As the COVID-19 pandemic spreads across the U.S., Indigenous people are particularly vulnerable to this virus. On March 24, Indian Country Today reported there were 40 confirmed cases, 29 of which were on the Navajo Nation reservation. The first person to die of the virus in Oklahoma was a Cherokee Nation of Oklahoma citizen. On April 1, the number of cases in Indian Health Services (IHS) had risen to 276 with 14 confirmed deaths; 214 of these cases are on the Navajo Nation reservation.

The dire living conditions of many Native people and the lack of resources allocated to tribal nations is creating a higher likelihood of COVID-19 contraction rates and deaths. The American Indian and Alaska Native (AI and AN) population has only recently comprised 2 percent of the American population. This growth is a rebound from over 500 years of continual genocide, which has included pandemics and germ warfare. Additionally, 42 percent of AI and AN people are 24 or younger, making the conditions of youth of particular importance to Native nations. Current conditions are bleak and could set tribal nations up for less resources and power for years to come.

Native people are more likely to live in poverty than non-Natives. In 2016, 26.2 percent of Native people were living in poverty while the overall U.S. poverty rate was 14 percent. These numbers can often vary across tribal nations. The Oglala Lakota on the Pine Ridge reservation, for example, have significantly higher poverty rates. Ninety-seven percent of Pine Ridge residents live below the U.S. federal poverty line. The median household income on the reservation ranges between $2,600 and $3,500 per year with a 90 percent unemployment rate. With the exception of Haiti, the Pine Ridge reservation has the lowest life expectancy in the Western hemisphere at 48 years old for men and 52 years old for women.

On more rural tribal lands, access to food and supplies are lower and significantly more expensive, creating a scarcity. Out of the 574 federally recognized tribes, 229 are in Alaska. Kevin Allis, CEO of National Congress of American Indians (NCAI), said during a press briefing on March 20 that Alaskan villages are dependent on goods flown in on bush planes or trucked in over ice roads, which increases the likelihood of COVID-19 or other illnesses being brought into these remote communities. A lack of infrastructure on tribal lands is setting communities back during this crisis.

There are 183 Bureau of Indian Education (BIE) schools that serve 48,000 students. However, not all Indigenous students on tribal lands attend BIE schools and instead receive their education through tribal-run schools, making the number of students out of school higher than 48,000. Diana Cournoyer, executive director of the National Indian Education Association (NIEA) stated in the NCAI briefing that 37 percent of these students at BIE schools are without internet, making online distance learning impossible and “the school year a wash.”

“Without internet access, it doesn’t matter how hard they [students] work,” Cournoyer said. With the schools closed, many students may also go without food as the schools provide breakfast, lunch and a snack.

Dante Desiderio, executive director of the Native American Finance Officers Association, explained during the briefing that Native youth who have aged out of foster care and are now enrolled in college are being removed from university dorms and have nowhere to go.

On more rural tribal lands, access to food and supplies are lower and significantly more expensive, creating a scarcity.

David Simmons, director of government affairs and advocacy at the National Indian Child Welfare Association told Truthout that Native youth who are living independently are facing potential layoffs in their jobs as well. “Some of these young people may not have a place to go or have other employment opportunities, such as youth who have aged out of the foster care system,” Simmons said.

According to the National Youth in Transition Database, 27 percent of Native youth who have aged out of foster care services at age 21 have reported being homeless at some point in the past two years. As is so often the case with data on Indigenous people, Simmons told Truthout that it’s likely Native youth are being undercounted.

A lack of safe and adequate housing could further the potential spread of COVID-19. Allis explained in the briefing that Native homes on reservations are eight times more likely to be overcrowded than non-Native households. The homes are also often multi-generational, meaning the very young to elders are living in one home, and this furthers the possibility that those more susceptible to the virus may be at higher risk. Many of these homes lack clean running water, so people are unable to wash their hands and clean their homes properly to prevent the spread of COVID-19. The housing situation is in such a horrible state that NCAI states that Indian Country needs over $33 billion to meet current housing needs.

Within Native communities, there are those that are even more vulnerable. 2LGBTQIA+ tribal citizens are often living in unsafe situations where they must remain closeted. “Sheltering in place” can put them in more danger due to bigotry in the home, said Tavi Hawn (Eastern Band Cherokee descendant), a mental health therapist at Native American Lifelines serving the Native community in Baltimore and Boston. The rates of domestic violence could rise as well.

Indian Country was in a health crisis before COVID-19. AI and AN life expectancy is 4.2 years less than the total U.S. population, and this number is significantly higher on some tribal lands. They also have higher rates of chronic illnesses and disabilities, many of which are the underlying health conditions that make COVID-19 contraction more likely. The diabetes rates are three times the national average. As can be seen with poverty rates and housing, these numbers vary across communities. Native Hawaiians between the ages of 19-35 are over five times as likely to experience diabetes as non‐Hawaiians. In some regions, AI and AN people are twice as likely as the general population to become infected and hospitalized with pneumonia, bronchitis and influenza.

