When COVID-19 (coronavirus) arrived in the U.S., some called it “the great equalizer,” suggesting that regardless of income, race, or any other factor, the susceptibility of contraction and risk of mortality would be the same. This perception of COVID-19 was and still is, entirely inaccurate. It is widely understood that there are numerous factors, social determinants of health, that influence individual and population health, for better or worse. That means, in the face of this pandemic, the inequities that exist in our society become even more apparent. The situation in the Navajo Nation today makes this starkly clear.
The territory of the Navajo Nation, home to the second-largest tribal group in the U.S., located in the Four Corners region, has a population of approximately 157,000. The Navajo Nation has a long history of morbidity and mortality (e.g., cancer, heart and respiratory disease) much higher than the rest of the Nation due to systemic oppression, underfunding by the Federal government, and lack of resources. In conjunction with the health problems, unemployment is nearly 50%, food insecurity is pronounced, and 40% of the population is without running water or indoor plumbing. In light of these factors, it should come as no surprise that the Navajo Nation is suffering extensively due to COVID-19 as compared to other parts of the U.S. Strikingly, West Virginia, one of the most impoverished states, and approximately the same geographic size of the Navajo Nation has 11 times the population (1.8 million people) and much higher population density. Even so, as of April 13th, the Navajo Nation had 813 confirmed COVID-19 cases and 28 deaths, compared to 640 confirmed cases and 9 deaths in West Virginia.
There are many factors that influence the higher prevalence of COVID-19 cases and deaths in the Navajo Nation. Access to clean water is of particular concern. According to the Centers for Disease Control (CDC), one of the primary methods to prevent contracting or spreading, coronavirus is by “cleaning your hands often.” Unfortunately, in the case of the Navajo Nation, this is less of an option, given limited water access. Individuals that do not have running water rely on hauling water themselves or receiving water from programs such as DIGDEEP. Since the institution of local shelter-in-place orders on the Nation, difficulty accessing water has further increased with closing and limiting the hours of government water distribution points. The recent changes further exacerbate the already difficult task of conserving water for consumption, bathing, and now following CDC guidelines.
In response to the exponential spread of the virus in the Navajo Nation, the U.S. Department of Health and Human Services gave the Indian Health Service (IHS) priority access to recently purchased ID NOW COVID-19 rapid point-of-care tests that diagnose COVID-19 in under 13 minutes. The tests were expected to arrive at public health labs as early as Monday, April 6th. On April 8th, IHS expanded telehealth services across their federal facilities, to increase access to health care while the population practices physical distancing. In an attempt to further curb the spread of COVID-19 among his people, Navajo Nation President Jonathan Nez instituted a 57-hour mandatory curfew, Public Health Emergency Order No. 2020-005, that took effect 8:00 P.M. Friday, April 10th and ended 5:00 A.M. Monday, April 13th.
Other Native peoples face similar challenges as the Navajo Nation. Navajo Nation Attorney General Doreen N. McPaul and other Indian Country leaders came together via webinar on April 8th to detail the issues affecting Native American communities and discuss measures to protect them. To aid in ensuring Indian Country receives the necessary aid, House Natural Resources Committee Chairman Raúl M. Grijalva encourages members to send information about coronavirus impacts and preparations affecting Native communities across the U.S. to inform congressional action.
During this deeply disruptive time, the Navajo Nation and its members are working to protect the vulnerable and mitigate the impact of COVID-19. Some Navajo people have reported returning to the traditional practice of storytelling to not only manage stress, but to remind themselves and their children of their self-reliance and resilience. Adrian Lerma, a Navajo Nation mother, reminds herself and her children that ‘these battles have been fought before in the past and that [they] can fight them again today,’ maintaining their confidence that they can get through this, much like they have before.
It is important to acknowledge and commend the continued self-reliance and resilience of the Native American people. However, the federal and state governments also need to take decisive actions to better support native populations and ensure that they are not fighting this crisis, or any other, alone.