HEALTH

Hopi Tribe releases ZIP code data, but

COVID-19 data for Arizona's 22
communities is confusing
Chelsea Curtis
Arizona Republic
Published 7:00 a.m. MT June 4, 2020 Updated 3:05 p.m. MT June 9, 2020

This story has been updated to include an additional response from the Hopi Tribe.

The Hopi Tribe recently began to identify its new coronavirus cases by ZIP code — a move
other Arizona tribes, including the Navajo Nation with the largest number of cases, have yet
to do.

The Navajo Nation has been hard hit by the new coronavirus pandemic, bringing
international attention to Indigenous communities and the issues many have faced for years. 

However, there's a lot to be learned about the true impact of COVID-19 on Arizona's
indigenous communities. There is a lack of detailed data released by tribes or the state health
department, for reasons that are unclear.

The detailed data that is released has been released inconsistently, leaving it impossible to
draw conclusions about how deeply COVID-19 has impacted Arizona's 22 tribes. 

Hopi Tribe identifies ZIP codes for known COVID-19 cases

The Arizona Department of Health Services released detailed data in April that makes it
possible to see how many COVID-19 cases are in all the state's ZIP codes,
from places between Nogales and Page. 

But not for any of the state's tribal lands. 

The state's map shows infection hot spots near tribal lands, but the lands themselves
remained blank on Wednesday. That's because state officials say they need permission to
release data in areas where more than 50% of the population are tribal residents. 

Holly Poynter, a spokesperson for the state's health department, told The Arizona Republic
on Monday it was working with its partners to release data in ZIP codes where it
was suppressed.

She did not indicate if any tribes gave the state permission to release its data but said the
process to do so was "specific to each tribe."

Poynter said tribes that choose to report their COVID-19 data to the state are included in the
state's overall numbers.

Not all tribes report their data to the state, leaving data released by the state less than
comprehensive. She did not indicate which tribes have reported to the state and deferred The
Republic to the individual tribes for further information their data. 

Until recently, no Arizona tribes publicly identified its COVID-19 cases by ZIP code. 

In the last week, the Hopi Tribe began identifying ZIP codes associated with villages where
cases were known. Prior to that, the tribe appeared to consistently publish its cases by
village, however, did not identify the villages' ZIP codes. 

Situated near the center of the Navajo Nation, the Hopi Tribe's more than 1.5 million acres of
land is home to 12 villages on three mesas, according to the tribe's website. There
are more than 19,000 members globally, about 9,000 of whom live in the villages' more than
2,000 homes, Duane Humeyestewa, executive adviser of the Hopi Tribe Office of the
Chairman, told The Republic last week. 

According to its most recent update on June 2, the Hopi Tribe has 101 COVID-19 cases
identified at the Hopi Health Care Center, which is the closest Indian Health Service facility
to a majority of the tribe's villages in First and Second Mesa. Of the tribe's 101 cases, 40 were
identified as tribal members from the following ZIP codes:

86034 - 5
86042 - 8
86043 -16
86039 - 8
86030 - 3 
86045 - unknown 
Some ZIP codes account for multiple villages, according to the tribe's website. The ZIP code
86043, which represents the Second Mesa villages of Mishongnovi, Shungopavi and
Sipaulovi, has the tribe's most COVID-19 cases at 16. 

However, no COVID-19 data was available for Mishongnovi nor the Third Mesa villages
of Bacavi and Upper and Lower Moenkopi due to people being tested outside of the Hopi
Health Care Center, the website noted. 

Humeyestewa explained last week that because the Upper and Lower Moenkopi villages are
located next to Tuba City, residents from the area go to Tuba City Regional Health Care
Corporation for treatment since it's closer. 

Until recently, the Hopi Tribe did not have access to the Tuba City hospital's data, nor others
from the surrounding area, he said. The tribe has since made agreements needed to access
data from surrounding hospitals and is working with state and federal officials to compile it,
which could take a couple of weeks, Humeyestewa said.

He also said the Hopi Tribe experienced "a number of COVID-19 related deaths," however,
the total could not be confirmed due to not having data from surrounding hospitals. 

Humeyestewa said the tribe hopes to release more data, including age, race, gender and
tribal affiliation demographics. 

