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
  • INDIGENOUS AFFAIRS EDITOR - HIGH COUNTRY NEWS
    High Country News is hiring an Indigenous Affairs Editor to help guide the magazine's journalism and produce stories that are important to Indigenous communities and...
  • STAFF ATTORNEY
    Staff Attorney The role of the Staff Attorney is to bring litigation on behalf of Western Watersheds Project, and at times our allies, in the...
  • ASSISTANT VICE PRESIDENT FOR DIVERSITY AND INCLUSION
    Northern Michigan University seeks an outstanding leader to serve as its next Assistant Vice President for Diversity and Inclusion. With new NMU President Dr. Brock...
  • EXECUTIVE DIRECTOR
    The Clark Fork Coalition seeks an exceptional leader to serve as its Executive Director. This position provides strategic vision and operational management while leading a...
  • GOOD NEIGHBOR AGREEMENT MANAGER
    Help uphold a groundbreaking legal agreement between a powerful mining corporation and the local communities impacted by the platinum and palladium mine in their backyard....
  • EXECUTIVE DIRECTOR
    The Feather River Land Trust (FRLT) is seeking a strategic and dynamic leader to advance our mission to "conserve the lands and waters of the...
  • COLORADO DIRECTOR
    COLORADO DIRECTOR Western Watersheds Project seeks a Colorado Director to continue and expand WWP's campaign to protect and restore public lands and wildlife in Colorado,...
  • DIGITAL MEDIA SPECIALIST, THE NATURE CONSERVANCY: WYOMING, MONTANA AND UTAH
    Digital Media Specialist - WY, MT, UT OFFICE LOCATION Remote and hybrid options available. Preferred locations are MT, WY or UT, but applicants from anywhere...
  • GRANT WRITER (PART-TIME, FREELANCE CONTRACT) HIGH COUNTRY NEWS
    High Country News seeks an energetic, articulate and highly organized grant writer to support a growing foundations program. This position works closely with our Executive...
  • ASSISTANT PROFESSOR OF HISTORY - INDIGENOUS HISTORIES OF THE NORTH AMERICAN WEST
    Whitman College seeks applicants for a tenure-track position in Indigenous Histories of the North American West, beginning August 2024, at the rank of Assistant Professor....
  • DAVE AND ME
    Dave and Me, by international racontuer and children's books author Rusty Austin, is a funny, profane and intense collection of short stories, essays, and poems...
  • CHIEF FINANCIAL OFFICER
    Rural Community Assistance Corporation is looking to hire a CFO. For more more information visit: https://www.rcac.org/careers/
  • EXECUTIVE DIRECTOR
    The Absaroka Beartooth Wilderness Foundation (ABWF) seeks a new Executive Director. Founded in 2008, the ABWF is a respected nonprofit whose mission is to support...
  • CANYONLANDS FIELD INSTITUTE
    Field seminars for adults in natural and human history of the northern Colorado Plateau, with lodge and base camp options. Small groups, guest experts.
  • COMING TO TUCSON?
    Popular vacation house, everything furnished. Two bedroom, one bath, large enclosed yards. Dog-friendly. Contact Lee at [email protected] or 520-791-9246.
  • ENVIRONMENTAL AND CONSTRUCTION GEOPHYSICS
    We characterize contaminated sites, identify buried drums, tanks, debris and also locate groundwater.
  • LUNATEC HYDRATION SPRAY BOTTLE
    A must for campers and outdoor enthusiasts. Cools, cleans and hydrates with mist, stream and shower patterns. Hundreds of uses.
  • LUNATEC ODOR-FREE DISHCLOTHS
    are a must try. They stay odor-free, dry fast, are durable and don't require machine washing. Try today.
  • 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...
  • ATTORNEY AD
    Criminal Defense, Code Enforcement, Water Rights, Mental Health Defense, Resentencing.