Col. Tom Leeper ticks off factors that in three weeks have turned the Navajo Nation into Arizona's COVID-19 hot spot.

His words come rapid-fire quick, with all the dry certainty of a clinical assessment, which for the Arizona National Guard's state surgeon, is what it is. Objective information needed for triage.

Medically: Small hospitals, overwhelmed staff, remote locations, lack of equipment, limited personal protection, few resources.

Socially: Remoteness, multigenerational housing with old and young living in close quarters, no running water, communal wells, high rates of diabetes and high blood pressure.

"There are a lot of issues that made (new coronavirus) a perfect storm on the reservation," Leeper said. "It is not a hopeless situation."

But Leeper, who is a point man in Arizona's emergency response to the Navajo Nation, warns the virus is a moving storm and the issues facing the reservation could serve as a "weather vane for the state."

Only a month ago, the number of confirmed COVID-19 cases on the country's largest reservation was zero. But as of Thursday, the Navajo Department of Health and Navajo Area Indian Health Service confirmed 1,042 people had tested positive for the disease and 41 had died.

That makes the Navajo Nation third in the country for the number of infections per capita behind only New Jersey and New York.

Unlike the densely populated Eastern states, the Navajo Reservation encompasses about 17 million acres of vast open desert that spills across the borders of Arizona, New Mexico and Utah.

For the Arizona National Guard and the state's Division of Emergency Management, it is a logistical equation of personnel, supplies, expectations — and need.

It means loading Black Hawk helicopters with PPE and flying them to Kayenta; trucking more supplies to Chinle; and setting up a field hospital at a school gymnasium.

It means training health care workers at the tribe's hospital in Tuba City, delivering groceries and distributing food on the reservation.

Its 1,000 active members went from emergency preparedness training to actual emergency when Gov. Doug Ducey activated the Guard on March 19. Since then, Guard members have helped with a variety of needed tasks, from assisting communities to restoring grocery store supply chains to delivering 20,000 pounds of fabric for a Tempe fashion business making reusable protective gowns for health care workers.

"We are mostly providing assistance," Arizona National Guard spokesman Maj. Aaron Thacker said. "We are there at the request of our communities. We are not there to impose our will."

He points out that the Navajo Nation might be sovereign, but it is very much an Arizona community that deserves all the support the Guard can give.

Thacker said the goal is to "bridge the gap" for the tribe during the crisis until the Diné people can manage it on their own.

One of the first orders of business involved helping the Navajo Nation safely manage the water supply.

More than 30% of the about 174,000 people living on the reservation don't have running water. Until last month, the tribe had 15 collection points where residents get water. But they were hard to monitor and even harder to keep sanitary.

So Guard members worked with tribal officials to limit water to three key collection points that can be controlled for health and safety.

Another action involved tapping the Guard's own cache of personal protective equipment, so-called PPE, for the tribe.

"We dipped into our own reserves," Thacker said, adding that the reserves weren't real deep. "You can hoard your own stuff, or you can share it."

Working behind the scenes

The National Guard and Emergency Management both fall under the Arizona Department of Emergency and Military Affairs. Both have the same operating goal, of serving as a conduit for Arizona counties and tribes.

The combined force includes nearly 8,100 soldiers and airmen and civilian employees who specialize in everything from administrative planning to operating heavy equipment.

Requests for help are channeled to the state through 15 county emergency management centers. Responses are prioritized by need and who is best suited to meet it.

The Guard initially assisted grocery stores in getting goods from distribution centers and restocking shelves that had been emptied in a surge of panicked buying and hoarding. Some service members have remained at stores, particularly at night during restocking.

Thacker compared the coronavirus pandemic to disasters occurring simultaneously across the nation. Usually, when one state experiences a hurricane, other neighboring states send assistance. In this case, every state is experiencing a hurricane at the same time, he said.

"Every state is having its own issues," Thacker said. "Some states have bigger categories (of hurricanes) than others. New York is a Category 5."

Thacker said much of the Guard's response is invisible to the public. It is behind-the-scenes work, administrative, bureaucratic. Work like managing supply lines and working with other state and federal agencies to find resources.

Focus on Navajo Nation

The first positive COVID-19 case on the Navajo Nation was announced on March 17 in the community of Chilchinbeto, Arizona.

Navajo Nation President Johnathan Nez said the tribe tried to close off Chilchinbeto, but the virus quickly spread among the close-knit communities.

Nez, who has been critical of the federal response to the virus, declared a state of emergency on March 11 two days ahead of the federal declaration. He closed schools, nonessential government services and imposed a 57-hour curfew over Easter weekend, with more weekend curfews planned the rest of April.

But cases were threatening to overwhelm the tribe's limited health care resources.

“We’ve reached a point where our medical facilities and health care workers are in dire need of more personal protective equipment, hospital beds, and other critical resources,” Nez told The Arizona Republic in an April 4 interview.

The Indian Health Service, which provides health care on tribal land, has 12 medical facilities on the Navajo Nation. It has 170 beds, 13 intensive care unit beds, 52 isolation rooms and 28 ventilators.

Leeper initially took an 11-member team of medical professionals to the Navajo Nation at the beginning of April as part "forward planning" operation and to determine the tribe's medical needs.

"The hospitals are really small affairs," Leeper said.

They have some ICU beds, but their ability to take care of really sick patients is limited, he said.

Leeper said the tribe could manage up to three critical patients at any one time, but any more than that could overwhelm the staff. He said on one day this month, seven coronavirus patients were intubated and put on ventilators.

He said his staff worked with doctors and nurses to ensure sick patients could be quickly transported to other hospitals.

"At this point in time, they are holding their own," Leeper said. "They are keenly aware of what they need to do."

The biggest issue facing Navajo Nation doctors and nurses, who have been working nonstop since the coronavirus took hold on the reservation, is illness, Leeper said. Some are infected with COVID-19, others are coming down with the flu.

"A lot of the issues we are seeing are related to staffing," Leeper said.

He cautioned that the Navajo Nation's experience with coronavirus could easily repeat itself on other tribal reservations or in small, rural communities throughout the state. He said the Navajo experience could be a "microcosm" for Arizona.

"It's going to be a threat for some time to come, I fear, for the entire state," he said.

Robert Anglen investigates consumer issues for The Republic. If you're the victim of fraud, waste or abuse, reach him at robert.anglen@arizonarepublic.com or 602-444-8694. Follow him on Twitter @robertanglen.

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