Indian Health Service works to distribute more coronavirus funding to tribes as cases continue to grow

Tuesday, March 24, 2020  

• PHOTOS: Lakota man helps fight the coronavirus

UPDATE:
Following publication of this story on Tuesday evening, the Navajo Nation reported another rise in positive COVID-19 cases on the reservation, the largest in the U.S. The total number of tribal citizens who have contracted the coronavirus has reached 49, President Jonathan Nez and Vice President Myron Lizer said.

With additional federal funds on the table, tribes continue to press the Trump administration to ensure their communities aren't left out of relief efforts as the coronavirus spreads among their people.

The Indian Health Service was already passed over when the Trump team put the Centers for Disease Control and Prevention in charge of an initial $80 million in coronavirus funds. The decision came despite requests from tribes and their advocates to transfer the money to the IHS, the agency with responsibility for the health and well-being of 2.2 million American Indians and Alaska Natives.

The disconnect came to a head as a new week opened in Washington. Though the Department of Health and Human Services on Friday had told Indian Country to expect "guidance" on the $80 million on Monday, none was provided by the CDC, according to a tribal leader familiar with the discussions.

Instead, as more coronavirus cases were confirmed on reservations, tribes were meeting with CDC leadership on Tuesday in an attempt to get the money out quicker and in a more equitable fashion. Key among the concerns was the omission of tribes in the Great Plains, where the first COVID-19 positive was reported by the IHS, from the initial funding stream.

"I just want to make it clear," President Rodney Bordeaux of the Rosebud Sioux Tribe said at a council meeting on Monday.

"This COVID-19, our people need take it seriously," said Bordeux, who declared an emergency on his tribe's reservation in South Dakota earlier this month and has seen the number of cases in the state grow to 30.

Another major issue was CDC's omission of a set-aside in the IHS area that serves almost every tribe in Arizona. The oversight comes at an ominous time, as the Gila River Indian Community confirmed its first two COVID-19 cases on Monday.

"The results of the tests took some time to obtain," Governor Stephen Roe said in a message to his people in the evening, highlighting an issue of concern throughout Indian Country.

"Both of these cases are now in isolation," Lewis added.

Dr. Anthony Santiago, the chief medical officer at the Gila River Health Care, said 39 people have been tested so far. He believes more positive results are coming.

"We have to be prepared to see more cases in the near term," Santiago said.

The Gila River cases are the first to be reported by a tribe in Arizona outside of the Navajo Nation, where the coronavirus continues to upend daily life on the largest reservation in the United States. On Tuesday, President Jonathan Nez confirmed that the number of COVID-19 patients among his people has grown to 39, the most of any in Indian Country.

“Help beat the virus by staying home," Nez said, emphasizing the unprecedented "stay at home" order he issued late last week.

"To prevent a massive public health crisis, every person must remain home, unless you need food, medicine, or other essential items, but beyond that we shouldn’t have anyone traveling or going out into the public," Nez said.

Informing the Navajo people and urging them to stay home to prevent the further spread of COVID-19. As of today, the Nation has 39 confirmed cases. Be safe and continue to pray 🙏🏽 pic.twitter.com/gd2adaTzVn

— Navajo Nation President Jonathan Nez (@NNPrezNez) March 24, 2020

But as the tribe keeps its people and the public informed, Nez a day prior announced a shift in the way future cases are being reported on the reservation. During a conference call with the media, he said updates will be linked to the county in which a tribal citizen lives.

Previously, the tribe had been disclosing the IHS facilities where COVID-19 patients reported symptoms or sought care. But in order to remain in line with authorities in Arizona and New Mexico, Nez on Monday said the cases will be broken out by county.

The data shared on Tuesday reflected the change. Of the 39 positive coronavirus cases, the tribe identified 35 in Arizona: 25 in Navajo County, six in Apache County and four in Coconino County in Arizona. Another four cases are in McKinley County in New Mexico.

“Stay home, stay safe, save lives!" Vice President Myron Lizer said. "Our first responders are on the ground working hard to help our communities. We will beat this virus together. We are praying every day for our people who are sick and their families."

Amid the change in reporting away from the IHS, the Navajo Area is seeing some improvements in responding to the coronavirus. By working with a lab in Arizona, testing times have improved in the region, Chief Medical Officer Dr. Loretta Christensen said on the media call.

"The turnaround time is half of what it was prior," said Christensen. Previously, she said it took "two to four days" for results to come back.

And with the Federal Drug Administration's approval of a rapid COVID-19 test, the agency should be able to obtain results even faster. Christensen said the Navajo Area is ordering supplies in order to take advantage of the new procedure.

"As soon as those supplies arrive, we'll begin offering rapid testing in the Navajo Area," said Christensen, who previously indicated that four facilities on the reservation -- two in Arizona, where the largest number of COVID-19 cases have occurred, and two in New Mexico -- are capable of conducting such tests.

