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1 day ago - New map gives detailed picture of coronavirus outbreak on Navajo Nation. Arizona Republic analysis shows infection rates of coronavirus in ...
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1 day ago - Arizona Republic analysis shows infection rates of coronavirus in most parts of the Navajo Nation far exceed those in any ZIP code across the ...
The Arizona Department of Health Services has suppressed the number of coronavirus cases on tribal land in its daily updates that detail coronavirus infection rates in local areas statewide.
But the Navajo Nation has begun publishing the number of cases stemming from each of its health service areas. An analysis of that data by The Arizona Republic shows infection rates in most parts of the Navajo nation far exceed those in any ZIP code across the rest of the state.
The Kayenta and Chinle service areas have been the hardest hit, with more than 400 cases per every 10,000 residents as of Thursday evening.
In Kayenta, the rate per 10,000 residents is more than 500, which outpaces even the worst-hit ZIP codes in New York City. New York ZIP codes have far more COVID-19 deaths.
That service area includes the place Navajo health officials believe the outbreak started when a tribal member who attended a basketball tournament in early March and then went to a church revival the next day in Chilchinbito, a small community south of the town of Kayenta.
Even the area reporting the lowest infection rate in the Navajo Nation shows a rate higher than all but the highest ZIP codes in the rest of the state.
About 62 people per 10,000 in the Indian Health Service area around Winslow have tested positive. ZIP code 85714 on Tucson's south side with about 90 cases per 10,000 and ZIP code 85363 around Youngtown with about 107 cases per 10,000 were the only ZIP codes not adjacent to tribal land to surpass that according to data as of Thursday.
Population size within the Indian Health Service areas is about 19,000 people, similar to the population in some ZIP codes. The average population of all Arizona ZIP codes is about 20,000, according to census data.
So while the service areas do not correspond to ZIP codes, the data may make for the most detailed comparison of the Navajo Nation and the rest of the state that has been published to date.
COVID-19 has since sickened more than 4,253 residents of the Navajo Nation and killed 146 as of 10 a.m. Wednesday. The nation's overall infection rate has surpassed New York, which had 181 cases per 10,000 residents.
Arizona public health officials released COVID-19 data by ZIP code more than a month ago, but have continued to publish daily updates without including the tribal toll.
Both the state and Navajo Nation did not respond to questions about the delay or to The Arizona Republic's questions about the health service-area data. A spokesperson for the Navajo Nation Department of Health said the tribe's epidemiologists were too busy to meet a deadline.
Because the tribes and the state have not released data on tribal lands, The Republic used estimates of tribal populations and geographic files of tribal chapters it obtained from the New Mexico Department of Health. The analysis uses those estimates to determine the population of each Indian Health Service area.
To me if you are not willing to report the data, it's a little bit concerning. I'm going to assume it is probably a lot worse and you just don't want us to know.
The populations were then compared with the number of cases the Navajo Nation Department of Health has reported online for those health service areas, to determine the per-10,000-people infection rate in each location.
Because both the state and tribal leadership declined to explain the data, it is not clear whether an infection case confirmed in each service area means the infected person resides in the same area.
Stephanie Silvera, an epidemiologist and professor of public health at Montclair State University in New Jersey, questioned why officials weren't reporting detailed testing data from the ZIP codes on tribal lands. She said she was skeptical of the reasons why.
"To me if you are not willing to report the data, it's a little bit concerning," she said. "I'm going to assume it is probably a lot worse and you just don't want us to know."
She likened the state of Arizona and the Navajo Nation's stance on the data to that of the state of Nebraska, which stopped providing data after outbreaks at meatpacking plants because "you don't need to know."
Extraordinary health challenge
Spanning Arizona, New Mexico and Utah, the Navajo Nation is vast yet sparsely populated: about 175,000 people live on the reservation, which is larger than 10 U.S. states.
Officials have enforced six straight weekend curfews and pleaded with people to stay home.
Donations have come in from all over the world. But challenges unique to the nation make containing COVID-19 extra difficult.
Social distancing is tough: Many extended families live together.
Basic prevention is impossible for some: 30% of Navajo Nation homes don't have electricity or running water.
And health problems abound. The nation has disproportionately high rates of diabetes and hypertension.
President Jonathan Nez has said the nation's health care system cannot manage so many sick people.
From Kayenta to Phoenix
Dr. Raquel Burbank Roberts, an internal medicine resident at Banner-University Medical Center Phoenix, said Banner has taken care of a lot of families from the Navajo Nation that were transferred to Phoenix for a higher level of care.
Many of the families were from the northern regions of the Navajo Nation, especially from the hardest-hit areas around Chinle and Kayenta.
"We took care of a lot of families from the northern region, so around the Kayenta area," said Burbank Roberts, who is with the University of Arizona College of Medicine-Phoenix.
