What was it like in these communities in the initial weeks of the COVID-19 outbreak?
There are 19 Pueblos in New Mexico, each with its own government but sharing a common history and culture. Each has its own governor and is independent in many aspects. These nations are separate from the state government and were actually excluded from funding in the first draft of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. As a result, they experienced many challenges getting COVID-19 test kits, equipment, and supplies and establishing isolation, quarantine, and contact tracing activities.
These small, independent nations have survived a history of infectious diseases introduced by colonizers and are particularly aware of the threat posed by outbreaks. With COVID-19, there was a fear of losing a large percentage of the community, as had happened in prior outbreaks including smallpox and the Spanish flu. Furthermore, the Pueblos were afraid of losing tribal elders and, with them, cultural knowledge.
So, like nations all over the world, the Pueblos reacted to the threat of COVID-19 by closing their borders and requiring people to stay home. Each one responded a little differently, quickly mobilizing their own emergency operations centers and services—such as home food delivery—with the idea that home quarantine and isolation would stop transmission. In early April, one Pueblo even opened a quarantine and isolation center for tribal members at their hotel.
Although these efforts helped control the spread of COVID-19 to some degree, it quickly became evident that household transmission was the biggest risk factor. The Pueblos traditionally live in multi-generational family homes with many people often living in close quarters, making it more difficult to reduce household transmission. At the same time, the community was not initially receptive to the idea of leaving the home while they were sick for isolation or quarantine, though attitudes changed over time.
How is MSF helping in Native American communities during the COVID-19 outbreak?
In general, we have provided infection prevention and control (IPC) assessments, trainings, and recommendations for decreasing transmission in households, community centers, health facilities, congregate living spaces, alternative care facilities, isolation centers and correctional facilities. We have also provided logistical, structural support to implement these recommendations and technical medical support for health facilities and isolation centers, such as helping to optimize patient flow.
We have also been training and supporting community hygiene and health promotion teams, which go out into communities house-to-house educating families on decreasing household spread and providing home hygiene kits, cloth masks, and health education materials. Lastly, we did a lot of local advocacy work with tribal leaders and the Indian Health Service (IHS).
We also supported correctional facilities in the Navajo Nation. Correctional and detention facilities can have high rates of infection. At one center, 31 percent of the staff tested positive for COVID-19. Being able to do very practical support to help staff improve procedures and reduce the spread of the virus was important in this setting. Similarly, bringing attention to the IPC needs of congregate living spaces in the Navajo Nation, including nursing homes and homes for people with special needs, was another highlight of the project there.