'Hit us at our core': Vulnerable Navajo Nation fears a second COVID-19 wave

Navajo officials want to use the millions in federal aid money to guard against the next public health crisis, but obstacles stand in their way.

(Ray Farmer / NBC News)

(Ray Farmer / NBC News)

By Kenzi Abou-Sabe, Cynthia McFadden and Didi Martinez
Aug. 3 2020

When the largest Indian reservation in the U.S. was hit by a surge of COVID-19 cases in April and May, it took weeks for federal aid to arrive. By the time it did, Navajo Nation had already begun to flatten its curve, but the virus had exacted a heavy toll. 

“It hit our relatives. It hit people that we knew and love and respected,” area resident Crystal Kee said. “And it has hit us at our core.”

With more deaths per capita than any U.S. state, community members say virtually everyone on the reservation knows someone who has been personally affected by the virus. 

The coronavirus was so devastating on Navajo Nation in part, experts say, because of severely lacking infrastructure on the reservation. An estimated 30 percent of homes don’t have running water, and over half of Navajo communities lack broadband access. Compounding the problem, a lack of healthy food options — there are just 13 grocery stores on land the size of West Virginia — overcrowded housing and high rates of heart disease, diabetes and obesity created a perfect storm for calamity in a pandemic. 

Now, officials and community members want to use some of the $714 million in federal aid they received to prevent a public health crisis of this scale from ever happening again, but two major obstacles stand in their way: onerous regulation that makes construction on tribal land near impossible and a looming deadline that mandates the money be spent by Dec. 30. If the money tribal governments received from the CARES Act isn’t spent by the end of the year, tribes risk having to send it back.

“Don't get me wrong, we are going to get PPEs, but if $714 million is there, we should be able to improve our economy and our communities with that money for the long term,” said Navajo Nation President Jonathan Nez.

Nez wants to spend the money on expanding access to running water and electricity and providing broadband access and more affordable housing on the reservation — in effect addressing the infrastructure gaps that experts said contributed to COVID-19’s deadliness there.

“This money is to combat, yes, the immediate needs of COVID-19, but also for the future. We have no cure. There's no vaccine. So how do we prepare for the future?” Nez said. “If we can get running water to our citizens, it will help push COVID-19 off our nation, and any future virus.”

The stakes are particularly high, experts say, because even though Navajo Nation has had success in containing its COVID-19 outbreak, the states that surround the reservation have experienced surges of coronavirus cases in recent weeks. At one point, Arizona’s infection rate — when adjusted for population size — was the highest in the world.

Cases on Navajo Nation peaked in May, with an average of 104 new cases per day. By July, that number dropped by half to about 48 new cases reported each day. In all, about 9,000 of the roughly 172,000 Navajo members living on and around the reservation have tested positive and more than 450 have died from the virus. 

Local officials say Navajo Nation’s success in flattening the curve has been largely due to three things: widespread adherence to mask-wearing and social distancing, one of the strictest stay-at-home curfews in the country and an aggressive testing regime. 

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Dr. Laura Hammitt, director of infectious disease programs at the Johns Hopkins Center for American Indian Health, administers a test at a COVID-19 "testing blitz" in Tuba City, Ariz. on May 29. (Nina Mayer Ritchie)
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Signs in Black Rock, Ariz. remind people to wear masks and socially distance. Following these protocols was key to flattening the curve on Navajo Nation, experts said. (Nina Mayer Ritchie)
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Dr. Laura Hammitt, director of infectious disease programs at the Johns Hopkins Center for American Indian Health, administers a test at a COVID-19 "testing blitz" in Tuba City, Ariz. on May 29. (Nina Mayer Ritchie)

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Signs in Black Rock, Ariz. remind people to wear masks and socially distance. Following these protocols was key to flattening the curve on Navajo Nation, experts said. (Nina Mayer Ritchie)

But even the most stringent measures could prove ineffective amid spiking cases in Navajo Nation’s neighbors: Utah, New Mexico and Arizona. Cross-border travel is frequent, and it’s not uncommon for people to live on the reservation but work in a border town.

