Four IHS cases confirmed; ‘serious public health threat’

The check-in station at the Gallup Indian Medical Center with initial screening for coronavirus. (Photo by Patty Talahongva, Indian Country Today)

Jourdan Bennett-Begaye

UPDATED: Majority of people who become infected with COVID-19 have ‘mild illness’ a few get ‘seriously ill’ and ‘some people can die’

The Indian Health Service confirmed what everyone already knows: Indian Country will not be immune from the global coronavirus pandemic.

During a media conference call, the Indian Health Service confirmed three COVID-19 cases, one in the Navajo area, another in the Great Plains area, and the third is in the Portland area. Navajo Nation President Jonathan Nez confirmed the second case on the nation Tuesday evening on KTNN.

A Navajo Nation citizen is one of the cases, according to the press release sent out by the President Jonathan Nez and Vice President Myron Lizer. The patient is 46 years old from Chilchinbeto, Arizona, “with recent travel history.” Family members of the tribal citizen are being screened and isolated.

The individual reported to Kayenta Health Center in Kayenta, Arizona, about symptoms and was taken to the Phoenix where the Arizona Department of Health conducted a test.

Crystalyne Curley, spokesperson for the Navajo Nation President and Vice President, confirmed the second case. The second individual is also a Navajo Nation citizen who reported to the Kayenta Health Center. The 40-year-old was also traveling. They don't know if the two individuals are family members. 

“We have health and emergency experts who have been planning and preparing for this situation for several weeks. We call upon our Navajo people to do their best to remain calm and make good decisions by staying home to prevent the spread of the virus among our communities. We are in close contact with officials from the Kayenta Indian Health Service Unit, Arizona Department of Health, Navajo County, and Navajo Area Indian Health Service to take the proper measures to inform the public, take precautions, and remain proactive,” President Nez said.

The Navajo Nation put together a COVID-19 response team last month and has held a live forum on the local tribal radio station with the president and a health expert. They are set to have another update tonight at 5 p.m. on KTNN AM 660 and 101.5 FM.

A Tulalip family of three contracted and recovered from the disease, reported the Tulalip News.

One family member said, “You could say we were never officially diagnosed with it because they refused to give us the COVID test, but we tested negative for the flu and everything else. Multiple members of the medical staff told us that our symptoms lined up exactly with coronavirus and there was no need to test us because the results were obvious.

“Of course we wanted the confirmation test so we’d have peace of mind. But we were literally told by members of Snohomish County Health District and Everett Clinic, ‘From your symptoms it’s obvious what the results will be. There’s no need for a confirmation test. If any member of the family begins to experience breathing problem, then go to the hospital.’”

Rear Adm. Michael Toedt, chief medical officer at the Indian Health Service, said they are asking tribal leadership, community leadership and urban Indian health programs to report numbers to them as the Indian health system is complex. It’s a combination of IHS, tribal, and urban, and there’s diverse health care.

The Indian health system, which includes IHS facilities and tribally-run facilities, has a total of 1,254 hospital beds nationwide, according to Dr. Toedt. There are 33 intensive-care unit beds and 116 negative pressure beds, but it wasn’t clear on the call if those are in each IHS facility or across the Indian health system. IHS officials didn’t specify how many ventilators they had.

Dr. Jay C. Butler, deputy director for infectious diseases at the Centers for Disease Control and Prevention, gave a situational update today on a media call about this “serious public health threat.”

“We are seeing much more activity now in the United States as well. With transmission in community so the cases that we're seeing now are more than just travel related,” he said.

The World Health Organization has said that COVID-19 is more infectious than the influenza. So protocols are often in place to protect health care workers. Indian Country Today observed patients walking right up to unprotected workers at the Gallup Indian Medical Center. There were guards at each of the stations and patients were asked if they had a cough or a fever. If they answered “yes,” they were diverted to a special area. People who said “no” could walk right in. None of the medical personnel were wearing masks, gloves or other protective gear.

IHS said they follow the CDC guidelines for health care workers and are communicating this daily in the facilities and workers.

