Navajo Nation response to COVID-19 outpaced Arizona

For months, the Navajo Nation cemented its spot as one of the larger COVID-19 hotspots in the country.

The high infection rate per capita made the tribe a spectacle across the country as members faced unique hurdles that made it especially difficult to tame the virus, such as no running water in homes and multiple generations living under one roof.

But, behind the scenes, the tribe may have been among the first to take the virus seriously, outpacing even the state of Arizona.

The Navajo Nation began preparing for COVID-19 more than a month before its first confirmed case and then strictly enforced orders through the pandemic to slow the spread.

“There’s really no secret formula to what’s happening here on Navajo: We just followed those protocols and then incorporated them into policy and mandated our people to wear their masks and stay home and did curfews,” Navajo Nation President Jonathan Nez said. “I commend the Navajo people, really, it was the Navajo people who did an outstanding job to bring these numbers down.”

Now, the Navajo Nation is reporting some of the lowest daily cases since the pandemic started, with less than 50 new cases per day for nearly a month. 

It's no small feat — the Navajo Nation is one of the largest tribes in the country with about 172,000 residents and land that spans more than 27,000 square miles across three states. 

State officials say the Navajo Nation early on was dealing with a greater level of virus spread than most Arizona communities, warranting a quicker response and dedicated state resources. 

Meanwhile, Arizona grappled with spikes in COVID-19 cases of its own, at one point drawing national attention for the increasing number of cases. The actions of Gov. Doug Ducey were often criticized during the pandemic for being too aggressive and then not aggressive enough.

Officials for both the state and Navajo Nation say their decisions were driven by data with guidance from public health officials. But a closer look at the respective communities over the past six months shows the stark difference between each leaders' responses. 

Navajo Nation preps for virus early on

Arizona identified its first COVID-19 case on Jan. 26 in Maricopa County. At the time, only a handful of cases were identified in the country, nearly a month after an outbreak was first discovered in Wuhan, China. 

While Ducey did not appear to make any public statements at the time, Nez and Vice-President Myron Lizer that day began encouraging residents to take precautions against COVID-19. The tribe had no confirmed cases at the time, but its leaders referenced Arizona's first confirmed case in a news release. 

“As we continue to closely monitor the coronavirus, we caution our Navajo people and encourage them to be aware of the growing spread of the virus," Nez stated in the news release.

Within a week, the Navajo Department of Health established an internal coronavirus workgroup. Officials a few weeks later continued efforts to inform the public about the virus, including radio forums and going door-to-door in remote areas of the Navajo Nation. 

By late February, the tribe established an official COVID-19 Preparedness Team to "monitor, plan, prepare and coordinate precautionary efforts" for COVID-19, a news release states. The team was comprised of various officials, including the tribe's executive branch and health department and Indian Health Service, according to the news release. 

It’s unclear what level of planning for COVID-19 the state did before its first confirmed case. Ducey's spokesman, Patrick Ptak, referred The Arizona Republic to the Arizona Department of Health Services, stating it had a response plan for respiratory illness. 

Ducey appeared to make his first public comments about the virus during a COVID-19 related news briefing on March 2 — more than a month after the first confirmed case. Officials assured Arizonans the risks of contracting the virus were low. The number of cases nationwide hovered around roughly 100 then. 

Cara Christ, director of the state’s health department, warned there would likely be more cases, but she reassured residents the state was prepared.

A second positive case in Maricopa County was announced the next day. 

Tribal parks and casinos close, school closures recommended before Navajo Nation's first case

Both the state and Navajo Nation declared a state of emergency as the World Health Organization classified COVID-19 as a global pandemic on March 11.

The Navajo Nation had yet to identify any cases, but the officials said the emergency declaration was simply proactive as the number of cases surrounding tribal lands increased.  

“If we were the 51st state, we would have probably been one of the last states to get a positive case," Nez said. “We had cases all around us…and so that’s when we issued our emergency declaration. That was our trigger.”

Ducey two days earlier announced steps to protect at-risk populations in Arizona, requesting long-term-care facilities to screen visitors and create separate dining areas for people with respiratory illnesses. State officials at the time said Arizonans' risk of contracting the virus was heightened, however, did not recommend canceling large events. 

As the White House declared a national emergency, the Navajo Nation's leaders urged establisments that could potentially draw large crowds to shutter. There were more than 1,600 cases in 47 states then, according to the White House's proclamation. 

Tribal parks, recreation areas and casinos were closed by March 14. The Navajo Nation Board of Education that day also recommended closing all grant schools, contract schools and Bureau of Indian Education schools.

Ducey and Hoffman the following day ordered schools statewide to close for two weeks. By then, about 40 districts and schools had independently announced closures, and governors in more than 30 states planned for schools to close statewide.

The statewide school closures were eventually extended through the remainder of the academic year. 

Large gatherings prohibited, restaurants restricted as first Navajo Nation cases identified

Ducey on March 15 also announced the state would follow federal recommendations to cancel "large events and mass gatherings" involving 50 or more people. Arizona had 21 identified COVID-19 cases. 

