Hospitals serving the Navajo Nation adjust as beds keep filling up

Farmington hospital applies for permission to ration care with the state’s DOH

By: - November 9, 2021 6:53 am

Gallup Indian Medical Center’s Dr. Jonathan V. Iralu. (Photo by Sharon Chischilly for Source NM)

Gallup Indian Medical Center was one of several New Mexico hospitals that was praised by the state’s Department of Health for its treatment of COVID-19 patients by using monoclonal antibodies.

Monoclonal antibody treatment for COVID-19 patients is an infusion given to patients through IV, and takes about an hour. Studies have shown that it has decreased the chances of death or hospitalization by 70%. This is an outpatient treatment and is used for patients who are identified to have mild-to-moderate COVID-19.  

“It’s particularly noteworthy because these people are darn busy,” said DOH’s acting Secretary David Scrase during an Oct. 29 livestreamed town hall. 

DOH will allow some hospitals to ration care

New Mexico DOH recently announced for the second time since the beginning of the pandemic it would enact the Crisis Standards of Care for the state’s hospitals because of the lack of resources.

The San Juan Regional Medical Center in Farmington, N.M., applied for a waiver to do so, said New Mexico DOH spokesperson David Morgan. 

“At this time, Gallup Indian Medical Center has not submitted an application to the State of New Mexico to implement crisis standards of care,” said Jenny Notah, spokesperson for the Navajo Area IHS.

Jonathan Iralu, the center’s infectious disease specialist, said a year ago, this form of treatment was one he thought he wouldn’t ever consider for COVID-19 patients, but he now believes it is vital. 

Since New Mexico is experiencing a crisis, Iralu mentioned that the use of the monoclonal antibody and continuing to encourage people to get vaccinated and get their booster shot would relieve the strain on the state’s hospitals. 

“Right now we are seeing an uptick of COVID-19 diagnoses since the summer,” said Iralu. “Our hospital at various times has been at very high capacity in our ICU and COVID ward. There’s been a real shortage of ICU beds and plain hospital beds, whether a person has COVID or not. So we’ve been facing this challenge for a couple months now.”

Every infusion given decreases the risk of hospitalization and death by 70%, and this, along with vaccination, is a way to address bed and staff shortages, Iralu said. “A year ago I would’ve thought this was a crazy scheme,” he said about the monoclonal antibody. “But we are really active in giving monoclonal antibodies. We are relatively a small hospital but we are able to give 12 infusions per day.”

If a person does get COVID, he continued, it’s good to get tested early, immediately after the onset of those cold-like symptoms because the sooner you get the monoclonal antibody treatment the better. This is important for those with underlying health issues to know, as well. 

Monoclonal antibody treatment is recommended for some people who have tested positive for COVID-19, according to NMDOH.

Staying careful

A year ago these life saving resources weren’t available, and even though they are now, combating COVID is still a battle. Navajo Nation is soaring in new case numbers, as of Sunday, there are a reported 60 new cases and no recent deaths. The total number of deaths since the beginning of the pandemic is 1,498. It is reported that 35,209 individuals have recovered from COVID-19. The overall number of positive COVID-19 cases is 37,411 since the beginning of the pandemic. 

In November 2020, the Navajo Nation resorted to weekend lockdowns, daily curfews and remote working for nonessential government employees to keep the virus from spreading. With the holiday season surge lasting until February, Nez reminded viewers of this grim time during the weekly Zoom town hall meeting. He emphasized that viewers should continue to be extra cautious by getting vaccinated, wearing their masks, reducing travels, social distancing and washing their hands. He mentioned people were catching COVID-19 on Navajo from social gatherings.

“Look at what happened last year with the high cases,” said Navajo Nation President Jonathan Nez. “We don’t want that to happen. We are trying to avoid that this holiday. Things are different now but that doesn’t mean we will let our guard down.” 

High vaccination rates

A memo sent out to Navajo Nation employees in late October said employees had to submit proof of full vaccination to their supervisors. Employees who fail to do so are required to provide documentation that they tested negative for COVID-19 every 14 days for as long as they are not vaccinated. 

