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Life is not the same during the coronavirus pandemic. Tribes have declared states of emergency, including the Navajo Nation, the Confederated Tribes of the Umatilla Indian Reservation in Oregon, and the Oglala Sioux Tribe in South Dakota.

Navajo Nation President Jonathan Nez declared a "public health emergency." The president's office said there were no confirmed cases but the declaration is a “proactive measure to help ensure the Navajo Nation’s preparedness and the health and well-being of the Navajo people."

Twenty states have declared states of emergency, opening up a stream federal dollars to fight the outbreak of COVID-19. 

Some of the tribes and states that have issued declarations of emergency have no cases and have reported no deaths. 

Thursday Alaska announced its first confirmed case of COVID-19, which means there are only four states -- Alabama, Idaho, Montana and West Virginia -- without any confirmed coronavirus cases.

Alaska has had time to prepare. The state halted employee travel outside Alaska on state business on Monday, and on Wednesday the governor declared a state of emergency. The legislature is looking at ways legislators can continue to conduct essential business long distance.

While schools are getting a deep cleaning during spring break, the state education department is meeting with school districts to plan the response to outbreaks in rural areas. The Alaska Department of Health and Social Services is monitoring the disease’s spread and has issued guidelines on what Alaskans can do to prepare for coronavirus.

In addition to preventing the spread of the disease, the health system is gearing up for a potential flood of patients. Officials continue to urge people to get flu shots. That would reduce the number of people who need care for that, freeing beds and respiratory equipment for COVID-19 patients. There is no vaccine for COVID-19. 

(Previous story: Coronavirus Q&A: What is it? The symptoms. And how it spreads)

Alaska’s tribal health system is holding planning meetings, stocking up on personal protective gear, and, in some places, screening people at health facilities for COVID-19 to divert them to isolation if they are symptomatic for COVID-19. A resource page says there are no confirmed cases at the Alaska Native Medical Center but the team "maintains readiness."

Tribal health organizations offer primary care via clinics and health centers in villages and small towns, and regional hospitals. If a patient needs specialty care, he or she is referred and transported to the Alaska Native Medical Center in Anchorage.

Christine Pinckney, director for infection control and employee health with the Alaska Native Tribal Health Consortium, and Roald Hegeson, Haida, CEO and administrator for the Alaska Native Medical Center.

Christine Pinckney, director for infection control and employee health with the Alaska Native Tribal Health Consortium, and Roald Hegeson, Haida, CEO and administrator for the Alaska Native Medical Center.

The medical center’s chief executive officer and administrator Roald Helgeson, Haida, said one of the strengths of Alaska’s health system is its experience with working together.

“We have an RSV [Respiratory syncytial virus] outbreak right now that's happening and some of those patients are in the [Yukon-Kuskokwim] area hospital,” Helgeson said.

Others are at Anchorage area hospitals.

“We do and we will work together whether it's here at ANMC or whether it's at Providence [Medical Center] or Alaska Regional [Hospital] or any of our tribal health hospitals across the state,” Helgeson said. “We are a health system. We're going to work together.”

Helgeson said tribal health organizations that usually meet in person five times a year are now meeting by teleconference weekly or more often as needed. 

He said health teams are updating emergency plans, with the latest decisions being to better define “at what level does a person get that [specialized] care. He said the aim is that “people get the right care at the right level in the system. So if they can be managed in our community clinics, they are managed there and otherwise move to more specialty care.”

He said the Alaska Native Tribal Health Consortium is also generating public education materials. 

“We ask people to consider, from a population health standpoint, good hand hygiene right from the very beginning.” Hand washing, he said, can “stop viruses in their tracks.” So officials are emphasizing that along with social distancing.

One message Helgeson wants Alaska beneficiaries of tribal health services to get is, “If you do need care, we want you to come in and get care. Our emergency room is open. We're ready to see our people. We want to see our people in those environments.” He added, “It would be helpful if you gave us a call in advance. We always prefer that in any of our clinics.”

Alaska’s troubled history of infectious disease may prove to be a strength in fighting COVID-19. Like other Native Americans, Alaska Natives had no immunity to infectious diseases common to Europeans. Alaska’s distances, isolation, and inattention from the Russian and American governments added to the ravages caused by disease.

