On Friday, the Navajo Nation, the largest American Indian reservation by geography and population, reported 92 new cases of COVID-19 and five deaths. That brings the corresponding totals to 6,470 with 303 deaths, with no end in sight. You can see the Navajo Department of Health’s take on it at Dikos Ntsaaígíí-19.
On a per capita basis, the reservation, with its population of about 175,000, was as early as mid-May worse off than New York, the state hit hardest by the coronavirus pandemic, which has now reduced its new infection rate to the lowest in the United States. For the Navajo, the situation is a combination of pre-existing conditions and indequacies of the chronically underfunded and understaffed Indian Health Service through which every Native is legally entitled to health care.
Meanwhile, as the acute impact of the pandemic continues scything its way through the Navajo population, Darius Tahir and Adam Cancryn at Politico report that federal and state authorities are refusing to let the Navajo or other Native tribes or their representatives see data about how the coronavirus is spreading on their lands, making bad matters worse.
Even though the Centers for Disease Control and Prevention readily share data with the states, they reject the same requests from tribal epidemiologists. Michigan and Massachusetts authorities won’t provide data on testing and confirmed cases on the grounds of privacy nor will they make agreements with the tribes on contact tracing. According to what eight tribal leaders and health experts told Politico, some officials have gone so far as to question tribes' legal standing as sovereign governments.
In a news release, Navajo Nation President Jonathan Nez said: "Please do not let your guard down against the coronavirus. We cannot go back to the way things were before the virus until the daily numbers decrease consistently and we have a vaccine. We must accept all of the preventative measures to keep our families and communities safe. It may be hard to accept the changes, but we have to create a new normal. Listening and encouraging each other will slow the spread."
Unfortunately, the feds have made keeping the guard up more difficult. As Tahir and Cancryn point out:
The communication gaps threaten to hinder efforts to track the virus within Native populations that are more prone to illness, disability and early death and and have fragile health systems. Tribal authorities say without knowing who's sick and where, they can't impose lockdowns or other restrictions or organize contact tracing on tribal lands. The lack of data also is weighing on epidemiologists who track public health for the nearly three-quarters of Native Americans who live in urban areas and not on reservations.
“Because of the nature of the virus, which respects no physical boundaries, the ability to get the resources to where it's being disproportionately felt is a way to protect the broader population as well,” said Rep. Denny Heck (D-Wash.), a prominent lawmaker on American Indian affairs.
As gets occasionally reported in local but almost never in national media, there have been decades of neglect afflicting Native health services despite treaty obligations. As Karen Goodluck at High Country News reports, the U.S. Civil Rights Commission has twice concluded that tribal infrastructure nationwide has been relentlessly underfunded by billions of dollars. “Since virus prevention requires access to information, electricity, running water, cleaning supplies, food and medical care, many Navajos are already at a disadvantage,” she lamented.
Among the findings of a 2017 report on Native infrastructure by the 76-year-old National Congress of American Indians, the nation’s oldest pan-Indian organization:
Simply put, many IHS facilities aren’t up to the task of providing quality care, primarily because of their increasing age and outdated infrastructure. The numbers and consequent impacts are startling:
- The average age of IHS hospitals is now 40 years old, which quadruples the average age of other U.S. hospitals (10.6 years of age). Aged facilities “risk code noncompliance, lower productivity, and compromises for health care services.”
- Advanced facility aging dramatically increases the costs of essential maintenance and repairs. For example, one recent report found that the annual operation and maintenance costs for a 40-year-old facility are 26 percent more than the costs for a 10-year-old facility.
- Insufficient funding has forced the IHS and Tribes to defer doing this critical work, further compromising the quality of the care these facilities provide and driving up the costs of undertaking essential maintenance and repair in the future.
- Between FY 2010 and FY 2016, the average federal appropriation for Health Care Facility Construction (HCFC) was $76 million. At this rate of funding, it would take 400 years for a new IHS facility built in 2016 to be replaced. [...]
- The current space capacity of IHS facilities is only 52 percent of what is needed to adequately serve the existing AI/AN [American Indian/Alaska Native] population. [...]
- The federal government spends $35 per capita on IHS facilities that serve Native people as compared to $374 per capita for the nation as a whole.
These ancient, chronic problems make dealing with the acute impacts of the pandemic all the harder. But the usual tendency of Washington to treat the tribes with disregard or outright hostility hasn't dissipated because of the health crisis plaguing the United States.
For instance, officials waited for close to six weeks for a limited, 60% distribution of the CARES Act $8 billion relief package. In the face of that, the Navajo and Hopi Families COVID-19 Relief Fund was set up by former Navajo Nation Attorney General Ethel Branch. So far, it has raised $4.9 million. That may seem like a lot of money. But it works out to $16.33 for each tribally enrolled Navajo, about half of whom live on the reservation.