“I watch the Arizona predictive models and New Mexico predictive models, including Texas and Colorado, every day, several times a day, because of the big effect it has on us,” said Dr. Loretta Christensen, chief medical officer for the Navajo Nation at the federal government's Indian Health Service.

Of particular concern is the nation’s intensive care capacity. According to Christensen, Navajo Nation health facilities currently have roughly 40 ICU beds. 

During the first surge of cases in April and May, Navajo health centers were able to transfer the most critical patients to ICUs in neighboring cities like Phoenix, Flagstaff and Albuquerque. That ability was critical to their success in managing hospital capacity and caring for patients, Christensen said. Now, as those cities deal with their own surges, that may no longer be an option. 

“I will be totally honest: It will be a huge challenge to manage that volume of patients in our facilities,” Christensen said. “Do I believe our staff can do it? Yes, they've risen way above all levels of performance, and they've been innovative and adaptive and strong.”

Complicating the risk is the fact that thus far, COVID-19 has proven particularly deadly for Native Americans. They have the highest rates of hospitalization from the virus of any racial group in the U.S., according to Centers for Disease Control and Prevention data.

“This isn't a matter of race, but a matter of institutional racism that has made people at higher susceptibility for infectious diseases and kept them at higher susceptibility for many, many years,” said Dr. Laura Hammitt, director of infectious disease programs at the Johns Hopkins Center for American Indian Health at the Bloomberg School of Public Health.

A child bathes in a sink in Navajo Nation.

A child bathes in a sink in Navajo Nation. According to the Navajo Nation Department of Water Resources, an estimated 30 percent of Navajo Nation's population does not have access to running water. (DigDeep)

A child bathes in a sink in Navajo Nation. According to the Navajo Nation Department of Water Resources, an estimated 30 percent of Navajo Nation's population does not have access to running water. (DigDeep)

“We have a situation here where we have inadequate access to health care, inadequate access to water, inadequate access to basic public health infrastructure that's placed people at higher risk for infectious diseases,” she said.

Experts like Hammitt also point to structural realities contributing to the spread of COVID-19, like the prevalence of one-or two-room homes overcrowded with multiple generations of the same family.

According to a 2011 Navajo Housing Authority report, the number of homes that had more than two persons per bedroom in Navajo Nation is at least six times as high as the overall U.S. rate.

“Certainly there are huge advantages to multigenerational living,” Hammitt said. “That's how traditions are passed. It's how we get to know our culture and our history. But also, in situations like the pandemic, living in small, overcrowded multigenerational homes is the perfect environment for COVID-19 to spread.”

Nez has proposed spending $20 million of the federal aid to build two housing manufacturing facilities on the Navajo Nation, but critics say the likelihood of getting a project like that done and paid for by the end of the year is low.

(Ray Farmer / NBC News)

(Ray Farmer / NBC News)

(Ray Farmer / NBC News)

(Ray Farmer / NBC News)

“My hope is that this pandemic will serve as a call to action for people to finally address these unmet health needs,” Hammitt said. “If we don't heed that call to action, we can't expect anything other than for history to repeat itself the next time.”

In parts of the Navajo Nation like Dilkon, Arizona, where a summer drought is already limiting access to available water, the situation is already dire.

“Water is life,” said Emma Robbins, director of the Navajo Water Project for the nonprofit DigDeep. “If you don't have running water in a country like the United States in 2020, that's a huge issue.”

Robbins estimates DigDeep has installed at least 300 home water systems for families across Navajo Nation within the past four years but said requests for water have only increased with the pandemic. At least 170 families are on a waitlist to receive water systems in the Dilkon area alone, she said.

“Knowing that not having running water is one of the largest issues why the spread of infection is so great,” Robbins said, “it is really hard when you have to say to somebody, ‘I'm sorry, there's still a waiting list.’”

In addition to nonprofit groups like DigDeep, the Indian Health Service also works on expanding water access across Navajo Nation, but its waitlist currently has 3,200 homes, according to the IHS.

Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box

Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box filled with hand sanitizer, masks, and non-perishable food in Lukachukai, Ariz. on June 6. (Nina Mayer Ritchie)

Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box filled with hand sanitizer, masks, and non-perishable food in Lukachukai, Ariz. on June 6. (Nina Mayer Ritchie)

A pump in Dilkon, Ariz., where locals go to haul drinkable water.

