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COVID-19 Infections and Deaths Among Natives Are Underreported. It’s Time For State Health Departments To Step Up.

While 80 percent of state health departments are recording race as part of their COVID-19 statistics, around half are not including Natives and are simply labeling them as “other.”

A nurse checks vitals at a COVID-19 testing center at the Navajo Nation town of Monument Valley in Arizona on May 21, 2020.
Photo illustration by Elizabeth Brown. Photo by Mark Ralston/AFP via Getty Images.

COVID-19 Infections and Deaths Among Natives Are Underreported. It’s Time For State Health Departments To Step Up.

While 80 percent of state health departments are recording race as part of their COVID-19 statistics, around half are not including Natives and are simply labeling them as “other.”


This piece is a commentary, part of The Appeal’s collection of opinion and analysis.

I come from a learned people. My ancestors studied the stars, medicinal plant uses, ecology, and wildlife, and while we practice an oral tradition, we keep historical records, too. 

Ancient medicine wheels were lunar calendars that marked the seasons and predicted astronomical events. Winter counts marked the passage of time and documented important occurrences. The Rosebud Winter Count, so named because it originated among the Sicangu (Burnt Thigh) band of Lakota who live on the Rosebud Indian Reservation, holds an image known as “Smallpox Winter.” It depicts an outbreak of the deadly virus among the Lakota people in 1837-1838. 

More than 90 percent of the indigenous people who called North America home were wiped out by diseases brought to our ancestral lands by European invaders—namely, smallpox. Elders say the blood remembers, but that etching stories holds immense power. It serves as a warning, allowing us to bear witness to the horrors the Lakota experienced then, while quietly reminding us that we survived. 

Indigenous people have sounded the alarm about the perils of unchecked climate change for decades, so we weren’t entirely caught off guard when a global pandemic of this magnitude emerged. Nothing can ever fully prepare you for living through one, though. 

A few months ago, Oceti Sakowin Tribes of the Great Sioux Nation began to prepare for the arrival of this genocidal pestilence in a new guise. We shut down schools and businesses, set up novel coronavirus task forces, and began stockpiling food and supplies. We established protocols and set up checkpoints to protect our most vulnerable. We implored Congress and the White House to honor their treaty and trust obligations to us and provide monetary assistance to help us combat the contagion. 

Then I began receiving word about Oceti Sakowin elders who had succumbed to COVID-19. What I found particularly troubling is their deaths seemed to be falling through the cracks like the disappearances of Native children who were taken from their families to boarding schools all those years ago, never to return. The elders I speak of had died while living in nearby urban areas off the reservation, not under the care of the Indian Health Service who had begun recording COVID-19 positives and fatalities. I was aware of their deaths and what caused them only because I knew their families. Indian Country Today, a Native media source, was scrambling to compile information about COVID-19 rates among Natives. I spoke with one of their journalists about the elders I knew who had died from the disease. If I had not, no one outside of my small community would have known. 

Now we know underreporting of racial demographic data in the U.S. regarding the virus is widespread, especially concerning Natives. A recent report found that while 80 percent of state health departments are recording race as part of their COVID-19 statistics, around half of those are not including Natives and are simply labeling them as “other.”


In the 2010 census, 111,749 New Yorkers identified as American Indian or Alaska Native, yet the city is not tracking them during this pandemic, either. 

Such data is vital to our survival. We know this because existing statistics regarding Native COVID-19 infection and mortality rates are damning. For example, Natives comprise only about 5 percent of Arizona’s population, but they make up 20 percent of the state’s reported coronavirus-related deaths. 

In Alaska, Natives comprise 15 percent of the population, but encompass 6 percent of all cases and about 20 percent of all deaths related to COVID-19 there, as of May 8. Taken together, this information suggests that while Native people represent just a fraction of the cases in some states, they are among the people most likely to die from it. 

Native communities are more susceptible to COVID-19 due to multigenerational poverty, housing shortages, and a lack of adequate health care, medical equipment, facilities, and resources. On the Navajo Nation, which is now experiencing the highest COVID-19 infection rates per capita in the country, 30 percent of the population does not have running water in their homes, making disinfection and proper hand-washing difficult.

Now a new issue has arisen, and it stands to exacerbate underreporting of COVID-19 among Natives. The Indian Health Service is charged with carrying out the federal government’s treaty responsibility of providing medical care to tribes. In a recent media call, Chief Medical Officer Michael Toedt said 250 coronavirus rapid testing machines manufactured by Abbott Laboratories and supplies for “over 90,000 tests” had been distributed within the Indian Health Service system that serves Native communities throughout the U.S. 

But Abbott tests have been found to produce 48 percent false negatives when the nasal swab is dry and 33 percent false negatives when the nasal swab is dipped in liquid solution, according to a study done at New York University. Tribal leaders have raised concerns about the accuracy of Abbott testing to the Trump administration, which has touted and promoted the tests, to no avail.

If tests the Indian Health Service performs on Natives are wrong half the time, the current statistics they do have are likely flawed, and rates are much higher.

So here I am. Trying to make a new winter count, striving desperately to show the faces of my people, who fight and die for one another because they love each other so much. We are standing bravely at the mouth of a hell the white man has created for himself, on the borders of our homelands, in our sweat lodges, and humble households. We’re offering prayer ties before our Creator, beseeching them for one more breath, one more chance to sacrifice so our unborn will see a new red day. Let future generations look back and see us and how we survived this plague. We must leave a trail, so I write the words. 

Ruth Hopkins is a Dakota/Lakota Sioux writer and enrolled member of the Sisseton Wahpeton Sioux Tribe. She is also a biologist, tribal attorney, former judge, and co-founder of Lastrealindians.com. Hopkins resides on the Lake Traverse Reservation in South Dakota.