“If we're not there, or we become ill, then there's less medical providers to care for the community so that's something that we hope very important and strongly and will continue to message and follow up on,” Dr. Toedt said.

There are 4,226 total cases in the United States with 75 deaths and 53 cases from areas reporting, including 9 states, District of Columbia, Puerto Rico, Guam, and US Virgin Islands. West Virginia has been the only state without a case.

He said that the majority of people who become infected with COVID-19 have a “mild illness,” but some people can get “seriously ill” and “some people can die.” More than half of the deaths have been residents in long-term care facilities.

Butler and other experts recommend that older individuals avoid contact with people outside of their families.

“So the people who are at highest risk are our elders. People who are over age 70 to 80 are at higher risk of more severe illness, as are people who have chronic heart, lung, or kidney disease, and those who have diabetes,” Butler said.

The country has been trying to contain the virus, limit entry of the virus into the country, and now, what we’re seeing, mitigation as a way to “slow the spread of the virus,” he said.

“And this is important to be able to flatten the peak of the pandemic over as long a period as possible, so that infrastructure and particularly our healthcare system doesn't become overwhelmed by the volume of patients that are seeking care,” he said. “The current focus on social isolation is based on what we know about transmission of the virus, which appears to be most primarily due to respiratory droplets meaning that when someone who is infected coughs or sneezes, the spray that is produced can carry the virus and can travel for distances of, we estimate, up to six feet. So being able to distance ourselves from other people and not have contact with people who are sick is particularly important.”

(Related coverage: Indian Country's COVID-19 syllabus)

The Hopi Health Care Center in Polacca, Arizona, is taking precautions in responding to the outbreak. The facility is asking patients and visitors to arrive at their appointments 20 minutes early so they can go through a screening process at one of two entrances.

“Because the virus spreads through person to person contact we are asking that patients please limit the number of family or caretakers accompanying them to the facility,” according to the press release. They also ask to limit the personal items to limit the risk of surface contamination.

Of course, social distancing is the key. Butler recognizes that this is a challenge.

“So our goal is to strike that balance between social distancing which we believe can be good, but not social isolation which we know can be very bad,” he said. “If at all possible, gatherings, particularly those of more than 10 people should be done either virtually, or at least with people remaining at a distance of at least six feet from one another, and minimizing any contact.”

Dr. Toedt said, if the country is able to social distance to prevent transmission, “then we'll be able to flatten that curve, and ultimately our healthcare system will be able to absorb the increased number of cases and that's across, not just the Indian Health Service, but we have to do this in partnership with our local referral partners as well as their tertiary care, medical centers that we refer to.”

There’s also a chance that the United States may act like some European countries, “where people don't take those actions and there is increased transmission,” Dr. Toedt said. “Currently, we could very well see a scenario where the needs outstrip our resources.”

In Window Rock, the Navajo Nation Council was in session to consider emergency funding. On Monday that body tabled a bill to spend $3 million on the emergency. That debate centered on how much money would be given to the nation’s chapter governments versus the emergency services from the Navajo Nation itself.

“I thought the funding was going to be given directly. We’re just creating obstacles for chapters,” said Council Delegate Eugenia Charles-Newton in a news release. The legislation was amended to allow that direct funding.

However the Navajo Nation’s president’s office pushed back. “This is not a regular emergency,” said President Nez’s Chief of Staff Paulson Chaco. “My question to the delegate is, ‘what is the chapter going to do? … Are they going to be taking people into the hospital?’

The administration supported more funding for the Department of Emergency Management to coordinate the Navajo Nation’s COVID-19 response operations.

The Navajo Nation Gaming Enterprises announced the closure of its four casinos, Fire Rock Casino, Flowing Water Casinos, Northern Edge Casino and Twin Arrows Casino, through April 6, 2020.

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Mark Trahant and Patty Talahongva contributed to this report. 

Jourdan Bennett-Begaye, Diné, is the Washington editor for Indian Country Today based in Washington, D.C. Follow her on Twitter: @jourdanbb. Email: jbennett-begaye@indiancountrytoday.com

See our COVID-19 updates and coverage: Indian Country's COVID-19 syllabus. 

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