As much of the country was contemplating whether or not to have a Thanksgiving gathering, residents of New Mexico were once again bracing for a stay-at-home order, starting in the second half of November, as COVID cases soared and hospitals reached near capacity.
While the whole state is dealing with a second wave, the pandemic has affected native americans in New Mexico at an alarming rate. This population represents a total of about 11% of the state total, yet they account for 17.26% of all COVID-19 cases.
The numbers become even more chilling when looking at the total number of deaths, as the percentage of Native American and Alaska Natives (AIAN) is almost half. Even by national standards that is notably high: the US average number of COVID-19 AIAN deaths per 100 people is 85, but that number jumps to 290 when looking at New Mexico alone.
The chart below shows the total numbers of deaths by race in New Mexico. About 44.66% of were American Indian/ Alaskan Native. The second most significat category is Latinx, followed by white.
“I feel like it’s almost criminal to let them die at such a high rate,” Jagdish Khubchandani, Professor of Public Health at New Mexico State University said.
Systemic issues that lead to poor healthcare and lack of access to basic services have put these communities at a disadvantage from the outset of the COVID-19 pandemic.
“Pandemics are not made in a day. Pandemics are made in decades. And preparedness is also not done in a day,” Khubchandani said. “[New Mexico] was a poor state before the pandemic, one of the poorest with such a diverse population that had chronically underfunded health systems. I think what we have is the sin of the past punishing us now. We have never prepared to deal with the pandemic nationwide. And with these populations, we didn’t have the outreach, the extension, the messaging methodology.”
Abigail Echo-Hawk, M.A., Director of the Urban Indian Health Institute (UIHI) and chief research officer of Seattle Indian Health Board has been advocating for the importance of better systems of data collection pertaining to American Indian and Alaska Native communities.
“We have seen an underinvestment of public health systems and public health surveillance systems for many many years and we are seeing what happens when you don’t invest in public health,” Echo-Hawk said. “I feel like screaming about this for more than twenty years, because we knew this kind of impact was happening in our communities, and for the very first time people are finally acknowledging it.”
The data for New Mexico seems alarming, but Echo-Hawk says the situation may be even more dire. The actual amount of AIAN population affected might be even higher, because of racial misclassification resulting in underreporting of race and ethnicity data for American Indian Alaskan Native population. A 2014 study by the CDS and Indian Health Service (IHS) found just this: that there were “significant underestimates” of mortality estimates within the AIAN population.
“So when you talk about the incredible amount of death that is showing on the current data trackers what we have to know is that is actually in a very horrific way a gross underreporting, because we know that death certificates are very often racially misclassified,” Echo-Hawk said. “There’s a very common saying for those of us that work in Indian country on data is that we are born native and we die white, because we are racially misclassified on death certificates.”
This underrepresentation is a result in part of faulty racial classification systems in place in hospitals, according to Echo-Hawk.
“People instead of asking race and ethnicity will look at somebody who’s checking into a clinic, who’s come in for an appointment, being hospitalized or has died and decide what race or ethnicity they are without asking families and not asking the individual,” she said.
Even just generally, many counties and states fall short of collecting all the necessary health data in order to keep track of how different communities are affected. In some cases, only a few options will be available for race — mixing all the rest together and doing so erasing the remaining ones from view.
“The ‘other’ category effectively hides all other racial and ethnic groups,” Echo-Hawk said. “I call that a trash category. It is meaningless, it shows nothing and is an excuse for jurisdictions to say ‘well, we did our best’. That is effectively creating a category that hides the disparities of racial and ethnic groups.”
To understand the devastating effects of the pandemic on the AIAN population, Khubchandani says we have to look at both pre causation factors and pandemic response issues.
“Much of what’s happening now with these populations and New Mexico is because of the historic underfunding and being historically marginalized,” Khubchandani said. “These are people who have very poor air quality. They don’t have water to wash their hands. They don’t have the resources and the money to buy materials, and they are getting sicker at a younger age, dying at a younger age than the national average. In part, because they have so many medical complications: high amount of diabetes, hypertension… which is related to poverty, the type of occupations.”
These health disparities are directly connected to the pandemic outcomes.
“These marginalized populations are more likely to not only contract Covid, but to have extreme complications and to die,” Echo-Hawk said. “Health disparities are based on your socio-economic environment: Whether or not you have access to transportation, whether you have access to housing, whether or not there’s been gentrification in your neighbourhood, whether or not you’re homeless.”
Access to healthcare is harder, not only because of geographic factors, for many who live in more remote areas, but also cultural reasons. This means many of the COVID patients from AIAN communities who reach the hospital will already be in a more severe condition.
“Imagine if you have fever right now and you have to go 15 miles to see a doctor, most likely we’ll just let it go,” Khubchandani said. “Most of them seem to be living in areas where there’s no healthcare. So it could be an urban neglected area or a tribal area where there’s no health care. And then it’s hard to reach out to the community. They have their own clanship and clan systems where they heal each other. Traditional medicine outreach has been weak.”
Communication is also a major issue, Khubchandani warned. “Not everyone understands English. Not everyone understands the seriousness of the pandemic,” he said, pointing out Texas — “a state with a large proportion of Hispanic people” — as an example. “They don’t even care to translate messages into Spanish or other languages or plan special communication strategies.”
While Khubchandani believes New Mexico has fared somewhat good in terms of communication, there is still a lot to be desired, especially when it comes to reaching out to people living in remote areas, who for example might not have a cellphone or speak English.
Entities such as the Indian health service, which falls within the Department of Health and Human Services, play a crucial role in this outreach, but their jobs are hindered by the resources they lack.
“They have tried to do some word of the mouth, local flyers and local info, but it’s not been aggressive enough,” Khubchandani said. “They have to be very aggressive. But that’s a difficult population to reach out to.”
Still, the professor believes that, while it’s one of the poorest states in the country, New Mexico’s overall response to the pandemic, on a larger scale has been exemplary when compared to other states — especially given that it’s working with very limited responses. The governor’s action has been stern, taking extreme measure when needed.
“I think New Mexico again is a role model, (…) given so many pre existing disadvantages, whereas I think there are places that had so much advantage and they messed up,” he said. “We have hard populations to reach out to. Navajo nations are not easy to deal with. But still they did what they could.”