1357. How the Navajo Nation beat back COVID-19, By Amy Donaldson Nov 14, 2021 -- in the Deseret News
I've been visiting my daughter in Arizona. This is my first time back on my blog!
How the Navajo Nation beat back COVID-19
From one of the nation’s worst hotspots to one of its safest places
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The hug didn’t need an explanation.
Jo Ward was busy waiting on customers when an older man, leaning on a cane, walked into the restaurant she inherited from her mother and wrapped her in an embrace.
Ward has relived versions of that hug over and over as customers have returned to the Blue Coffee Pot in Kayenta, Arizona, the last six months.
There are fewer tables at which to gather, as businesses on the Navajo Nation are only allowed to be open at reduced capacity.
But that doesn’t matter. Customers come and eat and remember. Some stay for hours.
“It was like, ‘OK, this is his normalcy,’” she said.
“Normalcy” has been elusive for most people during the pandemic. But in many communities people have had glimpses of it — a taste here, a moment there. On the Navajo Nation, more than 18 months into the COVID-19 pandemic in the U.S., people are just beginning to feel like the lives they lived before the virus upended the world might be returning.
Flea markets, food trucks, roadside jewelry stands, children frolicking on playgrounds — and gathering at favorite restaurants — are just a few of the signs that ordinary days are returning to the Navajo Nation.
But as familiar joys return to daily life, the question becomes, how did the remote Navajo Nation go from being one of the hardest-hit communities in the country to offering a model for how to control the spread of COVID-19, while protecting vulnerable populations?
The Navajo Nation’s solution
It isn’t just that the story of the pandemic’s impact on the Navajo Nation, which covers some of the most rural areas in Arizona, New Mexico and Utah, has shifted. It’s that, in many ways, the same things that made the Diné vulnerable in those early months are now the very strengths the community relies on as the Nation continues to actively fight the spread of the virus.
The reasons for the shift are complicated.
They include the efforts of public health, like vaccines and masks. The vaccination rate among tribal members is 70%, substantially higher than the 58% rate nationwide. Navajos are more likely to seek testing and treatment than in surrounding areas, and they continue government funded contact tracing, which aims to limit spread by letting people know they’ve been exposed and asking them to test or quarantine.
But those aren’t the only explanations for the change. Navajo culture played a large part in how the tribe — America’s largest with an enrollment of nearly 400,000 — has pulled through the pandemic.
“I have so many thoughts on why that is,” said Byron Clarke, chief operations officer for Utah Navajo Health Systems, a contract provider for federally operated Indian Health Service.
“It was mostly that it was very personal down here. We were one of the first ones to get hit nationally. And then, it spread quite rapidly because of the logistics of living down here, living situations and poverty. We were hit harder down here on the reservation than probably almost anywhere else initially.”
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The shift is so significant that while rural communities have been ravaged by COVID-19’s delta variant, the Navajo Nation has not been significantly impacted. That’s not to say the deadly strain hasn’t brought a resurgence of cases, just as it has throughout the country.
Navajo Nation President Jonathan Nez offers a weekly COVID-19 update that scrutinizes numbers, reiterates the importance of vaccines and masks, and looks at where outbreaks are occurring and what might be causing them. Neither the national government nor Utah’s state government continue the regular COVID-19 updates that once informed the public about the pandemic and efforts to contain spread.
As of Friday, the Navajo Department of Health reported 37,966 cases of COVID-19 since the pandemic began, with 1,507 reported deaths.
For the Navajo Nation, border towns — where Navajo culture collides with mostly rural communities that shun masks and have been lukewarm about vaccines — and family gatherings have become the most dangerous realities. Still, despite increasing numbers, the Nation enjoyed some of the lowest numbers in the country throughout the devastating delta variant surge.
“This latest wave hasn’t been as bad,” Clarke said, referring to the 10,000 tribal members who are served by Utah Navajo Health Systems in the Utah section of the reservation.
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An isolating fight
The initial outbreak on the Navajo Nation was so devastating, its plight attracted sympathy and help from around the world. At a recent virtual town hall, Nez illustrated just how grave the situation was with a chart showing positive COVID-19 cases in April and May of 2020 were three and four times the national average. And it wasn’t just that case counts were higher.