Indian Health Service Underfunding and Lack of Preparedness Increase COVID-19 Risk

IHS is the “world’s first pre-paid health care system” said Stacy Bohlen, CEO of National Indian Health Board (NIHB) on the March 20 briefing. These services were paid for with Native lives, lands and resources. The U.S. government has a treaty and trust responsibility to provide this medical care.

IHS serves 2.5 million Native people, more than a quarter of whom are uninsured; double the national rate. The annual IHS budget is less than 1/6 of what tribal leaders estimate is needed to fully fund the health system. This amounts to over $10 billion.

A lack of infrastructure on tribal lands is setting communities back during this crisis.

Lack of funding is not the only problem IHS faces. It has a staff shortage and a lack of facilities, supplies, equipment, and COVID-19 tests and labs to process the tests. Piling on to the already over-worked staff, Indian Country has lost close to 200 Commissioned Corps officers to COVID-19 deployments. The Commissioned Corp officers of the U.S. Public Health Service provide additional medical help during times of public health crisis and have been an integral part of filling in the staff shortages at IHS facilities. Tribes still have to pay the salaries of these officers even though they’re no longer providing care to tribes.

Dr. Katherine Crocker (Kaw Nation), a biologist at Columbia University Mailman School of Public Health, told Truthout that as a result of “medical racism,” Native people aren’t prioritized and this is shaping the lack of access to COVID-19 resources. IHS has claimed it is able to process test kits, yet tribal leaders are telling a different story.

In a press release on April 1, Navajo Nation President Jonathan Nez stated, “We’re two weeks into this pandemic and we need many more test kits, we need testing labs in our communities so we can get results much quicker.”

NIHB sent a rapid survey to tribes regarding their COVID-19 needs. Out of 197 responses, only six reported having diagnostic test kits, but none had used them. Eighty-two percent of tribes responded that they haven’t received COVID-19 diagnostic kits, and only 24 percent reported having the capacity to quarantine those who test positive. While the federal and state governments are bailing out corporations, 66 percent of tribes reported they haven’t received resources from the federal government and 68 percent haven’t received state resources.

A lack of safe and adequate housing could further the potential spread of COVID-19.

U.S. politicians haven’t responded to the demands of the tribal nations. Currently, there aren’t any IHS representatives on the White House Coronavirus Task Force. Funding has been inadequate. Forty million dollars was allocated to the Centers for Disease Control and Prevention (CDC) to distribute to IHS, tribal-run and urban Indian health centers under the Coronavirus Preparedness and Response Supplemental Appropriations Act. On March 20, another $40 million was allocated to the CDC to distribute to IHS. However, not only is this grossly less than what tribes need, the CDC still hasn’t dispersed the funds.

“It’s really evil” to not fund Native people during a pandemic, Hawn told Truthout. “The administration is lying when they say they’re funding tribal communities.” The CARES Act, signed into law on March 30, allocated approximately $10 billion to tribal nations and federal programs that serve tribal nations. Meanwhile, airlines alone were given $60 billion in corporate bailouts.

Why the Census Matters Even More During the Pandemic

Seventy-one percent of AI and AN people live in urban areas, but only 1 percent of the IHS budget is awarded to urban Indian health centers. Kerry Hawk Lessard, executive director of Native American Lifelines, told Truthout that these centers can’t rely on Massachusetts or Maryland health officials to accurately count Native people, so as a result, funds are rarely allocated for urban care.

The annual IHS budget is less than 1/6 of what tribal leaders estimate is needed to fully fund the health system.

Exacerbating future underfunding is the 2020 census. AI and AN people are the most undercounted racial group in the census and many live in what the Census Bureau considers hard-to-count tracts. Face-to-face enumeration is essential to an accurate count in Indian Country, but it has stopped due to COVID-19. The lack of internet and tech access on tribal lands excludes many people from completing the census online.

Even for urban Natives who may have the infrastructure to access internet and computers, high rates of poverty mean many have to use free resources at libraries and community centers, which are now closed.

The Census Bureau confirmed to Truthout that it’s working with tribes, but gave no specifics on what it is doing to support tribes during the COVID-19 pandemic.

Allis said in the briefing that “Indian Country will be faced with another 10 years of bad census data.” This data is used in a multitude of ways, which include political representation and funding. A lack of accurate census data could continue the cycle of poverty many Native people experience. It could also lead tribes to remain under-prepared for any future pandemics.

This isn’t the first pandemic Indigenous people have faced, and the ancestral knowledge to survive is within tribal nations. Despite the position that Native people are currently in, Hawn wants to remind Native people to “focus on the brilliance of Natives and the things that Natives are always doing to survive.”

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