SEATTLE — When a resident of the Tulalip Tribe here in western Washington tested positive for coronavirus, Chairwoman Teri Gobin quickly let her people know the tribe’s priority in limiting the spread.
“Our Elders are the most vulnerable,” Gobin said in a video address. “The important thing is to make sure that our Elders are OK.” (In many Native communities, "Elder" is an official title.)
The tribe, whose reservation is north of Seattle, had already closed its senior center, and is limiting access to its Elders’ home. The individual who tested positive for COVID-19, the disease caused by the latest coronavirus, self-reported last week and “isolated immediately” after limited contact, the tribe said.
As tribes across the country take steps to fight the spread of the coronavirus, they’re doing so mindful that the virus has proven especially dangerous to the elderly, a venerated group in many Native communities.
In her address, Gobin urged Tulalip members to look after the needs of Elders “so they don’t have to be in the public, because they are the most at-risk.”
Dean Seneca, an epidemiologist who spent years working for the U.S. Centers for Disease Control and Prevention’s Office for State, Tribal, Local and Territorial Support, said that is exactly the response he would expect in Indian Country.
“If [the coronavirus] were to get into a bingo hall in a tribal community or a casino hall, it could be devastating for small communities,” said Seneca, a member of the Seneca Nation who now runs his own private firm. “Our Elders in many cases keep the oral traditions alive, they keep the culture going, they share a ton of information. They're at the forefront of providing guidance to our young people.”
Adults older than 60 face the highest risk from a coronavirus infection, including greater mortality rates, according to the CDC.
John Okemah, the Tulalip Tribe’s chief medical officer, said officials are working to limit exposure to Elders, while explaining to older members why the precautions are in place.
Okemah spoke with Stateline one day before the tribe announced its positive case, but he was already worried about what might happen if the disease made its way into the tribal community, citing long testing delays and other concerns.
“If we have a case that does turn positive and we have to wait seven to eight days [for results], they've already exposed 10 people, then we have a mini epidemic,” he said. “My biggest concern is if we get one positive case, in most tribes around this country, you have families living in close proximity. By the time we get one household case, it's going to skyrocket.”
The tribe has since published an account of a Tulalip family that is recovering from the virus, but no further cases have been reported.
The Seattle Indian Health Board, which runs an urban clinic that treats predominantly Native Americans and Alaska Natives, has been hit hard by the crisis. It’s had to cut back on many services.
But it’s continuing its Elders program, which provides food and resources, as well as cultural and social programs. About 75 people use the program each day.
“Forty percent of our Elders are homeless, and if they don't have a place to come here to get a warm meal, then where are they going to go?” said Esther Lucero, the board’s CEO. “You're making a decision of having them socially isolate under a bridge versus coming here and getting a warm meal and potentially being screened.”
The board is screening all Elders who come in, providing exams and distributing food in grocery bags instead of cooked meals.
Just south of Seattle, the Puyallup Tribe has closed its senior facility, the House of Respect Residence, to visitors. Elders have been urged to remain at home, while the lunch program usually hosted at the center will provide takeout sack lunches. The tribe also is looking to provide alternate working conditions for the Elders it employs.
South of Olympia, the Chehalis Tribe closed its Elder Center and is replacing the facility’s nutrition program with home-delivered meals. Tribes around the country are taking similar measures, while also seeking to meet cultural challenges.
“One challenge that we're faced with right now is communicating with the elderly population and trying to explain what the virus is,” said Jared Touchin, communications director for the Navajo Nation, whose reservation spreads across parts of Arizona, Utah and New Mexico.
“It's difficult to translate these complicated health terms,” he said. “We’re trying to provide information in the Navajo language as well as written materials to reach elderly population.”
The Navajo word for coronavirus, according to a tribal press release, is “Diko Ntsaaígíí-Náhást’éíts’áadah.”
A Navajo tribal member tested positive for the virus Tuesday, the Nation’s first known case.
The Navajo Nation, along with others like the Oglala Sioux Tribe in South Dakota, has placed travel restrictions on tribal employees and discouraged visitors.
The Cherokee Nation in Oklahoma canceled events and is asking its Elders to avoid crowds and large gatherings, said Julie Hubbard, the tribe’s executive director of communications.
Tribes have advantages as well as challenges in responding to the pandemic. Most tribes lack sprawling bureaucracies that can slow response to a crisis. Small leadership councils often are able to meet and act quickly, tribal officials said, unlike state legislatures, which must convene scores of members from a wide geographic region.
“We're everything under one roof,” said Chuck Sams, communications director for the Confederated Tribes of the Umatilla Indian Reservation. “We're the federal, state, county and local government. Our systems are more streamlined, so we're able to move a little more quickly.”
Earlier this month, an employee at a casino operated by the Oregon tribe tested positive for the coronavirus, prompting a temporary closure and cleaning of the facility. Sams said the tribe has taken measures such as restricting travel.
Many tribes have closed their casinos and other public facilities in recent days. The Native gaming industry is asking the federal government for $18 billion in aid. Most tribes do not collect income or property taxes, and revenue from tribal enterprises like casinos and hotels pays for essential services like health and education.
