ABSTRACT
BACKGROUND: Approximately 173,000 persons live on the Navajo Nation (NN) and 14.7% live in multi-generational households. One-third of the Nation's residents are children and 44% live in poverty. The median household income is $27,389 with 1/3 having incomes < $15,000/year. The first confirmed case of COVID-19 on the NN was identified March 17, 2020. The Navajo government took swift action to combat COVID-19 by declaring a public health state of emergency which established the Navajo Department of Health Command Operations Center, closed the government offices except for essential employees, ceased inperson classroom instruction for all schools located within the borders of the NN and issued travel restriction for governmental employees. Even with strong public health efforts, Navajo Nation saw the highest per capita infection rate in the US during May of 2020 with 2450/100,000 versus New York 2119/100,000. METHODS: The Community Asthma Program is an NHLBI funded program working to improve health outcomes for children with asthma on the NN. We sought to determine the impact of COVID- 19 on the families of children with asthma who were participating in our study. RESULTS: Sixty-six of 193 families (34%) were interviewed about their pandemic experience. The average age of the child with asthma was 13.5 (SD=3.9) and 33% were female. On average, 5.2 people lived in each house (SD=2.1). Results of the interviews are shown in the table. Our data indicate that most Diné children with asthma in our study did not contract COVID-19. However, the pandemic had a significant impact on them and their families. Many family members contracted COVID-19, some children lost family members, and half of interviewed parents reported a decline in their child's mental health. Responses suggest that Navajo families may have been less able to work remotely than the US population at large, perhaps increasing stress for families. Despite the trauma from COVID-19, families adopted strategies to cope with the pandemic. Most diligently followed health guidelines including washing hands, wearing masks, and social distancing. One in four families sought the help of a traditional healer. Many accessed medical care through telehealth and most were able to obtain asthma medications when needed. More recently, as the pandemic subsides, parents indicate that their outlook and mental health have significantly improved. CONCLUSION. Despite significant challenges, our research indicated resilience among Navajo families and we heard stories of positive community structures and relationships that are particular to the Diné culture. (Figure Presented).