When my medical school asked its first-year students to move out, I had to decide where to go, and quickly. I could go to South Dakota, where one of my Chiefs had invited me to a thunder-welcoming ceremony, or Arizona, where a healing ceremony was taking place for a family member.

I chose neither. A few days earlier, I had been in two of Boston’s major health care centers and had recently been with patients. Cases of COVID-19 had already popped up in the city. I couldn’t risk bringing the virus to my two Indigenous communities.

Native Americans across the country have had to make similar decisions. Our communities suffer some of the highest rates of COVID-19 risk factors such as diabetes, cardiovascular diseases, and cancer. We’re exposed to pollution, have less access to health care, are less wealthy, live without clean water, and experience food insecurity on levels greater than our non-Indigenous counterparts. Dozens of people have tested positive in Navajo communities in Arizona, New Mexico, and Utah, and at least seven deaths have been reported, according to NBC News.

As Maria Givens at Vox wrote, “The coronavirus is exacerbating vulnerabilities Native communities already face.” But how did we get here, and what can each of us learn from America’s history during a time like this?

Over the last 500 years, colonization weakened Indigenous systems of self-reliance when it came to health care, food, water, and housing, and replaced them with unsupported and underfunded systems that have left us disproportionately unprepared for COVID-19.

Civilization was the supposed paternal aim. Underneath the surface, U.S. policies targeted the cultural, spiritual, social, and political norms that gave us the strength and cohesion to live healthy lives without reliance on any grocery store, hospital, or paycheck for thousands of years.

The construction of white superiority held our sustainable practices uncivilized in the discernments of the supposed dominant identity. The intentional castigation of our ways as uncivilized created a political opportunity to impose removal and assimilation programs upon us.

Under President Andrew Jackson’s administration alone, more than 70,000 Native Americans were relocated to foreign lands through force and fabricated promises, described in Fathers and Children: Andrew Jackson and the Subjugation of the American Indian, by Michael Paul Rogin.

This was done, in Jackson’s words, under the paternal guise of sympathy for the “red children.” Jackson argued “that the first original inhabitants of our forests are incapable of self-government by any of those rules of right which civilization teaches.”

Characterizing us as uncivilized and positioning life under the U.S. federal government as the morally advanced alternative permitted white policymakers to distance themselves from what they were really doing: dismantling our self-sufficient communities to expand the U.S. empire and economy.

Over time, more and more Native Americans were forced onto small reservations meant to bring us under government control and assimilate us into whiteness. The removal ideology established that we would not be able to withstand the imminent competitive nature of society and would need the government’s paternal care and guardianship.

The U.S. government’s brutal elimination of vital Native American cultural and social ties produced an extreme sense of loss, inducing dependency on the very system that oppressed Indigenous Peoples in the first place. Faced with famine, many Tribes signed treaties that, in exchange for cooperation, guaranteed food commodities and access to health care to account for loss of their original lands and traditional food systems.