Monument Valley • Since the first COVID-19 case was confirmed on the Navajo Nation in mid-March, the near-daily updates released by the tribal government have been alarming.
The Navajo Epidemiology Center announced 1,127 confirmed cases of the disease and 44 deaths as of Saturday, and Navajo Nation President Jonathan Nez has warned the peak may still be weeks away — a startling trend for a Native American nation that has an on-reservation population of about 174,000.
As The Salt Lake Tribune previously reported, if the Navajo Nation were a U.S. state, it would rank behind only New York and New Jersey for per-capita confirmed cases. And the news site New Mexico In Depth reported recently that 31% of New Mexicans who have contracted COVID-19 are Native American.
But a Tribune analysis of publicly available coronavirus data found that those numbers could be misleading. Residents of the Navajo Nation have had access to a far more proactive testing program than surrounding jurisdictions over recent weeks.
The Navajo Area Indian Health Service and other health care entities are conducting coronavirus tests at a much higher rate than any state in the Southwest. And as the area receives more national attention, testing has only increased, a key component to more successful efforts to contain the virus that has been used in countries like South Korea.
As of Saturday, 2,759 total tests had been conducted for every 100,000 residents of the Navajo Nation. Arizona as a whole, by contrast, was testing at about a quarter of that rate with 676 tests per 100,000 people.
Testing rates in Utah and New Mexico were also substantially lower compared to the Navajo Nation, with 1,870 and 1,698 tests per 100,000 people, respectively.
Since cases from the Navajo Nation — which has land in Arizona, New Mexico and Utah — are also counted in state totals, the off-reservation testing rate in each of those states would be lower if Navajo Nation numbers were not included.
More testing, more confirmed cases
The significant discrepancies in testing mean that any comparisons of infection rates have to be approached with caution, according to Jacqueline Keeler (Diné and Ihanktonwan Dakota), a journalist and editor-in-chief of Pollen Nation Magazine.
“The level of testing available to Native people on the reservation is actually much higher than it is to many people in the rest of the country,” Keeler said, adding that places with less testing are less likely to capture the full scope of the outbreak.
When comparing infection rates, Keeler said, it is important to ask a series of questions. “Are they testing the same proportion of the population, and who are they testing? Are they testing just the squeaky wheels? Are they testing everyone? I don’t think that the public health data is actually comparable unless those factors are true.”
The only states testing patients at a higher rate than the Navajo Nation as of Saturday were Louisiana and New York. Louisiana showed an infection rate somewhat lower than the Navajo Nation while New York’s was close to double.
Keeler said close community bonds in tribal communities can make contact tracing more effective, which can help identify other people who may have been exposed. Expansive health coverage for tribal members under the Indian Health Service may also make people more likely to seek medical attention.
Leaving out all of that context, Keeler added, can lead to dangerous conclusions that Navajo people are “infected,” a notion which has sparked displays of racism in neighboring communities. Earlier this month, a 34-year-old man from Page, Ariz., was taken into custody on suspicion of attempting to incite an act of terrorism after he made a Facebook post that urged people to use “lethal force” against the Navajo community because they were “100% infected” with COVID-19.
A proactive response
The Navajo Nation moved far more quickly than neighboring states in response to the pandemic, declaring a state of emergency March 11, and closing its casinos, schools and tribal parks soon afterward. It implemented a shelter-in-place order before any surrounding state, and after the first confirmed death, it imposed nightly and weekend curfews. Last week, Nez sent a letter to Interior Secretary David Bernhardt asking for the closure of federal lands that border the Navajo Nation.
Keeler said many tribes have taken similarly bold measures to protect their members. She contrasted those efforts with a series of protests and rallies that have been held by conservative activists in places like Michigan, where coronavirus-restriction protesters intentionally created a traffic jam around the state Capitol recently, and Idaho, where firebrand rancher Ammon Bundy has been encouraging followers to defy bans on mass gathering by exercising a constitutional right to assembly.
