FROM WYOFILE: Reservation communities ahead of the curve with testing, response
April 16, 2020
The Wind River Family and Community Health Center in Arapaho no longer resembles the bustling family clinic it operated as once upon a time before COVID-19.
Tents and a trailer have popped up outside, and the bulk of clinic activity now takes place in the parking lot, where physicians and staff in protective suits, masks, visors and gloves greet patients in their cars, assess their health or test them for COVID-19.
And test they do. The clinic, which like most facilities in Wyoming was initially hampered by testing supply shortages, has overcome those restraints by using saline solution as a transport medium, a method backed by the Centers for Disease Control and Prevention. Since early April it has offered tests to any tribal member who wants one — tribal employees, parents, young, old, sick, asymptomatic or already tested — at its Arapaho location as well as a satellite clinic in Ethete.
Though tests are mainly for Indian Health Service beneficiaries, the clinic has tested others, paying the $51 per test itself and hoping to recoup some of the costs through Medicaid and other third-party resources, WRFCH CEO Richard Brannan said. Many reservation residents have responded to the call, bringing a steady stream of cars through those parking lots. Staff estimates they’ve seen as many as 80 patients a day.
“We just wanted to make sure that we minimize the spread of COVID-19 within our tribal population,” Brannan said. Testing, he said, is “the only way you can figure out how widespread it is in your community. That’s the only mechanism you can use to decrease the infection rate.”
The clinic had conducted more than 1,200 tests by Wednesday, Brannan said, sending most to private laboratory LabCorp for processing. That number climbed to 1,300 by Thursday. The State Health Laboratory had separately analyzed 3,296 tests for the entire state by Friday, the Wyoming Department of Health reports.
Testing has allowed clinic staff to identify not only cases of COVID-19 with known exposure and symptoms, but also a handful asymptomatic carriers, Brannan said.
The clinic, an enterprise of the Northern Arapaho Tribe and known commonly as Wind River Cares, is one of few places in the state offering such generous testing. Many facilities, limited by supplies or laboratory capacity, have only tested those who meet strict exposure or health standards. The resulting scarcity of hard data fuels widespread belief that there are many more cases of infection than the state’s confirmed-cases number portrays. As of Friday morning, 18 patients on the reservation had tested positive.
Brannan said he realized early on that he couldn’t wait for the federal government to swoop in. Though the Northern Arapaho and Eastern Shoshone tribes that share the 2.2-million-acre Wind River Indian Reservation both have treaty rights to government-provided healthcare, the clinic had to act, he said.
“Reservations are kind of like, out of sight, out of mind,” Brannan said. “We always seem to be the last priority. Knowing that, we went ahead and started planning.
“We have to be self-reliant. We gotta take care of ourselves … We were very proactive,” he said.
The clinic’s rapid testing expansion and other COVID-19 adaptations are one element of a broader reservation effort to beat back the pandemic. As the medical response ramped up, tribal leaders closed businesses, issued stringent and enforceable stay-at-home orders, set-up a quarantine facility and launched an aggressive public-health-information communication campaign — going beyond state and local government actions.
The stakes are well-established and and by now oft repeated: A mix of poverty, crowded living conditions, a lack of housing and personal transportation, few medical facilities and high rates of underlying health conditions like diabetes and asthma makes the reservation population particularly vulnerable to worst-case pandemic scenarios. If the disease arrives here in force, it could be catastrophic.
“[Brannan’s] been doing an awesome job, the tribe has been doing an awesome job and we’ve been more proactive then the county and the state,” said Rep. Andi Clifford, a member of the Northern Arapaho tribe and state representative for District 33. “We just have been. And we know why. Because of our health disparities, because of our high incidences of underlying conditions, our poverty levels. That’s the picture. That’s our reality.”
Clifford, who has been posting PSAs advocating for tribal members to stay home, supports the extra precautions. “I’d rather be criticized of being over-reactive any day,” she said. “Because if it’s gonna save a life, then it’s all worth it.”
