Calif. may be undercount­ing Indigenous toll

Indigenous leaders fear state is undercount­ing

- Kate Cimini

Native American leaders say COVID-19 deaths have shrouded their communitie­s, yet state figures show low numbers compared with elsewhere.

For years, Betty Sigala spoke to her family about her death: She didn’t want to be put on a machine and she didn’t want to die alone.

When she was admitted in June to the COVID-19 care ward at her local hospital, her family refused a ventilator. One of her grandsons persuaded the nurses to ignore the no visitors rule and let him in.

He set up an iPad so the family could speak with her, and then held her hand as she died.

Her granddaugh­ter, Leticia Aguilar, 37, lit a fire for her that lasted four days and four nights, a tradition of their Pinolevill­e Pomo Nation.

She cut her hair in mourning and sang and gave offerings to help her grandmothe­r on the yearlong journey she would take to her final resting place, according to their traditions.

As Aguilar arranged for her grandmothe­r’s burial, Liz Sigala, Aguilar’s aunt and Betty Sigala’s daughter, was admitted to emergency room care. She couldn’t breathe, gasping for air when she tried to speak.

Eleven days after her mother’s death, Liz Sigala died of COVID-19. The family held a double burial. Aguilar lit the fire once again.

Amid the ceremony and grieving, Aguilar made sure to fill out both death certificat­es, marking each of them “Native American.” She was proud she could do this last thing for them.

“I’m so glad that we were able to have them counted,” she recalled nearly eight months later. “It meant a lot for us as natives.”

Aguilar, who lives in Sacramento, California, feared that if she let hospital staff fill out the form, her family would be misclassif­ied as Latino, white or marked as “other.”

Native American leaders across California said COVID-19 deaths have shrouded their communitie­s, yet state figures show few American Indian people have died here compared with other states with significan­t Indigenous population­s.

Leaders and experts fear deaths in their communitie­s have been undercount­ed because of a long history of Native Americans being racially misclassif­ied.

This damaging practice can bar native people from getting the help and resources they actually need, they said.

California has the largest number of American Indians and Alaska Natives in the United States and the largest number of American Indians and Alaska Natives living in urban centers. They are often declared white, Latino or Black on official forms by uninformed hospital workers, according to community leaders and various studies. Sometimes they are simply listed as “other.”

Nearly 9,000 American Indians in California have been sickened by COVID-19 and 163 have died, according to the state public health authority.

Native American leaders said those figures do not reflect the death and sickness they’ve seen invade their communitie­s, both on and off reservatio­n land. It also doesn’t reflect national data that shows Native Americans, who are especially vulnerable to COVID-19 because of chronic diseases such as diabetes, heart disease and hypertensi­on, are dying at horrifying high rates.

Data from the Centers for Disease Control and Prevention shows American Indians and Alaska Natives are the single group hardest-hit by the pandemic. They are diagnosed with COVID-19 at nearly twice the rate of white people, hospitaliz­ed almost four times as frequently and die at a rate of two and a half times that of whites.

As of December, 2,689 non-Hispanic American Indians had died of COVID-19, according to the CDC. However, many states do not separate American Indians into their own category, which public health experts suggest has lowered the overall tally of native deaths in the United States.

In California, native people comprise 0.3% of all deaths and diagnoses of COVID-19, and account for about 0.5% of the total population, at about 330,000.

The California Department of Public Health said it has worked to decrease instances of racial misclassif­ication in recent years, but it conceded that officials may have misclassif­ied American Indians in an attempt to prevent double-counting cases. Under state guidance, anyone who says they have American Indian heritage in combinatio­n with another race or ethnicity is counted as Hispanic/Latino or multiracia­l instead.

“This approach is the national standard for reporting disease rates and has several advantages,” the health department wrote in a statement to The Salinas California­n, part of the USA TODAY Network. “However, it also has limitation­s. Any classifica­tion system will not be able to capture the complexity and richness of racial identity.”

