health care

New Research on COVID-19 Infection Rates in Indian Country

Matthew L.M. Fletcher

American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic

April 25, 2020 

The SARS-CoV-2 virus is causing widespread devastation as rates of coronavirus disease 2019 (COVID-19) grow across the world. The United States is experiencing one of the largest outbreaks with over half a million confirmed cases as of mid-April 2020. However, outbreaks on tribal lands are largely ignored by the federal government, mainstream media, and case tracking web sites. To reverse this erasure, Indian Country Today has collected cases for the Indian health system. As of April 10, the ICT database contained 861 COVID-19 cases in 287 tribal communities. Infections are growing across Indian Country, but very little is known about the relationship betweencommunity and household characteristics and the rate of COVID-19 spread on tribal lands. This is the question that ateam of Indigenous researchers at UCLA and the University of Arizona are actively working to answer.

This interdisciplinary team includes social demographer Desi Rodriguez-Lonebear, health services researcher Nicolás E.Barceló, economist Randall Akee, and public health researcher Stephanie R. Carroll. Merging the ICT data with the 2018 American Community Survey 5-Year records, they conducted multivariate analyses to identify relationships between the rates of COVID-19 cases per 1000 population and average reservation (or homelands) characteristics. 

The results show that by April 10, 2020, the rate of COVID-19 cases per 1000 people was more than four times higher for the populations residing on reservations than for the U.S. as a whole. COVID-19 cases were more likely to occur in tribal communities with a higher proportion of homes lacking indoor plumbing. COVID-19 cases were less likely to occur in tribal communities where households spoke English-only.

This research finds that failure to account for the lack of complete indoor plumbing and access to running water in a pandemic may be an important determinant of increased incidence of COVID-19 cases in tribal communities. Access to relevant information in Indigenous languages may play a key role in the spread of COVID-19 in some tribal communities. Previous studies have identified household plumbing, overcrowding, and language barriers as potential pandemic and disease infection risk factors. These risk factors persist. Specific actions must be taken now to provide potable water, and culturally-relevant information via community preferred media.Urgent funding to strengthen tribal public health and household infrastructure, as delineated in treaties and other agreements, isnecessary to protect American Indian communities from COVID-19 and future pandemics. This research has been accepted for publication at the Journal of Public Health Management and Practice.

Media Contact Information – Dr. Randall Akee (rakee@ucla.edu)

Amended Complaint in CARES Act/ANC Suit [New Tribes Added]

Matthew L.M. Fletcher

Here is the pleading in Confederated Tribes of the Chehalis Reservation v. Mnuchin (D.D.C.):

7 First Amended Complaint

Prior posts here.

NYTs: “How Native Americans Are Fighting a Food Crisis”

Matthew L.M. Fletcher

Here.

Fletcher on the Pandemic and Tribal Powers over Nonmembers

Matthew L.M. Fletcher

I posted a draft paper, “Indian Lives Matter: Pandemics and Inherent Tribal Powers,” on SSRN.

Here is the introduction to the paper:

America’s reaction to the COVID-19 pandemic of 2020 is a microcosm of how Americans see the nation. It is a story of rugged individualism versus community needs. Many Americans insist on freedom to do as they please, rigorously pushing back on government. But in an environment where small numbers of individuals can easily transmit a deadly infection to others, creating the exponential increase in infections, rugged individualism is a terrible threat. Pandemics, luckily for humans, do not seem to occur all that frequently, but when they do occur, they can dramatically alter human history.

Indian people know all too well the impact of pandemics on human populations, having barely survived smallpox outbreaks and other diseases transmitted during the generations of early contact between themselves and Europeans. Indian people also suffered disproportionately from the last pandemic to hit the United States about a century ago. Some things have changed for the better for Indian people, namely tribal self-governance, but many things are not much better, including the public health situation of many Indian people.

Modern tribal governments navigate a tricky legal and political environment. While tribal governments have power to govern their own citizens, nonmembers are everywhere in Indian country, and the courts are skeptical of tribal authority over nonmembers. For example, after the Navajo Nation announced a 57-hour curfew for the weekend of April 10-13, 2020 (Easter weekend for many), the sheriff’s offices of Cibola and McKinley counties sent letters to the tribe insisting that the tribe refrain from citing nonmembers during the curfew, further insisting that nonmembers are governed more “fully” by the Governor of the State of New Mexico. Further, the fact that it is the county sheriff’s offices – and not counsel for the nonmembers – sending the letters is a deeply consequential signal to the tribal government. Of course, allowing nonmembers freedom to flout the tribe’s curfew defeats the purpose of the curfew. During a pandemic, the limitations on powers of tribal government could lead to tragedy.

This short essay is designed to lay down the argument favoring tribal regulatory powers over nonmembers in Indian country during a pandemic. It should be an easy argument, but federal Indian law makes it more complicated than it should be.

Here are some of the primary source documents noted in the paper:

Cibola county letter

McKinley County Sheriff Letter

The_Sacramento_Bee_Mon__Oct_28__1918_

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Arizona News 15: “Navajo Nation low on water, approaching top 3 hot spots in US”

Matthew L.M. Fletcher

Here.

Shanelle Afcan & Christina McDonogh: “Two Women Fighting To Prevent COVID-19 From Destroying Rural Alaska”

Matthew L.M. Fletcher

Here.

Confirmed COVID-19 Cases in the Indian Health System

Matthew L.M. Fletcher

Here.

As of April 6 – Total Cases: 539
Total Deaths: 24

The G in the Atlantic: “Gretchen Whitmer: ‘There’s Going to Be a Horrible Cost’”

Matthew L.M. Fletcher

Here.

KOAT: “Tribal communities hit hard by COVID-19 not seeing promised federal aid”

Matthew L.M. Fletcher

Here.

HuffPo: “The White House Wanted To Give $0 To Tribes In The $2 Trillion Stimulus Bill”

Matthew L.M. Fletcher

Here.