Virus outbreak highlights deep-rooted problems
WINDOW ROCK, Ariz. — Matalynn Lee Tsosie showed up at the Indian Health Service hospital in Gallup one day in April feeling poorly and having trouble breathing. When her coronavirus test came back positive, the hospital gave her a prescription for an inhaler, an oxygen tank and orders to go home and rest.
Three days later Tsosie, a 40-yearold secretary for the local school system, was back at the hospital, this time in dire condition. But the hospital was ill-equipped to handle severe coronavirus cases. She was transferred to a hospital two hours away in Albuquerque, where she died alone after doctors tried to take her off a ventilator.
“My thought from the beginning was that it was a slow response,” said her sister, Kirsten Tsosie, fighting back tears. “I think a lot of lives could have been saved if we had a quick response to it.”
Long before the coronavirus, the Indian Health Service, the government program that provides health care to the 2.2 million members of the nation’s tribal communities, was plagued by shortages of funding and supplies, a lack of doctors and nurses, too few hospital beds and aging facilities.
Now the pandemic has exposed those weaknesses as never before, contributing to the disproportionally high infection and death rates among Native Americans and fueling new anger about what critics say has been decades of neglect from Congress and successive administrations in Washington.
Hospitals waited months for protective equipment, some of which ended up being expired, and had far too few beds and ventilators to handle the flood of COVID-19 patients. The agency failed to tailor health guidance to the reality of life on poverty-wracked reservations and did little to collect comprehensive
data on hospitalizations, death rates and testing to help tribes spot outbreaks and respond.
The virus has killed more than 500 people in the Navajo Nation in the southwest United States, giving it a death rate higher than New York, Florida and Texas. It has infected more than 10 percent of the small tribe of Choctaw Indians in Mississippi.
A New York Times analysis found that the coronavirus positivity rate for Indian Health Service patients in the Navajo Nation and the Phoenix area was nearly 20 percent from the start of the pandemic through July, compared with 7 percent nationally during the same period. It is now down to about 14 percent in both areas, nearly three times higher than the current nationwide rate.
In Arizona, Native Americans account for 11 percent of all coronavirus deaths in the state despite making up only 5 percent of the population. In New Mexico, nearly 30 percent of infections are Native Americans even though they are only 11 percent of the population.
The systematic weaknesses in the health system forced tribal officials to take matters into their own hands, spending millions of dollars of tribal money to bolster the response and enacting curfews and other steps to enforce social distancing. The Oglala Sioux and Cheyenne River Sioux tribes in South Dakota, among others, tried to head off the spread by limiting entry into their reservations.
“If we would have waited for the federal government’s help, our deaths could have been in the thousands,” said Mike Sixkiller, a city coronavirus coordinator in Tuba City, Ariz., where the virus first entered the Navajo Nation.
The doctors and nurses at the federally run hospital in Tuba City pleaded on social media for protective medical equipment, hand sanitizer and other supplies while waiting for assistance from Washington. City officials took the same approach and began receiving donations from across the country.
In states with Indian Health Service hospitals, the death rates for preventable diseases — like alcohol-related illnesses, diabetes and liver disease — are three to five times higher for Native Americans, who largely rely on those hospitals, than for other races combined.
So the virus hit the Indian Health Service and the people it is supposed to serve like a freight train.
“It started as a complete nightmare here,” said Frank Armao, the chief medical officer at the Winslow Indian Health Care Center in Arizona.
He said the hospital struggled to obtain protective equipment for its medical workers during the initial surge. The hospital relied heavily on donations from outside groups and nurses stitching together masks as patients began to flood in.
“It was absolute panic at first; everyone assumed N95s were going to be forthcoming, and pretty quickly we realized that, holy cow, the tribe doesn’t have the stockpiles they were supposed to have,” Armao said.
He said 32 patients died at the hospital. Most were the tribe’s older members, who were in their 70s and had underlying conditions like diabetes and heart disease. Many critically ill patients had to be transferred to hospitals in Arizona and New Mexico because the health care system was not equipped to treat them.
Many of the service’s hospitals lack the medical expertise and equipment to treat patients with severe illness. The vacancy rate in the health system for doctors in Navajo Nation is more than 25 percent; for nurses, it is 40 percent.
Based in Rockville, Md., the Indian Health Service was created to carry out the government’s treaty obligation to provide health care services to eligible American Indians and Alaskan Natives. The tribes agreed to exchange land and natural resources for health care and other services from the U.S. government as part of the Fort Laramie Treaty of 1868.