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Jourdan Bennett-Begaye and Mark Trahant 

Indian Country Today

Indian Country Today

The Indian Health Service and tribal health facilities will need some 1,600 contact tracer positions in order to investigate COVID-19 outbreaks.

"This job far outstrips our capacity," said Rear Admiral Michael Weahkee, Zuni, director of the Indian Health Service. He said the benchmark is one contact tracer for every 1,000 patients served, “that number in Indian Country would be quite high with 1.6 million patients being served."

Weahkee told Indian Country Today’s daily newscast: “The best contact tracers are from the communities being served. So that bodes very well for trying to identify and then train those individuals up. We need a lot of them."

Especially in the hotspots identified by IHS and the Centers for Disease Control and Prevention.

"For sure, in those hotspots around Indian Country. I think everyone's well aware of a Navajo Nation being a hotspot,” Weahkee said. “We worked very hard and very closely with the tribes to identify, who's comfortable being identified publicly as a hotspot, and who's not. We wait until tribal leadership goes out and shares their numbers first."

He said there are other COVID-19 hotspots across Indian Country “at Mississippi Band of Choctaw Indians, White Mountain Apache, and we've had the Quechan and the Cocopah, the Hualapai here in Arizona, several tribes throughout the country.”

The White Mountain Apache Tribe in Arizona reported 1,711 total cases for residents on the Fort Apache Reservation and 21 deaths. The Mississippi Band of Choctaw Indians has a total of 906 cases and 63 deaths.

Test rates: Among the highest in the country, the world

In the areas that show up as hotspots the Indian health system will add resources, including testing.

Testing rates have been part of the discussion in the country and around the world. In the last month, multiple reports documented Navajo Nation President Jonathan Nez saying it has the highest testing rate in the country.

Weahkee reiterated, confirmed, and expanded that claim.

“I would say some of our tribal nations have some of the highest testing rates in the world,” Weahkee said. The Navajo Nation tests almost a quarter of its service population. “That’s something we should all be proud of, is that we've been able to build that capacity and ensure that our patients are being tested."

The Navajo Nation has tested approximately 40,000 individuals out of a 200,000 service population, according to Weahkee. That makes the testing rate 20 percent for the tribal nation.

The entire Indian health system follows not too far behind.

“But as a system overall, we've tested about 16 percent of our service population,” Weahkee said using 1.6 million, IHS service population, as the denominator and 263,000 tested. The service population is the number of American Indians and Alaska Natives have used an IHS facility in the last three years.

However, IHS doesn’t have all the data from health facilities owned and operated by the tribes and urban Indian programs. Back in May, IHS said “approximately 33 percent of tribally managed facilities and 44 percent of urban Indian organizations have reported some testing data to the IHS.” These percentages also have some flaws as not all tribal and urban Indian health programs may have testing for COVID-19. “Multiple facilities, such as satellite clinics in a service unit, may also report as one program.”

Lessons learned

Weahkee also said on the newscast: "The Indian Health Service, we've been engaged now for just over three months in responding through incident command posture to the coronavirus. This means that we've stood up a special structure and we have our teams meeting at least once a day, many times, multiple times a day."

"We've stood up each of our hospitals and health centers, incident command teams. So they meet every morning to huddle and plan out the day to really focus on those areas that need to be addressed. But overall the approach has been to prevent, detect, treat and to recover from the pandemic. Each of the teams is focused on those four areas and that makes up their daily routine. So you would imagine over three months now that it wears on you and it becomes very difficult. We start to have people fatigue. It's quite the undertaking."

"Hindsight's always 2020 but I don't think that the country really understood this was a true pandemic, the level of need for personal protective equipment and testing capacity."

"We've had pandemic plans on the shelf and have exercised according to those plans to ready ourselves but until you're really in the thick of it and you see the entire country dealing with the same situation at the same time, that was really eye opening, I think for everybody."

"Thankfully for the most part, we're in a much better place than we were just a month or two ago. We've had manufacturing really ramp up both domestically and internationally."

"We still do have some needs out there. Most recently we've been in need of gowns, tieback, gowns, and other protective gowns. Many of the manufacturers who were making gowns previously switched over to making masks because that was the big need."

"So they're making those adjustments on the manufacturing side. And I think for the most part, we've been able to find the majority of what we needed lately."

Challenges ahead

"We're trying to balance this, economics versus health, but there's also a very important balance of behavioral and mental health versus physical health that needs to be taken into account."

"We need to go back to our initial prevention discussion, social and physical distance taking frequent hand washing for at least 20 seconds wearing a face cover in public. There are things that we can do and still ramp up and move a little closer to normal. But I do think it will be quite some time before we get to our true pre-pandemic normal."

