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

Project Summary: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has generated fear anduncertainty as COVID-19 cases and fatalities spread across the globe. COVID-19 infection rates on tribal landsare more than four times the US national average and are still increasing. In the US, the highest COVID-19infection rate per capita is on the Navajo Nation, the second largest federally recognized tribe. COVID-19cases and deaths for the Navajo Nation continue to rise as COVID-19 cases have begun to decline in some ofthe 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, highprevalence of underlying medical conditions (comorbidities), and environmental health factors. However, we donot have direct evidence that the lack of access to healthy foods, high prevalence of diabetes, and heavymetal-contaminated water are responsible for increased COVID-19 infections on the Navajo Nation. There isan urgent need to identify the environmental and individual risk factors associated with COVID-19 infectionrates and deaths among Navajo Nation residents to inform new strategies and policies to mitigate the currentspread of COVID-19 and prevent future outbreaks. Our long-term goal is to mitigate the spread of COVID-19and other outbreaks on the Navajo Nation. Our research objective is to identify individual and environmentalrisk factors for COVID-19 infection and death among Navajo Nation residents. We hypothesize that individualswith 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-19infection and death. The rationale for the proposed research is that, once the specific risk factors for COVID-19infection and death are known on the Navajo Nation, it will be possible to develop useful community educationstrategies, 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 theNavajo Nation within 6 months. AIM 2: Identify community education mechanisms, public health messagingand 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 healthpractices (e.g. water sources, distribution) to prevent COVID-19 infection and death among Navajo Nationresidents. The Navajo Nation is actively addressing COVID-19, the Navajo Nation needs access to data-drivenanalyses for decision-making. We have chosen to focus on secondary data for the initial project activities formultiple reasons.