Reservation pandemic: how Indians fight coronavirus

Dr. Gene Noble worked as an emergency doctor. When asked at the University of California Hospital in San Francisco, where she works, if anyone wants to fly into the Navajo tribe and help with the escalation of the outbreak of COVID-19, the woman readily agreed. Writes about it CNBC.

Photo: Shutterstock

The Navajo nation, which reported its first case of COVID-19 in mid-March, showed one of the highest incidence rates per capita. To date, 8000 cases and more than 300 deaths have been recorded on the reservation, with about 170 people living in various desert corners of Utah, Arizona and New Mexico.

Noble went to work at the Navajo Nation hospital, Gallup Indian Medical Center in New Mexico, as part of the second group. The first group arrived in April to respond to a call from Navajo Nation President Jonathan Nez for more health care workers. Around the same time, a group of similar medical workers went to New York.

The group that included Noble arrived in May. She was immediately impressed by the steps taken to admit patients. “They installed plastic sheets and barriers to double the capacity in the emergency department and then converted an old pediatric clinic,” she recalls. “There were also tents outside for less sick patients.”

However, many patients with COVID-19 had to be transferred to larger facilities in Albuquerque, New Mexico, or Flagstaff (Arizona) if their health deteriorated. Noble often had to call three or four hospitals in these regions to find a place for a sick patient. Noble was worried that with the increasing number of cases in Arizona, it would be even harder for patients to get the intensive care they needed.

Noble and her colleagues returned to San Francisco for a few weeks, but their experience was a constant reminder that COVID-19 is a “terrible disease.” She also emphasized that the disease has disproportionately affected some groups of the population compared to others, including people with low incomes and people of different races.

Socioeconomic Inequality

The Navajo people, who have experienced social and economic inequality for decades, are especially vulnerable.

A large portion of the population is at high risk for serious complications from Covid-19: more than a third suffer from chronic diseases, including diabetes and heart disease. According to the CDC, the United States has the highest prevalence of diabetes among Native Americans and Alaska Natives, more than double that among whites.

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The lack of basic services, which many U.S. residents take for granted, is another big problem.

Noble recalls how one of her patients, a man of about 70, fell ill with COVID-19 and was discharged from the hospital after recovery. His home was 30 miles (48 km) away and he was unable to contact his family. Therefore, he decided to go home on foot under the scorching sun, as a result, he became ill from dehydration.

After the paramedics found him, the patient was returned to the hospital, from where he was recently discharged.

“He didn’t have a car or a phone. There was no insulin that was vital for him, she said. “Unfortunately, this is a common situation.”

Noble noted that there is a service that provides transportation of Navajo patients, but it is not ideal. Sometimes there is no vehicle available, and sometimes patients are not given a number so they can call.

Many Navajos live in crowded houses with their families, where the virus can spread quickly, more than a third do not have access to tap water at a time when it is important to wash your hands. In addition, water transportation can often mean a violation of the principles of social distance.

“It's compounded by the fact that in this community, a large percentage of homes don't have electricity or running water,” said Dr. Nathan Theismann, an emergency physician. “There are also relatively significant numbers of homeless people and high rates of chronic disease and health problems that are contributing to the spread of COVID-19.”

All doctors and nurses agreed that the government needed to do much more to protect this population. Noble continues to worry about the depletion of donations. She considered that, at the very least, funding for mobile medical facilities is needed so that healthcare providers can visit patients at home, as well as improve access to clean water. She encourages politicians to think about housing solutions so that people with COVID-19 have more options for safe isolation.

“These may be expensive proposals, but we are talking about basic human rights to things like access to drinking water,” she said.

Dr. Tara Soude, a specialist in emergency medicine, recalled how one of her patients with a positive coronavirus test was asked to return home and be treated there.

After talking with him, she found out that he lives in a small apartment with one bedroom with his wife and two children, and he does not have the opportunity to isolate himself from others.

“Luckily we got him a hotel room,” she said. But Dr Soud noted that "socioeconomic status" plays a huge role in both the impact of COVID-19 and the recovery.

According to Noble, the hospitals serving Navajo patients do "heroic work", making the most of what they had. But the need to improvise revealed a major shortage of medical supplies.

“We were always on the cusp of exceeding supplies,” said Theisman, who was working at the hospital in mid-June. “I kept wondering while I was there whether today would be the day when there would be no more ICU beds.”

Noble believes that a lasting solution is needed to ensure that hospitals in the poorest and most rural areas have adequate access to protective equipment. Donations can run low, especially because large US hospitals also need supplies.

Feeling of isolation

According to doctors and nurses, one of the hallmarks of COVID-19 is the isolation that many patients experience. During their stay in the Navajo nation, they met with old sick patients who spoke poor English. It was difficult to communicate with them without an interpreter.

Many were isolated from their family members and did not have mobile phones. Some patients were taken to unfamiliar places, including larger hospitals in other states, which only increased their feeling of loneliness. Some of these patients were on ventilators, and no one could visit them in person.

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“This is an incredibly resilient and strong-willed population that has stood up for itself for decades,” Noble said. “They have a strong sense of community.”

Those who needed hospitalization are twenty, thirty and forty years old, but most of them are older. Very few people died in the hospital, as the most sick were transferred to other places. In one particularly serious case, one of Noble's patients lost consciousness and died in a car on the way to the hospital.

“This pandemic will not be dictated by human preferences.”

Doctors and nurses returning from hospitals on the territory of the Navajo people want to share stories with their fellow citizens about their stay there.

“If you're young, you're still not immune to severe illness,” Noble said. “We need to wear masks and practice social distancing.”

"Just because you don't get COVID-19 doesn't mean everyone else is," said Sarah Kaiser, a nurse practitioner. She observed Navajo people following public health guidelines as best they could, and many were very concerned about the health and safety of family members.

“People are getting tired, but unfortunately the course of this pandemic will not be dictated by human preferences,” Theisman added. “Instead, it will follow the biology of a contagious respiratory virus.”

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