ZIP code data not published for other tribal lands 

It's unclear why other Arizona tribes aren't publishing their data by ZIP code. Most appear to
be reporting less than 100 COVID-19 cases and few to no deaths. 

The Navajo Nation — one of the largest tribes in the country spanning more than 27,000
square miles across three states — now has the highest COVID-19 infection rate in the
nation. The tribe had more than 5,533 identified cases and 252 confirmed deaths as of
Tuesday. More than 1,900 patients were deemed recovered. 

As a result, millions of dollars and donations, including $600 million in federal COVID-19
aid, have been funneled into the Navajo Nation to help residents in the face
of an unprecedented time in history. 

Yet, the details of its COVID-19 data remain to be seen by the public. 

Vice President Myron Lizer told The Republic on May 13 that "after all this pandemic has
passed" the tribe would "look at all the things that we can make better for the future potential
pandemic," including data.

"I don't know if we're just stretched thin or don't have the expertise, I would think it's the
latter, that we don't have the expertise with regard to somebody being able to create a
webpage," he said, later adding that he personally wanted ZIP code data to be released. 

The state has said its ZIP code map shows the location of cases based on a patient's home
address; however if an address is unknown, the case is mapped to the address of the provider
or reporting facility. The state's map indicates that, generally, more than 90 percent of its
cases were mapped to the address of the patient's residence. 

Last week, The Navajo Nation began publishing all of its number of cases stemming from
each of its health service areas, rather than by county as it previously did. An analysis of that
data by The Republic revealed infection rates in most parts of the Navajo Nation far exceeded
those in any ZIP code across the rest of the state. 

Of the 5,533 cases, the tribe reported on Tuesday, 31 cases could not be assigned to a service

unit. The data below represents the 5,502 cases that were correlated with Navajo Nation
service units: 

Chinle Service Unit: 1,423

Crownpoint Service Unit: 535
Ft. Defiance Service Unit: 295
Gallup Service Unit: 925
Kayenta Service Unit: 850
Shiprock Service Unit: 907 
Tuba City Service Unit: 464
Winslow Service Unit: 103

It's not clear whether a confirmed case in a service area means the infected person lives in
that area or sought care there. Indian Health Services, the entity that supplies the tribe with
most of its data, did not respond to multiple requests for comment.

No other Arizona tribes appear to be publishing specific locations associated with

their COVID-19 cases, including the White Mountain Apache Tribe, which could have
the second-largest amount of COVID-19 cases among the state's tribal nations. As of
Monday, the tribe had 769 identified cases and seven confirmed deaths.
A spokesperson for the tribe did not immediately respond to a request for comment.

The Gila River Indian Community — which received federal COVID-19 aid totaling $40

million last month — reported 62 known COVID-19 cases, 15 of which were identified as
residents on tribal land, Governor Stephen Lewis said during his most recent update on May
14. 

The tribe's casinos — Lone Butte, Vee Quiva and Wild Horse Pass — recently reopened with
modified guidelines for patrons.

The Gila River Indian Community declined to comment for this story. 

Confusion in the numbers

As the state implemented a stay-at-home order requiring most businesses to close, Arizonans
pressed officials to release more COVID-19 data to better understand what was being asked
of them. Some tribes in Arizona also implemented measures of their own, some of
the strictest in the country. The Navajo Nation completed its eighth 57—hour curfew since
Easter this past weekend — the third in which all businesses were required to close, essential
or not.

Meanwhile, the tribe's scarce data often leads to more questions than answers. 

Navajo Nation President Jonathan Nez told The Republic on April 13 the tribe's data
included only "Navajo residents that live within the boundary, the jurisdiction of the Navajo
Nation." 

"So if a Navajo gets COVID-19 in New York City, we're not counting that person," he said. "If
a Navajo that lives in the border town, off our nation, we're not counting them; it's just
people who are living within the boundary of the Navajo Nation, and that could include non-
Natives, too."

Border towns are communities that surround the Navajo Nation, such as Page and Winslow
in Arizona and Gallup in New Mexico. 

