In the United States, people of color have been disproportionately impacted by the coronavirus pandemic, and Native Americans are no exception. According to the Centers for Disease Control and Prevention, American Indian and Alaska Native people are 5.3 times more likely than white people to be hospitalized due to COVID-19, the largest disparity for any racial or ethnic group.
There are myriad reasons why Native Americans are particularly susceptible to the virus, including social inequities and disproportionately high rates of preexisting conditions – such as diabetes, heart disease, asthma and obesity – that can put them at extra risk of severe illness. Many also live in multigenerational homes with large families, which can make social distancing a challenge.
Access to quality health care is also an issue. The Indian Health Service, the federal agency that provides health services for many American Indians and Alaska Natives, is chronically underfunded and under-resourced. In 2018, most of its hospitals reportedly were operating with fewer than 50 total beds, while the agency had about 20% fewer doctors than what it believed was ideal.
While experts acknowledge the situation is dire, it’s impossible to know COVID-19’s true toll on the Native American community. Coronavirus data by race and ethnicity is notably incomplete; in late September, states reported race and ethnicity for just 74% of coronavirus cases and 89% of deaths on average, according to data from The COVID Tracking Project, a volunteer-run platform supported by journalists, scientists and other researchers.
Inconsistencies in how race and ethnicity are identified in states’ reporting of COVID-19 cases and deaths also limit analysis and understanding, with American Indians or Alaska Natives sometimes grouped into a broader category classification. And tribes themselves are not required to report all of the data they collect to the state.
U.S. News compared coronavirus case rates and death rates among American Indians and Alaska Natives with those among whites in 31 states that report race data consistent with Census Bureau classifications. The analysis used data from The COVID Tracking Project through Sept. 27, along with population figures from the Census Bureau’s 2018 American Community Survey 5-year estimates.
Coronavirus case rates among American Indians and Alaska Natives were higher than among whites in 23 states. The case rate was more than four times higher in five of those states: New Mexico, Montana, Mississippi, Oregon and Arizona. In New Mexico, where part of the hard-hit Navajo Nation is located, there were 3,624 cases per 100,000 American Indians/Alaska Natives, more than 15 times as high as the rate of 234 per 100,000 whites.
Similarly, coronavirus death rates were higher among American Indians and Alaska Natives in 15 states.
The map below breaks down the disparities in case rates and death rates by state, for those cases in which race and ethnicity were identified.
In Minnesota, where U.S. News used support from the Solutions Journalism Network to explore how one Chippewa band and a medical clinic serving Native Americans were tackling COVID-19, American Indians have so far avoided the kind of crisis witnessed by their peers elsewhere.
Jackie Dionne, American Indian health director for the Minnesota Department of Health, says state officials and tribal leaders anticipated the disproportionately deadly effect the coronavirus could have on American Indian residents. And, she says, because elected tribal leaders knew that coronavirus cases in their communities would likely be severe, they worked together to emphasize preventative measures that would limit the virus’ spread and minimize the strain on hospitals.
“We’ve been working really diligently to test, contact-trace, investigate and quarantine as much as we can,” says Dionne, a member of the Turtle Mountain Band of Chippewa Indians in North Dakota. “There was a big push made by tribal elected leaders to wear a mask, to not gather for sake of keeping our elders safe.”
Yet the picture in Minnesota is still far from rosy. While the coronavirus case rate among American Indians there was only slightly higher than among whites as of late September, American Indian and Alaska Native people have been nearly twice as likely to die from COVID-19 than whites in the state.
A boy holds a kitten in Oljato-Monument Valley, Utah, on the Navajo Nation in April.(Carolyn Kaster/AP)
“We’re not hearing tribes concerned about hospitalizations, but most of our American Indian population doesn’t live on reservations,” Dionne says. “But we are seeing it, in urban areas, in the homeless population. It’s a really precarious situation.”
Generally speaking, however, experts say Minnesota – and the entire Upper Great Lakes region – is faring better than other areas of the country in terms of infection rates among Native Americans. In fact, in the Bemidji Area of the Indian Health Service, which supports tribes and urban health programs in Illinois, Indiana, Michigan, Minnesota and Wisconsin, only about 3.5% of coronavirus tests had come back positive as of early October, far less than the national rate of 8% in late September.
“I get the impression [Minnesota tribes] are doing fairly well compared to other parts of Indian Country,” says Minnesota Lt. Gov. Peggy Flanagan, who is a member of the White Earth Nation of Ojibwe, a band of the Minnesota Chippewa Tribe. “We are certainly seeing that Black, native and communities of color are disproportionately impacted by COVID, but I would say, broadly speaking, that by partnering with tribes we’ve done a fairly good job in keeping the infection rates low and manageable.”
“We still have issues with the urban native community and making sure we are supporting our tribal members in the Twin Cities, but broadly, we’ve done OK.”
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to reporting about responses to social problems. Devon Haynie contributed reporting to this article.