After performing funerals for his 40 neighbors, Gary Lupe tested positive for COVID-19 in October. Lupe, a 56-year-old minister for the Fort Apache Indian Reservation of Whiteriver, Ariz., had spent the previous months in quiet anticipation despite being vaccinated in January. On October 10, when he was showing flu-like symptoms, a nurse at the nearby Indian Health Service (IHS) asked Lupe to go to the emergency room, because of his wife Berlita and their six children. Theirs immediately started quarantine. Lupe was treated with Regeneron’s monoclonal antibody without hesitation: IHS, he said, trusted. “They were (always) very respectful,” Lupe recalls. “They understood that we were dealing with something that no one else understood.”
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The reserve has 18,000 residents, and Lupe was part of the 29% that tested positive for coronavirus in the past 18 months. His recovery is a byproduct of a new method for contact tracing and testing that is being developed entirely on this dedicated White Mountain enclave, three hours east of Phoenix. In a report published October 14 in American Journal of Public Health, a consortium of 10 Caucasian and Indigenous health professionals demonstrated that by sending multidisciplinary teams of field nurses—trained to pick noses and get blood oxygen levels—to the Apache home. , they have minimized deaths from COVID-19 before. These experts say the model is a sensible alternative to the US’s distributed tracking framework, which is still being strained by the rise of Delta. Bypassing the text or phone-style tracking seen in nearby Maricopa County, IHS has minimized asymptomatic spread through monitoring an average of three times a week on high-risk patients ( mostly older adults over 50 with comorbidities), take them to the emergency room if oxygen levels are low. So far, it’s worked: Fort Apache has nearly half the COVID-19-related death rate as the state of Arizona.
In March 2020, Dr. Ryan Close, director of preventive medicine at the IHS branch of Whiteriver, knew that a unified tracing model was needed to protect the most vulnerable residents of the Tribe. White Mountain. A pediatrician-trained and expert in epidemiology, Close has spent years organizing home visits in the Dominican Republic village of Consuelo, and has carried out community-based HIV work in Swaziland in 2006. When White Mountain recorded its first positive case of coronavirus on April 1—making it one of the last spots in Arizona to record an account—Close and his 30-year-old staff he planned their High-Risk Pre-Access Program, which was formalized with White Mountain leaders and physicians in the U.S. Public Health Commission Corps. Goal: detect COVID-19 in older adults before they know they have it. “We have curated and honed a performance-based system,” says Close. “One that works for people as soon as they are diagnosed with COVID-19. Around there, the marking machines are working. ”
Come summer, Close and the crew have good reason to be proud. He and Dr. Myles Stone, director of the High-Risk Access Program, announced July 16 in New England Journal of Medicine that their new approach of “knocking” has “successfully leveled the curve.” Over a 4-month period, 1,600 cases of COVID-19 were confirmed. The White Mountain Apache died at half the rate (1.1%) of others across Arizona. And despite the 90-degree heat, mountain lions and wild dogs, remote roads and the danger of spreading, reassurance Close’s weekly home visits are crucial. “Only by being on the scene can we identify such patients early, provide supportive care, and possibly save a few lives,” he wrote.
Although some cynical Apaches resisted the field teams — no more than 100 flatly refused care, IHS found — White Mountain tribal leaders intervened to ease that hesitation, often is in their mother tongue. Gwendena Lee-Gatewood, the tribe’s president, says the sound of her voice over radio waves (a faulty cell reception at the time of booking) has reassured stubborn elders with silent hypoxia Silently refuse pulse oximetry tests or an emergency ride to the emergency room. “There was a time when I was angry on the radio: ‘Look! There are some you do not cooperate! ‘” Lee-Gatewood said. “’The way you show your love to your family is that you help them. High-risk group? They are here to help us. ‘”
Close and his team investigated the majority of cases within 23 hours. A month after the vaccine arrived in January, they limited a three-month study to the effects of three monoclonal antibody treatments (one of which is being made popular by President Trump), the first study of its kind involving indigenous peoples. The results, described in their October paper, reinforce Close and Stone’s initial findings: every high-risk patient for hospitalization who was treated with an antibody such as bamlaniximab survived and did not participate. join the ICU; Of the eight people who died during this time period, none were given antibodies.
But can this door-to-door model be replicated to other US cities? With only 18,000 residents and specialized hospital staff of the reservation, it is highly unlikely that Close’s success over the past 19 months can be reflected in metros like Chicago or Miami, where patterns follow The revised contact is out of date. If the city’s public health department wants to give it a try, Close said it will need to readjust or retrain all of its monitoring equipment, merge electronic health records and require medical staff to ER doctor diagnoses COVID-19 and administering antibodies — can be a waste of precious time for an already constrained department for months.
But Close has always shied away from excuses, even from skeptical doctors. “Some have said to me, ‘Oh, this is not going to work on the South Side of Chicago,’” he said. “Well, it looks like the phone bank isn’t working either. So why not try something new? ”
After two weeks of recovery, Lupe is equally optimistic. He knows how lucky he is to have recovered in the age of mRNA vaccines and antibody treatments, especially his hypertension. For those who don’t make it through, Lupe makes sure to pay tribute to them during his weekly Skype lectures. “I pray for everyone I can, IHS and tribal leaders,” he said. “After all, God is in control.”