Native Americans were sicker and more likely to die, even among younger patients. According to the Centers for Disease Control and Prevention, cases among Native Americans were 1.7 times higher than for white Americans, and hospitalizations were 3 ½ times higher. The most recent CDC statistics show Native Americans succumb to the virus at 2.4 times the rate of white Americans.
Even as scientists were still learning how the coronavirus spread, what it did to the human body and which treatments were most effective, the virus was ravaging Native communities.
“There was a point ... I think we lost seven people in one week,” Ward said of the first six months of 2020. “And it was just ongoing. For a while there, people were saying, ‘When is this going to stop?’”
Tribal response
Nez and the tribal government responded by imposing some of the most severe restrictions in the country, including weekend curfews, mask mandates, prohibiting public gatherings and shuttering businesses. It made life extremely difficult for people like restaurant owner Ward, but she, and others, now say it saved lives.
“I have to give praise to our Navajo Nation president,” Ward said. “He actually gave us a direction. And I feel like it really helped us. I know a lot of businesses were upset because we had curfews, weekend shutdowns, but it actually slowed COVID down in our community.”
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And, she said, Nez he was really strict about it. “At least we had a president on the Navajo Nation that gave us a direction on how to deal with this, and make sure the guidelines were all the same.”
But a clear plan and message from its government is just one thing tribal members point to when they talk about the difference between 2020 and 2021, not only on the reservation but compared to the rest of the U.S.
Among the factors cited are:
- More than 70% of tribal members are fully vaccinated, compared to vaccination rates in border towns, which are around 58%. Tribal officials recently issued a vaccine mandate for all government workers, including contractors, although some, like Utah Navajo Health Systems, were already above 90% before the mandate.
- Mitigation rules, like limited social gatherings, including for the upcoming holidays, masks and businesses operating at 50% capacity are embraced.
- People want to get tested if they’re sick or exposed, and testing remains free and accessible.
- Contact tracing remains an integral part of Indian Health Services and its contracted providers like Utah Navajo Health Systems.
- The cultural significance of older citizens made economic and social sacrifices more palatable. In fact, some have even called for a second shutdown as numbers crept higher in recent weeks.
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Dark days
In those initial dark days, health care workers across the tribal health care system responded with creativity and urgency.
Utah Navajo Health Systems teamed up with the Utah Department of Health to provide thousands of tests through a mobile lab. The testing events, held at four different clinic locations in Utah, attracted people from hundreds of miles away.
Denise Begaye, an X-ray technician, volunteered at those testing clinics, working 12-hour days — on her feet in layers of protective gear. It was exhausting, but it wasn’t the physical challenges, or the worries she had that she might take the virus home with her that sticks with her from last year.
It’s the faces of the patients.
“The people who came,” she said, pausing. “They weren’t familiar with what was going on. We just had a lot of fear. … We were here to reassure them that we’re here to help them.”
In January, vaccines became available, and the same system that ramped up to test, treat and educate citizens mobilized to offer vaccines.
More than a year later, Begaye said things have slowed so much, she’s now working emergency medical services, in addition to working as an X-ray technician, to “see a little bit more action.”
While the highly contagious delta variant of the virus has filled hospitals to or past capacities, especially in rural communities, it’s been a much different story on the reservation.
“So we saw the delta spike,” Clarke said. But, he added, there weren’t a lot of people hospitalized and for those who were, the disease was less intense.
“This latest wave hasn’t been as bad,” he said. “I think in our county, we’ve only lost one person this year (2021), compared to 38 (deaths) last year, countywide in San Juan County.”
But numbers do not tell the whole story of how things have improved in the Navajo Nation.
Because the virus spread so quickly, often with devastating consequences, the tribal government’s safety restrictions were not met with as much opposition as in other places. Additionally, mandates to wear masks, limit gatherings, shut down businesses and social distance never took on the political overtones they did in the rest of the country.
But the success the tribe is having battling the coronavirus isn’t just about good medical strategies and mitigation efforts. It’s also about culture.
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Protecting tribal elders
The tendency to live in multigenerational houses or clusters of houses meant the virus spread rampantly through families. But their sense of obligation to each other is what also pulled them through — and is part of what’s responsible for owning the highest vaccination rate in the country.
On the reservation, “elderlies” belong to everyone.