Robert Fortuine, a former Indian Health Service physician is the author of “‘Must We All Die?’ Alaska’s Enduring Struggle with Tuberculosis.” In the book, he said tuberculosis’ “relentless spread to the far corners of the land, and its grim impact on individuals, families and society,” left deep and abiding scars on the outlook of Alaska Natives.

Alaska Natives were hit by infectious disease later than some other Native Americans. Underfunding and a shortage of medical services left epidemics raging decades longer than in other places. Alaska Natives lost at least half their population to tuberculosis, measles, influenza, smallpox, typhoid, whooping cough, and mumps.

Historically, Alaska Native children ranked among the world’s highest for rates of meningitis, pneumonia, Influenza B, and pneumococcus rates were ten times that of non-Alaska Native children. Alaska once had the nation’s highest rate of hepatitis, which led to Alaska health care providers becoming world leaders in the prevention and treatment of viral hepatitis.

Like the rest of the country, health care providers in Alaska dealt with the threat of Ebola 2014 , the H1N1 influenza in 2009, and in 2002-2003 the SARS epidemic. Alaska continues to have three times the rate of tuberculosis as the rest of the country.

Yukon-Kuskokwim Health Corporation vice president for medical services Jim Sweeney said care providers are experienced at donning and doffing personal protective equipment.

“We have a long experience with tuberculosis in this area, so we've dealt with that quite a bit. And it's a similar type of precautions to what you deal with those types [coronavirus] of patients also,” Sweeney said.

That history led to the creation of the nation’s only Centers for Disease Control and Prevention research program infectious disease field station. The Arctic Investigations Program is part of the National Center for Emerging and Zoonotic Diseases, within the Division of Preparedness and Emerging Infections. It has a staff of 35, including epidemiologists, laboratorians, researchers, statisticians, and support staff located on the Alaska Native medical campus.

Helgeson said, “They are actually a part of our infection control committee and that's one of the strengths I feel like we have here is that with our community partners, we're working very closely with them, as well as the state and emergency operations folks.”

As a result of advice from CDC and state officials, Helgeson said “We have made some changes to our [emergency room department] for respiratory patients as they are coming in so that we can try to rule out “is this influenza, or something else?” The screening will also determine if someone needs to go into a respiratory isolation environment.

One of the ways to prevent the spread of infection in a hospital is to have patients in negative pressure rooms where excess air is sucked out of the room and put through a special system that captures airborne particles and sends them away from other areas of the hospital.

Christine Pinckney is director for infection control and employee health with the Alaska Native Tribal Health Consortium, which manages the in-patient side of the medical center.

“We do in-house right now have 29 negative pressure rooms throughout the facility in different areas of inpatient, the ER, different locations,” Pinckney said. “We can also convert any one of our ICU [intensive care unit] rooms to negative pressure if need be. We also can make an entire in-patient unit negative pressure if we need to.”

She said they set up the negative pressure systems and tested them, and the numbers showed they were successful.

“That was really a great opportunity for me as an infection preventionist to see what our facility can do,” she said.

Pinckney said an epidemic is a test of the mettle of infection control specialists. “It’s like I've been training and training and training … I want to clarify we're not excited that there's COVID-19. Because it's my world, what I live in, and because I see it [the years of training and planning] all coming together, I guess that's exciting for me.

“This is the stuff that we do every day ... we know what is important to keep all of us safe and the things that we need to do,” Pinckney said. “But now we're taking it a step further and creating [public education] videos and we're connecting with folks more frequently and having more conversations.

“The medical center plans to ask coronavirus patients to share who they have been in contact with so those people can be contacted and advised to self quarantine. Helgeson said they will call upon existing staff to take on those added duties. “I don't think anybody can say that we've had a ton of excess capacity. ANMC needs to be a bigger hospital. We've known that for a long time. We've had a lot of growth here to meet the needs of our people. And you've seen that here on the campus, the incredible growth that we have had and we need to expand our hospital."

“But that said, we have prepared ourselves to be able to treat our people and if there is a major mass casualty type of situation, we have plans on how we would manage that with alternative care locations.”

“We’re going to care for our people the very best that we can,” Helgeson said.

Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist.

The Associated Press contributed to this report.

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