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Outbreak on edge of Navajo Nation overwhelms rural hospital

GALLUP, N.M. – On the eve of New Mexico's shutdown of bars and restaurants to stem the spread of the coronavirus, the city of Gallup came alive for one last night of revelry.

Before the night was out in the desert oasis on the fringes of the Navajo Nation, 98 people were detained for public intoxication and sent to sober up at a detox center. Several homeless people also sought refuge in the same cinder block building, which doubles as a shelter. Somewhere in the mix, lurked the virus.

The outbreak seeded at the Na’Nizhoozhi Center would combine with the small, local hospital’s ill-fated staffing decisions and its well-intentioned but potentially overambitious treatment plans to create a perfect storm that has overwhelmed doctors and nurses and paralyzed this community in the state’s hard-hit northwest.

In all, 22 people infected with the coronavirus were transferred from the detox center to Rehoboth McKinley Christian Hospital, the only acute care medical center for the general public within 110 miles (180 kilometers) of Gallup.

“They were putting multiple cots in one room to accommodate them,” said pulmonologist Rajiv Patel, who helped lead the hospital’s initial response.

To care for that influx, any available doctor was pressed into service, including those who normally don't handle critically ill patients, Patel said.

“That’s right when we overloaded,” said hospital CEO David Conejo. “Now we’ve got too many patients, and too few (staff) to help.”

Rehoboth’s eight intensive care beds are full, and now it has to transfer all coronavirus patients with severe breathing problems away from the facility and the adjacent Gallup Indian Medical Center, which attends exclusively to the Native American community.

Of about 500 medical and support staff, at least 32 hospital workers have become infected, and doctors and nurses say that they all live with the fear of spreading the virus to their colleagues and relatives.

Conejo blames Patel for the fact that the hospital became overwhelmed, saying the doctor took on more COVID-19 patients than the staff could handle because of his ambition but also good intentions.

But Patel — who arrived at Rehoboth in March from an Army reserve stint in Kuwait — said the hospital simply didn't have enough staff with the experience to provide the right care and struggled to train more quickly. Patel has since left to work at Flagstaff Medical Center in Arizona.

Twice, the doctor said, alarms went off during the night on breathing machines — only to be misinterpreted by overnight staff. Within two days of those missteps, he and colleagues decided that severely ill coronavirus patients would have to go elsewhere — a heart-wrenching decision that meant sick people would be treated far from family and one that underscored the consequences of not having adequate care in the region.

“It was an easy decision because it was the right thing to do for patients,” said Patel, whose wife is Navajo. “It was very saddening for me personally because my heart and soul are completely invested in the health situation on the reservation."

Many nurses and doctors, meanwhile, say staffing at the hospital was inadequate because of Conejo's move to cut back on nurses in the first week of March to offset declining hospital revenues after elective surgeries were suspended. They voiced their discontent at a recent protest calling for his resignation.

“We knew it was coming to McKinley County, there wasn’t any ifs, ands or buts. I was directed that I had to let go of 17 agency nurses,” said Felicia Adams, chief nursing officer who has recovered from COVID-19. “We want to take care of our patients, we don’t want to have to send them away.”

Conejo defended his oversight, noting that he deferred to the hospital’s board of trustees and a team of nurses and physicians on final decisions. He also said the hospital couldn’t afford not to cut staff in March and that the facility wanted to reduce overall employment to qualify for small-business assistance. But Adams and others believe Conejo put profits ahead of care.

Physician Caleb Lauber said that, as experienced contract nurses were let go in March, unfamiliar responsibilities were thrust upon other nurses given only on-the-fly training.

New Mexico’s state auditor is seeking more information about the county-owned hospital's finances from its private operators. State health officials and philanthropists, meanwhile, are recruiting more than a dozen volunteer medical professionals and have hired a new critical care physician for the hospital.

While much of New Mexico is showing signs of emerging from the initial wave of the pandemic, stubbornly high rates of infection and death persist in the state’s northwest corner — including in the Navajo Nation that extends into Arizona and Utah. More than half of New Mexico’s roughly 6,200 confirmed infections are in Native Americans.

For most people, the coronavirus causes mild or moderate symptoms. For some, especially older adults and people with existing health problems, it can cause more severe illness and lead to death.

As the Navajo have suffered in this pandemic, so, too has Gallup, whose fate has long been tied to the neighboring Navajo Nation. In normal times, the city’s population of 22,000 can quickly quadruple in size since it is a crucial source of supplies and water for faraway Navajo households, many of which lack full plumbing.

The city is also a destination for many of the most marginalized Navajo, those who have left home and ended up on Gallup's streets, often as they grapple with alcohol addiction. Officials suspect that the coronavirus whipped through the homeless population, and some passed through the Na’Nizhoozhi Center, putting the liquor-tax funded shelter and detox center at the heart of the city's outbreak.

The city and its rural outskirts account for about 32% of COVID-19 infections statewide, with 79 related deaths as of Tuesday.

To stem the spread, Gallup was subject to an extreme 10-day lockdown this month — cutting the city off from many of those who depend on it for supplies. Authorities have now set up free water stations and deliveries — to avoid the risk of transmission posed by coin-operated water stations, where hand after hand scooped out returned change.

Now, the Na’Nizhoozhi Center is also part of the response as it steers destitute people infected by the coronavirus toward isolation in rooms at four otherwise unoccupied motel buildings. Some 140 people are currently participating in the impromptu system, and officials hope it will interrupt a treadmill of infections among Gallup’s homeless population.

But the virus has also taken its toll on the center. In addition to the 22 residents who became infected, several staff have been sickened by the virus and some simply stopped showing up, said Kevin Foley, executive director of the center. Six jobs now are open at a rate of $10 and hour, with just one application, he said.

He yearns for a Hollywood ending.

“I wish that all those people would come over in those space suits and just clean the place for good," he said, "but it’s not like that.”

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Associated Press writer Felicia Fonseca contributed to this report from Flagstaff, Arizona.