Since its arrival in the U.S. more than 19 months ago, COVID-19 has repeatedly challenged public health efforts. The crisis was initially concentrated in large cities, but inevitably reached rural areas and soon proved a threat to Americans across the country.
Native Americans in particular struggled with a disproportionate death toll—dying from COVID-19 at approximately 2.4 times the rate of white Americans. When U.S. daily infections reached all-time highs in early 2021, tribal lands were among the hardest hit. Much of this disparity was driven by poverty and other social determinants of health that continue to negatively impact the Native American population.
Today, however, Native American communities are leading the way in vaccination and the battle against the highly infectious COVID-19 Delta variant. The Navajo Nation specifically has fully vaccinated 70 percent of its eligible population against COVID-19, far outpacing the rest of the country, according to the Los Angeles Times. Currently, 60% of the eligible U.S. population is fully vaccinated.
The DO spoke with Matthew Nelson, DO, an Arizona physician who practices within the Navajo Nation, to learn about his experience serving the tribal community before and during COVID-19.
How much has changed in the Navajo Nation since the deadly winter surge of COVID-19?
The Navajo Nation has seen a slow and controlled release of COVID-related restrictions from those implemented at the peak of the pandemic. During the highest level of restriction, measures like mask mandates, limits on gatherings, curfews and checkpoints were common.
Since then, such things have loosened; life is not fully back to normal but many activities have resumed with caution. Health care infrastructure has greatly improved, especially telemedicine visits for lab reviews, medication renewals and other applicable forms of patient care.
Due to the recent resurgence of COVID-19 in the U.S., the Navajo Nation recently shifted its public health measures back to the slightly more restrictive Orange Status, with limitations on family gatherings and stricter mask mandates.
The Navajo Nation currently leads the U.S. in vaccinations by a significant margin. What do you think were the reasons for such success?
There are a couple of reasons. The Indian Health Service is a federally structured and federally funded entity, and had centralized access to COVID-19 vaccines early in the national rollout. The Navajo Nation made quick use of its ready supply of vaccines through mass distribution efforts.
In general, the Indian Health Service and the U.S. Public Health Service tend to attract providers with a public health background, so we know our communities well and conducted the appropriate outreach when the vaccines arrived.
Our public health nurses had an especially effective structure in place for reaching patients where they were. Access to trusted doctors also contributed to the overall effort of getting more shots in arms.
Lastly, the sheer amount of loss that Navajo families faced during the initial COVID-19 surge and the peak surge likely put the pandemic into perspective for many individuals, and gave the community a greater sense of urgency when the vaccine became available.
Vaccination is currently the most recognized form of preventive health care, but what is the state of preventive health care in general and why is it important for rural and tribal communities?
Preventive health care is one of the more difficult efforts in overall health care. Here in the U.S., it is one of the least emphasized areas of medicine, despite its role in greatly improving patient outcomes. Underprivileged communities in particular need preventive health interventions. Poverty, along with unemployment, is rampant in the Navajo Nation.
The poverty is structural here, as the barriers to building personal equity are difficult to overcome. These conditions naturally exacerbate health disparities.
Meanwhile, our health care system readily reimburses treatment for illnesses, but physicians and health departments are often underfunded when it comes to initiatives designed to address the social determinants of health. Progress is being made, but much more has to be done.
What else would you like to share about your tribal health experience?
The work is rewarding but difficult. It becomes tiresome to push against the structural barriers and disparities mentioned before. However, when you are able to make a difference it is an incredible experience. Some physicians come here for student loan forgiveness, but many more public health-minded physicians come here to change health outcomes. As much work as it is, this is what we were trained for.