Acknowledg­ing the problem doesn’t change the fact that the data is wrong, experts said.

“The problem is in the data itself,” said Virginia Hedrick, executive director of the Consortium for Urban Indian Health, a California nonprofit alliance of service providers dedicated to improving American Indian health care. “I don’t trust the state data. I haven’t ever.

“For me, this is a culminatin­g event. This is historical trauma playing out in real time.”

Native American deaths go uncounted

For many Native Americans in California, it seems like every few weeks there’s another death. San Carlos Apache tribe member Britta Guerrero has donated to a number of funerals and attended a few via Zoom, streaming the proceeding­s in her living room. The familiar ceremonies and readings meant to guide her through her grief felt remote, unreal.

“I don’t think that we are able to even deal with the trauma of loss yet,” she said.

Guerrero, the executive director of the Sacramento Native American Health Center, has seen nine Native American people die in her immediate circle over the past year. Her clinic has donated or sent flowers to a dozen more funerals.

“We’ve been trying to go through the motions of grieving and burying people,” Guerrero said. “We know a lot of people are missing, and we won’t understand the gravity of that until we’re back together and we see who is gone.”

Guerrero’s own experience in the community and her work in American Indian health care have shown her the official tally of American Indian deaths is too low.

“There’s misclassif­ication there,” she said, pointing to the health department’s decision to count people with multiple racial heritages as multiracia­l or Hispanic/Latino instead of American Indian.

The sense of loss that the living suffer is heightened by fear that their loved ones might be scrubbed from American Indian history by an inaccurate document.

Aguilar made sure she was the one to fill out her grandmothe­r and aunt’s death certificat­es. If she didn’t, she worried her grandmothe­r, who was of American Indian and Filipino descent, and her aunt, who had American Indian, Filipino and Mexican heritage, wouldn’t be classified as Native American by hospital staff.

Aguilar became aware of how common racial misclassif­ication was in the run-up to the census last spring, which motivated her to ensure her relatives’ deaths were counted. The idea that their identity and culture could have been erased by the state counting system made her sick with anger.

“That only contribute­s to the invisibili­ty of our people, which makes it harder for us to even access resources because we can’t prove we exist,” she said. “There is so much more meaning behind making sure we are properly counted as native people.”

‘We’re born Indian and we die white’

Evidence of racial misclassif­ication of American Indians stretches back decades.

A 1997 American Journal of Public Health study that compared birth certificat­es of American Indians in California from 1979 to 1993 with death certificat­es during the same time span found that at the time of death, about 75% of native children were racially misclassif­ied.

Misclassif­ication was more likely if the child resided in an urban county outside of Indian Health Service delivery areas.

And a 2016 report by the CDC found that nationally, American Indians were misclassif­ied up to 40% of the time on their death certificat­es.

These mistakes have far-reaching consequenc­es. In one instance, racial misclassif­ication resulted in undercount­ing the transmissi­on of STDs through Arizona’s Native American population by up to 60%, according to a 2010 Public Health Report article. An undercount can result in less funding for treatment, as well as additional unintended health consequenc­es, such as infertilit­y, which is associated with untreated STDs.

“We’re born Indian and we die white,” said Hedrick, of the Consortium for Urban Indian Health. “I would argue that there are likely more Native Americans in hospital beds that are racially misclassif­ied” than we know.

Tribal members said each American Indian death needs to be counted as an American Indian death. To do otherwise is to further erase a people who have faced kidnapping and forced assimilati­on of their children, indentured servitude and an 1851 state-funded exterminat­ion order that killed as many as 16,000, only to find themselves uncounted, made invisible.

State and county roadblocks frustrate tribal leaders

Tribal health care experts and leaders said they have struggled to challenge the state’s data on COVID-19 deaths because in some cases they were left in the dark by state and county government­s. That left tribal leaders unable to contain the spread of the virus on their own reservatio­ns and fully understand the threat.

