The Navajo Nation and White Mountain Apache Tribe chase down a virus

Contact-tracing programs in two areas hit hardest by COVID-19 are working.

 

Catherine Lee, a community health representative, talks with a man at his home on the Navajo Nation. The nation has nearly 200 contact tracers spread across numerous health-care agencies.
Jim Thompson/Albuquerque Journal

On a mild morning in April at Arizona’s Whiteriver Indian Hospital, Dr. Ryan Close tested nasal swabs from two members of an eight-person household on the Fort Apache Reservation northwest of Phoenix. About half of the family had a runny nose and cough and had lost their sense of taste and smell — all symptoms of COVID-19 — and, by late morning, the two tests had come back positive. Close’s contact-tracing work began.

For Close and his team, each day begins like this: with a list of new COVID-19 cases — new sources that may have spread the virus. The 35 or so people on the team must rapidly test people, isolate the infected and visit the homes of any who may have been exposed. Again, and again. Recently, though, their cases have declined, due in part to something rare, at least in the United States: an effective contact-tracing and testing plan. Both the White Mountain Apache and nearby Navajo Nation experienced some of the country’s worst infection rates, yet both began to curb their cases in mid-June and mid-July, respectively, due to their existing health department resources and partnerships, stringent public health orders, testing and robust contact tracing. 

“We've seen a significant decline in cases on the reservation at the same time that things were on fire for the rest of the state,” said Close, an epidemiologist and physician at Whiteriver Indian Hospital, an Indian Health Service facility. 

Tracing disease transmission from COVID-19 is crucial to slowing its spread, but successful contact tracing has proven challenging for communities that lack the funds, community cooperation, personnel or supplies for rapid testing. The White Mountain Apache Tribe of Fort Apache and the Navajo Nation, however, have been growing a contact-tracing army, setting them apart from other tribes during the pandemic. As tribal communities brace for multiple waves of COVID-19, public health experts from the two nations have already successfully adapted contact-tracing programs. 

The White Mountain Apache and the Navajo Nation “were hit hardest early on, and so they have had a little bit more time and opportunity to put these systems into place,” said Laura Hammitt, director of the infectious disease and prevention program at Johns Hopkins Center for American Indian Health, which is working with the Centers for Disease Control to develop a guide for tribal governments to train and grow their own contact-tracing workforces.

Across the country, tribes are employing a number of public health measures — closing reservations to nonresidents, setting curfews, providing free testing and aid to families and Indigenous language translations of public health guidelines — but few are actively contact tracing. Contact tracing requires fast and systematic testing and trained personnel. In March, Close trained eight Whiteriver Indian Hospital staffers, but the number has since grown to around 35, serving some 12,000 tribal citizens and residents. The relatively small team takes advantage of the firmly closed reservation boundaries and rapid testing to find and isolate new cases. COVID-19 cases were dropping in Fort Apache, which stayed closed, as the state neared its caseload peak in mid-June after the governor lifted stay-at-home orders, becoming one of the country’s worst coronavirus hotspots

Catherine Lee, a community health representative, talks with a man at his home on the Navajo Nation. The nation has nearly 200 contact tracers spread across numerous health-care agencies.
Jim Thompson/Albuquerque Journal

While most contact-tracing programs rely on phone calls to learn patient history, assess symptoms, encourage isolation and trace other contacts, the Whiteriver team relies on home visits. “I (can) come to your house to assess you, do a case investigation, or to inform you that you are a contact,” Close said. “The benefit of that is that, if you were ill-appearing, they can evaluate you right there.” Tracers can also determine whether other household members are symptomatic, checking temperatures and oxygen saturation, while health-care providers can check breathing with a stethoscope. The Whiteriver Hospital can turn around a COVID-19 test in a single day, a process that takes days or weeks at other public health institutions.

“We’re not just trying to flatten the curve. We’re trying to actually completely contain this virus.”

The Navajo Nation has succeeded in slowing the spread of the new coronavirus, even though the reservation spans three states — New Mexico, Arizona and Utah — so teams must coordinate across several jurisdictions. The nation has nearly 200 contact tracers spread across numerous health-care agencies. With scores of Indigenous communities to monitor over a huge geographic area, phone calls are its primary investigative tool. The Navajo Nation is setting its sights high. “We’re not just trying to flatten the curve,” said Sonya Shin, who leads tracing investigations for the Nation, “We’re trying to actually completely contain this virus.”

Still, critics say it is not enough. The most effective tracing relies on mass testing to catch asymptomatic people as well as those with symptoms. Due to a limited supply of tests, most tribes, like most states, can only test symptomatic people, so the number of cases is inevitably undercounted. “Contact tracing does not mean a damn thing unless you have really good tests, and you’re testing everybody,” said Rudolf Rÿser (Cree/Oneida), executive director of the Center for World Indigenous Studies. “Not just the people showing the symptoms, but everybody, whether they are Indian or non-Indian, in your area — you have to catch them all.”

