A little wiser, Western Navajo, Utah brace for 2nd wave

By Krista Allen
Special to the Times

KINŁÁNÍ-DOOK’O’OOSŁÍÍD AND TÓNANEESDIZÍ

When Dr. Diana Hu informs someone of their positive coronavirus test result, they usually get really quiet and then remark, “Oh.”

But others remark that they are feeling fine.

Perhaps that person became infected — but symptom-free — after attending a funeral. That person spreads it to their children and to their spouse who spreads it at their workplace.

The children may think they are fine, and they visit with their friends.

“You can see how this multiplies so quickly,” said Hu, a pediatrician at Tuba City Regional Health Care Corporation, where she is a member of the Epidemiological Response Team. “So, by having them all get tested, we can lock them down. The message appears to be different to people. We have to change that behavior.”

Symptomless transmission makes COVID-19 far harder to fight than other diseases in which symptoms show up almost immediately. The Centers for Disease Control and Prevention estimates that 40 percent of people infected with COVID-19 are asymptomatic and the chance of transmission from people with no symptoms is 75%.

“We have some people who are coming back from … construction work and who are coming back from traveling – stuff like that,” Hu said in a recent virtual COVID-19 update with the Tuba City Service Unit area.

“That puts you at risk as well,” she said. “But what we’re really concerned about … is it takes just one person entering into these extended family households to spread it really rapidly.”

Hu said once a person tests positive for COVID-19, TCRHCC’s contact tracers go to work to identify and isolate those who have contracted the virus.

“We need to … not have any gatherings at all,” said Dr. Sophina Calderon, a family physician and the deputy chief of staff at TCRHCC, where she is also a member of the Epidemiological Response Team.

“Even if brothers and sisters who live in a different house – usually you get together and have your (holiday) meal together – that shouldn’t be happening,” she said. “You’ve got to stay within your own household and have your own (holiday) dinner with your household. But don’t gather all of your siblings and their kids together because that’s when the risk goes high.”

Calderon said she and her colleagues at TCRHCC are seeing coronavirus clustering within families with children. This happens, she says, when people gather for a family function.

“It takes just one person who might not be symptomatic yet at the time to show up to dinner and then they spread it to everybody,” Calderon explained.

Hu added that the people – elders and those with underlying medical conditions – who are at a higher risk of getting severe COVID-19 disease are the ones who really understand coronavirus transmission and its health impacts.

“They say, ‘I don’t want to get sick. I’m not going to somebody’s house,’” Hu said. “It’s the healthy people (who) we’re detecting (now). Some of them get unhealthy unfortunately. That’s where we’re getting cut down at the knees.”

Cases surge

The Arizona Department of Health Services reported 3,840 new cases and 52 new deaths on Wednesday morning, including 69 new cases and two new deaths for Coconino County and 40 new cases and one new death for Navajo County.

The Navajo Nation Department of Health reported 104 new cases and three new deaths on Tuesday. The ongoing increase in coronavirus cases and hospitalizations come as the state’s health system tries to handle the new COVID-19 wave.

“As we’ve all seen across the country, COVID is increasing,” said Flo Spyrow, CEO of Northern Arizona Healthcare. “And it’s also increasing in Arizona, although at less rates and not as fast as other states across the nation.

“However, we continue to be concerned as we’re watching our rates in both Coconino and Yavapai counties,” she said, “and the effect that this is having on the health of our communities.”

Northern Arizona is in the third surge of coronavirus infections, said Dr. John Mougin, the chief quality officer at NAH. The first surge was in April and in May, when the rest of the state was not experiencing a surge.

“We then mirrored the rest of the state, especially Maricopa County in late June when we surged again,” Mougin explained. “And now, we’re – along with everybody else – seeing our third surge.

“In Flagstaff, we’re actually seeing more positive COVID than we were seeing at the beginning of June,” he said. “We’re a little bit higher on daily census as far as that goes.”

Mougin said NAH is using the Arizona Surge Line, a 24/7 toll-free call line that acts as a doorway for clinicians to facility transfer centers and independent critical care and palliative consultants. The Surge Line works with contractors to maintain a nearly real-time surveillance of all hospital bed and ventilator availability across the state.

Mougin said it’s a little bit different in the third surge. When the Surge Line first started, NAH was able to use it to its advantage, including transferring patients from the Native nations – such as Navajo and Hopi – to Phoenix and other health care facilities.

“Now though, we’re seeing a surge throughout the entire state,” Mougin said. “So the Surge Line is still an effective tool since we’re all going up together. (But) not as much as other states at this time. We’re keeping a lot more stuff local than we were back then.”

Josh Tinkle, the chief administrative officer at NAH, said he and his colleagues are seeing a positivity rate of 5.4% for all patients who are tested at NAH hospitals.

“We just want everyone to know the surge is coming again,” Tinkle said. “We’re taking the appropriate steps to heighten our visitor restrictions again for the safety of not only our patients here (Flagstaff) in the hospital, but also our staff members.”

Tinkle said even though NAH is prepared to activate its surge plan when appropriate, the biggest challenge would be finding the staff to take care of COVID patients.

“We’ve partnered with some firms to get travel nurses and our firm that we work with currently has 20,000 open nursing requests across the country,” Tinkle explained. “As you can imagine, as other states surge across the Midwest, everyone is looking for caregivers to provide the care.

