Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Across the United States, cities and states are easing the regulations that have so far helped to contain the spread of the novel coronavirus. Some areas are “open for business” and others are planning a gradual re-entry with continued emphasis on social distancing, hand washing, and use of face masks. The CDC reports that there have been 1,300,696 cases in the US with 78,771 deaths as of May 11.  State governors, public health experts and the federal government are struggling to find the safest way to open the economy with adequate testing and contact tracing, while simultaneously allowing our  health care system to recover and prepare for the new infections that will occur.

Over the course of this epidemic, I have been following the success of the Lummi Nation, a Native American community, two hours from Seattle, Washington. They are a model of how a community dealt with and contained the virus quickly. The Lummi Tribal Health Clinic has been better prepared for the spread of COVID-19 than almost any organization in the country. Its first physician from its own community, Executive Medical Director Dr. Dakotah Lane, was the first student leader to run the Women’s Clinic division of the Weill Cornell Community Clinic (WCCC), a medical student-run free clinic that offers comprehensive primary care to uninsured New York City residents who have incomes far below the poverty line. 

I am the voluntary attending physician of the Women’s Clinic, serving in this role since its creation in 2012. This has given me an opportunity to teach and mentor medical students and oversee the care of the patients in this division of the WCCC. Dr. Lane had already decided to return to the Lummi Nation when I met him, heeding a call to serve his community. After his graduation from Weill Cornell Medical College in 2013, he completed a residency in family practice and returned to the Lummi Nation to make a difference. I have stayed in contact with him since his return.

The Lummi Nation, a sovereign Native American tribe in the Pacific north-west in Washington State, has approximately 5,318 members. It is 100 miles from Seattle where the first COVID-19 case was documented in the US on January 22, 2020. After that first case was confirmed, Dr. Lane worked with tribal leaders and the director of public health at the Lummi Nation, Dr. Christina Toledo-Cornell, to prepare for a possible COVID epidemic. They moved quickly to get prepared for the virus and made their first order for PPE on January 28. 

In February, their efforts increased after the report of the first publicly declared death in the US from COVID-19 on February 26. The medical and public health team along with the tribal leadership created emergency plans and sourced and stockpiled testing kits and personal protective equipment. On March 3rd, the tribal leadership declared a state of emergency. 

The introduction of mitigation and preventive measures with drive-through testing, telemedicine clinics, home delivery service for the elderly and social distancing was seamlessly integrated with public health and medical experts working with community leadership. A temporary field hospital with 23 beds and a well stocked pharmacy was created in the community fitness center next to the health clinic. It was set up for the treatment of less critical inpatients with the goal of freeing up hospital beds in nearby Bellingham for more critically ill patients. These 23 beds have not been utilized during this pandemic. However, with various models suggesting potential surges in the fall, the Lunmi health team has kept it on standby.

After the first Lummi case on March 12, public health measures of enhanced testing and contact tracing became an essential part of infection mitigation. The Lummi Indian Business Council closed their schools on March 13, and on March 22, ordered all people living on the Lummi Reservation to “Shelter in Place.” There were no new confirmed cases between April 19 and April 29. 

Then, a new cluster of cases was documented among families who had visited each other and allowed their children to play together. Three children were found to be positive on April 29 after a telemedicine evaluation for symptoms of a cold. Immediate quarantine of those affected and contact tracing and testing of others revealed more cases with a total number of 18 new cases documented by May 2.  

The Lummi Indian Business Council then extended the “Shelter in Place” order through May 31 and added a curfew from 10 p.m. to 4 a.m. for residents of the reservation. To further curb the normal impulse of families and children to visit with each other, Lummi Behavioral Health made laminated “Stop” signs for families to place on their front door with the message, “This house is doing our part to protect the community.”  The information on the release of the “Stop” signs further reads, “The health of the community depends on us each doing our part to shelter in place and follow public health guidelines. Place this sign on your front door to show that you are doing your part to protect the community.” 

There were 41 confirmed cases in the Lummi Nation from March 12 to May 11 in a population of 5,318. There have been no deaths. Dr. Lane said the recent outbreak is a case study of a community prepared to deal with the virus by catching and containing it quickly. There is free healthcare for all enrolled tribal members. Tests are readily available with results the next day. And all aspects of the tribe’s health care system are integrated with a public health response that includes contact tracing.

Over the course of the last four years, Dr. Lane has worked with the tribal council to improve the health system on the reservation, doubling the number of doctors in the past three years to eight. There are now five family practitioners, one  internist who has a masters in public health, one nurse practitioner and one full time psychiatrist. The clinic employs about 80+ people and provides unique culturally appropriate care. Like an increasing number of tribes, the Lummi Nation has opted for “self-determination,” which enables greater financial flexibility and clinical autonomy—as opposed to depending on the federally controlled Indian Health Service (IHS), which has suffered decades of severe underfunding. As a result, the Lummi Health services raises revenue by treating patients who have Medicaid and Medicare. This revenue  has allowed them to invest in infrastructure and build capacity. The Lummi Tribal Health Clinic is now poised to replace its aging 1978 clinic with a much needed 50,000 square feet health center. 

The careful management of the COVID-19 epidemic by the Lummi Nation was the result of a  process that began several years ago and a proactive response to a potential epidemic by the The Lummi Indian Business Council, the medical team and the public health program there. According to Dr. Lane, much of the community buy-in for sheltering in place was cultural. “We respect our elders and want to protect them. Trust in leadership is part of the community as well.” These values coupled with determined public health methods for testing, contact tracing, and isolation of newly positive patients serve as a model for all American communities who plan to reopen and survive.