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IHS shoring up capacity, testing, tracing


While states like Arizona prepare to reopen, the Navajo Nation president’s office on Tuesday extended the emergency order until June 7 on the advice of health officials.

“We’re very busy here and we’ve been hit very hard with COVID in Navajo Area,” said Dr. Loretta Christensen, chief medical officer for Navajo Area Indian Health Service on a recent regional IHS media call. “Our emergency operations center is working 24/7 to constantly review, prepare, adapt and provide resources to serve our Navajo population.”

Christensen said multiple factors that have resulted in the high numbers across Navajo.

While she said social distancing has been supported throughout the Nation, practicing it is challenging when 30 percent of homes don’t have running water and multi-generational families are living in the same house.

“We are seeing a lot of clusters of cases in the same families from the same household,” said Christensen.

Navajo Area IHS has almost doubled inpatient capacity from what it was prior to COVID-19 and have added three alternate care sites, in Gallup, Chinle and Shiprock, she said.

These “stepdown” facilities for those who do not need full hospital services will be helpful in bridging treatment until patients can be discharged to home or temporary housing.

“This allows us the ability to decompress the acute care needs of our hospitals by placing patients in an environment where they can continue to receive oxygen therapy, medicine and care,” she said.

Christensen said typically across the country, about 20 percent of coronavirus patients will require in-patient care.

“Our concern is that we will reach our limits of space and personnel,” she said.

Peak in cases

Christensen said on April 30 that she expected to see the full peak of the virus for Navajo around mid-May.

A request to Christensen for confirmation as to whether Navajo is now past peak or if the projected peak is still ahead was not responded to on Wednesday.

Christensen says overall they are seeing a fairly even distribution of cases across the Navajo Nation with a few exceptions.

“In the Gallup area, we saw a sudden large jump due to some of the unsheltered population being exposed in a congregate situation,” said Christensen. “We had a lot of positive cases from that one event that really increased Gallup/McKinley County’s numbers.”

Christensen said the Navajo Area EPI response teams continue to work very hard.

“We are out tracing and have been for some time,” she said. “We are working on community mitigation.”

While Christensen said that there is a robust EPI surveillance team on Navajo, many chapter officials say they have not seen them in their communities even though there are COVID-19 positive cases.

A request on Tuesday for more information about how many EPI teams and contract tracers were deployed on Navajo was not responded to by NAIHS or the Navajo COVID-19 Health Command Operations Center.

IHS Public Affairs Director Jennifer Buschick did say on May 7 that the Navajo Area IHS epidemiology response teams are working to increase capacity for testing and the number of staff to conduct contact tracing.

“Due to the contagiousness of the virus, most contact tracing takes place through telephone interviews,” said Buschick.

In an Eastern Agency call two weeks ago, NAIHS Director Roselyn Tso also stressed that continued testing and contract tracing is extremely important in containing the spread of the virus.

`Tso said other critical issues she has been working on are water and sanitation services, expanding patient capacity at IHS sites, acquiring rapid test kits, and securing hotel and other facilities for unsheltered and other COVID-19 positive individuals who might not need to be hospitalized, but need a place to self-isolate.

“I need space right now,” she said. “If we’re asking someone to self-isolate, we need to give them a safe place to go and make sure they have food. We need to find every alternative possible.”

Boosting funding, resources

“The challenge with an emerging pandemic like this one is we’re learning more and more each day about this virus so it requires being nimble in planning and preparations,” said Rear Admiral Michael Toedt, M.D., IHS chief medical officer.

He said the IHS remains resolute in responding to the COVID-19 epidemic through partnership with tribes.

“We announced last week that we have already distributed over a billion dollars for coronavirus response with input from tribal and urban Indian organization leaders,” said Toedt. “These resources are key to prevention, detection, treatment and recovery.”

According to Buschick, “a total of $112,837,174 has been allocated to the Navajo Area to prevent, prepare for, and respond to the coronavirus pandemic.”

This includes $76,571,067 for service units, $34,826,766 for the Navajo Nation and tribal health organizations and $1,439,341 for urban Indian organizations, said Buschick.

Jillian Curtis, IHS director of finance and accounting, said everyone is working as fast as they can to rapidly disperse COVID-19 funds to the Indian health system and maximize support to the front lines of the pandemic.

Toedt confirmed they are working to find ways to expand testing, which he expects will lead to an increase in the number of positive cases reported.

He said risk factors for COVID-19 infection include those who are elderly or have chronic diseases, including asthma, COPD, diabetes, high blood pressure, which appear at higher rates in American Indians.

While the susceptibility to the virus is the same across all populations, he said, the risk of severe outcomes is higher in Native American communities.

Toedt said they are expanding telehealth services across IHS to allow more people to access health care they need from their home, without worrying about putting themselves or others at risk.

On May 12, the Federal Communications Commission Wireline Competition Bureau approved $954,990 to the Navajo Nation Department of Health for the COVID-19 Telehealth Program, authorized in the CARES Act.

The monies will be used to provide home health care and services, especially to patients who are isolated, low-income, elderly, and high-risk.

‘Most of the population will be exposed’

Dr. Henry Walker, a director at the Centers for Disease Control and Prevention, said the CDC is actively engaged in the “whole-of-government plan” to reopen America “safely and efficiently.”

‘The CDC is committed to helping state, tribal and local health departments in through a variety of efforts,” said Walker. “We are deploying field teams to support epidemiology, community mitigation, infection prevention and control and laboratory needs.”

The CDC has deployed two field teams to the Navajo Nation, said Walker, to support isolation of new cases and appropriate quarantine of contact.

The CDC’s spending plan for tribes includes $206 million in congressional COVID-19 supplements, he added.

“In the coming months, we believe most of the population will be exposed to this virus in some way,” said Walker.

Buschick said NAIHS is in close communication with Navajo Nation leadership and the Navajo Nation Health Command Operations Center team on all COVID-19 emergency response activities.

As far as providing adequate personal protective equipment, Buschick said Navajo Area and the IHS National Supply Service Center “are using every available avenue to secure sufficient personal protective equipment and supplies to meet demands.”

Capt. Rob Hayes, director of the IHS National Supply Service Center, explained that his organization is responsible for pharmaceutical and medical supply delivery during health emergencies and pandemics.

The NSSC has been distributing PPE, respirators, and rapid tests to IHS facilities, he said.

“We’re working tirelessly to get those supplies to the front line and keep our providers safe so they can take care of our patients,” said Hayes. “We have all the equipment we need. Like the rest of the country, PPE like masks and gowns are difficult to get but we have been successful in being able to stock all of our service units and clinics.”

The Navajo Nation has suffered a sever shortage of PPE, especially on the front lines of the coronavirus crises, which has launched many independent fundraising campaigns and mask and gown sewing campaigns who are helping to augment supply.

Buschick expects an approved antibody test for SARS-CoV-2, the virus that causes COVID-19, will available on Navajo in the next couple of months.

However, she said it is still not known if the antibodies that result from COVID-19 will provide anyone with immunity from a future infection.

“The best tool we have against COVID-19 is still social distancing and decreasing exposure to others,” said Buschick.



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