Officials confirmed the first case in Fremont County on March 13 in Lander. Within a week, the Northern Arapaho and Eastern Shoshone Business Councils had taken forceful measures: declaring states of emergency, urging tribal members to stay home and in the case of the NABC, forming a task force. Both began working closely with medical facilities: Wind River Cares as well as the Indian Health Service’s federally operated Wind River Service Unit in Fort Washakie.
The NABC took what was considered at the time a drastic move of closing its casinos and requiring employees over the age of 60 to stay home. It prohibited gatherings of 10 or more people. Wyoming Indian high and elementary schools in Ethete were the first in the state to close, according to a video the council put out in early March.
“Knowing what we do know about our population, we knew it was very important to try and get out ahead of it,” Northern Arapaho Business Councilman Stephen Fast Horse said.
At Wind River Cares, staff started acting early as well, Brannan said. The clinic is funded in part by IHS but run by the tribe under a contract. That arrangement allows it some flexibility, and he said it began ordering PPE and testing supplies before the crush of demand.
On March 21, officials confirmed the first case of COVID-19 on the reservation — a woman in her 70s from the Ethete area. The next day, the Wind River Inter-Tribal Council representing both tribes advised all tribal members to self-isolate at home.
“We must do everything to stop the spread of this illness and protect our elders, children and fellow Wind River residents,” the advisory stated. “Lives are at stake.”
On April 1, the inter-tribal council took its response a step further, passing a mandatory stay-at-home order for all residents of the Wind River Reservation. On April 10, the council received a court order from the Wind River Tribal Court to make that order enforceable through fines or even incarceration.
Meanwhile, Wind River Cares transitioned from its initial triage and telehealth model to widespread testing, first for medical personnel and tribal employees, Fast Horse said, then opening it up to families. The Wyoming Department of Health assigned an epidemiologist to the reservation who has been working closely with the tribes to help with tasks like contact tracing.
One issue that came up was the difficulty of individuals quarantining effectively in what are often crowded living spaces — it’s not uncommon for several generations and families to live under one roof. “If we have a positive for the coronavirus [in that instance] there’s no way to quarantine that one person without affecting the whole household,” Fast Horse said. “So we started thinking about how we could solve that.”
They decided to place such high-risk individuals in the empty hotel rooms at the Wind River Casino, with specific precautions, he said. “It was a way we could comfortably take care of our tribal members.”
Tribal leaders feel they cannot be too cautious as they plan and proceed, Fast Horse said.
“Luck favors the prepared,” he said. “We’re trying to keep this off the reservation.”
As of Friday, 18 patients on the reservation had tested positive, and Brannan said his staff indicated more symptomatic patients and more cases are beginning to pop up that don’t appear to be related to known clusters.
He stands behind the stepped-up response.
“In January the federal government was basically flat-footed and our tribe realized the danger from the virus was so immense that we had to get ahead of the curve,” Brannan said.
The impact on businesses and human health will likely be major. With nearly 500 employees at the Wind River Hotel & Casino alone, the Northern Arapaho Tribe was the largest employer in Fremont County.
But, Fast Horse said, “as far as the business aspect, that kind of went out the window a while ago. And again, that’s just kind of being responsible, right? Our no. 1 priority is the health and safety and wellbeing of our whole community.”
Messaging from the tribes has been ubiquitous and consistent with press releases, public service announcements and social media posts. “You should stay in your homes except to get food and to get medical care,” read a Wednesday Facebook post signed by Wind River Cares’ Chief Medical Officer Paul Ebbert.
Are reservation residents heeding the call?
Fast Horse said there’s a mix of reactions.
“It’s a little of both,” he said. “We’ve had a good response from a majority of people but then we still have those clusters of people who, it really hasn’t stuck with them the seriousness of this. And we are concerned.”
He went out Wednesday to grab a few things, he said, and could tell that stimulus checks had come in; “The whole town of Riverton was just bustling,” he said. “And that’s scary. That’s very concerning from a leadership standpoint.”
Clinic CEO Brannan too is trying to get the word out that the actions of individuals can turn out to have terrible consequences for others. There are too many factors stacked up against the reservation community to risk it, he said.
“The thing about this coronavirus is that it requires people to think of others, not just themselves,” Brannan said.
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