And it was the entire families who were transferred to Phoenix, she said.
"Mothers, fathers, their children, their adult children," she said. "They would all come in. And it was a difficult situation for them because they then they are all there."
Phoenix Indian Center collects donations to send to the Navajo Nation
Burbank Roberts is Navajo and grew up on the Navajo Nation in New Mexico, about 30 minutes north of Gallup.
She said the areas around Chinle and Kayenta are some of the most isolated, which may explain some of why those areas have higher COVID-19 cases.
Even those who don't have running water or electricity have an easier time going to stores and making purchases easier than someone who lives in more remote areas.
Deeper into the reservation, there are more multi-generational families living together in one home, Burbank Roberts said.
"That's just the way we've always lived. There are some places that have bigger families living together," she said. "And obviously if you have families living together in one home then it's easier to transmit the virus than if we were able to separate."
Coronavirus Arizona: As the Navajo Nation confronts cruelties of COVID-19, its leaders say 'we will win'
The lack of electricity or internet access can make it hard to get information about coronavirus.
"You are a bit more isolated," she said.
And the lack of running water can make it hard to follow proper handwashing procedures, because families have to ration water for drinking, bathing, cooking in addition to hand-washing.
"It's hard to think about if you never had to experience it," Burbank Roberts said.
'More difficult to ignore'
Silvera, the epidemiologist, said she is not surprised that the pandemic hit the Navajo Nation hard.
"Across the U.S., the life expectancy of the Native American population is amongst the lowest of any racial or ethnic group," Silvera said. "COVID is just highlighting disparities that have already existed."
COVID-19 has made those health inequities much more difficult to ignore, she said.
"More and more, COVID is looking like it is not just a respiratory illness, it's having significant impact on your cardiovascular system," she said. "And so when you have diabetes that puts you at increased risk for things like heart attack and stroke already, layering a disease or a virus like COVID on top of that dramatically increases your risk."
The Navajo Nation may be in a rural area, she said, but if people are congregating in centralized locations like grocery stores or health care facilities, "it can spread really quickly," she said.
"The challenge of a rural area is then access to a hospital and putting off care until a little later because it might be difficult to access health care," Silvera said.
She said more densely populated areas were hit first in the coronavirus outbreak, but they have a higher health care capacity to deal with cases.
"Rural areas, generally, yes they are later hit but when they are hit, they are hit hard," she said.
INVESTIGATION: Rural residents' access to hospitals is already a problem. Coronavirus could make it worse
A flatbed truck, a Dodge Ram and two SUVs
After the influx of patients from the Navajo Reservation, another resident at the UA College of Medicine-Phoenix wanted to do something about getting resources to the Navajo Nation.
The resident, Dr. Shaunak Pandya, sent out emails to coworkers and the university to solicit donations to take to the reservation to bring badly needed supplies. People who signed up got their churches, Esperanza Lutheran Church and the Arcadia Chapter of the Mormon Church, to donate supplies as well.
We always talk about how strong we are as a people and how resilient we are with things we have been through in the past. We will overcome this.
Burbank Roberts said she contacted the tribe who told them to bring the donations to a command post in at the Kayenta Boarding School, where they accepted donations to sanitize, separate and then distribute the items to families.
"We just wanted to give back," she said.
The group filled a long flatbed truck full of supplies such as toilet paper, paper towels, household cleaning supplies, hand soap, hand sanitizer, bottled water, hygiene products, nonperishable food products and even pet supplies. They also filled up a back of a Dodge Ram and two SUVs with supplies. Donations of personal protective equipment and baked goods were given to the Indian Health Service system too.
The group also donated fresh food as well including melons, fruit, squash and potatoes. Burbank Roberts said the fresh food was very important because the reservation deals with chronic medical conditions, especially diabetes, and the lack of fresh food is a big problem.
"A lot of the diet on the reservation, unfortunately, has to be nonperishable food items, which isn't necessarily healthy," she said.
In close-knit Navajo Nation communities, virus takes hold
Burbank Roberts also got to check in on a family of patients and do a clinical assessment of a family that she treated in Phoenix.
The family of four who all contracted coronavirus was improving, she said. The mother still required oxygen and was taking longer to recover, she said but was doing better.
The daughter was really excited her most recent COVID-19 test was negative and she was able to begin taking care of her mother.
"They had gone through this incredibly scary time of being positive, having to come down to Phoenix, be transferred down here," Burbank Roberts said.
But now she said they are at home, feeling better and believing they can overcome the coronavirus — and Burbank Roberts said the Navajo Nation will do the same.
"We always talk about how strong we are as a people and how resilient we are with things we have been through in the past," she said. "We will overcome this."
Republic reporter John D'Anna contributed to this story.
Updated 10:11 a.m. PDT May 22, 2020
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