Cars lines up for as far as five miles when leaders of the Navajo Nation provided food to a community on the Arizona portion of the reservation on April 14, 2020. Photo: Navajo Nation Council

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Coronavirus takes higher toll on Native Americans in hard hit region

Wednesday, April 15, 2020

By Acee Agoyo

Data from two states with significant Indian Country populations shows how the coronavirus is taking a disproportionate toll on the first Americans, whose health care is promised by the federal government yet often falls far short of the need.

In Arizona, American Indians and Alaska Natives represent 7 percent of confirmed COVID-19 cases, according to data released by the state. Since Native Americans make up about 4.6 percent of the population, the figures confirm a higher rate of infections of the deadly disease.

"It is no joke," President Jonathan Nez of the Navajo Nation said during a town hall to his people on Tuesday. The tribe has been the hardest hit by the coronavirus, with 838 confirmed cases so far.

Mortality rates are even more startling. According to the state, 21 percent of people who have died from the coronavirus have been Native Americans.

And a significant number of coronavirus deaths have been Navajo citizens -- 33 so far. Nez, who is running government operations on the largest reservation in the U.S. from self-quarantine after coming into contact with an emergency medical technician who tested positive for COVID-19, said too many of his people are "leaving us early."

Today we’ve launched a new online portal from @NMDOH with additional #COVID19 data for New Mexico, including county-by-county breakdowns of positive cases by age, gender & ethnicity, as well as reporting on testing by county.

See it here: https://t.co/uigcauDnnC
— Michelle Lujan Grisham (@GovMLG) April 14, 2020

Numbers from neighboring New Mexico paint a similar picture. Though the state overall has a smaller number of cases than others in the region, Native Americans represent a whopping 37 percent of confirmed COVID-19 infections, according to data from the health department.

As with Arizona, the coronavirus is having a disproportionate impact on American Indians and Alaska Natives in the state, where they represent 9.6 percent of the population. Hotspots have emerged in Navajo and Pueblo communities, even those in remote and less populated areas.

"Please stay home and comply with the stay at home orders that are in place," the Ramah Chapter of the Navajo Nation, which is separated from the main reservation, said in an update on Tuesday which confirmed 14 positive COVID-19 cases in the community.

Despite the existence of the sobering data, Arizona and New Mexico stand out among those willing to report coronavirus figures along racial and ethnic lines. Besides individual tribes, the District of Columbia appears to be the only other jurisdiction that has actively included Native Americans in their updates -- with 7 confirmed COVID-19 case so far, according to the latest data.

"WE ARE HERE. COUNT US": Native American LifeLines of Baltimore, an urban Indian health and services provider, is calling on the state of #Maryland to include American Indians and Alaska Natives in #COVID19 data. #Coronavirus #UrbanIndians https://t.co/JSmgupSkIK
— indianz.com (@indianz) April 10, 2020

Some jurisdictions are starting to break out racial and ethnic data. But the state of Maryland is grouping American Indians and Alaska Natives in a category called "other" -- or, worse, not at all -- in a state where about 13,000 Native Americans live, far more than the 1,900 in neighboring D.C.

"It is sadly the norm that our community is statistically 'othered', which means that a review of the data would suggest that American Indians/Alaska Natives aren't impacted by COVID-19," Native American LifeLines of Baltimore, an urban Indian health and services provider in the state, said last week. "And we know that isn't true. Data = dollars. No data, no dollars."

Native American LifeLines isn't the only one in Maryland concerned about the exclusion. Rep. Steny Hoyer (D-Maryland), who serves as the Majority Leader in the U.S. House of Representatives, has called on all states, territories and jurisdictions to report racial and ethnic data.

"We cannot wait to begin collecting data that will help us fight the spread of coronavirus in communities that are the most vulnerable," Hoyer wrote in a letter to state governors on April 10. "We must have reliable, public data to help us ensure that federal resources and assistance are being directed where they are most needed and will make the biggest difference."

The District of Columbia continues to report a small but rising number of #COVID19 cases among self-identified Native Americans. #Coronavirus #Race #DC https://t.co/Wim7xsS5Vx
— indianz.com (@indianz) April 9, 2020

Even the Trump administration is aware of the disparities. U.S. Surgeon General Jerome Adams, who has participated in events hosted by the National Indian Health Board, said Native Americans suffer from health conditions that put them at a higher risk of diseases like COVID-19.

"Well, it’s alarming but it’s not surprising that people of color have a greater burden of chronic health conditions," Adams said at a briefing of the White House Coronavirus Task Force on April 10. "African Americans and Native Americans develop high blood pressure at much younger ages, and it’s less likely to be under control, and does greater harm to their organs."

But Adams pointed out that social conditions, many of which have their roots in inadequate federal funding of the government's trust and treaty responsibilities, leave tribes and their citizens at risk in times of crises, just like the coronavirus pandemic. Lack of basic infrastructure, such as water and sanitary facilities, inadequate housing stock and harmful legacies of toxic resource development are among the many causes.

"We tell people to wash their hands, but as studies showed, 30 percent of the homes on Navajo Nation don’t have running water," Adams said at the White House. "So how are they going to do that?"

In hopes of bringing sufficient resources to Indian Country, tribes and their advocates are calling on Congress to do more to carry out the government's obligations. Although three coronavirus legislative packages included $10 billion for Indian health, social, education, housing and other programs, they say it's not enough to address more than a century of oversight, omission and policies that were premised on the belief that Native peoples would not be around any longer.

“Indian Country had significant wins in the CARES Act, but our systems operate on such limited resources, that the Indian health system needs more support to effectively respond to COVID-19," NIHB Chairperson Victoria Kitcheyan said of the last package, H.R.748, also known as the Coronavirus Aid, Relief and Economic Security (CARES) Act.

NIHB has been joined by 10 national and regional tribal organizations in seeking another $8 billion for Indian health in the next coronavirus bill, sometime being referred as "phase 4" legislation as it would be the fourth enacted since the start of the crisis. Included in the request is $1 billion for a program at the Indian Health Service known as Purchased/Referred Care (PRC), a pot of money that often runs out before people who need specialty care can benefit.

C-SPAN: Washington Journal with Victoria Kitcheyan

“With more and more positive COVID-19 cases increasing in our tribal communities, the need for specialty care increases too. Purchase and referred care dollars are already scarce even without a pandemic,” said Kitcheyan, who serves on the council of the Winnebago Tribe.

“A lack of sufficient funding for PRC forces IHS and tribal facilities to ration health care at a time when our people’s lives are at stake," Kitcheyan added. "We should never have to pick and choose who gets health care.”