Indigenous groups in U.S. have been leaders in pandemic.
Why are reservations still among deadliest places to get sick with COVID-19?
Few communities in North America fought COVID-19 with as much vigour as the Cheyenne River Sioux Tribe. As the virus began to spread, the South Dakota tribe traced contacts, imposed a 10-day lockdown, ordered a curfew and transformed a high-school dormitory and a veteran’s centre into quarantine isolation centres.
When vaccines became available, the tribe gave $500 in cash to each member who got inoculated. It formed a 250-person army of deputies to enforce quarantines and monitor nine checkpoints around its reserve, which is twice the size of Prince Edward Island, barring access to anyone from places with high COVID-19 positivity rates.
Across the United States, Indigenous groups have been leaders in the country’s pandemic response. No other ethnic group has a higher vaccination rate. In some conservative states, reservations are among the only places with mask mandates.
Yet two years after the beginning of the pandemic, many of those reservations remain among the deadliest places in the U.S. to contract COVID-19. In some, nearly one in 100 residents has already died.
Now, the onset of the Omicron variant has stirred fear that even the strictest of preventive measures will not be able to divert the path of a fast-spreading new wave of infections into Indigenous communities, which are among the most impoverished and crowded in America.
“What we’re seeing play out is that our communities are once again being hit harder than others by the virus,” said Mary Owens, director of the Center of American Indian and Minority Health at the University of Minnesota.
On the Cheyenne River reservation, COVID-19 has killed seven people in the past 30 days. Three were fully vaccinated, including two who lived in houses with at least 10 people. Omicron hasn’t hit the community yet, said Harold Frazier, the tribe’s chairman. But “with the numbers that have jumped up the way it is – it can only get worse.”
As a whole, Indigenous Americans entered the pandemic in poor health, with a life expectancy nearly eight years shorter than that of white Americans. At the Crow Creek Sioux Tribe’s reservation, also in South Dakota, more than 800 of the roughly 1,500 residents are considered medically “high risk.”
Overcrowding is widespread on U.S. reservations, a particular worry as tribes try to contain a disease that spreads through close contact. On some reservations, as many as 26 people share single homes. Based on their population, the Crow Creek Sioux have 600 fewer houses than needed.
Those factors have made COVID-19 especially deadly for Indigenous people. “When that first virus come through, oh my God, that shredded us,” said Peter Lengkeek, the Crow Creek chairman.
In May, 2020, before vaccines were available, the Navajo Nation reported the highest COVID-19 infection rate in the U.S. By September, the Mississippi Choctaw Band of Indians had counted more COVID-19 deaths than Hawaii, Alaska and Wyoming combined.
But even if many Indigenous groups fought off earlier waves of the pandemic with some success, health experts expect Omicron to cut a deadly swath through communities whose fundamental vulnerabilities remain as they were at the onset of the pandemic.
On reservations, “conditions haven’t changed,” Mr. Lengkeek said.
In Arizona, the White Mountain Apache Tribe is seeing daily case counts “rising rapidly and to levels not previously seen,” said chairwoman Gwendena Lee-Gatewood. “We expect this is due to Omicron, but our molecular testing takes a few weeks for results to return.”
For the Navajo, Omicron is arriving as case counts increase toward last year’s record highs. Navajo health authorities have so far confirmed only 19 Omicron cases, but they say 61 communities already have “uncontrolled spread” of COVID-19. The Navajo have begun urging people to wear two masks, one on top of the other. “We must be very careful,” Navajo Nation President Jonathan Nez said last week. “Continue to pray,” urged Vice-President Myron Lizer.
With Omicron, early vigilance has become a liability. The rush to vaccination meant many Indigenous people received doses sooner than other Americans. But the strength of vaccine-based immunity wanes with time, meaning the early start “may put them at a disadvantage for Omicron,” said Nicole Redvers, a scholar of Indigenous health at the University of North Dakota, and a member of the Deninu K’ue First Nation in the Northwest Territories.
She is hopeful that protective measures will be enough to stave off the high mortality rates of previous waves. But, she noted, “Within the last few weeks we’ve seen a large uptick in many of the reservation communities.”
Although data isn’t widely available on booster-shot adoption on reservations, just 23 per cent of eligible people in Alaska – the state with the highest proportion of Indigenous people – have had third vaccine doses. Alaska was once the most vaccinated state in the country. It is now in the bottom half.
In the state’s Northwest Arctic Borough, situated just a few hundred kilometres from Siberia, local leaders worry about the arrival of Omicron in the coldest months. “People tend to crowd in, especially in winter time,” said Peter Schaeffer, chair of the Kotzebue IRA Tribal Council. Heating fuel alone can cost a family more than US$600 a month, and so people share homes to save money. “It’s kind of a tough health situation,” Mr. Schaeffer said.
Some Inupiat villages in the borough have resisted widespread vaccination. “I suspect that the church had something to do with it,” Mr. Schaeffer said. “Misinformation, just like everywhere else, has permeated itself.”
Overall, 63 per cent of people in the borough have been fully vaccinated, slightly higher than the state average. “I actually feel a little more hopeful than I did last year,” Mr. Schaeffer said.
For the Sioux, the pandemic has coincided with a renewed effort to force the U.S. government to provide them with better medical care. In August, a federal appeals court confirmed a federal obligation under an 1868 treaty to provide “competent physician-led health care.” In December, the U.S. Department of Justice said it would not appeal the ruling. The Rosebud Sioux launched the court case in 2016.
Sioux leaders have described rampant shortfalls in health care, with one woman delivering a baby on a hospital bathroom floor, and others spending 36 hours in waiting rooms, with no beds available. Scholars and tribal leaders worry that stresses to Indigenous health care systems while COVID-19 spreads have worsened other health conditions.
For the Cheyenne River Sioux, the threat of Omicron has prompted a renewed discussion about restricting access to the reservation. Over the past week, the tribe has averaged dozens of new cases a day, at least half of them in fully-vaccinated people.
The tribe’s first use of checkpoints was controversial enough that it drew criticism from the state’s Governor and then-president Donald Trump. The tribe’s leaders accused the Trump administration of coercing them into changing course by threatening to take over the tribal police. Now, leaders have started talking again about reinstating the barriers.
“Them checkpoints were an awesome thing to really slow down the spread,” Mr. Frazier said.
“Our people are just very tired. It’s unfortunate, but you just got to keep going.”
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