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Copyright © 2020 Albuquerque Journal
GALLUP – Tammy Arnold lives in a home with eight others about an hour northwest of Gallup near the small community of Yah-ta-hey, New Mexico, on the Navajo Nation.
The 29-year-old, who brought her relatives into town to buy groceries Friday morning, said she’s trying to take every precaution to protect herself against the COVID-19 pandemic that’s sweeping through the reservation and the rest of the country.
In the evenings, when she returns home, she changes her clothes and washes her hands before embracing her young niece or touching anything.
On Friday, she waited outside the store in the parking lot trying to avoid the stream of people doing their shopping after getting paid the first week of the month.
“The whole outbreak that happened on the Navajo Nation now, it’s a large number,” Arnold told the Journal. “I’m really worried even bringing my cousin and aunt here.”
Rapid spikes in COVID-19 cases, and the severity of those cases, on the Navajo Nation has health care professionals, government officials and citizens worried.
Data compiled by the Journal shows that, as of Saturday night, the per capita rate of reported cases on Navajo land is more than seven times higher than in New Mexico. New Mexico had reported results for 16,828 tests, with 543 to date coming back positive.
(* See note about the Journal’s methodology beneath story)
The Navajo Nation’s results are based on testing of 2,117 people; as of Saturday night, at least 321 people have tested positive and 13 people have died, two more than in New Mexico, which has a population about 13 times that of the Navajo Nation. According to the last census, 156,823 people lived on the Navajo Nation in 2010 as the majority of Navajo people have moved away to cities or border towns. New Mexico’s population in 2010 was just over 2 million.
The total number of cases on the Navajo Nation includes 56 from New Mexico – 17 of whom were in McKinley County and 30 in San Juan County, parts of the state that officials are warning have been particularly hard hit. McKinley and San Juan counties have rates of 42.08 and 45.24 positive test results per 100,000 residents, compared with Bernalillo County’s 33.53.
(* See note about the Journal’s methodology beneath story)
In a news conference Friday, New Mexico officials said they expect Gallup and Farmington hospitals to experience a surge of patients as early as this weekend.
The virus has prompted a curfew and stay-at-home order on the Navajo Nation and the deployment of the Arizona National Guard for a mobile hospital. In a phone call last week with President Donald Trump, Gov. Michelle Lujan Grisham pleaded for more resources, warning that the virus could “wipe out those tribal nations,” according to a transcript of an audio recording obtained by CBS News.
“We did a good job initially of keeping the virus out, but once it came on the reservation, it just spread rapidly,” Navajo Nation President Jonathan Nez told the Journal in a phone interview last week. “It is scary, but we need to hunker down and listen to our leaders.”
Social distancing a challenge
In 1986 when Daniel Tso was first elected to the Navajo Nation Council, representing the far east edge of the tribal land in New Mexico, he was the youngest delegate.
Now, after he was elected again in 2018 after a 20-year absence, he is the oldest.
He said telling people to keep their distance from one another has been challenging, as so much of the Navajo culture is built around family and friends.
“Our social mores are to shake hands when you greet folks and close relatives, even folks that we’ve known for a long time,” Tso said in a phone interview last week. “There is the hugging and embracing, the whispering of kind words into each other’s ears…Families gather, they gather for meals, and to tell people to keep a social distance is hard.”
Tso’s remote, rural district stretches from US 550 to Interstate 40 and includes McKinley County and a sliver of Sandoval County. He said between 25% and 60% of his constituents lack access to running water, depending on which community they live in, making it harder to wash their hands regularly.
In public health emergency orders, Nez has cited concerns over the contagiousness of the virus as well as what it will mean for a health care system that is “rapidly exhausting available resources, including supplies and personnel.”
And Tso, the chair of the council’s Health, Education and Human Services Committee, says the Navajo Nation’s hospitals are ill-equipped to handle the most serious cases related to COVID-19. He said patients in need of intensive care treatment are sent to bigger cities in Arizona, New Mexico or Utah.
“The level of care that’s needed to try to heal the folks from the virus is a much higher level of care than what our hospitals are funded for or even equipped with,” Tso said.
The Navajo Area Indian Health Services has three hospitals in or around the reservation in New Mexico, with a total of 10 beds in the Intensive Care Unit, according to public affairs liaison Jenny Notah.
She said the Gallup Indian Medical Center has six ICU beds, the Northern Navajo Medical Center in Shiprock has four, and the Crownpoint Hospital has none. She did not say how many ICU beds are in Indian Health Services facilities in Arizona.
“The bed availability at Navajo Area IHS facilities is variable each day,” Notah wrote in an email. “Some may be full or some may be nearing capacity on a given day.”
New Mexico officials have offered aid, sending 10 ventilators to a hospital in Gallup last week and setting up ways for more experienced doctors to coach those in rural towns, said David Scrase, secretary of the state Human Services Department, during Friday’s news conference.
And Notah said the Navajo Area Indian Health Service is preparing as well. It has activated emergency response and facility readiness plans to monitor inpatient bed capacity and make referrals for overflow patients.
“We are working to ensure adequate numbers of staff, supplies, equipment, space, funding, and other resources to meet the demand of increasing numbers of COVID-19 cases,” Notah wrote in an email. “We are coordinating with tribal, state, and other resources to bring needed resources to the region.”