The Navajo Nation's leaders ordered stricter measures three days later, soon after identifying its first three COVID-19 cases in less than 48 hours. In comparison, more than a month passed between the state’s first and third confirmed cases. Testing differences between the state and Navajo Nation at the time are unknown; however, officials for both reported testing lags early in the pandemic.

The Navajo Nation's first public health order on March 18 prohibited gatherings of more than 10 people, lowered occupancy at restaurants and bars, restricted food businesses to drive-thru services only and suspended all indoor and outdoor markets. 

Tribal officials also began to strongly advise residents to stay home and avoid non-essential travel. They asked visitors to refrain from traveling on the Navajo Nation. 

Ducey ordered a similar measure the next day, calling on counties with COVID-19 cases torestrict restaurant service and close bars, theaters and gyms. By then, several mayors issued city-wide directives shutting down bars and eliminating dine-in service. 

He also ordered hospitals to halt elective surgeries and deployed the Arizona National Guard to help restock grocery stores and food banks. The Guard also helped the Navajo Nation, including providing food from food banks and water resources, according to Ptak.  

Tribe first to announce stay-at-home order

The Navajo Nation identified 14 COVID-19 cases by March 19. That same day, tribal officials issued a stay-at-home order for the community of Chilchinbeto, where a majority of its cases were located. 

The order, which required residents to stay home except for emergencies or essential activities, was expanded the next day to all residents of the Navajo Nation. Non-essential businesses were also ordered to close and restaurants forced to turn to take-out only.

While the tribe's cases remained at 14 by March 20, state officials reported Arizona's first COVID-19 related death. Ten more days would pass before Ducey issued a statewide stay-at-home order

The state's number of cases in the following days grew to 326 with at least five people dying from the virus. Ducey insisted in a news briefing Arizona was "not there yet" in terms of requiring residents to stay home. However, he issued an executive order that defined which essential businesses would be allowed to stay open in the event of such an order. 

City leaders criticized a section of the order precluding them from closing businesses deemed essential, as well as the inclusion of golf courses, gun stores and "personal hygiene services."

Amid mounting pressure from doctors and elected officials, Ducey announced a statewide order preventing Arizonans from leaving their homes for non-essential activities.

By then, more than half the country had similar orders in place. The state's number of cases surpassed 1,150 with 20 known deaths.

Navajo Nation orders strict curfews to slow COVID-19

The Navajo Nation extended its stay-at-home order indefinitely and announced a nightly curfew two days after confirming its first two COVID-19 deaths. Officials warned they didn't have enough doctors, hospital resources and other medical necessities to treat a mass outbreak. 

The nightly curfew soon expanded to a 57-hour curfew over Easter weekend. It was followed by 17 more weekend-long curfews. More than 1,400 citations were issued since March for curfew violations. 

Other Arizona tribes also implemented curfews while the city of Gallup, which borders the Navajo Nation, locked down for several days.

But Ducey didn't order anything of the sort statewide. Ptak said guidance from public health officials instead recommended preventing large gatherings, limiting high-risk activities and encouraging the use of masks.

Ducey did order a nightly statewide curfew for about a week to curb "violent civil disturbances" in Phoenix, Tucson and Scottsdale in late May following multiple police brutality protests. The order came after protesters broke windows and looted stores at Scottsdale Fashion Square.

State officials, people from around the globe help Navajo Nation

Ptak said the state health department stepped in early to assist the Navajo Nation with testing and coordinating communication between the tribe’s health officials and those in neighboring communities and states. Ducey's social media posts appear to show he was in regular contact with tribal leaders, including the Navajo Nation, during the pandemic.

By April, donations and supplies began to pour into the Navajo Nation from across the globe. The tribe’s former Navajo Nation Attorney General Ethel Branch's GoFundMe to assist Navajo and Hopi families raised more than $400,000 by early April and the Navajo Nation launched its own fundraiser shortly after.

Health care workers were sent to assist various communities on the Navajo Nation. 

Nez said he appreciated the help, especially since tribal leaders began advocating for federal COVID-19 aid in early March, only to receive it months later. The tribe is now on deadline to spend more than $714 million in federal COVID-19 aid.  

“Now the federal government wants to take credit for lessening the cases of COVID-19 positive cases here on Navajo, and I totally, respectfully disagree,” he said. “It was because of the Navajo people, the friends of the Navajo who, because the inaction of the government, came together and helped each other out.”

Navajo Nation orders masks to be worn in public

Tribal officials began donning masks in public days before it was officially recommended by the Centers for Disease Control and Prevention in April.

Nez called on the public to make and donate masks to the Navajo Nation. The tribe's executive branch even posted a photo of a mask pattern on its Facebook page for reference. 

Around this time, Ducey ordered salons to close and announced quarantine requirements for travelers from the tristate area. 

On April 17, the tribe issued another public heath order requiring those over the age of two on the Navajo Nation to wear masks in public. 

"Some individuals think we’re using scare tactics or extreme measures, but we are losing lives here in the Navajo Nation, and I’m going to do everything I can to help save lives," Nez said in a news release at the time. "We are on a mission to flatten the curve."

