For Alaska Native people, COVID-19 arrived with shadows of the past

SPONSORED: To understand the Tribal health care system’s response to COVID, look to the devastating history of pandemics in Alaska Native communities.

Presented by Alaska Native Tribal Health Consortium

Part 1 of 2

The announcement took many Alaskans by surprise: Southcentral Foundation, the Anchorage-area Tribal health care provider, would begin offering the COVID-19 vaccine to all Alaskans age 40 and older -- Alaska Native or not.

It was March 1, 2021, and Alaska health officials were still working overtime to vaccinate the highest-risk groups, with most adults not yet eligible to receive the shot. As Alaska’s Tribal health care system opened its doors to members of the general public, some Alaskans were left wondering: Why?

To understand the answer, it’s vital to know something about the history of pandemics in Alaska -- and what Alaska Native leaders have learned from past traumas.

A history of devastation

In the centuries since the first colonizing forces arrived on their traditional lands, disease has had a disproportionate impact on Alaska Native people.

“During the 19th and 20th centuries, the health of our people had continually deteriorated -- primarily, I think, from infectious diseases,” said Vivian Echavarria, vice president for professional and support services at Alaska Native Medical Center.

Smallpox, measles and polio were all devastating to Alaska Native communities, and the Indian Health Service built the original Alaska Native Service hospital in downtown Anchorage in response to an epidemic of tuberculosis. Still, the disease that looms largest among older generations is the influenza pandemic that began in 1918.

“It killed thousands of our Alaska Native people within the space of a few months to a few years,” Echavarria said.

But you don’t even have to go back to the 20th century to find an example of a pandemic impacting Alaska Native people.

“We saw that in the 2008-2009 H1N1 pandemic,” said Alaska Native Medical Center Administrator Dr. Robert Onders. “Alaska Native and American Indian people had four times the ICU rates, hospitalization rates and mortality rates.”

Lack of adequate sanitation, running water and sewer service, lack of housing, multigenerational housing, and overcrowded housing contributed to H1N1′s outsized impact on Alaska’s Indigenous people, and they remain risk factors for COVID-19 as well.

“It isn’t necessarily distant history,” Onders said. “It’s still alive, and it’s carried through the generations.”

Intergenerational trauma lingers

One of the descendants carrying that trauma today is Perseverance Theatre playwright and “Molly of Denali” television writer Vera Starbard, whose grandmother still remembers the devastation in her childhood village.

“She’s lost friends to pandemics,” said Starbard, who is Tlingit and Dena’ina. “She used to travel around to villages all over Alaska for her work, and she would see the long-term impacts of (disease), whether it was pandemics or epidemics, on a single village, and then that impact going forward for the entire region and then the state.”

During past pandemics, the hardest hit villages lost as much as 90 percent of their population, sometimes almost overnight. The loss of language, culture and tradition from these deaths remains a considerable void today.

“Spanish flu specifically was devastating to the social and political organization of communities because Spanish flu is unique in that it hit young adults to middle age harder,” Starbard said. “And then, of course, Elders. So you had a lot of the catalyzers of the community organization and the wisdom being lost overnight, and you had a lot of young people having to sort of make up the culture as they remembered it.”

New pandemic, old fears

More than a century later, the 1918 influenza pandemic still casts a long shadow on Alaska Native families -- one felt intensely as the “novel coronavirus” began to make headlines early in 2020.

“For me, it was fear,” Echavarria said. “We just heard ‘pandemic.’ I remember hearing what my aunt had to go through, hearing that loved ones had died, the fear of not having anything to be able to help save people’s lives. My first thought was fear. I’m a grandma, I have grandchildren, I was afraid.”

Echavarria herself grew up hearing stories from her great-aunt who survived the flu and lived to be 103.

“(She) was sick for a very long time,” Echavarria said. “When you have so many people sick, nobody’s doing any food gathering. And then there was the disintegration of the whole social dynamic of our communities. Whole villages were wiped out.”

That trauma has lifetime impacts, she added.

“It’s no different than when we send our loved ones to war,” Echavarria said. “We’ve not seen what they’ve seen, but yet, if they make it back, then there’s that long-term trauma.”

Those traumas are passed down through oral histories -- the stories that Elders tell about what happened to their loved ones -- and they have long-term consequences for the culture, which was what Starbard found herself worrying about when COVID-19 arrived.

“I did experience a lot of fear,” Starbard said. “A lot of that fear was based in knowing what previous pandemics have meant to Alaska Native culture, our politics, even -- but most of all the people themselves.”

But a lot has changed since the last time a pandemic threatened Alaska. And this time, Tribal health care leaders were determined things would be different.

Coming Thursday: Part 2 -- How the Tribal health care system helped Alaska become a vaccine leader

This story was sponsored by the Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with ANTHC. The ADN newsroom was not involved in its production.