“[Tribes] are taking the science more seriously,” Keeler said. “As a community, they're responding more seriously, and they shouldn't be punished for that.”
Eli Leslie, public information officer for the Navajo Department of Health, said, “Everyone has been trying to push for test kits — on our end at the health command center but also our legislative branch, our executive branch — all of our leadership has been trying to push for these test kits ... and that is starting to pay off now.”
Leslie added that more rapid test kits are being sent to health care facilities across the Navajo Nation, which will allow patients to see results in a matter of hours instead of days. “Our numbers will go up with these rapid tests coming in, but we will have more accurate [data] and a better understanding of results and therefore we can better prepare and help get people resources.”
Other rural areas across the West have skewed coronavirus data as a result of the opposite problem as the Navajo Nation: limited testing availability. Journalist Anne Helen Petersen, for example, noted on Twitter that her home county in Idaho, Nez Perce County, had nine confirmed deaths from COVID-19 out of 20 confirmed cases on Tuesday, which she attributed to a “massive undertesting issue.”
A ProPublica analysis of death rates showed a large, recent uptick in deaths at home in major metropolitan areas across the country that have not been counted in coronavirus totals.
According to numbers released by Utah, the state’s peak of confirmed cases was on April 2, and it has been in decline for the past two weeks, a trend Utah Gov. Gary Herbert recently applauded. But the number of tests conducted also has dropped off, closely following the trend of confirmed cases.
A national shortage of tests in March forced many health care providers to test only patients with severe symptoms, and although Utah leaders have recently pushed for wider testing, some patients have reported being turned away by health care providers along the Wasatch Front despite having symptoms.
A partnership between the state of Utah and Silicon Slopes, TestUtah.com, set the goal of 7,000 tests per day early this month, including of asymptomatic people, but testing has barely topped 3,000 and that’s only happened on a few days.
Heath care officials have been encouraging more Utahns to get tested and state epidemiologist Angela Dunn has said the state has more testing capacity than demand.
The Utah Navajo Health System and Utah Department of Health’s Public Health Laboratory, meanwhile, brought in mobile testing units to the Navajo Nation in southern San Juan County. More than 1,300 free tests were administered over four days at drive-thru testing sites. Local health officials have warned that numbers will likely spike due to increased testing, not increased infection rates.
The mobile testing units were open to high-risk individuals, anyone with symptoms and those who have had close contact with a confirmed case. But San Juan Public Health, which recently loosened its coronavirus restrictions on visitors and businesses, said that now that the units have left, “local providers will continue testing but only for those patients who show serious symptoms and who are at high risk.”
Regardless of testing rates, the Navajo Nation has had a high coronavirus death toll, which may in part be attributed to a lack of resources. The Navajo Nation was promised funds through the federal stimulus legislation passed last month, but it has been slow to arrive, and the tribal government has been forced to cover those costs in the meantime.
Smaller casinos, which for many tribes provide an essential source of revenue, have been barred from receiving federal assistance under the CARES Act. Economists at Harvard University’s Project on American Indian Economic Development sent a letter to Treasury Secretary Steven Mnuchin on April 10, warning that without sufficient federal aid to tribes, the coronavirus outbreak could knock reservation economies back 30 years.
“Our Nation is slowly seeing the benefits of the three COVID-19 bills passed by Congress, but it is not arriving fast enough," said Navajo Nation Vice President Myron Lizer in a recent statement. “We need more rapid testing, health care personnel, [personal protective equipment], ventilators, and other essential services to adequately address the expected increase of COVID-19 cases on the Navajo Nation.”
Despite some emergency funds flowing to the Indian Health Service, family members of IHS workers at the heart of the outbreak near Chinle, Ariz., are still raising money for essential protective equipment through GoFundMe campaigns.
“Navajo people are responsible — not responsible for what they don’t have — but they are responsible for what they have been able to achieve,” Keeler said, including the widespread testing program. “And I think that the response to the pandemic shows that they deserve a lot more. Any assistance that is given is going to be utilized properly.”