A pump in Dilkon, Ariz., where locals go to haul drinkable water, on July 13. Due to COVID-19, the local chapter government that runs the pump only unlocks it for eight hours per week. (Spencer McFadden Hoge)

A pump in Dilkon, Ariz., where locals go to haul drinkable water, on July 13. Due to COVID-19, the local chapter government that runs the pump only unlocks it for eight hours per week. (Spencer McFadden Hoge)

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep.

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep. The Navajo Water Project has installed at least 300 free home water systems for families across Navajo Nation in the past four years. (DigDeep)

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep. The Navajo Water Project has installed at least 300 free home water systems for families across Navajo Nation in the past four years. (DigDeep)

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health.

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health. (Nina Mayer Ritchie)

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health. (Nina Mayer Ritchie)

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Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box

Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box filled with hand sanitizer, masks, and non-perishable food in Lukachukai, Ariz. on June 6. (Nina Mayer Ritchie)

Cherish Tso-Redhouse of the Johns Hopkins Center for American Indian Health delivers a wellness box filled with hand sanitizer, masks, and non-perishable food in Lukachukai, Ariz. on June 6. (Nina Mayer Ritchie)

A pump in Dilkon, Ariz., where locals go to haul drinkable water.

A pump in Dilkon, Ariz., where locals go to haul drinkable water, on July 13. Due to COVID-19, the local chapter government that runs the pump only unlocks it for eight hours per week. (Spencer McFadden Hoge)

A pump in Dilkon, Ariz., where locals go to haul drinkable water, on July 13. Due to COVID-19, the local chapter government that runs the pump only unlocks it for eight hours per week. (Spencer McFadden Hoge)

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep.

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep. The Navajo Water Project has installed at least 300 free home water systems for families across Navajo Nation in the past four years. (DigDeep)

Emma Robbins, second from left, is the director of the Navajo Water Project for the non-profit DigDeep. The Navajo Water Project has installed at least 300 free home water systems for families across Navajo Nation in the past four years. (DigDeep)

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health.

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health. (Nina Mayer Ritchie)

Children in Chinle, Ariz., wait for a delivery of water and supplies from the Johns Hopkins Center for American Indian Health. (Nina Mayer Ritchie)

“I think a lot of people are under the impression that you just dig a hole, and there's water, and there's a well,” Robbins said. 

The reality, she said, is rarely that simple. A maze of regulation — both federal and tribal — makes digging new water lines and building water towers on the reservation incredibly difficult. 

So far, Navajo Nation has only allocated just over $60 million of its $714 million in federal CARES Act money, largely spent on personal protective equipment and hazard pay for its front-line workers. None of a proposed more than $300 million on infrastructure projects has been spent yet, although Nez said there are “shovel-ready” projects they could put the money toward immediately.

“In an ideal world, it'd be great to say, ‘We're gonna take these millions and do X, Y, Z,’ but right now, the president's office is making decisions, and the speaker [of the Navajo Nation Council] is making decisions, and there's a lot of back-and-forth,” Robbins said.

“Where my parents live, we still don't have running water, and I'm the president of the Navajo Nation. So I know that frustration,” Nez said.

Diante Thomas washes his hands at a handwashing station set up by volunteers for the Johns Hopkins Center for American Indian Health. Thomas lives in Chinle, Ariz., in a home with no running water. (Ray Farmer / NBC News)

Diante Thomas washes his hands at a handwashing station set up by volunteers for the Johns Hopkins Center for American Indian Health. Thomas lives in Chinle, Ariz., in a home with no running water. (Ray Farmer / NBC News)

Diante Thomas washes his hands at a handwashing station set up by volunteers for the Johns Hopkins Center for American Indian Health. Thomas lives in Chinle, Ariz., in a home with no running water. (Ray Farmer / NBC News)

Diante Thomas washes his hands at a handwashing station set up by volunteers for the Johns Hopkins Center for American Indian Health. Thomas lives in Chinle, Ariz., in a home with no running water. (Ray Farmer / NBC News)

Because most tribal land is held in trust, and technically owned by the federal government, development on many tribal lands is fraught with complications.

