Dear Tribal Leaders, Public Health Officials, and Indian Country Professionals:

On March 19, Xavier Becerra was sworn in as the 25th Secretary of the U.S. Department of Health and Human Services. During his first week, the Secretary marked the 11th anniversary of the Patient Protection and Affordable Care Act, stating “In the eleven years since it became law, the Affordable Care Act has saved lives, brought down health care costs, and expanded Medicaid to our most vulnerable neighbors. The lifesaving law has been a game changer, protecting roughly 133 million people with pre-existing conditions and extending quality, affordable health care to millions more… Beginning on April 1, millions of Americans will be eligible for even more affordable options on HealthCare.gov. Because of the American Rescue Plan, four out of five enrollees will be able to qualify for coverage for as little as $10 per month.”

Follow the Secretary on Twitter at @SecBecerra.

HHS Departmental Updates

IHS Update:  Testing remains an important part of IHS’s broader strategy to monitor the spread and prevalence of COVID-19, as well as to protect our communities.  The IHS has reported over 2.1 million tests, and while the 7-day average positivity rate continues to decline, this week at 2.7% down from 2.9%, Indian country must remain vigilant. Regardless of vaccination availability and total number of COVID-19 cases, people who exhibit symptoms consistent with COVID-19 should continue to get tested. The same is true for those who suspect that they’ve been exposed to someone with the disease, even if they themselves have been vaccinated or previously had COVID-19. IHS is well on its way of meeting its March goal of administering at least 1 million doses of COVID-19 vaccines across the Indian health system.  As of today, more than 945,000 vaccine doses have been administered.

NIH Update: Watch this recording of the NIH Facebook event, A Q&A on COVID-19 Research & Vaccines for American Indian & Alaska Native Communities featuring Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and Dr. David Wilson, Director of the NIH Tribal Health Research Office, discussing important questions about COVID-19 research, clinical trials, and vaccines within American Indian and Alaska Native communities.  Another initiative that NIH is working on is a faith-based initiative to enhance trust and meaningful engagement in key groups throughout the United States disproportionately impacted by COVID-19 disease and death. Participants include Black, Latino, and American Indian/Alaska Native/Native Hawaiian faith leaders.

ACF Update: The Administration for Children and Families is planning two virtual Tribal Consultations to be held to discuss new programs funded under the American Rescue Plan Act of 2021. One of the sessions was held last week to discuss the funds provided to the Administration on Native Americans and the Tribal TANF Program.  However, written testimony can still be submitted to anacommissioner@acf.hhs.gov; subject line: American Rescue Plan, by April 2^nd.  Registration for the Tribal Consultation on the Office of Community Services and Family Youth Services Bureau on April 1, 2021 3:00 PM – 5:00 PM Eastern information can be found here. Written testimony is requested by Friday, April 9, 2021, and can be submitted to anacommissioner@acf.hhs.gov; subject line: American Rescue Plan. If you need assistance with registration, please call 1-877-922-9262.

OMH Update: April is National Minority Health Month, and this year, the HHS Office of Minority Health (OMH) is focusing on the disproportionate impact the COVID-19 pandemic is having on racial and ethnic minority and American Indian and Alaska Native communities and underscore the need for these vulnerable communities to get vaccinated as more vaccines become available. This year’s theme for National Minority Health Month is #VaccineReady. The goal of this campaign is to empower vulnerable populations to get the facts about COVID-19 vaccines, share accurate vaccine information, participate in clinical trials, get vaccinated when the time comes, and proactively practice COVID-19 safety measures

CMS Update: CMS released an updated data snapshot detailing the impact of COVID-19 on Medicare beneficiaries, particularly among underserved beneficiaries including racial and ethnic minorities, adults 85 years old and older, and people with certain pre-existing conditions. More than 2.7 million beneficiaries were diagnosed with COVID-19 during the snapshot period, and nearly 700,000 beneficiaries were hospitalized with COVID-19, based on a review of services provided January 1, 2020 to December 26, 2020 (for claims received by January 22, 2021).

As Secretary of Health and Human Services, I commit to you that when I get up in the morning, I am fighting to make sure you have health and hope each and every day. pic.twitter.com/IIu4LpMm4r

— Secretary Xavier Becerra (@SecBecerra) March 19, 2021

Vaccine Updates

Preparing for Your COVID-19 Vaccination: COVID-19 vaccines are effective at protecting you from getting sick. Vaccination is an important tool to help us get back to normal. This information will help you prepare for your COVID-19 vaccination.

