federal government’s agency that provides medical services to Native people, including two deaths, according to Indian Country Today. This number likely does not include individuals who went immediately to a non-Native hospital or ICU because their symptoms were serious. In addition, testing is not accessible in most Native communities, leaving many cases to go unreported or experience extensive delays.

While nearly no one in the country is safe from the coronavirus outbreak, its impact on Indian Country looks different from the rest of the US. Tribal elders are more at risk of Covid-19 because of high rates of diabetes and heart disease. Clean water for proper hand-washing is not accessible in all tribal communities, and overcrowding in Native homes is also common as many are multi-generational, creating social distancing challenges. Meanwhile, emergency federal funding for tribal health organizations has been delayed within the bureaucracy at US Health and Human Services. Then there are the negative economic effects, with hospitality businesses like casinos — often tribes’ greatest source of income — closing. Indian Country’s resources were stretched thin to begin with, and the coronavirus pandemic is exacerbating the disparities.

“Covid-19 could be a perfect storm for Indian Country,” Dante Desiderio, executive director for the Native American Financial Officers Association (NAFOA), told Vox. Not only could the virus cause a drastic death toll — especially among at-risk elders who serve as community knowledge keepers — it could also wreak havoc on tribal economies that have barely recovered from the economic crash of 2008. If the government doesn’t act fast, tribal populations, prosperity, and ways of life could be set back for a generation.

The American government isn’t doing enough to combat the virus in Indian Country

The federal government is obligated by hundreds of treaties with Indian Tribes to provide health care to Native people. To execute this treaty obligation, Congress set up the Indian Health Service (IHS) in 1955 to provide direct medical care to Native people through local clinics and hospitals. Tribal leaders call this a “prepaid health care system,” where land cessions over the past few centuries have paid for the medical care administered today.

Earlier this month, the National Indian Health Board — which represents tribal governments, including those receiving health care directly from the IHS — conducted a rapid survey to assess the needs of tribes earlier this month during the US’s coronavirus outbreak. Only half of the respondents said they had received information from state or federal governments. Less than a fifth reported receiving resources (money, technical assistance, or supplies) from the state or federal governments, and only 3 percent reported having diagnostic test kits.

”The federal government keeps putting tribes in touch with their state and local health authorities, but in some places, they simply are not serving the tribes,” Stacy Bohlen, CEO of the National Indian Health Board, told Vox. “It’s a mixed result across Indian Country.” When asked if Indian Country is prepared to fight the pandemic, Bohlen said, “I believe we are not prepared, our country as a whole is not prepared.”

On March 6, Congress allocated $40 million in coronavirus aid to Indian Country through the Centers for Disease Control and Prevention (CDC), which was supposed to pay for surveillance of the virus, laboratory capacity, infection control, and other initial preparedness and response activities. Congress also allocated another $64 million in aid directly to the Indian Health Service last week. On March 20, the US Department of Health and Human Services, which oversees both the CDC and the IHS, announced it was ready to disperse $80 million in funding from the first two relief packages to tribes, tribal organizations, and Urban Indian Organizations. However, sources familiar with the Indian Health Service said that as of March 21, 98 percent of tribal clinics have not yet received funds from the initial allocation because of the lack of bureaucratic mechanisms to distribute funds from the CDC.

Still, tribal health advocates continue to look ahead. For the next round of coronavirus aid, they’re asking for $1.2 billion for health-related spending in Indian Country. This would include funding to recruit doctors and nurses, secure medical supplies and protective gear, as well as increase testing capacity at tribal clinics. Currently, there are no IHS clinics that can run Covid-19 lab tests in-house.

Since the health impacts of the virus are exacerbated by a slow federal response, tribal advocates are asking for funding that allows tribal governments to have the most flexibility to address the outbreak in their local communities. They also ask that Congress include tribal governments every time state and local governments are listed in legislation. This often-unintended exclusion creates massive policy hurdles down the line that could mean life-or-death decisions in Indian Country when tribes do not have explicit authorization from Congress to take action to protect their communities.

”History won’t be kind if the federal government forgets about Indian Country during this crisis,” VaRene Martin, first vice president of NAFOA and citizen of Thlopthlocco Tribal Town, Mvskoke Creek Nation, told Vox.

Much like blue-state governors have acted more swiftly and effectively in recent weeks than the federal government has when it comes to their communities’ public health, the same could be said for tribal leaders who are taking every step possible to stop the spread of the virus. Of the 574 federally recognized tribes, 53 have declared public health emergencies, 41 have imposed travel restrictions, and 39 have closed their reservations or issued a stay-at-home notice, according to the Department of the Interior.

