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Law360 (June 17, 2020, 4:47 PM EDT) -- In late April, as the coronavirus pandemic spread across the country, Oyate Health Center in Rapid City, South Dakota, reported a 60% drop in routine care visits. Furloughs seemed imminent.
Then, coronavirus cases began to crop up locally, and everything changed. Stress about too little business was out, replaced with the fear that the tribal health center — which serves the city's native population and surrounding reservations — wouldn't be able to keep up.
"Literally the pay period we had identified that we would need to reduce staff, COVID-19 hit, and it hit our center pretty significantly where then we needed all hands on deck," Jerilyn Church, CEO of the Great Plains Tribal Chairmen's Health Board, told Law360 recently.
Church is particularly concerned that South Dakota has not issued stay-at-home orders, leaving it to cities to set their own guidelines. She says the native population in Rapid City is at a heightened risk of contracting the virus, while reservations in the state have instituted strict road closures.
"We are much more vulnerable because we are living within the state's jurisdiction and there are no real efforts to contain the spread," Church told Law360 this month.
The Centers for Disease Control has advised governments that before reopening, 20% or fewer COVID-19 tests should come back positive for at least 14 days. For the week ending June 9, according to the Great Plains Tribal Epidemiology Center, South Dakota's percent-positivity was 4.1%.
While this is "encouraging," Oyate Health Center told Law360, its own positive rate has remained north of 20% since May 6.
As of June 12, Church told Law360, the state had not responded to three requests: for resources for mass testing, for a partnership with the state's Department of Health to assist in contact tracing and for a data exchange.
The South Dakota Department of Health did not respond to multiple requests for comment on these requests, and its pandemic response more broadly.
This week, on June 15, Rapid City's City Council voted 7-2 to lift its remaining COVID-19 restrictions on bars, restaurants and other businesses, including customer limits, urging residents to "be diligent in their behavior to slow the spread of the virus."
"If the situation warranted they could put the restrictions back into place before the end of July," city spokesperson Darrell Shoemaker told Law360, adding that the city has been in close contact with Oyate Health Center.
Most of Oyate Health Center's native patients are members of the Oglala Sioux, Cheyenne River Sioux and Rosebud Sioux tribes. The center has had 104 positive cases to-date, out of 484 tests administered.
The native population has heightened COVID-19 risk factors, Church said, including higher rates of diabetes and obesity than the general population.
Dr. Donald Warne, an associate dean and director of the Indians into Medicine program at the University of North Dakota, said that South Dakota's collaboration with tribes has lagged as COVID-19 cases have increased among native populations across the Northern Plains.
"In North Dakota we have Medicaid Expansion and we have a good functioning state-tribal relations through the North Dakota Indian Affairs Commission," he told reporters during a recent event hosted by the Robert Wood Johnson Foundation. "South Dakota, it's more adversarial, unfortunately."
Warne has helped coordinate a test-and-trace program for North Dakota tribes, he said.
A significant number of homeless people in Rapid City are native, according to Church. Native families also often live in multi-generational homes where isolation is difficult.
In addition to a 100-bed emergency shelter at Rapid City's Rushmore Plaza Civic Center — a collaborative effort with the city, county and nonprofits — Oyate Health Center opened its own alternative care site inside a hotel on May 6. It has quarantined 45 people to-date.
"We have this population of elders who are not in nursing homes but need a safe place to quarantine that is not the shelter," Church said.
South Dakota currently accounts for 12% of positive COVID-19 cases across the Great Plains states of Nebraska, Iowa and the Dakotas, according to the tribal epidemiology center. The center tracks all cases, tribal and non-tribal, using data from Johns Hopkins University and respective state health departments.
--Editing by Alyssa Miller.
For a reprint of this article, please contact reprints@law360.com.
