GALLUP — Vince Mariano was at home eating dinner with his family when the phone rang. It was news that his wife had tested positive for the novel coronavirus.
Some days later, while at work, he got another call: Mariano also tested positive. His two sons, ages 16 and 19, were positive, too.
“It was pretty shocking and pretty scary,” he recalled.
Mariano, who is Navajo, said he experienced relatively minor symptoms: headaches, body aches, fatigue. His wife went through some shortness of breath. His sons had mild symptoms.
All have recovered, but what Mariano remembers most is the fear.
“I thought, you know, ‘I’m immune to a lot of stuff,’ ” Mariano said. “But when I got it, it scared the heck out of me.”
That kind of panic lingers in Gallup and McKinley County, even as the spring and summer explosion of virus cases has begun to abate. The worry is understandable: The Western New Mexico city and surrounding area have seen more deaths from COVID-19, the disease caused by the virus, than anywhere in the nation — more per capita than even New York City, according to data compiled by the New York Times.
But as the hardscrabble town of 22,000 celebrates a recent sharp decline in both cases and deaths, local leaders say the threat of the virus is far from gone. In fact, they worry another surge may be on its way to a region where persisting health problems already have led to devastating losses.
Officials say the underlying factors that fueled McKinley County’s high mortality rate are still present in the community: an uncertain economy, the high diabetes rate, a lack of healthy food options, a poverty level nearly triple the national average and a severe lack of running water for many in the nearby Navajo Nation.
Fixing those problems will take a long time in a dusty swath of the state that has waited months, years and decades for solutions. But with fall and winter on the way, some worry they are running out of time.
“In the minds of our leadership, they do see that our communities had these issues for a long time,” said Wendy Greyeyes, an assistant professor of Native American studies at the University of New Mexico. “It’s just the cost of actually doing these things. The resources haven’t been there. The guidance hasn’t been there.”
A spring like no other
The pandemic hit Gallup and McKinley County with a devastating wrath. More than 230 McKinley County residents have died — almost 33 percent of the state’s 711 total deaths. Virtually anyone you talk to here knows someone who lost someone. Some people tell stories of entire families, like the Marianos, who were infected but survived. Some talk about families that were devastated.
Even for those who survived, the virus can carry a stigma. One woman, who didn’t want to give her name, said she is afraid of what might happen to her if her employer found out she’d been ill. She worries friends and neighbors might treat her differently if they knew, too.
“You don’t want to move. You don’t want to eat. Certainly you have to force yourself to do some self-care, what you can,” the woman said of her experience with the infection. “It wasn’t until I started to have the difficulty breathing and had to go back to the hospital I realized how serious it was.”
But if people’s lives have been altered, their way of living remains largely the same.
Many in the Navajo Nation come to Gallup to refill large water tankers hauled on truck beds and to buy groceries and other supplies for far-flung homes across the bone-dry Arizona-New Mexico borderlands. Between 30,000 and 50,000 people shop in Gallup every month, primarily from five Native pueblos and reservations, said Gallup Mayor Louie Bonaguidi.
An influx of people into the same stores and water collection points was a public health nightmare during McKinley County’s surge in April and May.
To protect Gallup and nearby tribes, the city went on lockdown for 10 days in May as cases climbed. Gov. Michelle Lujan Grisham sent state police, National Guard troops were mobilized and the bustling town settled into a strange, two-week silence.
Bonaguidi, who was sworn into office on the first day of the lockdown, said the effort let people know the virus is a life-or-death matter. It also let the city catch its breath as nearby Navajo Nation residents faced strict evening and 57-hour weekend curfews that have only recently been relaxed.
That kind of action, some say, was critical in helping beat back the virus.
“What I think is powerful about what’s happening with Navajo Nation and why Navajo Nation was able to start to flatten the curve is primarily because of the leadership,” Greyeyes said.
But some local leaders still worry about how the regional economic and social hub will survive a second spike health experts fear could strike this fall and winter.
“The thing we ought to be doing right now is preparing for winter,” said state Sen. George Muñoz, D-Gallup. “Whenever the second wave comes.”
Fixing the hospitals
While executives at Gallup’s two hospitals are working through major upgrades to add more beds and isolation rooms with negative air pressure and medical filters that can suck up the virus, Muñoz, state Rep. Patty Lundstrom, D-Gallup, and Sen. Shannon Pinto, D-Tohatchi, say they fear the facilities are still underprepared.
They worry about a lack of bed space. If a second spike in the area were to coincide with peaks in Albuquerque and Phoenix and Flagstaff, Ariz., hospital staff might have limited options for patients who needed to be transferred because of the short supply of local beds.
When cases spiked beyond control earlier this year, Gallup hospitals in April had to repurpose a local high school gym to hold 60 more beds for patients with severe COVID-19 symptoms.
“I think the facilities are terrible,” Lundstrom said. “They’re not going to be adequate, and if we thought they were, there would have not been the need to stand up the hospital in the Miyamura High School.”
The top two administrators at one of the hospitals, Rehoboth McKinley Christian Health Care Services, did not respond to requests for an interview. Ina Burmeister, chief development officer for the hospital, said in an email that “staff is experienced in caring for critically ill patients and we have an excellent board-certified critical care physician as part of our team.”
Gallup Indian Medical Center CEO Mark Alford said his hospital, which is owned and operated by the federal Indian Health Service, can meet the current demand. But hospital officials expect cases to rise.
“That’s part of what we’re making plans and preparations for, is at any point if it does start showing an uptick of positive COVID patients, then we should have a plan in place,” Alford said.
