COVID-19 has imposed a heavy toll on the entire United States, but the pandemic has been particularly brutal among Indigenous communities. According to the Centers for Disease Control and Prevention, Native Americans are nearly twice as likely as white, non-Hispanic populations to contract the coronavirus and four times as likely to be hospitalized following infection.
These disparities exist even as tribal governments have instituted mitigation measures like face-mask mandates and lockdowns with greater diligence than many state governments. Consequently, the statistics point to long-term issues that have placed a disproportionate disease burden on reservations, such as inadequate investment in education, infrastructure and health care services.
Recognizing these gaps, the National Science Foundation and the National Institutes of Health are funding engineering research and community outreach led by Arizona State University to support tribal nations in combatting coronavirus and improving local resources.
Otakuye Conroy-Ben, an assistant professor of environmental engineering in the Ira A. Fulton Schools of Engineering at ASU, is the principal investigator on both the NSF and NIH projects. A member of the Oglala Lakota Nation, she has always felt inspired to apply her technical expertise to advance the status of Indigenous communities.
Conroy-Ben says the scientific focus of these projects applies wastewater-based epidemiology to detect coronavirus in reservation sewer systems.
“We use molecular biology to actually count the virus particles present in wastewater,” she said. “It happens through a process called reverse-transcriptase quantitative polymerase chain reaction, or RT qPCR.”
Coronavirus particles contain single-stranded nucleic acids or molecules known as RNA. Using RT qPCR, the coronavirus RNA segments from the wastewater are transcribed or synthesized by an enzyme into complementary DNA and then amplified or copied to improve their signal to a level that can be detected by analysis.
“However, that RNA is very unstable. It degrades quickly, so it’s difficult to track coronavirus within the wastewater environment,” Conroy-Ben said. “And that’s an issue when we are working with remote tribal communities. By the time we collect the sample, we need to analyze it immediately or we lose the RNA signal.”
Looking for an alternative, Conroy-Ben says the ASU Biodesign Institute research group of her colleagues and co-principal investigators Rolf Halden, a professor of environmental engineering in the Fulton Schools, and Kerry Hamilton, an assistant professor of environmental engineering in the Fulton Schools, is working to develop a new method to quantify the proteins of the coronavirus rather than its RNA.
“Proteins are relatively stable within the environment,” Conroy-Ben said. “So we can investigate whether they represent a more practical way to measure the presence of the virus within a wastewater matrix.”
The sensitivity of these processes enables measurements of coronavirus within a community far more quickly and cheaply than testing individuals with nasal swabs or saliva samples. The RT qPCR process, for example, can detect a single infected individual among hundreds of people in even less-than-ideal sampling conditions. And that real-time data can inform better public health decisions.
But alongside developing these diagnostic tools, the project needs to determine which Native American communities can effectively implement them.
“There are more than 570 registered tribes in the U.S., but only about 100 or so have the wastewater infrastructure in place to actually apply the technology we want to provide,” Conroy-Ben said. “And we’ll invite those tribes to consider participation. But then it becomes a matter of whether they have the necessary staff and protocols in place. It also requires agreements between ASU and the tribes, so it all takes some relationship-building.”
Making those connections and sharing necessary information will happen through a new Wastewater-Based Epidemiology Tribal Coordination Center. While initially not a physical center, it will operate as a network hub for collaboration among tribal leaders, health administrators, wastewater operators, tribal colleges and any others who can help advance the effort.
ASU will encourage this participation through Construction in Indian Country, or CIIC, a program within the Fulton Schools that expands infrastructure development capabilities among tribal communities.
“One key partner in this project is the Inter Tribal Council of Arizona, which serves as a planning and development hub for 21 tribes in the state,” said Marcus Denetdale, the program manager for CIIC and a member of the Navajo Nation. “The ITCA will help us to connect with tribes through the Tribal Water Systems training program they conduct for utilities operators in different communities.”
Denetdale adds that the potential of this work is broader than mitigating coronavirus through wastewater analysis. He points out that there is significant work to be done in establishing new health care facilities or improving existing ones on reservations, and the new Wastewater-Based Epidemiology Tribal Coordination Center could foster the connections to help address those needs.
As an example, he references the work that CIIC does with the Indian Health Service, or IHS, a federal agency within the U.S. Department of Health and Human Services that is responsible for the majority of hospitals and clinics on tribal lands.
“IHS devotes several hundred million dollars for new construction and renovations,” Denetdale said. “So, as an example, they will fund a tribe to build some new resource. But then it’s up to that tribe to comply with various specifications and deadlines as they hire an architect and a contractor, and conduct an environmental assessment before the project can begin. Combined with time limits for the use of this federal money, there are situations in which funds don’t get used and projects fail to materialize.”
Denetdale says this is why CIIC offers its expertise and its network of professional connections to get these developments completed. For example, the program offers training called CON 101 and 102: Introduction to Construction Management for tribal projects.
Denetdale hopes relationships established through the COVID-19 mitigation work with Conroy-Ben will enable CIIC to extend even more development support. He says this project can also help connect ASU with young Native Americans who are interested in doing research related to the environment or who would thrive in infrastructure and construction careers.
“We may find the next cohort of Native American engineering professors and practicing professionals from this collaborative effort,” he said. “And that’s really exciting.”
But first, Denetdale and his colleagues need to start outreach for Conroy-Ben’s wastewater analysis project. They expect to work with up to 10 tribes based on current funding. Those will include tribes in Arizona because of the logistical advantages of proximity. But Denetdale says they have many contacts in Oklahoma and in the Dakotas, as well as with tribes in Washington state.
“We are happy to go wherever we are needed,” he said. “We just need to get the word out.”
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