On a recent Thursday afternoon, bus driver Marita Chief grins as she opens the doors to her bus. She greets each student as they climb aboard and find seats for the ride home. Last year, she and members of the Tse’Bii’Nidzisgai Elementary School staff logged thousands of miles on mostly empty buses, delivering educational packets, books and meals to children waiting along the bus route with their families.
One fourth grader walks past her, puts his backpack on his seat, and then returns to Chief’s side. He calls her “grandma,” and then tells her another boy won’t be riding the bus this afternoon. She responds with gratitude, and he returns to his seat.
When asked how they’re related, she laughs.
“They’re all my grandkids,” she said.
Her affection for the students isn’t just a feature of her personality. It’s an idea that is foundational to the culture. It’s imbued in the language and a part of every interaction.
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In Navajo, one doesn’t just say “grandfather,” which is acheii. Words for blood relatives must belong to someone — as in my grandfather, translated as shicheii. Clarke, who grew up in Blanding, said that when he began working in Navajo health care, people would correct him if he ever just said “grandfather.”
“When you meet a grandfather, in Navajo, that’s your grandfather,” he said. “Everybody has a relationship to the elderly that way. … It was already built into the culture to have some ownership over your elders’ safety basically. … By and large, the population down here was like, ‘Yes (I’ll make sacrifices) because that’s my grandma. That’s my grandpa.’”
It’s not just that Navajo culture values its oldest citizens. For Diné, their history, tradition and wisdom lives in their elderly citizens.
“Native American culture is very dependent on the elderly,” said Pete Sands, communications director for Utah Navajo Health System, who created and ran the COVID Relief project until February of this year when most of it was discontinued because the need was waning. “Because they are the source of our knowledge and our cultural preservation goes through them.”
And that, for most people, is no small thing because of the many ways native people can be separated or disconnected from their language and culture
“Down here, elders are sacred,” Clarke said. “It was tragic for us seeing so much history pass away when each elder passed. … That’s not to say that outside of Navajo tribal areas that they don’t honor and respect elders. But I think it reaches a new level down here when we say, ‘If it saves one elder by me doing this or that thing of personal hygiene, then sure, absolutely I’ll do it.’”
Sands said the eagerness for vaccinations was twofold. People wanted to protect the vulnerable and they wanted to get back to some semblance of normal.
“When we did the vaccination drives, people lined up in droves,” he said.
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Return to normal
Daphne Parrish was one of the first in line for the vaccine. She left a life in Colorado seven years ago to care for her mother in Kayenta. As she arranges jewelry on a plastic table on the side of U.S. 163, the same road, and scenery, made famous by the Tom Hanks film “Forrest Gump,” her 78-year-old mother Ella Parrish sits in the back of her pickup truck making earrings.
She said even among those who understand the cultural significance of protecting their elders, the last 18 months have been uniquely challenging for them.
“It was very difficult,” she said. “We had to shut out family. It’s just her and I who live together, and we had to refuse visitors.”
Parrish even found herself refusing visits from her nine siblings.
It’s been wonderful to get back to some ordinary pleasures, like visits with family and trips to the grocery store, she said. And like others who rely on tourists for income, she’s happy to see visitors back in Monument Valley.
One of the most heartwarming changes is seeing children on the playground of the elementary school that sits across the street from the Monument Valley Clinic.
Jody Lee-Chadde walks past the array of water bottles labeled for each student, one of the many pandemic precautions that make in-person classes possible. She’s been a teacher for 19 years, and she said last year was challenging for all involved.
“I did not like it,” she said. “I enjoy seeing these faces, and so it was very difficult for me not to see them and know that they’re in my room where we’re talking to each other, creating relationships, where they’re safe, where they’re learning. And I can see that they are learning. I can see their minds working and their hands working.”
While she and her students did what they could to connect through technology, she said the disconnection was significant.
“The few kids that I did get, that came to me every day, it was a joy to see them, and we had conversations,” Lee-Chadde said. “But it just was not the same.”
Lee-Chadde said she feels comfortable being in the classroom, though some teachers do not.
“I think that the Navajo community is really being careful with their families and their kids and their elderly, taking precautions,” she said. “This is probably one of the safest places to be.”
And then she adds, “I’d do this 100 times over, with six masks on, rather than sitting behind that computer. … There is just no comparison. I just think it’s critical that we’re here together.”
