Investigating linkages between arsenic exposure, diabetes, and COVID-19 infections and risks on the Navajo Nation

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Project Summary The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has generated fear and uncertainty as COVID-19 cases and fatalities spread across the globe. COVID-19 infection rates on tribal lands are more than four times the US national average and are still increasing. In the US, the highest COVID-19 infection rate per capita is on the Navajo Nation, the second largest federally recognized tribe. COVID-19 cases and deaths for the Navajo Nation continue to rise as COVID-19 cases have begun to decline in some of the initially hardest hit states. There are many reasons that Diné people (Navajo) are at higher risk for COVID- 19 infections, complications, and death including, but not limited to food, energy and water-insecurities, high prevalence of underlying medical conditions (comorbidities), and environmental health factors. However, we do not have direct evidence that the lack of access to healthy foods, high prevalence of diabetes, and heavy metal-contaminated water are responsible for increased COVID-19 infections on the Navajo Nation. There is an urgent need to identify the environmental and individual risk factors associated with COVID-19 infection rates and deaths among Navajo Nation residents to inform new strategies and policies to mitigate the current spread of COVID-19 and prevent future outbreaks. Our long-term goal is to mitigate the spread of COVID-19 and other outbreaks on the Navajo Nation. Our research objective is to identify individual and environmental risk factors for COVID-19 infection and death among Navajo Nation residents. We hypothesize that individuals with comorbidities (e.g., diabetes), in low socioeconomic situations (e.g., households without indoor plumbing), and/or living with access to water sources with inorganic contaminants will have a higher risk of COVID-19 infection and death. The rationale for the proposed research is that, once the specific risk factors for COVID-19 infection and death are known on the Navajo Nation, it will be possible to develop useful community education strategies, public health messaging and interventions that may benefit these high-risk communities. AIM 1: Identify environmental and individual risk factors for COVID-19 infection and death by Chapter (regions) on the Navajo Nation within 6 months. AIM 2: Identify community education mechanisms, public health messaging and interventions to mitigate risk factors for COVID-19 infection and death in Navajo Nation. AIM 3: Determine effectiveness of community education and public health messaging on knowledge of public health practices (e.g. water sources, distribution) to prevent COVID-19 infection and death among Navajo Nation residents. The Navajo Nation is actively addressing COVID-19, the Navajo Nation needs access to data-driven analyses for decision-making. We have chosen to focus on secondary data for the initial project activities for multiple reasons.