"Unfortunately in Indian Country, as most you know, we have had high disparity rates and diabetes, upper respiratory infections, heart disease, even before the pandemic hit. And so ensuring that services continue in some way for those individuals through innovative mechanisms like tele-health, or even by making telephone calls to ensure that individuals are getting their medic medications and the treatment that they need - many of our sites have provided prescription delivery services or they've had drive up delivery of prescriptions, just ways to maintain that physical distancing."

"Tele-health, I think, has really been the sea change. We've seen a 12 time increase in the use of tele-health in the Indian Health System with care alone which we're very hopeful that we'll be able to retain even beyond the pandemic."

"Being a federally operated healthcare system, you know, we get compared often times to a socialized system like they have in Canada, or they have in England and there are goods and the bads. And there are both very much dependent on federal appropriations. But we're also equally dependent on third party revenues, Medicare, Medicaid, private insurance. But we do have the benefits of being able to really focus on the population's health as a priority. And we now have multiple generations of families, health data, and our electronic health record, which we can learn from and improve over time. And I think that we've really seen the benefit of that in the area of diabetes care and treatment, where for the first time ever, we've seen a slight decrease in adult prevalence of diabetes and American Indians and Alaska Natives, which has never happened. And it's not happened in any other race or ethnic group to this point."

"I do have concerns. We're being innovative and we're doing everything we can to ensure that treatment continues but there are some things outside of your control and we are worried about the effects of the social isolation on mental health status and whether people turn to other coping mechanisms as a result."

"We have some anecdotal data because all the data we have in our system is based on our federal operations. And then we have many tribal and urban programs who voluntarily provide their data to us as well. So we've been using that as a flag to what's happening overall in Indian Country and we've seen between 30 percent to 80 percent reductions in the third party collections at sites, depending on where they're at geographically or the type of facility that they're operating. We've made up for that gap through some of the congressional appropriations, the waves of funding that have been provided, provider relief funding is a good example, which one of the primary purposes was to make up for that loss of third party revenue but I do feel strongly that it's going to take several years to make up for these lost third party revenues that we're experiencing currently."

"They're forced to rely on reserves that they may have had, or for a pull from other sources. Gaming revenue is always looked to as a resource, but, you know, as we all all know in Indian Country, not everybody has a large reserve of funds built up. Many of those casinos are just providing jobs and breaking even so very few of those large tribes that have huge reserves that they can rely on."

"There is quite a bit of discussion at the White House level. We have now stood back up the White House Council on Native American Affairs and one of their first focus areas is they bring tribal leaders together will be on energy, energy consumption energy use, looking at those tribes that have oil and gas and other reserves that they can focus on but when it comes to casinos and gaming, I know that the National Indian Gaming Commission has been working closely with tribal leaders to set their casinos back up in a safe way, both for their employees and for the consumers of those facilities, we're working hard to do it but to do it in a safe way."

"Through the Office of Personnel Management we've had the ability to pay hazard pay during this time so that has enabled us to increase pay by up to 25 percent of their regular base. And it's proven to be a pretty good retention tool. So we've historically been operating with a 20 percent vacancy rate across all professions, even higher in some of our physician nurse, physician assistant positions up to 30 percent. But for the most part we've been holding steady, steady with bad vacancy rates to start with."

"For the most part, I think our numbers have held, we have seen over the last several years, slowly decreasing rates of employment for physicians and dentists in our system. We've been losing physicians slowly and turning more to contract providers."

"We are really trying to build up the training capacity through graduate medical education, residency rotations, HERSA and the VA have both put funding together with Congress's support to increase the number of residency programs in Indian Country and we're hoping that that enables us to develop a new pipeline of providers."

"I always like to look for that silver lining and that next best thing that could be coming our way and I would love to see a renewed interest in healthcare, within our Native communities. We could really use those nurses and respiratory therapists and nursing assistants, you name it."

"We all need to continue wearing our cloth masks, keep them handy, use them, continue social distancing. If you feel ill call your provider in advance before you go into the hospital and get to your providers advisements on what you should do."

"We really need to do all we can to protect our elders at home. And we're seeing now that the demographics are changing slightly, that we're starting to see more young people getting sick. And I think that part of that is a result of not adhering to some of the public health orders that have been put in place. We really do need to continue to practice these as long as we can to hopefully keep the new cases flattening off."

Also in the newscast, Jourdan Bennett-Begaye has the latest numbers of positive COVID-19 testsin Indian Country.

The anchor and executive producer of the newscast is Patty Talahongva.