Channalynn Chee, 11, said remote learning was impossible for her because “most of the year, we didn’t have any Wi-Fi at our house.” She’s glad to be back in the classroom, even if she doesn’t love every subject.
“I kind of like school,” she said. “I like math because it’s easy for me. … I like playing outside and talking to my friends.”
Lee-Chadde said she sees light at the end of the tunnel but doesn’t want to let her guard down.
“That’s what happened last year. … Oh, my God, we’re almost there. We’re getting better. Then the second wave hit.”
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Healing from loss
Ward said the last year has presented all kinds of challenges — from financial hardships to worries about doing her part to limit the spread of COVID-19. She didn’t get money from the tribe or the federal government to help keep her businesses afloat, but she said she’s lucky she owned her buildings and had no debt heading into the shutdowns.
That affectionate customer at the Blue Coffee Pot who insisted on coming inside last May, sat at a table for several hours with his daughter, eating and visiting with other regular customers who gravitated to the iconic restaurant for the same reason. He’d lost his wife, and for many months, the ability to commune with his friends.
But in that moment, he could feel the familiar comfort of his pre-pandemic life.
“In May, we decided to open the restaurant and everybody was excited,” Ward said, adding that customers would hug her waitresses over and over in those first few weeks after they reopened.
“They were just so thankful we were here. … The hard part was the individuals who come in, like that gentleman sitting over there, who tell us how their spouse died. And they sit here for hours because this is the last place that they were able to go eat with them.”
Others crowded around tables with family members and friends they hadn’t seen for months, and told stories about how they made it through the emotional challenges of isolation and the financial hardships of the shutdown.
“We got to hear these stories from the community,” she said.
Some made her laugh. Some filled her with gratitude. But many broke her heart.
“We began to hear about all of our customers who had passed away, and there were so many that we ended up doing a COVID walk where we remember those who died,” she said.
In the summer, they began making a list of people claimed by the virus. “It was about six pages long of all the individuals who’d passed,” Ward said.
One woman who was picking up a takeout order sobbed as she listed off the six family members she’d lost — a grandfather, four brothers and a nephew. Ward said her community will be struggling with the reverberations of these losses for years to come.
“I never imagined something would take so many people,” Begaye said. “You hear stories, but you don’t know because it’s just history. But to actually live it, and to see the changes, it was overwhelming.”
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Lessons learned
The pandemic tested the Diné in many ways, but some said it also brought unexpected blessings. Sands, who is an actor, musician and filmmaker, returned to his hometown to work for Navajo Health Systems just a few months before the nation was hit with that first devastating outbreak.
“It really taught me humility to the greatest degree,” Sands said. “Being able to sit with an older lady who I’d brought firewood to, who was freezing, but all she had to give me was 3-day-old coffee. She wanted me to sit there and drink it with her. So you do that because you’re there. You’ve got to be in the moment, even though the coffee was horrible.”
While most understand there is no way the Navajo Nation could have known how uniquely brutal the pandemic would be for them, Sands and others admit it has helped the refocus in some very important ways.
“I had been saying for so long that we had to preserve our language or our culture will die. … Once we started seeing the decline and the demise of the old people, we’re like, ‘He was the only guy who knew how to do the ceremony. Did he teach anyone? No.’ So I think what really brought back this sort of revitalization of the culture is we got stuck at home. How are we going to feed ourselves? What if there is no more food at the grocery store?” Sand said.
Some of the lessons of the pandemic were harsh and very personal. Many, like placing more value on traditional ways, were communal.
Baby June has no idea why relatives he barely recognizes cannot wait to hold him.
The 4-month-old grins up at his uncle before being passed from one adoring family member to another as his mother prepares to sell food that will raise money for his grandfather’s cancer treatments. The family cooks, eats and visits outside the food truck owned by Marilyn and Bobby Benally. Their granddaughter, Sophie Hunt, quizzes her young cousin on math problems while they wait for a dish of food, which they share. They crowd Treasha Hunt when it’s her turn to hold baby June.
Above the stove where Marilyn, her sister and June’s mom, prepare blue mash, fry bread, dumpling stew and pigs feet, and beans, Bobby Benally hung a piece of paper on the wall. There, written in blue marker, hanging next to the fire extinguisher, is a reminder of the hope that awaits them on the other side of the pandemic:
A new awakening …
A new beginning.
For the people,
Of the people,
After a long and hard
Pandemic hibernation
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