Navajo Nation: From the Frontlines in the fight Against Covid-19 by Rae Rose

On March 20th 2020 at 7am a positive COVID-19 case was confirmed on the Navajo reservation. In preparation for this Tsehootsooi Medical Center had already activated the Incident Command Team which prompted the hospital to close outpatient services and elective procedures in order to re-direct all efforts toward preparation for a COVID-19 pandemic. The first suspected COVID-19 cases had arrived in mid-March however testing results would take more than a week to return. By March 23rd 2020 at 630am Tier 3 protocol was put in place. Tier 3 protocol required the closing of all entrances except the emergency room and main entrance to the hospital. At the emergency and main entrance every visitor, patient, and staff member are required to go through a screening before they are allowed to enter the hospital. This is a situation that can now be seen in hospitals all over the Country.

According to the Huffington Post on May 11th with a count of at least 100 deaths the Navajo Nation marked a grim milestone. That day they recorded more Coronavirus cases per capita on their reservation than in any of the 50 United States. That is 1,751 cases per 100,000 people. To make matters more concerning, the count is an underestimate since many patients who had been put on ventilators were transferred to hospitals outside of the reservation.

Today the Navajo Nation has reported 5,145 confirmed cases of COVID-19 and 231 deaths. This makes them one of the hardest hit during the pandemic. Medical staff are working around the clock to care for patients in this “new normal”. One staff member stated “I personally have felt like I’ve been going to war every time I go to work and this comes with the fear of the unknown.”

Healthcare workers at Tsehootsooi Hospital and other reservation hospitals face constant exposure with dwindling Personal Protective Equipment (PPE) like mask, gowns, and gloves. These supplies are essential to keep both healthcare workers and their patient’s safe during this pandemic. There is genuine concern that if they run out of PPE staff at Tsehootsooi will not be able to care for the community safely. Shutting down a very necessary healthcare option to the Navajo people.

The COVID-19 virus is easily spread from person to person and is speculated to be transmitted to and from animals. Scientists have discovered the receptors that allow Covid-19 access to the human body is receptor ACE2. The virus can easily attach itself to ACE2 receptors found in the eyes, nose, and mouth. Normally ACE2 receptors separate two forms of proteins most commonly used to keep blood pressure stable called angiotensin. Illnesses like COVID-19 use this receptor to sneak inside the human body attaching to the spike or S protein. From here the virus replicates itself inside the cell creating a cytokine storm that leads to an attack on the body.

COVID-19 is more contagious than influenza, but not as contagious as the measles. What makes COVID-19 more contagious? People can show no symptoms, but still pass the virus. This virus lives on hard surfaces and objects for days after leaving the body. If an infected person sneezes they send 100,000 contagious germs into the air at speeds of up to 100 miles per hour. “The sneeze sends aerosol droplets (a diameter less than the width of a human hair) the virus can remain suspended in the air for prolonged periods of time. This means even after someone sneezes you can still breathe in the virus,” Allen Haddrell PhD.

This situation is made even more difficult for the Navajo because of the lack of running water on the reservation and because many families live in multigenerational homes making it almost impossible to self-quarantine. Staff at Tsehootsooi believe these factors contribute to the high infection rates on the Navajo reservation. One person in the household gets sick and it spreads throughout the household until everyone has been exposed. The virus is easy to transmit, someone gets sick then touches a shared surface and then another person touches that infected surface. The person now has the virus on their hand and touching their eyes, nose, or mouth they then have the virus too.

According to the Center for Disease Control (CDC), symptoms of COVID-19 include cough, fever, shortness of breath, muscle aches, sore throat, unexplained loss of taste and or smell, headaches, diarrhea, nausea, and vomiting. Both Influenza and Covid-19 are very similar in symptoms, transmission, and prevention methods. Distinguishing between the two in near impossible without testing. If your symptoms are mild it is recommended that you quarantine yourself until the symptoms pass. If your symptoms are severe or any respiratory issues arise seek care immediately, but warn first responders and patient care staff you may have or may have been exposed to the virus.

If you know you have COVID-19, public health staff at Tsehootsooi Hospital recommend having pulse oximetry device in your homes to check your oxygen levels. If your oxygen level stays above 90% you are okay, just keep watch checking at least 2 times a day. If your oxygen level dips below 90% you should follow up with your physician or public health nursing instructions, and will need to seek emergency care if it does not improve. A home Pulse Oximetry device cost around 50 dollars online. My source also recommends using “Proning” positions to increase your oxygen levels, such as laying on your belly for extended periods of time, or lay on your side. Do not lay on your back as this can cause your oxygen level to drop.

