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Law360 (May 15, 2020, 12:50 PM EDT) -- The Navajo Nation added 99 previously unidentified novel coronavirus cases to its official tally Thursday, part of quality assessment efforts that highlight the challenges of tracking and verifying cases on a reservation spanning 10 counties and three states.
The Navajo Nation is now reporting 3,632 cases to date and 127 total deaths. This count includes 141 new cases and eight deaths since Wednesday, plus the previously unreported cases.
The Navajo Epidemiology Center collaborates with the Indian Health Service to track cases, according to its website. The largest reservation in the country, the Navajo reservation spans parts of Arizona, Utah and New Mexico and has been particularly hard hit by the pandemic.
"This week, the Navajo Epidemiology Center worked closely with healthcare providers to conduct a quality assurance assessment on the number of COVID-19 cases," the office of Navajo Nation President Jonathan Nez said in a statement. "Due to cross jurisdictional challenges and longer than normal verification processes, an additional 99 previously unreported positive cases were identified and added to the overall total."
The Navajo Nation has also begun to collect data on recoveries.
"Preliminary reports from a few health care facilities indicate that approximately 515 individuals have recovered from COVID-19, with more reports still pending," the nation said Thursday.
Michael Toedt, IHS' chief medical officer, acknowledged the data collection challenges during a press call Thursday, and said the U.S. Centers for Disease Control and Prevention has deployed 12 staff members to the region to assist in coordination.
"They look at the data sharing between IHS, tribes, Urban Indian organizations and the local public health authorities, and help to make sure that everyone has a common operating picture," Toedt said. "We know there are differences in jurisdiction where you have tribes that may span multiple counties or, in the case of Navajo, multiple states. These kinds of challenges are exactly what IHS and CDC are partnering to overcome."
The latest data comes as Arizona lifted a stay-at-home order Friday. Pools, gyms and spas reopened May 13 with social distancing guidelines.
"It is time to move forward with the next steps of Arizona's economic recovery — while continuing to make health and safety our number one priority," Arizona Gov. Doug Ducey said in a statement.
"We are disappointed to see that Arizona is reopening," Nez said in a statement Friday. "The Navajo Nation spans northeast Arizona where COVID-19 has devastated our communities."
The Navajo Nation this week extended its state of emergency through June 7, and is continuing 57-hour weekend lockdowns during which all residents are required to stay at home and essential businesses including gas stations, restaurants and hay vendors are closed.
As of May 9, the incidence rate on the reservation was more than 1,200 cases per 10,000 people, according to the Navajo Epidemiology Center, compared to roughly 400 per 10,000 people on April 9.
"You can see that the incidence rate is increasing and it's not flattening," Melissa Begay, an assistant professor at the University of New Mexico School of Medicine's Division of Pulmonary, Critical Care and Sleep Medicine, said during a Zoom presentation Thursday.
However, the actual rate of daily cases at IHS hospitals is well below the predicted rate, Loretta Christensen, chief medical officer for the Navajo Area IHS, told Law360.
IHS hospitals serving the Navajo region are currently seeing 100 positive cases per day, according to the agency, compared to a model that had predicted 250 per day.
"The peak we are experiencing now is much lower in magnitude [than expected]," Christensen said.
According to the IHS website, the Navajo region accounts for 59% of all tribal coronavirus cases nationwide.
This, too, comes with an asterisk, because tribal health organizations and Urban Indian health centers self-report to IHS. According to the agency, fewer than half of all tribal and urban facilities have reported COVID-19 data to IHS.
During her presentation Thursday, Begay noted another likely undercount: total deaths.
"What's being found is there are many tribal members who have died at home," she said. "The numbers are going to be much higher and I think the data will be very interesting when it comes out."
--Editing by Marygrace Murphy.
For a reprint of this article, please contact reprints@law360.com.