In preparation, the hospital is expanding to offer more beds in a prefabricated structure that will be installed in the parking lot. It also is placing medical-grade air filters and preparing to ensure every isolation room sucks in fresh air from outside and dispels potentially contaminated air.
The hospital also is hunting for more storage space to house a three-month supply of personal protective equipment it has not yet obtained, and it’s looking for more permanent staff. Up to 75 percent of the hospital’s nurses are temporary or volunteer workers.
If anything, Lundstrom and Chamber of Commerce CEO Bill Lee say the crisis has underscored the urgent need for a new hospital. Lundstrom said she has pressed the state’s congressional delegation and even President Donald Trump to fund a new facility.
“We need a modern medical facility for the Native American people in this region,” Lundstrom said. “I think that it has played havoc.”
The 60-year-old Gallup Indian Medical Center is housed in “an ancient building,” said Jonathan Iralu, chief clinical consultant for infectious diseases at the Indian Health Service.
When some new construction is completed by mid-September, the facility will have 44 rooms with negative airflow and 35 medical-grade high-efficiency particulate air filters that could help protect hospital staff and others needing care who don’t have the virus, Iralu said.
The hospital has only six intensive care unit isolation beds. Before winter, there will be up to 14 intensive care unit beds and 44 isolation rooms.
“So the entire hospital would be like one big isolation room,” Iralu said. “These upgrades are all to be able to handle a massive surge. We want to be extra ready in case every ICU bed in Albuquerque and Flagstaff and Phoenix are completely full. We want to be able to handle the care here in Gallup, and we think to do that, we really should trade a lot more negative airflow rooms.”
The hunt for water
Along N.M. 264 on the way to Window Rock, Ariz. — the seat of the Navajo Nation’s central government — olive-green shrubs dot an endless tan expanse punctuated only by the occasional mobile home, church or gas station.
In a land of parched earth, water has always been held sacred to the Navajo people. And yet, more than 30 percent of the 173,000-member Navajo Nation lacks running water.
“In this day and age, that is totally unacceptable. We live in the most powerful country in the world. We give aid and relief to war-torn countries in the billions. But yet right here in the middle of the most influential country in the world, Indigenous peoples — first citizens of this land — have been pushed aside for decades. Centuries,” said Navajo Nation President Jonathan Nez.
The lack of water pipelines only provides more hurdles to controlling the virus, Nez said. Without running water, it’s difficult to wash your hands. And although many Navajo families haul tanks of it back to their homes on a regular basis, families often seek to preserve water by reusing it when they can.
“In developing nations, not having running water is considered a health emergency and a crisis, whereas in the United States, we’re not defining it as that,” said Emma Robbins, director of the Navajo Water Project run by the Los Angeles-based nonprofit DigDeep.
While progress was made when the Navajo Utah Water Rights Settlement Act passed the Senate in June, the House still has not taken action on the federal legislation. If enacted into law, it would offer the Navajo Nation rights to 81,500 acre-feet of water a year from
the Colorado River Basin and $210 million in federal funding to build water infrastructure on Navajo Nation land.
Efforts to build pipelines have been bogged down for years by onerous federal barriers from a number of agencies that often don’t communicate with one another when tribes seek to go through the regulatory hoops to build anything, said U.S. Rep. Ben Ray Luján.
“A lot of the problems that exist within the various federal agencies working with the Navajo Nation is because they simply don’t talk to one another and there’s no meaningful consultation with the Navajo Nation,” said Luján, a Nambé Democrat. “If these federal agencies would simply communicate with one another and establish ways of working with tribal governments and embracing meaningful consultation, many of these hurdles could be addressed without even having to change a rule.”
The federal CARES Act delivered some $714 million in pandemic aid to the Navajo Nation. Even after receiving the money in May, the Navajo government is still fighting to extend a Dec. 30 deadline the Trump administration has imposed on spending CARES Act money.
Nez blasted the Trump administration over the short deadline, which he says isn’t nearly enough time to spend much of that money on building new water pipelines and new homes for Navajo Nation residents. Both projects are central efforts to combatting the coronavirus in the long run.
The ability to turn on the tap and wash your hands is crucial to preventing the spread of the virus. So, too, is having a place for family members to isolate in a culture where many families live with several generations in a single home. Nez has plans to use federal aid to build more homes.
“The CARES Act was for all U.S. citizens throughout this country for relief because of this virus,” Nez said. “But the first citizens of this country had to wait months in order to get their share of CARES Act funding. And that just shows you the priorities in Washington.”
Since they were ill, Mariano and his family have gone back to living their lives largely as normal. Or at least as normal as can be.
Mariano is back at work as a plumber and maintenance man for Muñoz Corp., a 12-person construction business owned by the state senator. Mariano said he’s grateful he and his family all had relatively mild cases of the virus.
“I tell people on a scale of 1 to 10, I had about a 4,” he said.
Others had it worse. His sister ended up in the hospital but recovered. His wife’s grandfather died.
The Marianos wear masks, wash their hands frequently and remain cautious. He said he worries his friends could blame him if they or a family member contract the virus because so little is still known about it.
Even weeks after his recovery, Mariano said he still feels a momentary wave of illness. It seems to disappear as quickly as it came on.
But mostly, the 52-year-old said he worries about his extended family and friends who have so far evaded sickness.
“Some families, they lost a lot of relatives on the reservation,” he said. “Some lose three or four in a family, and you’re like, ‘Man, that is bad.’ Gratefully, that did not happen to us. That’s the part that really scares me.
“To me, it is not just a game or it’s not a hoax,” Mariano continued. “You hear on the news, ‘Be careful.’ Some people think it’s not [serious]. But I wish everybody would listen and obey the rules. If we obey all the rules — I don’t know, it will slow down.”