'Truly in crisis mode': Navajo Nation requests Major Disaster Declaration amid medical shortages, growing COVID-19 infections

Emily Wilder
Arizona Republic

The Navajo Nation requested a Major Disaster Declaration from the federal government as COVID-19 cases surge amid shortages of medical supplies, personnel and hospital beds. 

Navajo Nation President Jonathan Nez announced the declaration in a virtual town hall on Thursday morning after hearing from public health officials and health care workers about shortages and challenges across the Nation.

The declaration, which can only be signed into effect by President Donald Trump, would bring a wide range of additional infrastructural and financial resources to the Navajo Nation, Nez said. These would include reimbursements for general fund spending and mental health resources for doctors, children and front-line workers.

Nez also announced an extension until Dec. 27 of the Nation's current lockdown, which was initially due to expire Sunday. The Nation also will reinstate a 57-hour weekend curfew for three weeks beginning at 9 p.m. on Dec. 11.  

These announcements came as the Nation's COVID-19 total reached 17,035 confirmed infections and 658 deaths on Wednesday.

Wednesday alone saw 310 confirmed infections — the third day in a week of 300 or more new infections, according to Dr. Jill Jim, director of the Navajo Nation Health Department.

Rates of COVID-19 infections are also growing, according to the Navajo Nation COVID-19 data dashboard. Chinle has the worst rate on the Nation with 1,263.9 cases per a population of 10,000. This rate is closely followed by Winslow and Crownpoint.

Public health and health care officials shared on Thursday morning's town hall how facilities and systems are struggling to handle the growing COVID-19 rates as the Nation — and the country — face shortages in personnel, beds and supplies.

They also urged strict adherence to public health precautions and executive orders.

"You have the power to stop this virus," Nez said. "The Navajo Nation needs your help. Our doctors and nurses need your help. Our elders, our most vulnerable population, need your help. Our front-line workers need your help. Let's help save lives."

Urgent shortages in staff and supplies

Health officials from three Navajo Nation hospitals shared how the pandemic has turned dire on the front lines.

The facilities are competing with health care systems across the country for personal protective equipment, additional nursing staff and critical supplies like oxygen, said Dr. Loretta Christensen, chief medical officer of the Navajo Area Indian Health Service.

"We're competing with other areas across the Unites States for the same limited resources of the nurses and respiratory therapists," agreed Dr. Paula Mora at Gallup Service Unit.

The problem is aggravated by outdated or ill-equipped medical facilities on the Nation, some of which don't have enough capacity to meet the growing demand.

Oxygen hookups are limited at Northern Navajo Medical Center, for example, according to Clinical Director Dr. Quida Vincent.

"On Friday, we had too few high-flow (oxygen) machines for the patients that were needing them," Vincent said. "We were able to make adjustments, but it was traumatic for staff."

There are also staffing constraints across the board, officials said, with health care providers overtaxed and running out of steam alongside shortages in staff to help or replace them.

At Northern Navajo Medical Center, Vincent explained that the nursing vacancy rate is 50%, compelling the facility to use a "team-based" approach to nursing. This means delegating some nursing responsibilities to qualified non-nurses like dentists and assistants.

Doctors elsewhere in Arizona have reported significant staffing shortages as well.

'Reaching a breaking point': Limited hospital beds on Navajo Nation, across Arizona 

The Navajo Nation's medical system is also under extreme duress from state and nationwide shortages in critical care hospital beds, officials said. Facilities are struggling to find other places to send patients who need more intensive or specialized care than they can provide. They are also running out of space themselves.

"We are truly in crisis mode here on Navajo," said Dr. Jonathan Iralu, infectious disease specialist at Gallup Indian Medical Center.

In Arizona, official data from the state Department of Health Services shows that 10% of total ICU beds are still available. But doctors have described the difficulties finding space for patients and significant shortages in hospital staff.

This makes the current surge different from, and in some ways more severe, than the summer's first wave, as entire regions are stretched to the limits and there is nowhere to transfer people.

"Our regional health systems are under extreme strain right now," said Dr. Paul Charlton, emergency medical director at Gallup Indian Medical Center.

"But people should realize that we are already at the point that there are very long wait times. Care is being provided in non-traditional locations in order for us to try to meet the unprecedented demands that are coming on our system. Many times we find that there are no beds, there are no locations to admit sick patients to anywhere in Gallup or in the surrounding regions ... and when we are successful at finding locations where patients can be transferred to we often find that there are no flight teams or ambulances to transfer them."

The Gallup center has 45 beds available for COVID-19 patients and is at 89% capacity. However, with winter weather approaching, these beds could easily fill up completely, causing extremely long delays in emergency treatment.

This isn't only affecting people with COVID-19. It's limiting access and resources for anyone on the Navajo Nation who requires medical care.

"Our hospitals are reaching a breaking point," said Dr. Eric Ritchie, chief medical officer at Chinle Hospital. "Having a health care system that is overwhelmed is not beneficial to anyone seeking care, whether they have COVID or not."

Ritchie shared how someone who was in a coma for ingesting something toxic required specialized dialysis in another facility — but they didn't have space for them for 24 hours.

At Northern Navajo Medical Center, Vincent said that facility is admitting five to six COVID-19 patients per day and transferring three to five non-COVID-19 patients to other facilities. Its ICU has six beds, three of which are filled. They are working to quickly expand their capacity, however, as they fear that if hospitalizations continue to grow and demand exceeds their supply, they will be forced to ration and allocate resources. 

"We are trying to proactively address that so our hospital staff doesn't have to make those decisions," Vincent said.

Reach the reporter at emily.wilder@arizonarepublic.com or on Twitter @vv1lder.