Robert Anderson, director of the University of Washington’s Native American Law Center, noted that tribes’ status as sovereign nations enables them to act without waiting for other levels of government.
“Tribes have their own jurisdiction over their reservations and lands,” said Anderson, a member of the Bois Forte Band of Ojibwe. “It's unique in the way that tribes are governments that are really close and really responsive to their citizens and are careful to look out for them. That's the beauty of being a small, responsive government — you can be fairly nimble.”
Like state governments that have taken drastic measures to enforce social distancing in recent days, tribal nations have broad powers to respond in cases of emergency, Anderson said, including some cases in which they have jurisdiction over non-Native members who live on tribal land. Many tribal nations have made emergency declarations in recent days.
That autonomy is an asset, but it’s also a necessity, tribal leaders said, because they expect little outside support.
“The [Chehalis] Tribe has long understood that if something like this were to happen, the federal government is not coming to our aid,” said Jeff Warnke, director of government and public relations for the southwest Washington tribe. “The federal government has certainly not reached out to us to let us know what we can expect or when to expect it. We're going to take care of our own here.”
The $8.3 billion measure passed by Congress to fight coronavirus includes $40 million for tribes and tribal organizations. Leaders in Indian Country say that’s a paltry amount, and they expect long delays before the funding works its way through layers of bureaucracy to reach health care providers.
“That money is so minuscule, even after you get through the red tape of administering that $40 million — by the time it trickles down the Native community, it's going to do very little,” said Seneca, the former CDC epidemiologist.
Navajo Nation President Jonathan Nez has sent a letter to Vice President Mike Pence asking how the funding will be distributed. Meanwhile, the National Council of Urban Indian Health has asked for $94 million “at the very least” for the 41 Urban Indian Organizations it represents, which provide services to many of the 70% of Natives who live outside reservations.
“As of right now, we've received no guidance and there's no funding mechanism in place,” said Meredith Raimondi, the organization’s senior communications manager. “We're just trying to get any answer we can from the administration.”
One of those urban clinics, the Seattle Indian Health Board, is losing $700,000 a month during the public health crisis. The funding gap is a huge problem, said Lucero, the CEO, because Native health care, unlike private systems, is a federally guaranteed right promised to tribes who ceded their land.
In Seattle, Native people are 10 times more likely to be homeless than any other ethnicity, Lucero said, and they’re more prone to being immunocompromised by diabetes and other conditions.
A quarter of the clinic’s own staff falls into those high-risk categories, which include pregnancy, and have been kept from working during the outbreak, leaving the center shorthanded.
Lucero said the shortage in testing supplies has been “infuriating,” and it’s taken a long time to get results back from the tests they have sent off. The clinic was down to its final three tests when Lucero spoke with Stateline. None of the clinic’s patients has tested positive for coronavirus. She is pushing for tribal health providers to be equipped to do testing in-house.
“Our community is very distrustful of institutionalized systems, especially health care systems,” she said. “We have to offer testing here, otherwise it's not likely that our people will go to seek out tests.”
The Cherokee Nation can test for coronavirus within its own health system, while the Navajo Nation is able to do on-site testing as well. But many smaller tribes contacted by Stateline said they lack resources to conduct prompt testing.
Oglala Sioux Tribe President Julian Bear Runner declared a state of emergency after learning that the reservation’s hospital lacks testing supplies.
Tribal members can get health services at on-reservation clinics, some of which are run directly by the federal Indian Health Service, while others are overseen by tribes with some Indian Health Service funding. Off the reservation, Urban Indian Organizations, which also receive IHS funding, serve many other members.
In a letter obtained by Stateline, the IHS informed tribal clinic leaders that it would be sending them expired respirators with masks that might still perform safely. IHS officials admitted on a recent call with the White House that they have limited ability to track the spread of the virus, Seneca said.
“We don't have good tracking in our tribal communities like states do with local health departments,” said Seneca, who was on the call. “That surveillance is not set up in Indian Country the way it should be.”
In a fact sheet shared with Stateline, the IHS advised clinics to collect samples with standard specimen swabs and send them to laboratories in their jurisdictions.
IHS said it is “working closely” with other federal agencies to determine how the funding allocated by Congress will be distributed to tribal care facilities “in a timely manner.”
Seneca said that Native communities are more prone to have several families under a single roof, as well as respiratory issues like high smoking rates and radon exposure.
“That's a cocktail effect for disaster,” he said.
Amid the concern and confusion, some say that the social isolation necessary to stop the spread will cause more hardships for tribes. Jordan Lewis, a professor at the University of Minnesota-Duluth who studies Native health, said that quarantines could affect the quality of life for many, including Elders often at the center of community life.
“[Elders] are the people communities go to in terms of ‘What should we be doing?’” said Lewis, an Aleut from the Native village of Naknek in Alaska. “They've lived a full life of experiences. They're sought after for that knowledge across all ages.”
Several tribal leaders noted pandemics have been a tragic part of the Native American story, as diseases brought by Europeans killed vast numbers of Indigenous people on the continent.
“We’re still here,” Lucero said, “so we’re incredibly resilient.”