BLANDING – As a triage nurse in Monument Valley, Utah, Amber Rasmussen stands in the parking lot all day, testing people for COVID-19.
On a typical day, she sees 20 to 30 patients, many of whom arrive at the Utah Navajo Health System clinic with severe COVID-19 symptoms.
“It’s been much worse lately,” she said. “I’d say at least once a day I’m having to send patients out in the ambulance on oxygen to the closest hospital.”
While Utah is reopening, the coronavirus is still ravaging the Navajo Nation. The number of COVID-19 patients arriving at hospitals there increased by 10% last week, while cases admitted to intensive care units doubled, according to the Navajo Area Indian Health Service.
And the worst could be yet to come. The Indian Health Service, which operates 14 facilities on the Navajo Nation, projects the infection rate on the Navajo Nation will peak in late May.
If that happens, there could be problems, Rasmussen said, as hospitals on the reservation are filling up.
“It’s hit or miss, to be honest. Some days there isn’t any space, and then you get lucky,” she said, adding that many of the patients that arrive at her clinic needing hospitalization are from Arizona.
The two closest hospitals to Monument Valley are in Kayenta, Ariz., about 30 minutes away, and Tuba City, Ariz., about 1 ½ hours away. If both are full, Rasmussen has to send patients 2 ½ hours away to Farmington, N.M.
Rasmussen said she’s also worried about her capacity to triage more patients, adding that coordinating care for multiple COVID-19 patients is like a puzzle she has to work out every day.
“The only thing we could do to see more patients is to have another provider there,” she said. “Because we only have one provider seeing those walk-ins.”
But the numbers on the Navajo Nation could be worse, according to Dr. Loretta Christensen, chief medical officer of the Navajo Area Indian Health Service. The surge in COVID-19 patients arriving at hospitals in the past week is actually lower than what the Indian Health Service was projecting.
“I still believe that our social distancing is working,” Christiansen said. “We feel like we have flattened the curve and are compensating well.”
The Indian Health Service has been able to handle the current level of COVID-19 patients by transferring them to hospitals off the reservation, according to Christensen. That’s also the case at the Utah Navajo Health System, which is a non-profit organization contracted with the federal government to provide health care on the Navajo Nation.
“We’re doing well because we can use tertiary centers in New Mexico and Arizona,” Christensen said, adding that the number of patients the Indian Health Service sent to hospitals off the reservation tripled last week.
The Indian Health Service and the Utah Navajo Health Service have partnered to build temporary field hospitals where people can receive care after they are discharged from the hospital. And the Indian Health Service is working with motels to create isolation units, where people who have tested positive and are in need of shelter can go to self-isolate.
They don’t have any in Utah, but the Utah Navajo Health Service is developing a similar model right now, according to CEO Mike Jensen.
Jensen said if there is a spike in patients at the Monument Valley Health clinic this month, hospital officials can move an extra provider there to help nurses like Rasmussen keep up. He added that the Utah Navajo Health System also has a contract with the University of Utah Hospital in Salt Lake City, which currently has room for critical patients.
“I feel good about our ability to handle an increase in cases,” Jensen said. “I’m in touch with the University of Utah, and they’ve got plenty of beds up there.”