With high vaccination rate and masks, the Navajo Nation confronts delta COVID wave

Widespread vaccinations and strict public health measures put the nation in a better place than neighboring states, officials say.

San Juan County • When the first coronavirus case hit the Navajo Nation in spring 2020, it looked like the nation, located in the Four Corners region, would have one of the worst outbreaks anywhere. In fact, at one point early in the pandemic, the Navajo Nation had the highest per capita of COVID-19 cases in America.

Living conditions made controlling the disease harder than in other parts of the country. The Navajo Water Project says 1 in 3 Diné (Navajo) people lack running water to wash their hands, and it is harder to quarantine and isolate in overcrowded households situated far away from basic needs, like food and other essentials, in more developed border towns.

But the nation’s response was swift. Authorities instituted a shelter-in-place order to limit any exposures. Navajo Nation Police drove around communities, shouting through megaphones, “Stay Home, Wash Your Hands, Wear A Mask.” Public health officials created campaigns to get as many Diné people vaccinated as possible, and as a result, 70% of the current population is fully vaccinated.

With about 400,000 enrolled Diné citizens, the Navajo Nation has about 175,000 people living within its 17 million-acre territory, which extends into parts of Arizona, New Mexico and Utah. There have been more than 32,000 positive cases and about 1,300 deaths since the pandemic started. Most of the deaths came from the early days of the pandemic.

As the country confronts a third wave of infections, the Navajo Nation is in decent shape compared to the nearby states of Arizona, Colorado, New Mexico, and Utah, say public health officials here.

The extremely transmissible delta variant has reached the reservation and cases are creeping up. The Navajo Nation reported 33 new cases on Sunday and had 46 new cases on Saturday. An executive order issued on Sunday also requires all Navajo Nation government employees to be fully vaccinated against COVID-19 by Sept. 29. Unvaccinated employees will be required to submit a negative COVID-19 test at least once every 14-days.

“Nationally, I think they say about 75% to 80% of infections are attributed to this variant right now,” said Shawn Begay, public health director for Utah Navajo Health System (UNHS), which serves about 3,000 Diné people daily at five locations in San Juan County, Utah. “Navajo Nation is no exception. We have seen a few cases of that here within San Juan County.”

Dr. Jill Jim, executive director and epidemiologist for the Navajo Department of Health (NDOH), says the improved public health surveillance tools her department created help contact trace outbreaks quicker than earlier in the pandemic.

(Sharon Chischilly | The New York Times) Dr. Jill Jim, the Navajo Nation health director, in Window Rock, Ariz., on Aug. 19, 2020.

The Navajo Nation’s COVID-19 Dashboard, she says, helps to send resources and health care providers to communities surging with the virus. The dashboard also allows her to issue timely public health orders in line with how the virus trends, such as requiring masks for all Diné citizens and visitors. Mask wearing is widespread and accepted in the Navajo Nation while states are still deciding whether to institute mask mandates, she says.

To stay in front of the curve, Jill issued an updated Aug. 16 public health order, which changed the Navajo Nation from yellow status to orange status. The amended order requests the public to limit social and family gatherings to 15 people or less, and businesses maintain 25 or fewer people indoors. Under the order, masks are required everywhere.

In a positive sign, Jim said that most hospitalizations happening now in the Navajo Nation are non-COVID-19 cases. According to the Navajo Nation COVID-19 Dashboard, most of the new cases are from the delta variant, with most being among the unvaccinated.

However, there have been some breakthrough cases, says both Jim and Begay.

In spite of the breakthroughs, Jim credits vaccine access across the Navajo Nation as an essential mitigation tool contributing to the Navajo Nation’s comparatively lower numbers. She estimates that over 70% of Diné people have received the Pfizer, Moderna or Johnson & Johnson vaccines.

Dr. Ouida J. Vincent, acting chief medical officer for Navajo Area Indian Health Service, says she relies on Indian Health Service and NDOH data on COVID-19 daily to send out help to communities in the midst of a surge. She also points out that while it is crucial to get as many Diné people vaccinated as possible, it is also equally vital not to stigmatize those who choose against being inoculated.

“It’s really important that we do not label people who are not getting the vaccine in any way that’s derogatory,” Dr. Vincent said. “And I think at this point in the pandemic, nationally, we’re actually saying that in the mainstream press that people who are not getting vaccines are given, you know, a name that’s not good, which is just not going to encourage people to get vaccinated.”

Some wonder why the public health work on the Navajo Nation is not getting positive media attention. Earlier in the pandemic, press reports highlighted the Navajo Nation as the virus ran rampant. Now that it’s seeing fewer cases, the attention has vanished.

Navajo Nation President Jonathan Nez recently asked on Twitter why media outlets were not writing about how the Navajo Nation is enforcing stricter public health orders to keep the Navajo Nation safer than other jurisdictions. Though, he said, what happens in Arizona, Colorado, New Mexico and Utah still impacts what happens in the Navajo Nation.

(Courtesy of the Navajo Nation Office of the President and Vice President) Screen grab of Navajo Nation President Jonathan Nez speaking at a recent town hall event.

Residents of the Navajo Nation, which has one of the highest vaccination rates in the country, are still getting the shot. “We have seen an increase in shots these last couple of weeks here on Navajo because of the fear of the delta variant,” Nez said. “Those that have not been vaccinated are now wanting to get a shot, so that’s a good thing.”

President Nez anticipates that the Nation could be up to an 80% vaccination rate in the next few weeks. “We are hopeful that our Navajo people are following these protocols that we’ve been reiterating almost every day now.”

Ethel Branch, executive director for the Navajo-Hopi Families COVID-19 Relief Fund, said in an email that the grassroots group is working on an aggressive pro-vaccination program and a third phase of its Clean Hands Project — an effort to get hand-washing stations to Diné homes lacking any running water.

Even though the Navajo Nation has not seen a paralyzing spike in infections like many parts of the country, Branch thinks it’s a crucial moment to act and encourage Diné people to get their vaccines.

“We hope 100% of our Navajo people eligible for vaccines will seek that protection now before the full impact of [the] delta [variant] reverberates in our community. Delta is a reset on COVID that strips away many of the protections we fought hard to acquire for our community,” Branch said.

“This is a pivotal moment during which we need our people to act quickly if they love and wish to protect our language, culture, and our most vulnerable,” Branch added.