“You have to jump through so many hoops in order for development to occur. We have to get the Bureau of Indian Affairs on board, Department of Interior, the White House,” he said.

“In order for us to build a highway here, a paved road, it takes $2 million to $3 million to pave one mile of road here,” he said. “And it's because we can't even use the material on our land, our rock, our soil, to build and create a paved road. We have to import that off the Navajo Nation.”

Nez conceded that tribal law also severely restricts infrastructure development on the reservation, but he also said there are concrete federal regulations that can and should be waived to allow for construction. In early June, the tribal government sent a white paper to the White House that proposes waiving certain federal regulations so the tribe can fast-track development projects. So far, Nez said, they have not heard a response. 

“Now is the time to change these regulations and policy. The window is open. Let's take advantage of that,” he added.

White House spokesman Judd Deere said the letter from Nez has been shared with the “relevant agencies” and some of the recommendations have already been addressed.

“We continue to review the other recommendations and appreciate this sort of feedback as we continue to identify ways to put people over paperwork and improve our nation’s infrastructure,” Deere said.

U.S. Rep. Tom O’Halleran, D-Ariz., has introduced a bill to extend the spending deadline for tribal governments to Dec. 30, 2022, a move Nez said would help.

But some locals without running water told NBC News they doubt anything will really change. 

“I think we're abandoned, pretty much,” said Katherine Paymella, a traditional weaver.   

Paymella, 59, lives on a homestead in Black Rock, Arizona, so remote that when the access road is muddy, she said it takes about two hours to drive to the nearest convenience store. She said she got electricity about a decade ago, but after years of attending fruitless community meetings, she’s given up hope on ever getting running water.

Katherine Paymella, 59, lives in Black Rock, Ariz., in a home with no running water.

Katherine Paymella, 59, lives in a home with no running water in Black Rock, Ariz. Paymella said her home was hooked up with electricity about a decade ago, but she has begun to lose hope that she will ever receive running water. (Nina Mayer Ritchie)

Katherine Paymella, 59, lives in a home with no running water in Black Rock, Ariz. Paymella said her home was hooked up with electricity about a decade ago, but she has begun to lose hope that she will ever receive running water. (Nina Mayer Ritchie)

In the meantime, the human toll of COVID-19 builds. 

Jeneda Benally lives in Flagstaff, Arizona, just outside the reservation’s recognized borders but within what’s considered ancestral Navajo land. 

She’s already lost multiple relatives to COVID-19, and she is determined not to lose her father, Jones Benally, a traditional medicine man and hoop dancer. Jones, who is in his 90s, has traveled the world showcasing Navajo culture and was one of the first traditional medicine men to work at a Western medical facility. His daughter calls him an “Arizona living treasure.”

Benally and her brother Clayson make up the Navajo rock band Sihasin and are drawing on lessons of resilience left behind by their grandmother, who survived the 1918 Spanish flu. 

The siblings have spent their quarantine devising ways to pass down the oral traditions that are at risk of being lost every time a Navajo elder dies, making YouTube videos where they share traditional sheep-shearing tips and explaining the medicinal properties of plants in the area.

Sometimes, Benally said, it feels like an uphill battle.

“Right now, people are dying because whether or not they've lost a loved one to the pandemic, they have also lost what was normal to them,” Benally said. 

“COVID-19 has opened the world's eyes to the conditions that Indigenous peoples in America, in the United States, face and have faced for so long,” Benally said. 

She’s hopeful that all the attention on what they’ve lost will open doors for positive change.

“We need systems that invest in our people, that are not Band-Aid solutions but really, truly invest in the strength and the resilience of our people,” Benally said. “We don't ever want to go back to what the normal was for Indigenous peoples on the Navajo Nation. We have to do better.”

Shiprock Peak, located in the portion of Navajo Nation that straddles New Mexico, is a rock formation with deep cultural significance to the Navajo people. (Ray Farmer / NBC News)

Shiprock Peak, located in the portion of Navajo Nation that straddles New Mexico, is a rock formation with deep cultural significance to the Navajo people. (Ray Farmer / NBC News)

Julia Ingram and Spencer McFadden Hoge contributed.