COVID-19 Vaccine Webinar Series: CDC is offering a series of brief (15-20 minute) webinars addressing topics around COVID-19 vaccination. These interactive, web-based training modules offer a real-world perspective on different issues around COVID-19 vaccines. Topics range from routine clinical and vaccine safety information to guidance for on-site clinic vaccination activities and having conversations with vaccine recipients. Each webinar includes self-test practice questions and lists additional resources related to the topic discussed.

Vaccine Rollout Recommendations: Because the U.S. supply of COVID-19 vaccine is limited, CDC has provided recommendations to federal, state, and local governments about who should be vaccinated first. CDC’s recommendations are based on those from the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts.

Workplace Vaccination Program: By providing information about COVID-19 vaccination and establishing supportive policies and practices, employers can help increase vaccine uptake among essential workers. Although COVID-19 vaccine supply is currently limited, it’s not too early to share clear, complete, and accurate messages, promote confidence in the decision to get vaccinated, and engage your employees in plans to address potential barriers to vaccination. Strong confidence in the vaccines within your workplace leads to more people getting vaccinated, which leads to fewer COVID-19 illnesses, hospitalizations, and deaths.

What You Can Do Once You’ve Been Fully Vaccinated: COVID-19 vaccines are effective at protecting you from getting sick. Based on what we know about COVID-19 vaccines, people who have been fully vaccinated can start to do some things that they had stopped doing because of the pandemic. After you’ve been fully vaccinated against COVID-19, you should keep taking precautions in public places like wearing a mask, staying 6 feet apart from others, and avoiding crowds and poorly ventilated spaces until we know more.

Investigational AstraZeneca Vaccine Prevents COVID-19: Results from a large clinical trial in the United States and South America indicate that AstraZeneca’s COVID-19 vaccine, AZD1222, is well-tolerated and protects against symptomatic COVID-19 disease, including severe disease or hospitalization. The independent Data and Safety Monitoring Board (DSMB) overseeing the trial identified no safety concerns related to the vaccine. The United Kingdom-based global biopharmaceutical company AstraZeneca developed the vaccine and led the trial as regulatory sponsor.

Actions to Mitigate COVID-19 Prevalence in Nursing Homes: CMS updated their toolkit on state actions to mitigate COIVD-19 prevalence in nursing homes. This toolkit catalogs the many innovative solutions designed at the state level to protect our nation’s vulnerable nursing home residents during the Coronavirus disease 2019 (COVID-19) pandemic.

Vaccines and Health Departments. This page provides states, tribes, localities, and territories health facilities with key resources on COVID-19 vaccination information including operational guidance, funding, reporting, training and more. As the COVID-19 vaccination program is implemented across the United States, jurisdictions and organizations confront this historic and challenging undertaking, tailoring programs to their population’s needs. Learn about their unique approaches to distributing the COVID-19 vaccine and educating their populations.

About Vaccination Data: CDC is using both new and existing information technology (IT) systems to rapidly collect reliable data about how many doses of COVID-19 vaccines have been delivered (distribution) and how many people have been vaccinated with those doses (administration). CDC; other Federal agencies; vaccination providers; state, local, and territorial public health departments; and tribal health facilities across the country use vaccine distribution and administration data to inform decisions about COVID-19 vaccination. The COVID-19 Vaccination IT Overview provides an overarching view of the vaccine IT data systems and how they integrate to track COVID-19 vaccine distribution and administration.

How to Talking about Vaccines with Friends and Family: CDC updated their information on how to talk about vaccines with friends and family. CDC recommends listening to their questions with empathy, asking open-ended questions to explore their concerns, asking permission to share information, helping them find their own reason to get vaccinated, and helping to make their vaccination happen.

Funding

GSA Provides COVID-19 Response Support Resources: The General Services Administration (GSA) has completed a COVID-19 response support package that will enable state, tribal, local, and territorial health departments to enter into contracts with vendors who can support surge staffing and other needs in their jurisdictions. Working with CDC over the last several months, GSA has developed a “Best Practices Ordering Guide” and templates to support the acquisition process, including cost estimate worksheets and requests for quotes. GSA has a designated team of support staff who are available to help walk through the acquisition process with health department staff. More than 120 vendors responded to GSA’s market research which covers all regions of the country, territories, and freely associated states. Jurisdictions can also receive copies of the documents, or request assistance, by emailing CRSSHelp@gsa.gov.The scope of services include medical and other personnel, equipment, wrap-around services, contact tracing, and logistical support. GSA’s Acquisition Gateway includes a section on its front page for COVID-19 resources.