However, Navajo Area IHS facilities serve a community that is not exclusively Navajo Nation
members. The facilities treat all people, like members who live in border towns
or members of other tribal nations. As a result, it's possible, yet unclear, if the tribe's data
could be incomplete and could have more cases than reported. 
This is also apparent in the Hopi Tribe's data: only 40 of 101 known cases by June 2 were
identified as residents of the tribe's 12 villages. Details about the other 61 known cases were
not provided.

The Gila River Indian Community, Tohono O'odham Nation and Hualapai Tribe also
appeared to separate from tribal member residents and others.

While the Navajo Nation reported 5,479 known cases by Monday, the Navajo Area IHS
reported 6,272 known cases — a difference of 793 cases. The IHS website noted its data was
"from IHS, tribal, and urban Indian organization facilities" that voluntarily report. It's
unclear who those 793 cases represent, but some likely reflect border town cases that until
late April were included and then later removed from the tribe's data. There has been no
explanation given for why those cases were included, then removed, despite questions from
The Arizona Republic.

It is another instance of how confusing and complicated reporting COVID-19 data has been.
About a week after Nez told The Republic the tribe's data did not include border towns, the
tribe's executive branch noted in an April 20 news release its "overall number of
positive cases" included border towns. Four days prior, the tribe's health department was
the first to note in a news release that its identified cases and confirmed deaths included
some from border towns.

On May 21, the executive branch and health department both announced border town cases
were removed from the tribe's data, bringing its overall positive cases down by 115 to a total
of 1,206 identified cases at the time. However, the tribe's confirmed deaths at the time
increased from 45 on March 20 to 48 the following day.

"Even I don’t know that (why) as the vice president," Lizer told The Republic during a May 5
phone interview. "Those decisions are made within the emergency operating command that’s
been set up and the health command operating center; they’ve become the guards or the
stewards of all of this information and data."

Tribal members living in urban communities are also excluded from the Navajo Nation's
data, Nez explained. 

The Navajo Nation only lists cases identified at Navajo Area IHS facilities, which in Arizona
are in Tuba City, Winslow, Kayenta, Chinle, Fort Defiance, Pinon, Tsaile, Tonalea and Red
Mesa, according to its website. It also includes five facilities in New Mexico, one of the largest
being Gallup Indian Medical Center. 
Meanwhile, nearly half — more than 156,000 — of the Navajo Nation's more than 300,000
members nationwide lived outside of the tribe's boundaries, according to a 2010 U.S. Census
report compiled by the Navajo Epidemiology Center. 

The Phoenix Area IHS identified 1,850 cases while the Tucson Area IHS identified 58,
according to the health service's website. It does not indicate any COVID-19 related deaths.

It's unclear how many of those cases represent urban Natives or other tribal nation residents
within those areas.

State and tribe information are murky on demographic data

Each morning, Arizona's Department of Health Services releases detailed data which gives
insight into how COVID-19 is affecting communities by age, race, ethnicity, gender and
more. 

Arizona tribes for the most part aren't sharing that information.

State data at one point showed that Native Americans — who make up 4.6% of the state's
population — were dying from COVID-19 in disproportionate numbers in the state. As of
Wednesday, Native Americans made up 14% of the state's identified cases and 19% of
confirmed deaths for which race and ethnicity were known, the state's data showed. 

There are news releases from the Navajo Nation's executive branch nearly every day since its
first identified case, but they rarely indicate the age or gender of cases. The branch has been
handling the bulk of the tribe's media inquiries. 

On March 18, a news release from the branch noted its first three cases were a 46-year-old
woman, a 40-year-old man and a 62-year-old man. The following day's news release
didn't identify any of the day's 14 reported cases by age or gender. Releases continued with
no demographic data for nearly a month. 

On March 27, the Navajo Nation identified its first two COVID-19 related deaths,
releasing no details or demographics about who died.

As COVID-19 cases grew and the Navajo Nation became a focal point nationwide for cases
and deaths, the daily releases inconsistently provided demographic data. For three days in
April, the executive branch noted age and gender in its news releases. But from April 24 to
date, the branch's news releases did not include any age or gender demographics for reasons
that are unclear. 
The executive branch's news releases state the tribe's COVID-19 data is complied by its
health department in coordination with its epidemiology center and the Navajo Area IHS. A
spokesperson for the epidemiology center and health department did not respond to multiple
requests for comment. 

