American Indians in Minnesota experience worse COVID impacts than reported

As COVID-19 relief resources and vaccines are distributed across Minnesota, we must adjust strategies in response to the fact that American Indians in the state have suffered even greater losses due to the pandemic than official data indicates. Once again, systemic bias and colonialism negatively impact this population, with fatal consequences.

Official statistics from the Minnesota Department of Health capture COVID-19 mortality that was confirmed by a test or other medical diagnosis, but not all COVID cases are officially diagnosed. The pandemic has also led to increased deaths from other causes. A new study from researchers at the University of Minnesota (including two of the authors of this article) found that overall deaths have increased compared with typical years across all demographic groups (epidemiologists call this "excess mortality"), but Minnesotans of color, including American Indians, have been most affected. From March 1 to Nov. 25 (the last day with reliable data), the state's relatively small American Indian population has seen nearly 100 more deaths than what would have occurred on average during the same time period over the last three years.

For American Indians in particular, confirmed COVID deaths tell only a small part of the story of the pandemic's impact on the community. Just 58% of the excess mortality for American Indians — compared with 86% for white Minnesotans — are deaths that wind up in the state's official COVID statistics.

This disconnect between official COVID deaths and the full toll of the pandemic for American Indians and other people of color in our state probably results from a combination of factors. First, some demographic groups may be more likely to get an official diagnosis when they are sick with COVID, such that deaths caused by the coronavirus in populations of color are less likely to be counted in the official statistics. Second, compared with the white population, there may be more deaths in the American Indian population and other populations of color that are not directly attributable to COVID illness but may still be related to the pandemic, such as deaths associated with not getting needed medical care for chronic health problems or food insecurity due to income loss.

In short, American Indians and people of color are dying at far higher rates than white Minnesotans during this pandemic. This is due to bias within the health care system, lack of access to care in some areas of the state or among some demographic groups, and differences in material hardship.

We can take three steps to address the needs of the American Indian population, whom this pandemic has disproportionately affected:

• American Indian tribes and community organizations need more resources to address their communities' COVID-related needs (which are vast and significant), and they should have self-determination to distribute and decide the uses of those funds.

• Health care and service providers need to be especially vigilant to attend to the needs of American Indian people who have chronic health conditions. Providers should be aware of patients who are avoiding or may not be able to access the care they need, and provide additional supports and resources to these individuals. Systems should modify their practices and policies to address the ways in which historical trauma and systemic racism have affected health care and health outcomes for American Indians, including how this is playing out during the pandemic.

• American Indian reservations and communities should be prioritized for vaccine distribution. We need to provide education, specifically tailored to American Indian communities, on vaccine safety and other topics that will increase trust in the vaccine. Tribes will need resources, support and technical assistance to manage logistics and informatics needs related to vaccine distribution. Importantly, this all needs to be done within the context of tribal sovereignty.

Social determinants of health, racism, and the suppression of Indigenous cultures, languages and traditions that came along with colonization of Turtle Island (North America) created this higher-than-average mortality in the American Indian population during the COVID pandemic. These features of our society caused a systemic disparity. Only a systemic response can effectively address it.

Nicole MartinRogers is a descendant of White Earth Nation and a senior research manager at Wilder Research. Elizabeth Wrigley-Field is an assistant professor of sociology and a faculty affiliate at the Minnesota Population Center at the University of Minnesota and a co-author of the recent study "Racial Disparities in COVID-19 and Excess Mortality in Minnesota." Sarah Garcia is a doctoral candidate in the sociology department at the University of Minnesota and a co-author of the same study. Shannon Geshick is a citizen of the Bois Forte Band of Chippewa and the executive director of the Minnesota Indian Affairs Council. Dan Milbridge is a descendant of Bois Forte Band of Chippewa and the director of Bois Forte Health and Human Services.