“Currently, we’re OK,” he said, “but certainly if it spiked to the 50 or the 60 percent positivity rate that you’re seeing in other states, it would be a challenge for us.”

Dr. Derek Feuquay, the chief medical officer at NAH, said he and his colleagues are starting to see a lot more patients from the county and the Navajo and Hopi nations, as well as other surrounding communities.

“But we are definitely seeing more in Flagstaff, more than we’ve ever have,” Feuquay said.

Spyrow added that looking ahead, she’s concerned about her employees now that the COVID-19 metrics are showing an upward trend in communities where they live.

“Where COVID’s gotten really bad is where there’s been a combination of community spread,” Mougin said, “causing lots of cases to come to a hospital and then staff being subjected to the virus either in the community or at work and getting sick.

“And when you don’t have enough staff – because you’ve got to keep them home for (up to) 14 days — that’s the threat to continuing to deliver the care you need for COVID and non-COVID illness in your facility,” she said.

Calderon agrees, saying just as TCRHCC was struggling at the beginning, she and her colleagues could start to see hospital beds taken up by COVID-19 patients soon. But the TCRHCC staff can handle only so much.

“We need to make sure we have enough (physicians). We need to make sure we have enough nurses,” Calderon said. “Early on in the pandemic we had a really, really tough time with getting enough nursing staff … to keep all of our patients here and take care of our own patients.

“Now, we’re running into a number of issues with our nursing staff as well,” she said. “And trying to make sure that we staff (the hospital) very well to keep as many patients as we can.”

Calderon said it’s tough when COVID patients arrive at TCRHCC and they have to be sent away because either there aren’t enough hospital beds or because their disease is severe enough that the hospital staff cannot help them in Tuba City.

“It’s a really tough time for families to kind of have to go through that,” Calderon said. “And we really, really have to get on this to keep our beds available for the sick people we need to take care of.”

Tuba City’s Rt, pronounced r-naught, is around 3, according to Hu. That means each sick person is infecting an average of three other people.

Values over 1.0 mean more cases are expected in the area. Values under 1.0 mean cases are expected to be fewer. Arizona’s Rt is 1.04 as of Dec. 2, according to the national Rt live website.

“R-naught tells you how quickly this spread,” Hu said. “The r-naught for this coronavirus is probably 3. That’s high! That’s bad! Regular flu is like 1. Measles is super high, but we have a shot against measles. But this is 3!

“That means for every person who is infected, they are likely to spread it to three more people. Think about that. We also know that Native Americans are two-and-half times higher at risk of getting infected – just from our stats.”

Tinkle added that this month and in January would potentially be the peak.

“What we’re asking of the (communities) must be like we did in April, May, and in June: Social distance; sanitize and wash your hands; wear your masks,” Tinkle said. “That’s going to help us out more than anything. And predicting that peak really depends on how well the community does in following those precautions.”

Utah Navajo

The Utah Department of Health reported a total of 198,216 cases of COVID-19 with a total of 638 cases for the Utah Navajo Health System as of Dec. 1.

The COVID-19 cases in the Naatsis’áán-Rainbow City and in the Paiute and Navajo canyon communities remain steady, according to Revina Talker, the provider at Navajo Mountain Community Health Center.

“All of the transferring people out has been difficult because all the hospitals in Albuquerque and even here in Utah, they’ve all reached capacity,” she said. “Sometimes when we want to transfer someone out, we have to wait hours.

“But we just call and call, and it’s been really frustrating,” she said. “And it’s really sad too because people are really sick. And trying to get them to the right facility can sometimes be really difficult.”

Amanda Begay, a licensed practical nurse in Oljato-Tsébii’ndzisgaii, said there is an increase of people who tested positive for COVID-19 in Utah Navajo.

“Now, we see an incline,” Begay said. “And more patients are coming into our facility who are experiencing symptoms.”

Many Utah Diné use dietary therapy and herbal medicine for virus prevention, said Albert Holiday, vice president of the Oljato-Monument Valley Chapter.

“Some of the people out here, they gather herbs to drink and to use,” Holiday explained, “our own traditional medicine that we use. Some (of the people here) know how to do it.”

Holiday added that seeing the losses to COVID-19 and the cost in lives lost every day still climbing scares him.

“Our ancestors told us that this herb is the medicine you use when something – a health pandemic – happens like this,” Holiday added. “When I was (a child), my (late) grandmother and parents knew this would come. They said, ‘A pandemic is coming, so be aware of it. Be aware that there will be no food.’ So, they told us to plant crops and raise livestock, raise sheep.”

“I think that’s all true,” Josh Tinkle said. “I think we learned early, trial by fire, how to set up and be prepared for a pandemic. I think we know the recipe of how to do it. I don’t think overreacting is going to be helpful in the situation. I think we found a much calmer approach.”

Tinkle added that this is what works: Handwashing, social distancing, and mask wearing.

“And having adequate, appropriate personal protective gear for our staff is kind of the recipe to get through a pandemic,” Tinkle added.

But there is some hope with COVID-19 vaccines on the horizon, said John Mougin.

“But man, we’re going to have a tough time before we get enough of the population immunized to really get a handle on this thing,” he added. “We have a long way to go.”

Flo Spyrow added, “Continue masking, continue social distancing, washing your hands, stay home if you’re sick, and really evaluate family gatherings and how those might be held. I think the holidays will be really important to keeping our communities safe as well as supporting our efforts here to be able to treat everyone from our communities who need healthcare.”

---