Kalen Goodluck is a contributing editor at High Country News. Email him at [email protected] or submit a letter to the editor.

High Country News Classifieds
  • NORTHERN NEW MEXICO PROJECT MANAGER
    Seeking qualified Northern New Mexico Project Manager to provide expertise, leadership and support to the organization by planning, cultivating, implementing and managing land conservation activities....
  • NORTH FORK RECREATION DISTRICT ADMINISTRATOR
    The NFPPRD District Administrator provides leadership and managerial services associated with the Recreation District. Facilities include a seasonal pool, ballfields, bike trails, tennis/pickleball and skateboarding....
  • EXECUTIVE DIRECTOR, BADLANDS CONSERVATION ALLIANCE
    The Executive Director of the Badlands Conservation Alliance (BCA) builds and leads a premiere North Dakota advocacy group that serves to protect the ecology of...
  • CLIMATE FELLOW
    Application deadline: Monday, March 6th, 2023, at 5 p.m. MST. Anticipated start date: May 15, 2023 About the position Are you ready to craft an...
  • RISING LEADERS MANAGER
    Application deadline: Monday, March 27, 2023, at 5 p.m. MST Anticipated start date: May 22 or May 30, 2023 About the position Do you want...
  • SENIOR SPECIALIST, LANDSCAPE CONNECTIVITY YELLOWSTONE TO YUKON CONSERVATION INITIATIVE
    About the Organization Yellowstone to Yukon Conservation Initiative (Y2Y) is a joint Canada-U.S. not-for-profit organization with a mission to connect and protect wildlife habitat from...
  • VIRGINIA SPENCER DAVIS FELLOWSHIP
    High Country News, an award-winning magazine covering the communities and environment of the Western United States, seeks applicants for a Virginia Spencer Davis fellow. The...
  • GRANTS MANAGER
    The Grants Manager is a passionate information manager, fundraiser, and communicator versed in government and foundation grant and cooperative agreement writing and management, specifically to...
  • COMMUNICATIONS DIRECTOR
    The Communications Director is a passionate communications professional versed in conservation and regenerative agriculture, as well as nonprofit communications and data management across several program...
  • EDUCATION AND OUTREACH PROGRAM DIRECTOR
    The Education and Outreach Director is a people-oriented facilitator, communications wizard, and team leader who has experience designing, managing, and fundraising for land based educational...
  • ADOBE HOME FOR SALE
    Restored traditional adobe home in No. New Mexico on 1+ acre site, irrigation water, separate large shop/studio. Please email for photos/full description.
  • HIGH COUNTRY NEWS EDITORIAL INTERNS
    High Country News, an award-winning magazine covering the communities and environment of the Western United States, is looking for its next cohort of editorial interns....
  • DEVELOPMENT PROGRAM SPECIALIST
    hat We Can Achieve Together: If you are a detailed individual that takes pride in your accuracy, this position may be the perfect opportunity for...
  • EXECUTIVE DIRECTOR - LEMHI COUNTY HUMANE SOCIETY (SALMON, IDAHO)
    Are you ready to take the reins at Lemhi County Humane Society and make a difference in the lives of countless animals? We are seeking...
  • ENVIRONMENTAL AND CONSTRUCTION GEOPHYSICS
    We characterize contaminated sites, identify buried drums, tanks, debris and also locate groundwater.
  • DEVELOPMENT DIRECTOR
    The Clark Fork Coalition (CFC) seeks an enthusiastic Development Director to lead all fundraising activities in support of our mission to protect and restore the...
  • MATADOR RANCH MANAGER
    The Matador Ranch Manager directs operations, communication, and maintenance for TNC Montana's Matador Ranch preserve with a focus on ecological management and restoration, grazing management,...
  • WESTERN NATIVE SEED
    Native plant seeds for the Western US. Trees, shrubs, grasses, wildflowers and regional mixes. Call or email for free price list. 719-942-3935. [email protected] or visit...
  • CEO BUFFALO NATIONS GRASSLANDS ALLIANCE
    Chief Executive Officer, Remote Exempt position for Buffalo Nations Grasslands Alliance is responsible for the planning and organization of BNGA's day-to-day operations
  • "PROFILES IN COURAGE: STANDING AGAINST THE WYOMING WIND"
    13 stories of extraordinary courage including HCN founder Tom Bell, PRBRC director Lynn Dickey, Liz Cheney, People of Heart Mountain, the Wind River Indian Reservation...