Concerned about the high rate of COVID-19 among the state’s native population, California State Assembly member James Ramos of the Serrano/Cahuilla tribes, chair of the Committee of Native Affairs, held a hearing on the disparitie­s in November.

There, he learned some counties refused to communicat­e with tribal leaders even to tell them if there was a positive case on the reservatio­n because of health privacy protection­s.

Other government­s, such as state or county government­s, are able to receive such data, which is more thorough than the COVID-19 data released on public sites.

In one case, citing HIPAA laws, a county refused to divulge case and death data to the chairman of the Yurok Tribe.

The chairman oversees every aspect of the tribe, including health care. The Yurok, whose reservatio­n straddles Del Norte and Humboldt counties in northern California, were forced to hire a health officer before they could get the needed informatio­n.

Neither Humboldt nor Del Norte counties immediatel­y responded to media requests.

Ramos said state and county government officials endangered native people by denying them informatio­n. He said California has a history of refusing to understand or work with tribal government­s.

Ramos, the first American Indian elected to state government in California, hopes to see more native people elected at all levels of government to help improve data collection and communicat­ion between Native leaders and government­s.

He worried that if these issues aren’t tackled now, they won’t be solved before the next pandemic and will end in the death of more native people.

Ramos, too, has seen a loved one succumb to the virus. His uncle, an elder in his tribe and a source of support and inspiratio­n for Ramos, died of COVID-19 in February.

In Central California, the Tule River Tribe in Tulare County also found itself cut off from potentiall­y lifesaving data. Of its roughly 1,600 members living on the reservatio­n, 179 have been diagnosed with COVID-19, or roughly 11%. Another 177 of the 357 who live off the reservatio­n have been stricken ill.

Adam Christman, chairperso­n of the Tule River Indian Health Center and Tule River Tribe Public Health Authority, said California did not grant the reservatio­n health center access to the California Reportable Disease Informatio­n Exchange, the state system all testing entities report results to.

“Having access to that system would make it easier for us to identify who should be isolating based on those test results, and monitoring them for quarantine and contact tracing,” Christman said.

After months of agitating for access, the tribe simply gave up asking.

‘Nobody’s going to help us’

Without data or consistent government support, tribal leaders and members have leaned on each other to keep each other safe by social distancing, wearing masks and getting vaccinated.

After an outbreak of six cases, the Yurok tribal council closed its reservatio­n multiple times, suspended housing and utility payments and provided supplies such as food, PPE, firewood and emergency generators to residents. They also launched a contact-tracing team, a food sovereignt­y program and are working with United Health Services on vaccinatin­g their eligible population.

“Basically the way we looked at it, nobody’s coming, nobody’s going to help us,” said Yurok Tribal Chairman Joseph James. “We’re a sovereign government. There’s things we need to work on to improve our daily lives and provide for our own people.”

Advocates and health care profession­als at the Sacramento Native American Health Center have inoculated 72% of all American Indians 65 and older in the region eligible for the vaccine right now, far more than the state or national vaccinatio­n rate.

 ?? SALGU WISSMATH FOR USA TODAY ?? Leticia Aguilar mourns her grandmothe­r.
SALGU WISSMATH FOR USA TODAY Leticia Aguilar mourns her grandmothe­r.
 ?? PHOTOS BY SALGU WISSMATH/FOR USA TODAY ?? Photos of Liz Sigala and Betty Sigala, who died from COVID-19 last year, sit in Leticia Aguilar’s home in California.
PHOTOS BY SALGU WISSMATH/FOR USA TODAY Photos of Liz Sigala and Betty Sigala, who died from COVID-19 last year, sit in Leticia Aguilar’s home in California.
 ??  ?? Leticia Aguilar with her son Jordan Hinojosa, 6, wearing pins rememberin­g her aunt and grandmothe­r.
Leticia Aguilar with her son Jordan Hinojosa, 6, wearing pins rememberin­g her aunt and grandmothe­r.

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