Long before COVID-19 arrived at Kettle and Stony Point First Nation, Chief Jason Henry started bracing for the first case.

He knew that overcrowding on the reserve near Sarnia, Ont., would make the virus hard to contain, and that the underlying health conditions of many residents made it a particularly dangerous threat.

This concern — shared by some Indigenous leaders and top medical officials grappling with how to protect vulnerable communities — became more urgent on Wednesday when Six Nations of the Grand River, near Brantford, Ont., reported a community member had died from COVID-19. It is believed to be the first on-reserve death from the virus in the country, a spokesperson from Indigenous Services Canada said.

At Kettle and Stony Point First Nation, the virus crossed into the reserve in late March. A member tested positive for the virus in hospital, where he was receiving treatment for an unrelated medical issue.

By then, the chief and council had limited the size of gatherings and cancelled community events. The community then fast-tracked another key feature of its pandemic plan, installing concrete barriers and signs at entry points to funnel traffic to “health check points,” to screen for symptoms and limit visitors.

When the man fighting COVID-19 was discharged from hospital, the community rented him an apartment off-reserve so he could safely self-isolate, provided catered food and arranged visits from healthcare workers.

Henry said he is proud of his team for finding a way to protect the community while supporting the man, who is recovering well. But he said the band does not have the resources to make this the go-to plan for COVID-19 cases and is calling on government to help fund a dedicated self-isolation centre, possibly in the local school.

“This was one case,” Henry said. “You have to think about what can and will happen – it’s that we have five or 10 or 20 members at once.”

As of Thursday, there were 37 confirmed COVID-19 cases on reserves, according to Indigenous Services Canada, including four in Saskatchewan, 22 in Quebec and 11 in Ontario.

That includes the first case in a remote northern community, in Eabametoong First Nation, about 300 km northeast of Thunder Bay, Ont., which has been on a boil-water advisory for nearly two decades and has an average of more than six people per household.

Eight of the Ontario cases are in Six Nations of the Grand River, Chief Mark Hill said in a Facebook video announcing the death to the community, which is the most populous First Nation in Canada, with nearly 13,000 members living on reserve.

“When all of this is over, we will hold each other close,” Hill told the community. “But right now, we need to show unimaginable strength and do everything in our power to ensure we do not lose any more lives,” he said.

At a press conference this week, Canada’s top public health officer, Dr. Theresa Tam said, “A single case in any First Nations, Inuit or Métis community is high cause for concern. These communities are among the most vulnerable to COVID-19 due to distances, access to necessary resources and underlying health conditions.”

As the pandemic surges, many First Nations are taking dramatic steps to protect vulnerable residents from the highly-contagious and possibly deadly respiratory virus. They include establishing COVID-19 taskforces, launching public health campaigns and restricting movement through checkpoints, curfews and lockdowns.

Proactive measures can only go so far, particularly in remote communities with longstanding, unmet infrastructure needs.

“Unfortunately, in a lot of these cases, we have to seek external support. What needs to happen now is that the federal government needs to recognize that First Nations know what is in their best interest … and act accordingly,” said Hayden King, who is Anishnaabe from Beausoleil First Nation in Ontario and executive director of the Yellowhead Institute, a First Nations-led research centre based at Ryerson University.

“The federal government has obligations to First Nations in Canada. Now is the time to fulfill those obligations,” King said.

In an interview this week, Indigenous Services Canada Minister Marc Miller acknowledged the historic “lack of trust” between Indigenous communities and government. He said leadership from chiefs and on-reserve health authorities is critical in the COVID-19 response.

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“Communities have different approaches to dealing with this, depending on the situation,” he said. “But what I’ve seen across the country is people taking this very, very seriously, knowing the effect this can have on their community and being very responsible.”

At this stage of the pandemic, Miller said he is working closely with First Nations health authorities to implement pandemic plans to “limit exposure and limit onset” of cases.

“I always encourage people to go back to their health officer and as these situations develop to liaise with my team to make sure that their needs are addressed.”

In mid-March, the Liberal government pledged $305 million for a new Indigenous community support fund to address COVID-19. That includes $215 million for First Nations, $45 million for Inuit, $30 million for Metis and $15 million earmarked for organizations that serve urban Indigenous populations.

“We’re prepared to move quite quickly with more financial resources and more physical resources that money can’t buy,” such as healthcare professionals and military support, Miller said.

However, in the wake of the first positive COVID-19 case in Eabametoong First Nation on Sunday, Chief Harvey Yesno has been frustrated by the blurred lines of responsibility between Ottawa and Queen’s Park. He says there has been a sluggish response to his request for contact tracing. He said he tried for weeks to engage the government in Ottawa but did not receive a response.

“This is biological warfare. There is no vaccine in place. We basically consider ourselves Code Red right now,” Yesno said on Thursday. “My biggest disappointment has been that both levels of government were not ready. They didn’t have a plan in place.”

In an email, a spokesperson for Indigenous Services Canada, said, “We are actively working with the community to ensure the necessary resources are in place and are in close coordination with the nurse-in-charge to ensure medical staff remains at full capacity and requests for additional staff are addressed.”

Eabametoong received a supply of personal protective equipment (PPE), including surgical and N95 masks, gowns, gloves and face shields, on March 30 from the government, which also sent a shipment of COVID-19 testing swabs on Wednesday evening, the spokesperson said.

“Regular checks on supply will continue to ensure the community has all the tools to respond to the COVID-19 pandemic.”

Ontario Minister of Indigenous Affairs Greg Rickford did not respond to requests for comment. On Wednesday, the province pledged $37 million “to support outbreak, planning, prevention and mitigation efforts to ensure the health and well-being of Indigenous people and communities — particularly those in remote and far-northern regions,” the ministry said in a press release.

The announcement was welcomed by Nishnawbe Aski Nation (NAN) Grand Chief Alvin Fiddler, who helped create a COVID-19 taskforce to respond to the pandemic in the 49 northern Ontario communities that NAN represents. He has been urging the province to come to the table for weeks.

“I’m hoping they can quickly figure out a way to streamline the process so that communities can easily access the funding,” Fiddler said.

At Kettle and Stony Point, Chief Henry has been working closely with local partners. This week, a proposal for a 150-bed field hospital was approved at nearby Lambton College, which Henry said could benefit his community.

He is also encouraged by the response he has received to the proposal to turn part of the community school into a dedicated isolation site.

“We have business plans out there, and we’re working closely with our provincial and federal counterparts,” he said. “It seems promising.”