The tribe's health department on March 29 began creating and distributing its own news
releases detailing the Navajo Nation's COVID-19 cases. In the two weeks prior, the
department distributed the executive branch's news releases. 

Throughout April and May, with the exception of a couple of news releases reporting
different numbers, the executive branch and health department reported the same number of
overall COVID-19 cases and deaths. However, the health department on April 21 began
releasing additional COVID-19 data by including in its news releases age and gender
demographics of the tribe's cases.

As of Monday, 2,913 women and 2,566 men made up the tribe's then 5,479 identified cases,
the department shared on Facebook. Of that, 12% were 18 years old and younger, 64% were
18 to 60 years old and 24% were 60 years old and older, the department said. 

Of its 248 deaths at the time, 102 were women and 146 were men, according to the
department. Of that, 34% were 18 to 60 years old and 66% were 60 years old and older, the
department said. 

The Navajo Nation also has an online COVID-19 data dashboard, which provides no details
about the demographics of its cases. 

To date, news releases from the tribe's executive branch office and health department have
not once identified any of its cases by race, ethnicity or tribal affiliation. No other tribes
appear to have identified these demographics either. 

The Tohono O'odham Nation appears to be the only other tribe in the state identifying its
COVID-19 cases by age and gender. The tribe had 62 known cases and eight confirmed
deaths as of May 29. 

Of its 62 cases, 39 were women and 23 were men. 

The average age of its 62 known cases was 46.5 years old with an age range of 12 and 87.
Four of the cases were less than 20 years old, 25 were between 21 and 44 years old, 11 were
45 to 54 years old, 10 were 55 and 64 years old and 12 were 65 years and older. 
The Tohono O'odham Nation also noted in its data that 26 of 54 cases were hospitalized and
40 of 50 cases had serious underlying medical conditions. It appears to be the only Arizona
tribe to release such data. 

"It needs to be on Indigenous terms"

For tribes, publicly releasing data comes with a complex set of issues, said Stephanie Russo
Carroll, who heads a University of Arizona lab group focusing on Indigenous data sovereignty
and governance.

"My dissertation work was largely impacted by a lot of the complex data issues that affect
tribal communities, so I know from personal experience that tribal communities often don't
have the data they need for decision-making," said Carroll, who is Alaskan Native. "Our data
can basically be weaponized against us, used against us and are used as tools of measuring
colonization." 

Many tribes, Carroll said, don't have the resources in place to access or collect data about
themselves, for reasons from not having preexisting agreements in place to not having the
expertise. Arizona is home to two of 12 tribal epidemiology centers in the nation.

 Some tribes also get overlooked when data is being collected, she added. 

"We call it the asterisk, right, Natives are the asterisk, they're just too small to measure," she
said. "Which is absolutely ridiculous."

Due to years of historical trauma, some tribes might also be protective of the data they do
have, Carroll said. 

"You have this ongoing push and pull, and I often describe it as a pendulum, too," she said.
"Once tribes start to gain control and have their own data, you have maybe for awhile this
pullback of, 'We need to get our house in order before we're comfortable sharing,'" she said. 

"In general, many of the tribal program directors and leaders that I've talked to see there is a
place for data sharing but it needs to be on Indigenous terms; the pendulum hasn't swung
enough times to be back in that middle place yet."

Lizer briefly discussed tribes' inclination to guard its data "like nobody's business" in early
May, because it was among few things on they can stake a claim. 
“It’s one of the things that we do have — we don’t own the land, we don’t own the method in
which funding is given; everything’s kind of mandated for us, we’re wards of the federal
government," he said. "I’m not saying we’re concealing stuff, it’s just like one of the only
things that Indian tribes own, other than their culture and their language; they treat it as one
of the pristine upmost things to guard."

Indigenous nations have a right to govern their own data, Carroll said. In fact, Arizona tribes
aren't required by law to report communicable diseases to the state, although many do. 

Reach the reporter at chelsea.curtis@arizonarepublic.com or follow her on

Twitter @curtis_chels. 

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