Earlier this week, eight Native people were identified as infected by the coronavirus, two of them on the sprawling Navajo Nation, the geographically largest reservation with an overall population in three states of 356,000. One case is in the area around Portland, Oregon, one from the Great Plains, and three from the Lummi Nation of Washington state. A citizen of the Cherokee Nation of Oklahoma died from the disease Thursday. As with the rest of America, this count is almost certainly missing many cases because there has been so little testing.

A week ago, Michael Toedt, the chief medical officer of IHS, made the astounding claim that "“IHS believes this virus will be slower to reach Indian country,” according to a person on the conference call who was shaken upon hearing this. That’s an assessment that would seem to posit what the Native population looked like in 1920 instead of 2020, not to mention the fact that 501 Indian casinos in 29 states have attracted huge numbers of gamblers every day.

More than half of the 2.5 million American Indians and Alaskan Natives counted by the Census live in urban areas, not reservations. All are eligible for IHS treatment, but many urban Indians have health insurance and use the same health services as the rest of the U.S. population. IHS and tribally run facilities have 1,257 hospital beds. Of these, 37 are intensive care unit beds and there are 116 negative pressure beds. The ventilator count at all such facilities is 81.

The Tulalip News, a Native paper on the Tulalip reservation of the Coast Salish people in Snohomish County, Washington, reported on three people who had been infected but recovered from COVID-19. Tulalip has a modest reservation clinic but no facilities to handle such cases. Micheal Rios reports that one family of three came down with symptoms and called their primary doctor, who recommended going to the nearby Everett Clinic, which they did:

“At that time, we were told they were only administering the COVID-19 test to first responders and people who’ve come into confirmed contact with the virus,” explained John [a pseudonum]. “You could say we were never officially diagnosed with it because they refused to give us the COVID test, but we tested negative for the flu and everything else. Multiple members of the medical staff told us that our symptoms lined up exactly with coronavirus and there was no need to test us because the results were obvious. “We were told then to contact our local health precincts and let them know of our status and that we’d be self-quarantining until our fever was gone for at least 72-hours,” continued John. “Of course we wanted the confirmation test so we’d have peace of mind. But we were literally told by members of Snohomish County Health District and Everett Clinic, ‘From your symptoms it’s obvious what the results will be. There’s no need for a confirmation test. If any member of the family begins to experience breathing problem, then go to the hospital.’”

They got very sick, but all recovered.

Given the course of the coronavirus, more cases are inevitable, and IHS facilities, like other hospitals across the nation, fear being overwhelmed and could use that $40 million the government’s stuck in a drawer somewhere. Meredith Raimondi, a spokesperson for the National Council of Urban Indian Health, which supports health services for urban American Indians, told Politico: “Health providers across Indian Country are risking their lives on the front lines of this crisis. We don’t know what the delay is.”

In fact, it’s a jacked-up rule. The $40 million was allocated as part of the $8.3 billion coronavirus response bill that was signed last Thursday. Congress decided to distribute this money with grants through the Centers for Disease Control. Tribal leaders and staffs knowledgeable about what happens so often in Native matters said this could lead to bureaucratic hassles. Sure enough. Cancryn writes:

But the CDC has since told tribal organizations that it can’t distribute the funds because it doesn’t have the necessary funding relationship with the IHS hospitals, tribal-run health facilities and urban American Indian organizations that are supposed to receive it. Tribal leaders said the CDC has also balked at their idea to set up an inter-agency transfer that would deliver the money to IHS directly, questioning whether it has the authority for such a transfer

Catch-22 was common in Indian Country long before Joseph Heller wrote his novel. Natives have long been familiar with delays when it comes to federal promises even when those delays have resulted in people dying. Same old, same old.