With a small intensive care unit it is hard on the hospital’s resources and staff to care for everyone. An anonymous source stated “Because we are in a remote hospital on the Navajo reservation, we do have the capacity to care for vented patients, keep them in an Intensive Care Unit, but that limits the number of staff members that we have. It requires a lot of staff to take care of one critical patient. If there condition starts to worsen such as needing to see a cardiologist or if they are having complications and we can’t take care of them we transfer them to a bigger hospital with more resources.” The bigger hospitals like Flagstaff Medical Center, University of New Mexico, and Honor Health have been cooperative with taking as many patients as they can, but sometimes there may be a waitlist due to the high volume of patients created by the COVID-19 surge.

In a close knit community it hard to take care of critical patients with limited resources. With cultural and community ties it is also hard on families since visitors are not allowed to visit patients even for end of life care. This is designed to protect the community as a whole, but it remains heartbreaking to families and staff, especially since some staff are related to these patients.

For much of Indian country death is a time to come together to honor their loved one’s life and to support each other as we grieve the loss of those we love. But because of COVID-19 being so contagious we are not allowed, for our safety, to be physically beside our loved one’s as they pass or to even dress their body after they have passed away.

Because family can’t be there staff are trying to help families by putting family members on speaker phone in their loved one’s room. One source from the Tsehootsooi hospital had this to say. “Our hospital has sought direction from the mental and traditional Indian Health programs so they could help the community with the how to deal with death and what to do when their loved one has passed away at this hospital.”

Watching people die alone and knowing there is nothing more you can do, it is hard on staff emotionally and physically. When asked how staff are handling and caring for themselves a source had this to say. “I have also had to take care of my spiritual health because we see death in front of our eyes and we’ve worked extra hours just to save people’s lives. I realize we can’t save everybody so it’s very difficult for myself also for my coworkers. Some of us go home and have nightmares.”

When asked about worries staff may have as the country starts to reopen my source had this to say. “I am concerned about people in the media and politicians saying that it is safe to open up the Country. It is not safe to go outside and into public places right now. I’m concerned some people from different parts of Indian Country are listening to this false information and actually believe it. I want Indian Country to know that this is serious and I want them to know what’s happening to the Navajo Nation here.”

The Navajo Nation has put out their own media campaign Flatten the Curb asking their tribe to stay home, they are mandating everyone to wear face masks when out, and to obey the curfews. The Navajo Nation has received 600 million in relief aid. Although the Tsehootsooi Hospital has yet to see if any of that will go to providing staffing or Personal Protective Equipment to keep the community safe. A staff member had this to say “For many weeks now we have been waiting to receive PPE and as far as I am aware we have not received anything directly from the tribe. So it’s very disheartening to see that we haven’t received it though we see these news reports.” It remains to be seen how the tribe will distribute that money to curb the crisis.

The best way to prevent COVID-19 is to avoid exposure whenever possible. When in public wear a mask and try to keep a distance of 6 feet between you and others. Wash your hands often rub soap generously all over hands and clean under nails for at least 20 seconds before rinsing with warm water. If you do not have access to running water use generous amounts of hand sanitizer and make sure the sanitizer is at least 60% alcohol. Avoid touching your eyes, nose, or mouth with unwashed hands. Clean common area surfaces regularly and try not to touch surfaces outside whenever possible.

When asked how to advise Indian Country to stay healthy my source had these words to share. “Covid-19 is a virus that we have never seen before and our bodies have not been exposed to it so we don’t have any antibodies to protect ourselves from getting exposed the first time. It has also not been determined if having these antibodies will be enough to protect oneself. It is a very potent virus here on the reservation and many of our patients are being hospitalized for weeks. It is very important for people to go back to their traditional beliefs, there is a lot of wisdom in that. Many of us Natives on the frontlines have been advised to not only do protection prayers in our language, but to go back to our traditional medicines which are high in vitamin C. In western medicine vitamin C is believed to help the immune system fight the virus. Some people here are using cedar and sage tea. Native communities, from what I’m seeing are also smudging with cedar and sage while they pray for their protection and to help them deal with what we are experiencing. It’s very traumatic when you’re actually on the frontlines and seeing people suffer and die so these old way practices have been very helpful.”

As a healthcare professional and indigenous woman I agree with my sources statement. We need our traditions and medicines to help us through this pandemic. Western science has only proved what our ancestors already knew and how powerful our knowledge is. Studies show burning sage and cedar kills viruses and cleanses the air around us. We need to support each other, our families, and our communities as we face this crisis. This article is my prayer to protect Indian Country, to connect the knowledge of our past, with our present situation, for a stronger future.

By Rae Rose (Paiute/Mayan)

Rae Rose is a Pacific Northwest author of Paiute, Mayan, and Japanese heritage. She writes historical fiction, poetry, picture books. “Stories are very important to me, I hope you enjoy these stories I share with you.” You can follow her @Rae_Rose7