But it would be another two months before Ducey allowed local governments to impose and enforce mask policies. He never issued a statewide mask mandate. Ptak explained that compliance was greater when mandates were implemented at the local level, instead of the state.

However, Ducey himself was rarely seen wearing a mask in public, even as health officials pled with Arizonans to do so as the state saw a spike in cases. Ptak told The Republic in June Ducey "wears a mask when necessary" and had been tested.

Nez and Lizer were often seen wearing masks to weekly town halls and food distribution events. They were both wearing masks when they came in close proximity to a first responder who later tested positive for COVID-19 in April. Neither of them had COVID-19 symptoms after a 14-day quarantine.

Research studies have shown masks can be effective in preventing transmission of COVID-19. Nez credits the tribe's mask mandate for its decline in cases.

According to Nez, a majority of Navajo Nation citizens accepted the tribe’s public health orders, including its mask mandate. He acknowledged the same could not be said about Ducey’s orders, adding that the Navajo people were likely more accepting because of cultural teachings rooted in protecting and respecting elders.

“If you’re a warrior, you have to protect your family, you have to protect your elders,” Nez said. “Our elders hold the culture, traditional teachings that are important to hand down from one generation to the next.”

“We’re all in this together; what affects Navajo affects off the Nation and vice versa,” he continued. “I wish that there would be a little bit more bold leadership out there that will say wear your masks; mandate it and don’t be scared about the perception of taking someone’s freedom away, it’s not about that, it’s about keeping the citizens safe.”

Navajo Nation reverses course quicker than state

Days after extending the state's stay at home order on April 29, Ducey accelerated his reopening plan for the state. Both decisions were met with criticism. 

Arizona gradually began reopening, with restaurants again offering dine-in services and gyms allowing members back. 

Ducey said the state was "clearly on the other side of this pandemic" on May 12. However, he acknowledged he didn't know for sure if COVID-19 infections had peaked in Arizona. The state at the time exceeded 11,700 identified cases with 562 known deaths. A week later it ranked 50th in the nation for testing. 

Almost immediately, restaurants and bars across the Valley were shown packed with people.

Meanwhile, Nez said the Navajo Nation tested about 14.6% of its population by May 25 with nearly 4,800 identified COVID-19 cases and 157 confirmed deaths. Tribal leaders learned around the same time that it passed peak demand on its healthcare system around late April.

Nez credited the decrease to high testing capacity, contract tracing and the public health orders.

The tribe began to take its first steps toward easing restrictions in early June, lifting its 57-hour weekend curfews and allowing some drive-in gatherings. The Navajo Nation reversed course within two weeks, quickly reinstating weekend curfews as COVID-19 cases in communities around the tribe began to spike.

“We were like a little island at one point where everyone around us was totally spiking big time, but we managed to keep our numbers flat,” Nez said. “We were discouraged at times that states around us weren’t doing anything to address the pandemic or the rise of cases, but now it’s a lot different.”

Ducey ordered all businesses in Arizona to take preventive measures again. However, he did not completely reverse course for nearly two more weeks when he ordered another partial shutdown on June 29, requiring bars, gyms, theaters and water parks to close by the end of the day.

The state at the time exceeded 74,500 identified cases with 1,588 confirmed deaths.   The number of daily cases topped 3,000 or more in the days before while hospital figures were on the rise. July 1 saw nearly 4,900 cases and 88 deaths, shattering previous daily records. 

By mid-July, the state’s COVID-19 outbreak began to show signs of improvement. However, testing for the month of July dramatically dropped, making it difficult to understand the virus’ spread. 

Navajo Nation prepares for winter

The tribe recently began a phased reopening, allowing most businesses to operate at 25% capacity. Food establishments continued to be restricted to drive-thrus as salons and barbershops and parks and marinas began running by appointment only.

The Navajo Nation's four casinos remain closed despite other tribes quickly reopening. Navajo Nation Gaming Enterprise, which oversees the casinos, said a combination of being closed during the pandemic while continuing to pay its employees caused a financial strain in recent months, resulting in layoffs. The tribe has since allocated $24.6 million in federal COVID-19 aid to help the casinos. 

Nez hasn't lightened up, though. He said the Navajo Nation modified its weekend curfews from 57 hours to 32 hours to give residents more time to prepare for the winter and potential second wave of COVID-19 cases along with the flu. Another 32-hour curfew will be in effect from 9 p.m. Aug. 29 to 5 a.m. Aug. 31.  

“The flu and COVID-19 could be a deadly combination,” he said. “So we’re telling our people, 'Let’s get prepared for winter: Haul your wood, get your harvest done, get it packaged,' because during the winter people are going to be indoors more than now during the summer.”

Republic reporters Maria Polletta, Lily Altavena, Josh Bowling, BrieAnna J. Frank, Ronald Hansen, Stephanie Innes, Debra Krol, Rachel Leingang, Andrew Oxford, Yvonne Wingett Sanchez, Alison Steinbach and Perry Vandell contributed to this report.

Reach the reporter at chelsea.curtis@arizonarepublic.com or follow her on Twitter @curtis_chels. 

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