May 4, 2020 — The Navajo Nation is struggling to manage a COVID-19 outbreak on its reservation that appears to have started at a large religious gathering last month. The number of positive cases has since escalated to 2,373, with 73 deaths, the Navajo Department of Health reported May 2.

Loretta Christensen, MD, chief medical officer of the Navajo Area Indian Health Service, expects the number of cases to increase as testing expands. The IHS and other health care groups are doing coronavirus testing at a much higher rate than neighboring states, TheSalt Lake Tribune reported. The agency within the U.S. Department of Health and Human Services provides health services for about 2.56 million of the nation’s estimated 5.2 million American Indians and Alaska Natives.

So far, more than 11,500 tests have been done in the Navajo Nation, including 9,200 negative tests, the Navajo Department of Health says. The Tribune on April 20 calculated a rate of 2,759 tests per 100,000 people for the Navajo Nation, giving it the third highest testing rate, after New York and Louisiana, and ahead of New Jersey and California.

“The IHS has been given priority access to rapid point-of-care COVID-19 test systems as part of White House efforts to expand access to testing in rural communities,” Christensen says in an email. The agency has received and distributed 250 ID NOW COVID-19 care test systems to federal and tribal health care facilities throughout Indian Country in 31 states. The Navajo Nation received 36 of the systems, she says.

“This test allows for medical diagnostic testing at the time and place of patient care, provides COVID-19 results in under 13 minutes, and expands the capacity for coronavirus testing for individuals exhibiting symptoms as well as for health care professionals and the first responder community,” says Christensen.

Since only gloves and a face mask are needed to give this rapid test, it will save personal protective equipment (PPE) while still keeping health care workers safe.

There are shortages of PPE, including non-N95 masks, goggles, and face shields. “The Navajo Area is delivering supplies to the service units as quickly as possible and using every available avenue to purchase more supplies and keep up with the demand,” says Christensen.

There is also a longstanding shortage of nurses on the reservation to deal with the pandemic. The Navajo Area has used volunteers to help and reassigned other staff to needed areas.

Challenges with CDC Guidelines

The Navajo Nation will be under lockdown until May 17, to help slow the spread of COVID-19. Nightly and weekend curfews are enforced with checkpoints and patrols. Residents were ordered to start wearing masks in public a few weeks ago.

But some residents aren’t able to follow CDC guidance on social distancing and frequent hand-washing. “While many Navajo people have access to modern-day amenities like water, electricity, and housing, there are segments of the people without running water and bathroom facilities. Some families may not have a separate home and may reside with other family members such as grandparents and grandchildren in the household,” says Christensen.

Many Navajos have health conditions that make them more vulnerable to COVID-19, including diabetes and upper respiratory diseases like infections, pneumonia, and asthma, Christensen says.

Funding Relief

The IHS has faced funding shortages in the past, which often result in less money for tribal health infrastructure. The Coronavirus Aid, Relief, and Economic Security (CARES) Act delivered a record $1.032 billion to the IHS last month, including $600 million to fund health programs. After input from tribal and urban Indian organization leaders, the agency will also distribute the remaining $367 million, Christensen says. The IHS Navajo Area will receive a total of $80 million of the CARES funds.

“Most tribal health facilities are already operating on a slim budget, so this funding is vital to tribes’ ability to respond to the COVID-19 outbreak safely and effectively while also caring for their communities, families and elders,” National Indian Health Board chairperson Victoria Kitcheyan wrote on Twitter.

The IHS funding is separate from the $8 billion Congress allocated in the CARES Act “to help tribal governments fight the COVID-19 pandemic under the Coronavirus Relief Fund,” according to a statement from the Navajo Nation Office of the President.


Interview: Loretta Christensen, MD, chief medical officer, Navajo Area Indian Health Service.

Navajo Department of Health: “Dikos Ntsaaígíí-19 (COVID-19),” “Navajo Nation Health Command Operations Center reports 104 new COVID-19 cases, and one new death,” “Public Health Order, Navajo Department of Health, Navajo Office of Environmental Health & Protection, April 17, 2020, Public Health Emergency Order No. 2020-007.”

The Salt Lake Tribune: “Navajo Nation extends closing of tribal government to May 17,” “Navajo Nation has a higher coronavirus testing rate than Utah and most states.”

The Navajo Nation, Office of the President and Vice President: “U.S. District Court rules in favor of tribes for CARES Act funding.”

Indian Health Service, the Federal Health Program for American Indians and Alaska Natives: “Disparities,” “IHS receives more than $1 billion for coronavirus response.”

U.S. Department of Health and Human Services: “HHS Supports State, Territorial and Tribal Public Health Labs with COVID-19 Rapid Point-of-Care Test.”

Roll Call: “The Never-Ending Crisis at the Indian Health Service.” “’We need the money right now’: Tribes await billions of dollars in coronavirus relief,” “Judge sides with tribal governments in first round of $8 billion coronavirus dispute.”

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