In Lakeside, Arizona, Dr. Laura Hammitt, director of Infectious Disease Programs for the Johns Hopkins Center for American Indian Health, said Navajo facilities are converting outpatient clinic areas into COVID-19 units.
She said the outbreak on tribal lands is complicated by the factors that are already hurting the Navajo people.
“We know that social determinants of health such as poverty, indoor crowding, indoor air pollution, and insufficient access to running water and power, contribute to the high risk of respiratory infections,” Hammitt said. “In pandemic conditions these disparities are exacerbated, which places the communities at further increased risk.”
In late March, President Nez instructed residents to stay home except for essential trips, limit interactions with those who are not immediate family members and not to travel off the reservation unless they have to. On March 29, he implemented a curfew from 8 p.m. to 5 a.m.
In virtual town halls Nez has been increasingly adamant about people staying home, expressing frustration at reports that residents are still gathering to play bingo. He has also urged non-tribal members to stay away from the reservation, warning that drivers with “foreign license plates” will be pulled over.
Others are echoing the president’s message.
Shaandiin Parrish, Miss Navajo Nation 2019, has been sharing public health messages about COVID-19 on Instagram, urging her followers to stay home.
“I felt the best way I could show my peers was to lead by example,” Parrish said. “As Navajo people, when times are uncertain or unknown on the outside, like during an eclipse or certain ceremonies, the teaching is always to go inside.”
And radio stations are broadcasting regular updates on coronavirus, or Dikos Ntsaaígíí-Náhást’éíts’áadah in Navajo, trying to reach those whose only information source is the radio.
In the meantime, help trickles in from the federal government and neighboring states.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a little more than $1 billion for the IHS. The Navajo Area Indian Health Services has received $2.34 million so far.
The package also includes an $8 billion relief fund for tribal governments. But Nez said that money has yet to reach the Navajo government.
In Chinle, the Arizona National Guard set up a 50-bed mobile clinic for a quarantine site.
“That site will be used for patients that test positive but don’t require hospitalization,” Nez said. “Here, many generations live in one household, so this is a way to prevent these patients from potentially spreading the virus in their homes and communities.”
Nez said he has also petitioned the federal government for rapid tests since right now, residents often wait four days for results from laboratories in Albuquerque and Phoenix.
Schools across the Navajo Nation closed March 13, leaving districts grappling with how to educate students, many of whom do not have access to computers or the internet.
In Teec Nos Pos, a small town in Northeast Arizona, not far from the New Mexico border, the school district began handing out physical learning packets for each grade level once a week so students can continue their studies. Officials estimate that fewer than 40% of households have access to the internet or a device.
“It’s a combination of accessibility to the internet as well as the devices needed to connect – chromebooks, laptops, whatever – the families don’t have them,” said superintendent Robert Tollefson. “This is a nationwide issue, not only for students but for many of the people. Their offices are now out of their homes.”
Sunnie Clahchischiligi, an instructor and doctoral candidate in the English Department at the University of New Mexico, grew up in Teec Nos Pos. She said reservation life was already difficult, but those challenges are made harder by COVID-19.
“The reservation is hard to sum up, but it is a safe haven for us,” Clahchischiligi said. “For some, having to stay 6 feet away is difficult, but for Navajo, it’s excruciating.”
Many shared the same sentiment as they darted into Gallup on Friday to do their shopping trips or loads of laundry, feeling eager to return home to remote areas where they can isolate themselves and their families.
The parking lots of Lowe’s grocery store was mostly full, although many waited in their cars for family members to complete their errands.
Arnold was one of those patiently waiting drivers.
She said her life has changed a lot in the past couple weeks. Her job as a security guard at Fire Rock Casino east of Gallup now mostly consists of cleaning and patrolling the empty grounds.
“I like being a security guard there, but now since this virus shut us down, it’s really hard,” Arnold said. “Especially emotionally because I used to see a lot of our guests, our regulars that would come in. Now when I walk through, it’s just nothing, nobody.”
As for Council Delegate Tso, he’s trying to see the silver lining in the pandemic, and hold onto hope where he can. He said he has been inspired by the way his community has banded together to help each other and adapt to make sure needs are being met, such as when school bus drivers suggested using their routes to deliver meals to children who are now out of school.
Tso said he also hopes that the traditional Navajo teachings and values will reemerge and people will be more apt to garden and live off the land, rather than relying on grocery stores.
“Those things will start coming back,” Tso said. “It gives me hope for the nation, hope for the communities, hope that we’ll still be here after the virus is gone.”
Journal digital editor Robert Browman contributed to this report.
* Note about chart methodology: The first of the two charts above uses rate per 100,000 people to compare the number of reported cases of COVID-19 in a Navajo population of 156,823 to a New Mexico population of 2,059,179. (Both population figures are from the 2010 census.)
Per capita rates are often used this way to compare the occurrence of something in areas with differing populations. The method works by dividing the number of occurrences by a given population to result in a rate of it per person. Because the resulting numbers are often very small, they are multiplied by 100,000 to represent the occurrence per 100,000 people. This allows them to be better visualized and charted.
On Saturday, there were 321 reported cases of COVID-19 on the Navajo reservation, and as of Thursday, 2,117 tests had been administered. New Mexico on Saturday reported 543 total cases and 16,828 total tests.
The second chart shows the raw number of cumulative cases on both the Navajo reservation and in New Mexico.