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Bluff • Confirmed coronavirus cases on the rural Navajo Nation rose to 14 on Thursday night as health care officials in southeast Utah brace for the arrival of the virus.

The majority of the cases were clustered on the northern Navajo Nation near where the first case of COVID-19 was confirmed on Tuesday after a patient from Chinchilbeto, Ariz., tested positive. The patient was examined at the health center in Kayenta, Ariz., where more cases were later discovered, according to a statement issued by the Navajo Nation on Thursday.

Confirmed cases were also discovered in patients who reported to — or who were transported to — the Chinle Health Care Facility in Arizona and the Northern Navajo Medical Center in Shiprock, N.M. Navajo Nation President Jonathan Nez said health care officials were gathering more information and “working proactively to investigate each case to prevent the spread of the virus.”

“Everyone must remain home at this point and let the health care and emergency experts do their jobs,” Nez advised in a prepared statement. “Please be respectful and adhere to their directions as they are doing their best to protect our communities.”

The sudden outbreak of the virus in a remote area of the Navajo Nation has required a quick response from clinics and hospitals. The Northern Navajo Medical Center, for example, rearranged the flow of its clinic last week to create two separate wards, one for COVID-19 patients and one for other patients — no small feat for a rural facility run by the Indian Health Service (IHS).

As of Friday afternoon, there were no confirmed cases in southeast Utah.

Patients with respiratory symptoms reported being unable to get tested in San Juan County earlier this week, but Mike Jensen, CEO of the Utah Navajo Health System (UNHS) — which oversees clinics on the Utah portion of the Navajo Nation and in Blanding — said his network now has 45 sample kits to test patients for the novel coronavirus.

A couple of tests have been administered, but the results have not yet been returned, Jensen said.

In order to protect health care workers and others, UNHS is attempting to see as many patients as possible over the phone or with video conference technology. The Navajo Nation in Utah has no broadband infrastructure and coverage can be spotty at many residences. To address the issue, Jensen said his team is working to set up Wi-Fi hotspots in clinic parking lots to allow patients to speak to medical professionals from their vehicle.

(Zak Podmore | The Salt Lake Tribune) In order to protect health care workers from the spread of coronavirus, outdoor screening was being done at the Montezuma Creek Clinic on the northern Navajo Nation on Friday, March 20, 2020.

The Southeast Utah Health Department, which oversees Grand, Emery and Carbon counties, issued an order earlier this week closing all hotels to visitors and closing campgrounds. Nez has released a similar order for the Navajo Nation, which closes tribal parks, resorts and discourages travel.

San Juan County has issued fewer restrictions. Hotels and campgrounds remained open as of Friday, though events have been canceled and restaurants are restricted to takeout orders.

“We fully anticipate that cases will continue to increase statewide, and we fully anticipate that we will not be escaping this without local cases,” said Kirk Benge, executive director of the San Juan Public Health Department.

“From a public health perspective, our primary concern is to slow down transmission so that this virus doesn’t hit us all at once like a tidal wave and overwhelm our health care infrastructure in the county," he added. "All of the action that we’ve taken to date has been aimed to flatten the curve.”

Benge said Friday his department did not yet plan to close hotels, which have been suffering economically from the pandemic and have been forced to lay off workers during the season when hospitality hiring is usually ramping up. The department is discouraging tourism to the county, however. Benge said hospital administrators, economic development personnel and emergency management officials have spoken.

“We're on a consistent message, which is, ‘Please, right now, everyone avoid leisure travel. Avoid unnecessarily travel. Stay home and come visit us when this is over.’”

Environmentalists urge delayed outings

Utah environmental groups Friends of Cedar Mesa and Southern Utah Wilderness Alliance both released statements on Thursday also encouraging people to save their visits to public lands for another time, using the hashtag #StayHomeSaveLives.

The advocacy organization Western Values Project issued a statement on Friday criticizing Interior Secretary David Bernhardt for waiving national park and BLM fees at at a time when Moab hospital administrators are asking that tourists stay away. And Raúl M. Grijalva, D-Ariz., chairman of the House Natural Resources Committee, made a similar point.

“While I understand the appeal of outdoor recreation during a difficult time, Interior Secretary Bernhardt needs to prioritize the health and safety of visitors to national parks and public lands during this crisis," Grijalva said. "[Bernhardt] should revise his recommendations to better reflect the advice of public health experts.”

State Rep. Phil Lyman, R-Blanding, signed a letter to Utah Gov. Gary Herbert on Wednesday, making the opposite case. Lyman and a group of rural county commissioners said the seriousness of the disease “absolutely and in no way supports the levels of concern that have been raised and the panic that has spread.”

“I think a week from now people are going to say, ’What were we thinking with that coronavirus thing?’” Lyman, a former San Juan County commissioner, told The Salt Lake Tribune on Thursday.

Limited capacity

But local public health officials were not so sanguine, noting there is a limited health care capacity to deal with a severe outbreak in southeast Utah. Hospital intensive care units in nearby cities like Farmington, N.M., and Grand Junction, Colo., where critical patients from rural areas are often transferred, could be overwhelmed, especially if restrictions on businesses are lifted and social distancing is not practiced by individuals.

The majority of the patients who become infected with the coronavirus will not require hospitalization, however. Many will be asked to stay in home quarantine, a prospect that could be difficult for families who may not have the luxury of a spare room and separate bathroom. Some physicians are requesting government funding that would allow people to stay in temporary lodging designated to hold infected people who don’t require hospitalization, such as motels or government housing.

“Flattening the curve is absolutely vital in this area,” said one IHS physician who asked not to be named. “Our referral hospitals don’t always have beds for us to transfer patients to, even in good times. If a lot of people are going to get sick, we need them to do it slowly over time. It’s critical that people stay at home right now because if everyone is out and gets sick at once, we simply won’t have the capacity to take care of them all.”