Read the Article: Coronavirus takes toll on Navajo
Read the Article: Navajo Communities surpasses New York for highest infection rate in the US
Navajo communities, including the Tuba City area, has been ravaged by the COVID-19 pandemic, with 1,873 positive cases and 60 deaths as of 4/29/20. In fact, Navajo communities have the highest per capita cases of Coronavirus in the United States outside of New York and New Jersey. Native Americans make up 4.6% of the Arizona’s population, but have accounted for 18% of the state’s COVID-19 deaths to date. TCRHCC has tested 843 individuals since March 12, and 35% (295) of those tested positive. TCRHCC is seeing an average of ten COVID-19 positive patients in the emergency room every day, five admitted daily to the ICU, and/or the Respiratory Care Unit, with a daily inpatient census of 20-25 COVID-19 positive patients every day for the past five weeks.
Health and socioeconomic inequities make TCRHCC’s service area particularly vulnerable to COVID-19. High poverty rates coupled with housing shortages mean it is very common for multiple generations to live in one small dwelling with only one bathroom. When one member of the family is diagnosed with COVID-19, there is nowhere for that person to go to quarantine away from the other family members, including elders. Many people from Navajo communities do not have running water in their homes and must travel to communal spots to haul water. This makes the most important preventative measure in the fight against COVID-19 – hand washing – much more challenging. Prevalence of diabetes, obesity, and other chronic health conditions is high among TCRHCC’s patients, putting them at increased risk for serious complications or death resulting from COVID-19.
Navajo communities declared a state of emergency in mid-March, and President Jonathan Nez recently extended that through declaration through mid-May. Navajo communities also issued a Shelter-in-Place order and has been implementing 57-hour weekend curfews throughout April and mid-May to slow the spread of the virus.
To do its part to help control the spread, TCRHCC quickly instituted processes to separate individuals who are potentially COVID-19-postive from other community members and staff at the hospital. A screening/triage tent was set up in the TCRHCC parking lot. Staff working this area distribute cloth masks to those who don’t have one, serve as Navajo language translators when needed, and direct those with respiratory symptoms to a “red” emergency room with a separate entrance from the main “green” ER for those without respiratory symptoms. This reduces the risk of symptomatic individuals walking through the indoor waiting room. A negative air machine would remove contaminated air from these “red” zones, further reducing the risk of virus spread within the hospital. Because we know asymptomatic individuals can still spread the virus, public relations such as newspaper ads, billboards, and videos are critical to remind the community it is their duty to stay home to slow the spread.
Less than half of TCRHCC’s 73 beds are currently in use due to staffing challenges, in particular a 30% deficit in critical nursing. A large number of TCRHCC staff have also had to take time off of work due to contracting the virus via community spread or due to sickness, as all staff with any virus symptoms were required to self report. Other TCRHCC specialty physicians, allied health and support staff have stepped in to fill the gaps, working in the screening tent and triaging. TCRHCC also has limited ventilator capacity, which resulted in many individuals needing that level of care needing to be flown out to Flagstaff or Phoenix hospitals. Transferring those patients comes at a financial cost to TCRHCC, and leaves those critically ill patients far from family members and without health care providers who understand their language and culture. To reduce the number of patients who must be transferred, TCHRCC has ordered additional ventilators and is pursuing separate funding to cover those expenses.
TCRHCC is the sole health care provider in the Tuba City service unit of the Navajo communities, and thus bears a heavy load in responding to the COVID-19 crisis among this population. TCRHCC is currently in the midst meeting the COVID-19 health care surge, and we believe we have not yet reached the peak. Because of the unique factors placing our service population at elevated risk for contraction of the virus and serious complications, TCRHCC must be prepared to respond to COVID-19 for the foreseeable future.
We are grateful for the funding opportunities that are allowing us to prepare for the long road ahead, including covering personal protective equipment (PPE), health care equipment such as ventilators, other supplies, and ramping up telemedicine capacity to care for patients with chronic illness without potentially exposing them to COVID-19 at the hospital. This Rural Tribal COVID-19 Response Program will allow TCRHCC to recoup funds for several immediate needs not covered through other funding sources, as detailed below.
- Marcello Toscanini
- Joe Gilvary
- Timothy Keesey
- William Bruno
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