"We've been here forever. We'll be here forever": As #Coronavirus cases across America continue to surge, tribal leaders are taking dramatic steps to ensure the safety of their people and those they serve. #COVID19 https://t.co/x0gjf38IMY

— indianz.com (@indianz) March 23, 2020

According to Christensen, testing a patient for COVID-19 requires a nasopharyngeal swab, which is used for the detection of respiratory viruses, such as the coronavirus. But in order to obtain a result, the rapid testing method approved by the FDA requires specialized equipment that may not be present in every IHS facility.

For the four facilities in the Navajo Area with such capabilities, there are eight more that would not be able to utilize the test based on criteria explained by Christensen last week.

The IHS has not responded to a request for comment on whether facilities elsewhere in Indian Country can take advantage of rapid testing.

Tribal leaders have been asking about testing capabilities for weeks. During conference calls this past month, officials from the White House and from the IHS have promised that tests will be available at facilities in Indian Country, according to those who have participated.

It took two weeks for the Trump administration to announce #Coronavirus funding for Indian Country. But some tribal communities are being overlooked in the initial round as the number of #COVID19 cases continues to rise. https://t.co/B1Y5VhqNEw

— indianz.com (@indianz) March 23, 2020

President Donald Trump also said that "anyone who wants a test can get a test" but tribal leaders -- and ordinary tribal citizens who have tried to get tested for the coronavirus -- have said that is not the case for the first Americans.

"Instead of lying to us and putting blame on our shoulders, our Trustee - the United States - needs to work with us to get test kits to our communities on a scale that NBA franchises seem to enjoy," President Bryan Newland of the Bay Mills Indian Community said in widely-read thread on social media. Entire professional basketball teams have been able to secure testing, well before they were available to most others.

Testing is still going to be a major issue going forward. On Monday, the IHS held a consultation call with tribes to ask them how $64 million should be distributed in order to cover the costs of COVID-19 testing.

According to a tribal official who participated in the call, most leaders wanted the agency to utilize existing and proven methods to get the money to Indian Country. That would be in the form of supplements to self-determination contracts and self-governance compacts, along with targeted spending -- and reimbursements if necessary -- for those populations served directly by the IHS.

The same tribal leader said IHS officials more than once acknowledged the push for their agency -- instead of the CDC -- to be in charge of coronavirus resources in Indian Country. The IHS also took time to admit that some tribes "were left out" of the CDC's plans for distributing the first round of funding, the person said.

CDC's relationship with tribes is not on the same level as that enjoyed by the IHS. A new sign of the disconnect was shown on Tuesday, when Navajo President Nez said he wasn't made aware of any plans for his people to receive a share of the CDC's funding even though an internal document seen by Indianz.Com over the weekend had the tribe on the list.

"To this day, I have yet to see any of that $40 million that was earmarked to tribes," Nez said of the money authorized by H.R.6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act.

The Department of Health and Human Services boosted the amount to $80 million after tribes asked for at least $120 million to be set aside for their needs.

It is morally wrong to continue to neglect the Indigenous people of America who paid for their healthcare with the ceding of millions of acres of their land. #HonorTheTreaties #Coronavirus #COVID19 @Kevin_Abourezk https://t.co/mKjnovSINo

— indianz.com (@indianz) March 24, 2020

Separate from the $64 million authorized by the H.R.6201, the Families First Coronavirus Response Act, the IHS is also preparing to ask tribes about another pot of money. The agency is due to receive $70 million in emergency funding that was approved in the same legislation. Congress provided $1 billion overall for the Public Health and Social Services Emergency Fund.

Beyond being embraced by tribes as their primary partner within the executive branch, the IHS also got a boost from key members of Congress.. Leaders of the House Committee on Natural Resources said information provided by the agency during a briefing on Wednesday indicated that voices from Indian Country are indeed being heard in the halls of power in Washington, D.C.

“I’m encouraged to hear that the administration is now taking some of the necessary steps to support Indian Country, and the set of upcoming deadlines we heard about today will offer an important measurement of their progress,” said Rep. Raúl Grijalva (D-Arizona), the chairman of the committee.

But Grijalva also said the legislative branch must uphold its trust and treaty responsibilities to the first Americans. That message has not been entirely accepted by everyone on Capitol Hill.

"Congress needs to continue to give Indian Country the resources, funding and support necessary to protect human life and prevent the virus from spreading beyond our control, and the administration needs to distribute funds and support as quickly as possible to high-need areas," said Grijalva.

ICYMI: The so-called "Phase 3" #Coronavirus relief package leaves Indian Country behind. Here's what Kevin Allis, Chief Executive Officer of the National Congress of American Indians, said about the CARES Act. @NCAI1944 #COVID19 #CoronavirusIndianCountry pic.twitter.com/pVy0RCIOUe

— indianz.com (@indianz) March 21, 2020

Rep. Deb Haaland (D-New Mexico), who is one of the first two Native women in Congress, also took part in the briefing. She too sounded encouraged by the IHS.

“Today’s call was a step in the right direction to ensure Native communities aren’t left behind as our country works to keep families safe and healthy, said Haaland, a citizen of the Pueblo of Laguna who serves as the vice chair of the committee -- the first Native person in that leadership role.

"We’ll keep this administration’s feet to the fire and continue to ensure our legislative priorities are included in any relief package moving forward," Haaland said.

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