COVID-19: Prevention of suicide, intimate partner violence and adverse childhood events (ACEs) in Indian Country - Coronavirus Disease 2019 (COVID-19) is a pandemic that is changing the face of our local, regional, and national communities. This impact will in many ways be profoundly negative and – through opportunities like this one – will lead to renewed emphasis on the importance of preparedness, partnerships, and effective response in the face of crisis. As of April 7, in counties within, on, or near the boundaries of tribal reservation lands in the Great Plains states of Iowa, Nebraska, North Dakota, and South Dakota, there have been 455 confirmed cases of COVID-19 identified, with 445 active and 10 proving fatal as of that date. Great Plains Tribal Chairmen’s Health Board (GPTCHB) and its Great Plains Tribal Epidemiology Center (GPTEC) stand ready to expand our response to COVID-19 and provide regional public health leadership by expanding and fostering collaborative relationships between Great Plains tribes, states, and federal entities/agencies for the purposes of tribal emergency preparedness, response, mitigation, and recovery. In support of this vision, GPTCHB and GPTEC plan to: 1) Stand up a regional tribal Emergency Operations Center (EOC) with the ability to develop and implement culturally-responsive public health emergency management plans and procedures in support of Great Plains Area tribal communities; and 2) Support Great Plains Area tribes in developing or enhancing tribal level EOC and/or Incident Command infrastructure, policies, and plans as appropriate, to ensure consistent and effective operations. These activities will develop the capacity and form the basis for a public health preparedness and emergency response learning center and tribal emergency management coalition centered around GPTCHB/GPTEC and serving the specific needs of the Great Plains Area. There is a critical need for this type of infrastructure development throughout the Great Plains and across the nation. Sovereign tribal nations have been consistently left out of opportunities to participate in the growth of public health systems, capacity, and infrastructure at the federal, state, and local levels, leading in part to complex jurisdictional considerations. Ongoing conversations with tribal health partners in the Great Plains Area have illuminated their experience with and preparedness to respond to a variety of environmental disasters, including those experienced recently that have already stretched public health resources and infrastructure significantly and provide a foundation upon which to build. These conversations also emphasized the need for support to develop similar capacity for preparedness and response to pandemics and infectious disease outbreaks like COVID-19, which found existing infrastructures and systems across the country unprepared. Further, American Indians experience higher rates of comorbidities associated with increased risk for COVID-19 compared to their White counterparts and – in the Great Plains Area – increased rates of death associated with pneumonia and influenza between 2013 and 2017. Significantly, access to healthcare is a challenge for tribal communities, with a high proportion of the population uninsured and nearly all reservation communities in the Great Plains Area designated as Health Professional Shortage Areas. This emphasizes both the need for concerted yet tailored efforts to head off this outbreak as soon as possible and the opportunity to establish lasting impacts on tribal readiness to respond to emergencies. Leveraging our extensive network of existing partners, GPTCHB/GPTEC – through technical assistance, training, and other mechanisms – will support complementary and comprehensive preparedness, response, mitigation, and recovery activities at the regional and local levels to blunt COVID-19’s impact on tribal communities and citizens, while generating emergency management systems and plans poised to alter the potential effects of future outbreaks.
