In trust, COVID-19 and Native America

Last week the New York Times published an article with the headline “Virus Rips through Navajo Nation.” Someone asked me to write a brief response. I said yes and regretted it immediately. What could I possibly say?

I was reminded of Hayden Carruth’s poem “On Being Asked to Write a Poem Against the War in Vietnam”—a poem in which Carruth refuses to write a poem against the war because he has written other poems against other wars

David Tooleand not one
breath was restored
to one

shattered throat
mans womans or childs
not one not

but death went on and on
never looking aside

except now and then
with a furtive half-smile
to make sure I was noticing.

– Hayden Carruth


Wendell Berry once said of this poem that it seemed to be a response to a problem: “Why do something that you suspect, with reason, will do no good? It is impossible not to see that the poet, in the act of refusing to write a poem against the war, has written one.” Trying to make sense of what Carruth had done, Berry said: “There is a world of difference between the person who, believing that there is no use, says so to himself or to no one, and the person who says it out loud to someone else. A person who marks his trail into despair remembers hope—and thus has hope, even if only a little.”

The Bureau of Indian Affairs (BIA) defines a federal Indian reservation as “land held in trust by the United States for various Indian tribes and individuals.” By the BIA’s count, “there are approximately 326 Indian land areas in the U.S. administered as federal Indian reservations.” I worry about that word approximately. I wonder if it is a Freudian slip—letting us know by mistake that the federal government has lost track of exactly what it holds in trust for the native peoples of this continent.

After the arrival of the first Europeans on the continent in the sixteenth century, diseases like smallpox routinely wiped out indigenous communities. That history adds crushing weight to the arrival of COVID-19 in Native America.

The other day my wife had the New York Times spread out on the dining room table. She was looking at a color-coded map of the United States that showed county-level data for confirmed cases of COVID-19. The darker the color, the higher percentage of cases as a percent of the local population. The darkest colors congregated mostly on the coasts in big urban centers, but there were some exceptions in unlikely places. My wife pointed to one and asked, “What’s that?” I replied, “probably an Indian reservation.”

That was my reply because, at a glance, the map looked alarmingly similar to two other maps: the U.S. Health Map and the map of the Social Vulnerability Index (SVI). The SVI is an estimate of how vulnerable a community is to “a natural disaster like a tornado or disease outbreak.” The scale is 0 to 1. The closer a community comes to a score of 1, the higher their vulnerability.

On the U.S. Health Map, the darkest location in the country is Oglala Lakota County, South Dakota, home to the Pine Ridge Indian Reservation, where life expectancy is 66.81 years. A click on the dark blue of the same county on the SVI map reveals an index of .9908. In Pennington County, the next county to the north, life expectancy is 80.43 years and the SVI is .4011.

Thankfully, Oglala Lakota County does not, at the moment, show up as a dark color on the COVID-19 map, but that’s not the case for Navajo County, Arizona, which overlaps the Navajo, Hopi, and White Mountain Apache reservations. A jump to the SVI map for Navajo County shows an index of .9946.

Yesterday when Dr. Deborah Birx was explaining the Trump administration’s guidelines for phasing back into life beyond COVID-19, she stopped to call attention to a specific bullet on one slide. The bullet concerned sentinel surveillance. As the WHO explains, “data collected in a well-designed sentinel system can be used to signal trends, identify outbreaks, and monitor the burden of disease in a community.” Dr. Birx said specifically that the goal moving forward was to establish sentinel surveillance in “communities of particular vulnerability,” including “throughout indigenous populations.”

Maps showing the location of vulnerable communities are readily available. But I worry, because the location of vulnerable communities has never been a mystery. In fact, the SVI is the work of the CDC itself. So why is COVID-19 now ripping through the Navajo Nation?

I worry about that word approximately. I worry that, just now, death glanced my way with a furtive half-smile.

David Toole wears many idiomatic hats at Duke. Reflective of his wide-ranging academic endeavors, Toole holds appointments not only with the Kenan Institute for Ethics, but also the Global Health Institute and the Divinity School, where he serves as Associate Dean for Interdisciplinary Initiatives. He teaches courses on ethics, humanitarianism, and health systems, and is working on another book that gathers together a decade of research on the role of mission hospitals in African health systems.

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