Note: This article is part of the project: "Indigenous Impacts: How Native American communities are responding to COVID-19." We invite you to view the entire project here.
Expanded testing capacity, partnerships between states and tribes and perhaps a little bit of luck helped Native American communities around the region avoid coronavirus outbreaks that have rocked tribal nations in other parts of the country.
But more needs to be done to ensure Native American and Indigenous people can access tests and are being assessed at rates comparable to other demographic groups, tribal health officials said.
The Forum News Service reviewed national and state data and spoke with health and tribal leaders Minnesota, North Dakota and South Dakota as part of a special series highlighting the impact of COVID-19 on Indigenous communities.
Testing shortages early on in the COVID-19 pandemic could’ve proven a dire setback as the illness started spreading across the country. But tribal leaders and state health officials said partnerships helped get resources out to tribal communities and prevented more severe outbreaks of COVID-19.
And federal officials along with health experts closer to home have built up relationships with tribes and committed to ongoing prevention and mitigation efforts in Native American communities.
In August, the CDC put $200 million in additional funding toward increased efforts to track COVID-19 in Indian Country after officials learned the disease disproportionately affects American Indian and Alaska Native populations.
In 23 states studied by CDC officials, American Indian and Alaska Native people were lab-confirmed positive for the illness at 3.5 times the rate of non-Hispanic white populations. And the CDC said the additional funding would supplement tribes’ efforts to prepare and respond to COVID-19.
“American Indian and Alaska Native people have suffered a disproportionate burden of COVID-19 illness during the pandemic,” CDC Director Robert R. Redfield, said in a news release. “This funding approach will broaden access to COVID-19 resources across tribal communities.”
In Minnesota, 22% of American Indian patients who tested positive for COVID-19 have been hospitalized as compared to 9% of all COVID-19 patients and 10% required intensive care whereas 3% of all COVID-19 patients sought intensive care, department of health data shows. The illness has also proven more deadly for American Indian people.
Five percent of American Indians with COVID-19 have died from the illness as compared to 3% of COVID-19 positive Minnesotans who’ve died overall. Those figures are age-adjusted.
With additional tests on-hand nearly six months into the pandemic, state governments and federal health officials working through the Indian Health Service have tried to pool resources to offer testing for those with symptoms and those who might go into high health-risk situations.
Minnesota health officials said additional testing efforts are set to roll out this month all over the state and were set to focus on communities at particular risk of contracting the illness. And American Indian communities could be among those areas set to get additional “barrier-free” testing.
Minnesota Department of Health Assistant Commissioner Dan Huff said neighboring states had recently reported spikes in new COVID-19 cases and the testing strategy in Minnesota was an effort to size up emerging hot spots and get those with the illness into quarantine quickly to avoid allowing it to spread into populations at heightened risk.
“We do not want that to happen here,” Huff said. “These states are a reminder of how quickly we can go from walking a cliff’s edge to tumbling over it.”
The ramped-up testing capacity is a step in the right direction, Mary Owen, director of the University of Minnesota Center of Native American and Minority Health, said.
“We have just been lucky I think that we haven’t had this virus introduced more in our communities because we haven’t had the infrastructure to be able to do all that testing up until more recently,” Owen said. “If the disease had been present in our communities without the testing, without the PPE and with crowded living situations and people trying to support one another the best ways they can, it would’ve spread like wildfire, which in fact it did in Navajo Nation. That’s exactly what we saw there.”
As the pandemic first hit the United States, tests were in short supply and states had to ask the federal government to send them supplies. Where those efforts failed, states ventured out on their own to bid for the supplies and start making tests of their own that could be conducted with less sought after components.
Concerned about communities around them, some tribal nations imposed curfews, stay-at-home orders or mask mandates to prevent the spread of COVID-19 from outsiders. And in South Dakota, where tribal officials had urged national and international health organizations to help them secure testing, tribal leaders set up checkpoints at tribal reservation entry points to screen visitors for the illness.
While the disagreements sparked a dustup with South Dakota Gov. Kristi Noem’s administration, health officials in the state and federal health organizations continued work with tribes to boost tests among tribal nations.
In Minnesota and North Dakota, state health leaders said they viewed pooling the resources and consulting with tribal leaders as key steps to fighting COVID-19.
“We just agree up here in North Dakota that (testing is) a better use of resources between the tribes and the state,” Scott J. Davis, executive director of the North Dakota Indian Affairs Commission, said. Davis is a member of the Standing Rock Sioux Tribe and a descendent of the Turtle Mountain Band of Chippewa.
A question of equity in testing
While testing capacity and availability of personal protective equipment have improved in Native American communities, health care providers said they were still working to draw out state data about COVID-19 tests.
Across the country, the availability of data around the demographics of who tests positive for COVID-19 and who can access a test is inconsistent. Not all states require the reporting of a person’s demographic information and tribes can decide if they want to share their COVID-19 data.
And in the region, as in most states, there isn’t public data around the groups who get tested. Without a clearer picture of how many Native American patients can access COVID-19 tests, health officials won’t know if they’re getting an accurate assessment of the illness’ spread in the community and could limit the number of people who can gain access to the tests.
“That has to be factored in because how valid is it if most Native Americans can’t even get to the test? That is really important and how do they get that?” Owen said. “I don’t know that they do tease that piece out and it’s a big question. It’s one of the questions we’ve asked in ethics meetings.”
Forum News Service Reporter Jeremy Fugleberg contributed to this report from Sioux Falls, S.D.