Diné Navajo Resilience to the COVID-19 pandemic

Abstract

Objective To date, there are no studies of COVID-19 cases and deaths in the Navajo Nation, US. The primary objective of this manuscript is to understand whether counties with a higher proportion of Navajo (Diné) population also had higher cases and deaths of COVID-19 and whether these dropped with vaccination. Method We undertook a cross-sectional analysis of county level data from March 16, 2020—May 11, 2021. Data were obtained from public repositories and the US Census for the Navajo Nation, including northeastern Arizona, southeastern Utah, and northwestern New Mexico. The primary outcome measure is the number of individuals with confirmed cases or deaths of COVID-19. A secondary outcome was COVID-19 vaccinations. Results The 11 counties in Navajo Nation have a wide variation in the percent Navajo population, the resources available (ICU beds and occupancy), and COVID-19 outcomes. Overall, there was a substantial increase in the number of cases from March 16 –July 16, 2020 (the height of the pandemic) with a doubling time of 10.12 days on Navajo Nation. The percent Navajo population was a strong predictor of COVID-19 cases and deaths per million population. COVID-19 vaccinations were inversely associated with COVID-19 cases and deaths in these counties. Conclusions The COVID-19 pandemic on the Navajo Nation is a story of resilience. Navajo Nation was one of the hardest hit areas of the United States, with peak cases and deaths due to COVID-19. With an aggressive vaccination effort, these cases and deaths were strikingly curtailed, showing the resilience of the Navajo (Diné) people.

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

“…Although the NN has high COVID-19 vaccination rates, the NNDOH continues to safeguard their community by stressing the importance of vaccination, which includes reaching out to those who remain vaccine hesitant. According to Denetclaw et al [ 37 ], by May 2021 over 85% of Diné people on the NN over 16 years old received the first dose of the COVID-19 vaccinations. Rates of COVID-19 vaccinations were inversely associated with COVID-19 cases and deaths in the NN [ 37 ].…”

“…According to Denetclaw et al [ 37 ], by May 2021 over 85% of Diné people on the NN over 16 years old received the first dose of the COVID-19 vaccinations. Rates of COVID-19 vaccinations were inversely associated with COVID-19 cases and deaths in the NN [ 37 ]. As of February 2023, 71.2% of Diné people from five to 65 years old and older completed their vaccination, and 24.2% stayed up to date by receiving the booster shot [ 38 ].…”

Assessing the Impact of Mask Mandates on SARS-CoV-2 Transmission: A Case Study of Utah

“…Additionally, San Juan HD saw a 104.5% increase in R e following the SLSC mask mandates, and a 11.2% increase in R e following the statewide mandate. One potential explanation for this is that 21% of San Juan HD's population is self identified as Navajo 30 and the Navajo nation was experiencing a major outbreak of SARS-CoV-2 during this time 30,31 .…”

Aiming for Equity: Addressing COVID-19 Vaccine Hesitancy among American Indian/Alaska Native Populations through Educational Interventions

“…This model emphasizes individual perceptions of susceptibility, severity, benefits, and barriers to health actions, helping tailor interventions to the specific needs and beliefs of AI/AN communities [29]. By offering culturally sensitive and appropriate health education, these interventions empower individuals to make informed decisions about their health, advocate for their healthcare needs, and engage in preventative health measures, such as vaccination [30][31][32][33]. For example, previous culturally tailored interventions in smoking cessation have shown to be impactful among AI/AN populations [34,35].…”

“…Furthermore, individuals with two or more co-morbidities exhibited decreased negative perceptions of COVID-19 compared to those with one or no comorbidities. Given that AI/AN exhibit lower life expectancy than most other ethnic groups, partly due to an increased likelihood of obesity and diabetes, addressing misconceptions and promoting positive attitudes towards COVID-19 vaccination becomes imperative [33,59,60]. According to the Great Lakes Inter-Tribal Epidemiology Center 2021 report of AI/AN in Michigan, Minnesota, and Wisconsin, AI/AN individuals reported having higher prevalence of hypertension at 35.7% and diabetes at 16% compared to their White counterparts in this three-state area [61].…”