“There is no agency that I know provides resources in any meaningful way for epidemiology in the Indian country,” said Bryan Newland, leader of the Bay Mills Indian community in far north Michigan. “We do all of this on the fly.”
The IHS now counts 110 coronavirus cases in the country’s tribal areas, from single-digit numbers earlier last week. However, this number is only a rough estimate and is largely based on strains to voluntarily submit data.
“This is likely to be an underrepresentation of Alaska Indians and Natives who may have tested positive,” said Michael Toedt, IHS chief medical officer, during a call to tribal leaders Thursday.
“This will be a big challenge”
Just under a sixth of the 423 healthcare facilities that serve Native Americans are operated by the IHS and have to report cases on a regular basis. The rest are operated by tribes or local urban organizations that have to choose to report coronavirus patients to the federal government themselves. In contrast, disease control and prevention centers regularly collect data from public health laboratories and health departments in all 50 states.
Some tribes work closely with state and local authorities to monitor cases, while others have little to do with states that tribal leaders say have routinely neglected their native population. This has made it more difficult to consistently track the spread of the virus, identify emerging hotspots, and figure out where help is most needed.
“This will be a big challenge, and I really haven’t heard the discussion about data collection and cohesion,” said Nicole Redvers, a professor at the University of North Dakota who works closely with tribal organizations, about informal case tracking occurring in many tribes.
The piecemeal coverage has already created confusion in at least one important case: the death of Merle Dry, a Cherokee nation citizen in Oklahoma, who was believed to be the first among the local population – although tribal leaders could not say for days.
The March 19 death was reported by the Oklahoma Department of Health, but was not reflected in IHS public data, which had no deaths until March 22. The category that lists the number of coronavirus deaths was then completely eliminated.
An IHS spokesman said the agency’s data only includes patients treated in IHS, tribal, or urban Indian settings – much of which are voluntarily submitted. IHS has removed the death category to avoid under-reporting. It may also not provide information about patients diagnosed in an IHS facility who were later transferred outside of the Indian health care system.
It is inherently difficult to collect health data across the Indian country, where tribes act as sovereign entities and have different connections to federal and state agencies. In the case of remote reservations, a lack of internet or landline phones further impedes communication.
However, tribal leaders and Indian health experts also say that due to chronic underfunding, which has only been exacerbated by the growing public health emergency, the agency simply does not have the resources to track and investigate cases across reservations. The budget of IHS is smaller than that of most of the major federal health authorities and has seen almost constant changes in scandal and leadership – since 2015 by five managers.
The currently highest-ranking IHS official, deputy director Michael Weahkee, was nominated for the management of the agency in October. It still has to be confirmed.
A system “far, far back”
Congress has provided additional funding of more than $ 2 billion to Indian healthcare in the past few weeks. Legislators and tribal leaders recognize the impending challenge for institutions and tribal organizations whose finances are already tight.
However, institutional barriers remain: IHS hospitals face a widespread shortage of doctors and nurses, and patient data communication over this hospital network is slowed down by reliance on an archaic electronic health record system that first introduced in the 1980s has been.
“Our system is way back, and one of the immediate problems with surveillance is that we have no interoperability,” said Stacy Bohlen, executive director of the National Indian Health Board, which represents the tribal government on health issues.
Alaskan Indians and natives are faced with significant health differences overall compared to the rest of the United States, including lower life expectancy and a higher rate of respiratory diseases, where coronavirus patients are at higher risk of death.
Every sixth household reserved qualify as crowded, which increases the likelihood of a quick transfer. With some remote reservations, there are no water pipes to ensure adequate hand washing, and the nearest healthcare facility can be hours away. At the same time, the government spends far less on Native American health care than on beneficiaries of other federal programs.
“It is no mystery why the Indian country is suffering from alarming and shocking health inequalities, even if there is no pandemic worldwide,” said Kevin Allis, CEO of the National Congress of American Indians. “We are in a very precarious situation right now.”
This public health divide has widened during this pandemic. As the virus spread, tribal leaders said the government abruptly pulled out around 170 of its public health officials tribal Areasto redirect them to fight coronavirus elsewhere – and leave tribes without the trusted health professionals who had spent months in local communities.
The IHS contested this number, saying that approximately 137 officials had been temporarily deployed elsewhere “to support HHS-wide efforts” to fight the virus – and that the aim was not to affect patient care for local populations.
With test kit production increasing and private health laboratories accelerating American tests across the country, tribal leaders also say that IHS hospitals will still be unable to conduct their own tests due to the lack of required certification.
Instead, these facilities must send swab samples to laboratories for evaluation. Of the 2,646 patients who have been tested so far according to the IHS, the results for 1,023 are still pending.
An IHS spokesman said waiting times vary by location, and results will be available sooner as more commercial laboratories offer tests.
Bureaucracy and serious shortage
Medical care was also slow to arrive and was bureaucratic. For weeks, federal officials urged the tribes to contact states and regional partners directly, who, according to tribal leaders, were in turn referred to the local authorities – many of whom were flooded with inquiries – and to return them to the federal government, which was supposed to work directly with Indian tribes and organizations based on many years of federal trust.
“Often the problem is that the federal government is not directly dealing with Indian nations and our health systems as sovereign,” said Chuck Hoskin Jr., chief executive officer of the Cherokee Nation, which runs the country’s largest tribal health system. “We are at the forefront of public health in the region. We need an optimized way to conserve these resources.”
Some larger tribes have so-called cooperation agreements with the CDC that allow them to more easily access funds and supplies, including withdrawals from the country’s Strategic National Stockpile. The Navajo Nation – whose vast territory spans parts of Arizona, Utah and New Mexico – is receiving two deliveries of medical care this week after a ten-fold leap in cases has caused leaders to block them, IHS officials said Legislators with.
Others are waiting for the IHS or have to contact states and counties that are already under pressure. For example, an urban Indian organization searched for supplies after its state received a delivery from the Strategic National Stockpile. But district officials told the organization it was so low on the priority list that it was unlikely to get anything.
Trump has touted the new production of millions of masks, respirators, and other protective equipment on Tuesday, despite tribes saying they are unsure if and when they will have access to these supplies.
IHS merely announced that 1.3 million respirators were shipped this month that have expired but are considered fit for use, and that regional supply centers have another 3.4 million available.
An important device that doesn’t make it to large parts of IHS and tribal-run hospitals and clinics: ventilators that IHS officials told the lawmakers to use by trained professionals. IHS facilities don’t have these experts, which means patients who need intensive care need to be brought to non-IHS hospitals instead.
“If we don’t have them, the ventilators are doing no good,” said Rep. Deb Haaland (DN.M.), adding that it is almost impossible for patients in remote areas to find a second nearby hospital.
Currently, only 81 ventilators are available nationwide in the entire IHS system, the agency emphasized, emphasizing that “the core competence of IHS is primary care” and that a network of non-IHS facilities is regularly required to provide specialized or intensive care.
And while the tribal leaders cheered the billions on their way as part of the Congress bailout on Thursday, they warned that it could take weeks for these reinforcements to arrive.
In early March, $ 40 million was initially allocated for two weeks – and even after the Trump administration doubled that amount, bureaucratic restrictions were imposed prevented Some smaller and poorer tribes have no access to the first payout round.
They now have to apply for grants to get access to the others – which means they will have to wait longer if the tribes fear the next major outbreak has already occurred.
“I don’t think people really appreciate the risks,” said Allis. “Over a million of these people are elders. The numbers, if things are not contained and controlled – I’m not trying to overdo it – you could See possible mortality rates for a number with many zeros after it. “