Vaccination rates in the Navajo Nation

  • 96% of Navajo Nation employees are fully vaccinated
  • Over 70% of Navajo citizens who are eligible have been fully fascinated
  • 86% of people who are older than 65 have been fully vaccinated
  • Around 60% of people aged 20-44 are fully vaccinated
  • Less than 2% of people who are fully vaccinated have experienced a breakthrough COVID infection, according to President Nez

When it comes to Indian Health Services across the country, there have been over 1.7 million doses of vaccine provided, and about 52% of Native American and Alaskan Natives are fully vaccinated, said Brian Johnson, acting deputy director for Navajo Area Indian Health Services. 

“We do know the Navajo Nation has excelled by comparison in terms of vaccination,” said Johnson. “We know vaccinations are the safest and most effective way to prevent COVID-19, including the most serious consequences of the vaccine.”

Kids under 12

This week it was reported children 5-11 years old are able to receive the Pfizer vaccine. Jill Jim, director of Navajo Department of Health, said the vaccines are on their way and should be administered next week. 

Pfizer COVID-19 vaccine is over 90% effective at preventing COVID-19 in kids 5-11 years old. The children’s Pfizer vaccine is not the same as the vaccine given to adults. It’s the same active ingredient but it’s one-third the dose and it comes by way of smaller needles designed specifically for kids 5-11, explained Dr. Puthiery Va, an Internal Medicine Specialist in Chinle.

Delta variant driving a surge

In the past 60 days the Navajo Nation has seen a continuous rise in cases. Within the Four Corners area of Navajo, COVID-19 has had a high transmission rate since the summer. There has been 627 new cases in the past seven days with the most cases coming in from Gallup and Shiprock, Va said.

Case counts on the Navajo Nation by variant strains

Delta: 656 COVID cases are a result of the delta variant

Alpha: 156 COVID cases are result of the alpha variant

Delta / Epsilon: 81 COVID cases are a result of the Delta/Epsilon variant

Epsilon / B: 21 COVID cases are a result of the Epsilon/B variant

Gamma: 8 COVID cases

Mu: 8

Beta / Gamma: 6

Iota: 5

—Info from the Navajo Nation COVID-19 SARS Strain Surveillance report from Nov. 3

On the Navajo Nation there is only one contact tracer for each case, when there should be five. The hospital bed capacity is 63% and ICU beds are occupied at 66%. Va said this will go up. 

Iralu said the rise in cases is due to multiple factors. Respiratory viruses are easily transmissible as we head into the colder months. But, a major component is that after six months the potency of the vaccines begins to wear off, which is why getting the booster should be a priority. 

The U.S. Food and Drug Administration amended the emergency use authorizations for COVID-19 vaccines to allow for the use of a single booster dose for those who received the Moderna and Johnson & Johnson vaccines. Moderna recipients are able to get the booster after six months from when they were fully vaccinated, and Johnson and Johnson can get their booster two months after being vaccinated. Also made possible is the mix-and-match choice where a person can get a booster that is different from the vaccine they initially received. 

Since the Navajo Nation is considered high risk, everyone 18 years or older who have been fully vaccinated is eligible to get a booster.

“We are roughly nine months after these vaccines rolled out, first to health care workers then to elders,” said Iralu. “So this is to be expected. It’s still considered quite protective against Delta. But don’t rely on that little protection from the original series. It’s time for a booster.”

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Arlyssa Becenti
Arlyssa Becenti

Arlyssa Becenti is a Diné journalist with 10 years experience reporting on Navajo Nation. She recently placed first for Arizona Press Club’s community investigating reporting for her series on the illegal hemp and marijuana farms in Shiprock, N.M. She was also awarded Arizona Press Club’s 2020 Nina Mason Pulliam Environmental Journalism Award for community reporting. She has reported for the daily Gallup Independent and weekly Navajo Times. She is pursuing her masters in investigative journalism at Arizona State University’s Walter Cronkite School of Journalism.