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Felicia Fonseca
Associated Press

Medical professionals serving the Navajo Nation made an urgent plea to residents Thursday to stay home as coronavirus cases rise, testing the limits of health care on the vast reservation. 

"If we don't stop COVID, we will run out of beds, we will run out of nurses, we will run out of supplies," said Dr. Loretta Christensen, chief medical officer for the Navajo-area Indian Health Service.

The Navajo Nation has been seeing more cases daily than it did in the spring when it was a national hotspot. The difference now is that cases are rising in all the states that border the reservation — New Mexico, Utah and Arizona — and nationally, and the tribe no longer can draw on the resources it once did.

That has left medical professionals scrambling to find hospitals off the reservation to take in critically ill patients, extra nursing staff and supplies, like high-flow oxygen.

On the Navajo Nation, officials are responding by closing outpatient facilities and redeploying staff to hospitals. They're expanding the number of beds but still face challenges in finding enough people to care for patients. Dentists, physical therapists and nursing assistants are being called on to fill in for nursing duties. 

The Northern Navajo Medical Center in Shiprock, New Mexico, has a 50 percent vacancy rate for nurses, some of whom left because of fatigue after the first wave of COVID-19 hit the Navajo Nation hard in March and as schools closed to in-person learning, said chief medical officer Ouida Vincent.

The Shiprock hospital and the Gallup Indian Medical Center in northwestern New Mexico also are constrained by the number of oxygen hookups in the aging facilities. 

In the spring, the Navajo Nation sent patients in need of intensive care to hospitals in Phoenix, Flagstaff and Albuquerque, New Mexico. Doctors on the reservation increasingly are having a difficult time finding a place for patients in need of specialty care.

Dr. Paul Charlton at the Gallup Indian Medical Center said staff there has had to call up to 15 hospitals at times — including in Tucson, Denver and El Paso, Texas — looking for a transfer site. Even if they're successful, they might not have a flight team or ambulance that can transport the patients. 

"The regional hospitals are doing everything they can to help out, but it really is a dire situation," Charlton said.

Standard intensive care units in Albuquerque are full. Major hospitals are converting other rooms, including hallways, into emergency care facilities. COVID-19 infection rates in New Mexico have rebounded to levels seen in May when the state's governor invoked riot laws to cordon off Gallup, which borders the Navajo Nation, to limit the virus' spread. 

Christensen said hospitals that serve the Navajo Nation are not at the point of having to ration care.

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The Navajo Nation on Monday reported 310 new coronavirus cases and two additional deaths, bringing the total to 17,035 cases since the pandemic began and 658 known deaths. Its seven-day average is 194 cases, according to the Navajo Department of Health. 

The U.S. recorded a record number of deaths Wednesday, according to the tally kept by Johns Hopkins University. The number of Americans in the hospital with the coronavirus likewise hit an all-time high Wednesday at more than 100,000, according to the COVID Tracking Project.

The Navajo Nation has had some of the most restrictive measures anywhere in the country, and most of those have been in place since March. They include a mask mandate and daily curfews. Essential businesses are required to limit their hours to between 7 a.m. and 3 p.m. 

Navajo Nation President Jonathan Nez said during a virtual town hall with the medical professionals that he will extend a stay-at-home order through at least Dec. 27. He's also preparing to send a request for a major disaster declaration to the federal government. 

He urged residents not to leave the reservation or to gather with families, which officials have said contributed to uncontrollable spread in most Navajo communities. 

In the Navajo community of Ganado there is a legal dispute about lapsed funding for the Navajo Health Foundation - Sage Memorial Hospital. 

Law360 reports that a suit was filed in New Mexico federal court that accused the Indian Health Service of failing to renew the hospital's contract. 

"The Navajo Nation is in the middle of a raging pandemic that is literally killing people," Lloyd Miller of Sonosky Chambers Sachse Miller & Monkman LLP, counsel for the hospital, told Law360 that it's an "outrage" that "at a critical time like this … the agency would discontinue contracting with Sage and direct suffering patients to drive long distances to other IHS providers."

Meanwhile in Washington, President-elect Joe Biden says he is keeping Dr. Anthony Fauci on as a chief medical adviser and a member of his COVID-19 advisory team.

Biden made the comments Thursday during an interview with CNN's Jake Tapper. He said he spoke with Fauci earlier in the day about the need to instill confidence in any coronavirus vaccine and the fact that "you don't have to close down the economy" to combat the virus.

Biden says he'd be "happy" to get a vaccine in public to prove its safety.

 The president-elect also said he would ask the public to wear masks for 100 days to help drive down the spread of the virus, which has killed more than 275,000 Americans.

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Associated Press Writer Morgan Lee in Santa Fe, New Mexico, contributed to this report.