The Temporary Battle Against COVID-19 Taught This N.C. Native Community How to Combat a Longstanding Epidemic
A few weeks ago, I found myself tearing up at my kitchen table as I listened to a healthcare official from the Eastern Band of Cherokee Indians explain to me the intricate and bold steps my tribe has taken to combat COVID-19 on the Qualla Boundary – specifically Cherokee, North Carolina. We had enacted policy and consolidated resources completely separate from state or federal aid and mandate. This was the third conversation on the topic I had had with a tribal official — the third time I teared up out of pride.
As of July 12, even after the summer holidays’ surges, the EBCI has administered 5,620 COVID-19 tests, with 86 positive test results. Sixty-one of those have fully recovered. These are exemplary rates compared to our neighbors in surrounding counties like Henderson and Macon, and in mid-May when I began speaking with tribal officials, our numbers were even more remarkable. But just as I was celebrating our assertion of sovereignty in the midst of a global pandemic, the story took a complex turn. I was about to tear up over a much different statistic.
The EBCI has reacted to COVID-19 with an abundance of caution that exceeded much of Indian Country’s and certainly our home state’s response. In partnership with the nonprofit Dogwood Health Trust, a nonprofit health organization based in Asheville, we began providing access to free community-wide testing (even asymptomatic) long before North Carolina recommended it. We set up roadblocks and allowed only residents or EBCI enrolled members to access the Boundary. We closed non-essential businesses, including Harrah’s Cherokee Casino and our government offices. We employed a sophisticated and comprehensive contact tracing system that has been credited with identifying asymptomatic carriers before they unknowingly transmitted the virus.
However, one week prior to the removal of roadblocks, my Facebook feed was inundated with local memorial postings. At this point, no enrolled members of the EBCI had succumbed to the virus, yet seven residents of the Qualla Boundary – a population of approximately 2,100 – had died within a couple of days of each other. While we focused on slowing the COVID curve, we experienced an explosion of drug overdose deaths. Additionally, the total number of overdoses, including those not resulting in death, was literally incalculable.
During state-wide lockdowns, nonessential Tribal employees continued to be paid, though now at home. A per capita loan fund provided ready cash for those not willing or able to wait until the June 1 disbursement of gaming revenue. Food assistance programs continued to run and emergency services ramped up their care for elders and the needy. A tractor trailer even brought a full load of free frozen chicken to the Boundary, providing 10 pounds each to anyone who showed up.
These were all tremendous examples of a community caring for the collective and stabilizing an economy, but it also meant that we became one of the few communities in far western North Carolina who still had the means to be paying customers — especially in the illegal drug trade.
Ready access to cash stiffened across the remainder of the western North Carolina, but the Boundary continued to provide a fluid market for dealers.
The blockades provided a challenge for traffickers, how to move product across barriers when passage required drivers to either be enrolled EBCI members or prove Boundary residency. They needed to move larger quantities fewer times. What resulted was an inflow of fentanyl-laced heroin. For dealers, they could stretch their product and meet the demands of all customers in a timely manner. ,
“The narcotics industry follows a customer service model. It’s a sophisticated business,” Principal Chief Richard Sneed described. They were going to meet demand. They weighed their risk-reward ratio.
But members of the community who struggled with substance use disorders who were accustomed to a typical dose were caught off-guard by this production adjustment, the addition of fentanyl – a synthetic opioid that is 50 to 100 times stronger than morphine. Seven died. Others turned to Narcan for a life-line.
Vickie Bradley, Secretary of Health and Human Services for the EBCI, argues that we have a dearth of consistent overdose/drug usage data that can show clusters of overdoses and deaths in almost real time.
“But it relies on EMS and healthcare facilities to code a death as an overdose and some providers are reluctant to do so because of stigma for the family,” she explained. “They may code it as a heart attack or other similar event instead.”
The EBCI’s Overdose Map, where the collected data is housed for analysis, also does not account for instances when Narcan, an overdose reversing medication, was used to revive a patient.
While we have more COVID-19 contact tracers than North Carolina’s goal, we “don’t have a consistent philosophy” for tracking overdoses, according to Bradley. She notes that the take-away from our COVID response is the effectiveness of employing a multi-user platform to capture data and her programs are in the early stages of expanding just such a platform.
Chief EBCI Alcohol Law Enforcement Agent Josh Taylor, who was tasked with expanded responsibilities during the shutdown, believes the COVID-19 precautionary measures highlighted one very important truth in the fight against the drug epidemic on the Boundary.
“It was one of the few incidences when we got to take outsiders out of the equation. It was a sad reality that our own people were working so hard to bring [drugs] into our community. Maybe they were now having to traffic the drugs more themselves, or maybe they just always have been,” he said.
The most difficult adjustment for Taylor was realizing “that dope was killing more of our people than this pandemic.” With COVID-19 proliferation in the drug community, contact tracing simply won’t be as effective. People abusing or misusing drugs rarely obey stay-at-home orders, even if they test positive.
Overdoses seemed to diminish with the removal of blockades and officers were no longer needed for border control. Warrant issuing and arrests became the newest trend. Trafficking intelligence was gathered not only from police surveillance efforts but also from community services that were making more home visits as a result of COVID-19. Unfortunately, this led to the next challenges for the EBCI – 14 law enforcement officers were exposed to COVID-19 while on a drug-related call and had to quarantine for two weeks, sidelining them from their duties.
To-date, state and federal aid has done little to assist impoverished native communities coping with historical grief and trauma in their fight against substance use. But if we are to learn anything from COVID-19, it is that waiting for outside help is a death sentence.
When I speak to them as I sit at my kitchen table, the EBCI officials tasked with safeguarding our communities, whether it be from the coronavirus or illegal drugs, are more than just names and titles to me. Secretary Bradley and Chief Sneed are Vickie and Richie, whose children were students at the school where I teach. Officer Taylor is my cousin, Josh, with whom I grew up.
This is one reason why their stories are emotional for me. They don’t sensor their words because they know the importance of being honest with ourselves now, of learning from this seemingly temporary epidemic how we might begin to combat a much more longstanding one. Because sovereignty is not only a protection from the outside; it is a responsibility to derive power from the inside.