“We took swift action [to declare a state of emergency] as we saw the numbers of confirmed cases in the state escalate from 5 to 14 to 21,” Melanie Benjamin, chief executive of the Mille Lacs Band of Ojibwe in Minnesota, told Vox. Tribal governments, just like state and local governments, become eligible for a large number of federal funds after they officially declare a state of emergency. “We shut down schools and sent all nonessential employees home. We took every precaution we could up front,” she said. “My biggest concern is if that virus shows up here.”

The circumstances that make Indian Country so vulnerable to coronavirus

To prevent the spread of Covid-19, CDC guidelines ask individuals to wash their hands and sanitize all surfaces — both of which require access to clean water. However, according to the National Institutes of Health, 13 percent of Native American homes lack safe water or adequate wastewater disposal facilities, compared to the national average of less than 1 percent. Advocates are asking for $1 billion in assistance for safe water and sanitation systems in Indian Country, short of the $5 billion the Government Accountability Office says is needed to cover all tribal areas.

Another factor that makes Native communities vulnerable to the coronavirus is the overcrowding in tribal housing. Sixteen percent of American Indian and Alaska Native households in tribal areas are overcrowded, eight times the national average. Many tribal homes are intergenerational, where grandparents are active in their grandchildren’s lives, making transmission to elderly and at-risk individuals very easy and social distancing more difficult. “Social distancing is not a cultural value of Native people, but it’s a safety measure that we need to adopt,” Bohlen of the National Indian Health Board told Vox.

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A third factor is health: Those with preexisting conditions like diabetes and hypertension have higher death rates from Covid-19 than those without. And American Indians and Alaska Natives have higher rates of diabetes than any other racial group in America at 16 percent, double the rate of white Americans at 8 percent. When it comes to high blood pressure, Native people have 3 percent higher rates compared to non-Hispanic whites. Both of these factors make the Native American population more at-risk to the severe impacts of the coronavirus.

Much like national and global economies, tribal economies have also taken a hit during the pandemic. The hospitality industry — resorts, golf courses, casinos, and restaurants — is the largest source of income for tribes and their surrounding rural communities. Native American food and retail businesses, as well as casinos that normally operate 24 hours a day, have all closed their doors.

“The hardest decision so far was deciding when to shut down our two casinos,” Benjamin told Vox. For the Mille Lacs Band and many other tribes, these casinos serve as the economic engine for the community. The $32.8 billion tribal casino industry provides critical funds for elder, youth, and health programs, as well as jobs for tribal members. Benjamin worries that “for some tribes farther North where the population is smaller, this is going to be devastating. Smaller tribes in more rural regions will be hit first and be hit the hardest economically.”

For many Native people, the coronavirus outbreak is reminiscent of the diseases that swept across Indian Country in the 1800s and 1900s that killed a majority of their ancestors. An estimated 90 percent of Native Americans died from disease and warfare when white colonizers spread across the continent.

Even in times of crisis and uncertainty, though, Native people continue to find strength and resilience in their culture. To heal a young girl who was close to death during the outbreak of influenza in 1918, the Anishnaabe created the jingle dress dance. According to the Anishinaabe story, the young girl’s grandfather, a medicine man, dreamed of a dress made out of jingles that would create a healing sound when she danced in it. When the girl first put on the dress her grandfather made, she was too weak to dance. But with her relatives holding her up, she started to dance on her own, making a rain-like sound, and she eventually recovered from her illness. Since then, the jingle dress dance has become a popular women’s powwow dance, as well as a traditional healing and prayer dance. The wooshing sound of the jingles can be heard at gatherings across the country every summer.

Since the outbreak of Covid-19, hundreds of videos have been shared across social media of women partaking in the traditional Anishnaabe healing dance and praying for those who are ill. When asked about the popularity of the videos, Benjamin, whose tribe is of the Anishnaabe culture, said: “Our resilience is what is going to get us through this.”

Maria Givens is an enrolled member of the Coeur d’Alene Tribe (Schitsu’umsh) in northern Idaho and resides on Cheyenne, Arapaho, and Ute homelands in Boulder, Colorado. She has a master’s degree in environmental issues from the University of Colorado and has worked for the National Congress of American Indians and in the US Senate. She is passionate about tribal food sovereignty and shares pictures of Native food on her Instagram.