Cost Share Adjustments for Disaster Declaration: Last week, FEMA announced that President Joseph R. Biden, Jr. made additional disaster assistance available for all 50 states, the District of Columbia, five territories and two tribes. On Feb. 2, 2021 the President authorized an increase in the level of federal funds for all major disaster declarations that occurred in 2020 and 2021 due to COVID-19. Specifically, the President’s directive allows FEMA to amend the disaster declarations to pay 100% federal funding for the costs of activities that have been determined as eligible expenses.

Funeral Costs for COVID-19-Related Deaths: In early April, FEMA will begin providing financial assistance for funeral expenses incurred after Jan. 20, 2020 for deaths related to coronavirus (COVID-19) to help ease some of the financial stress and burden caused by the pandemic. The policy was finalized today, and FEMA is now moving rapidly to implement this funeral assistance program nationwide. To find out if you qualify, view the COVID-19 funeral assistance program policy.

Research

Expanding COVID-19 Testing on Reservations: Researchers are studying ways to encourage American Indians to seek tests as soon as possible after exposure to COVID-19, an important part of controlling outbreaks in communities.  Read more Research Highlights about the efforts underway to prevent, detect, and treat COVID-19 and its effects on our health.

Counties with High COVID-19 Incidence: CDC released an MMWR on counties with high COVID-19 incidence and relatively large racial and ethnic minority populations. During April 1–14, 2020, 11.4% of counties reported high COVID-19 incidence, including 28.7% and 27.9% of counties with large Asian and Black populations, respectively. During August 5–18, this percentage was 64.7%, including 92.4% and 74.5% of counties with large Black and Hispanic populations, respectively. By December 9–22, 99.1% of counties reported high incidence. As the COVID-19 pandemic evolves, public health efforts can be tailored to the needs of communities of color that may be experiencing high COVID-19 impact and integrated with longer-term plans to improve health equity.

Reopening Schools Research and Updated Guidance

K-12 School Operational Strategy: CDC updated their K-12 school operational strategy. These changes include: revised physical distancing recommendations to reflect at least 3 feet between students in classrooms and provide clearer guidance when a greater distance (such as 6 feet) is recommended, clarified that ventilation is a component of strategies to clean and maintain healthy facilities, removed recommendation for physical barriers, clarified the role of community transmission levels in decision-making, and added guidance on interventions when clusters occur. View CDC’s guidance and considerations for operating schools during COVID-19.

Vaccines for Teachers, School Staff, and Childcare Workers:  CDC updated their recommendations and information on COVID-19 vaccinations for school staff and childcare workers. On March 2, the U.S. Department of Health and Human Services issued a directive that all states immediately make teachers, school staff, and childcare workers eligible for COVID-19 vaccination across all vaccination providers.

COVID-19 in Primary and Secondary School Settings: CDC released an MMWR on COVID-19 in primary and secondary school settings during the first semester of school reopening. COVID-19 school-related disease incidence among Florida students was correlated with community incidence in the counties observed and was highest in smaller counties, districts without mask requirements, and those that reopened earliest after closure in March 2020. Incidence increased with the proportion of students receiving in-person instruction.  Fewer than 1% of registered students were identified as having school-related COVID-19. Both community-level and school-based mitigation measures are important in limiting transmission of COVID-19; school reopening can likely be achieved without widespread student illness in K–12 settings.

Low SARS-CoV-2 Transmission in Elementary Schools: CDC released an MMWR on low SARS-CoV-2 transmission in elementary schools in Salt Lake Country, Utah. SARS-CoV-2 testing was offered to 1,041 school contacts of 51 index patients across 20 elementary schools in Salt Lake County, Utah. In a high community transmission setting, low school-associated transmission was observed with a 0.7% secondary attack rate. Mask adherence was high, but students’ classroom seats were <6 ft apart and a median of 3 ft apart. These findings add to evidence that in-person elementary schools can be opened safely with minimal in-school transmission when critical prevention strategies including mask use are implemented, even though maintaining ≥6 ft between students’ seats might not be possible.

Investigation of SARS-CoV-2 Secondary Transmission in K-12 Schools: CDC released an MMWR on the pilot investigation of SARS-CoV-2 secondary transmission in Kindergarten through Grade 12 Schools implementing mitigation strategies in St. Louis County and City of Springfield, Missouri. In 22 participating K–12 schools implementing multiple COVID-19 mitigation strategies, school-based SARS-CoV-2 secondary transmission was detected in two of 102 tested close contacts of 37 persons with COVID-19. Among 21 tested student contacts participating in a modified quarantine, all SARS-CoV-2 test results were negative. Schools implementing strategies including mask mandates, physical distancing, and increased ventilation had much lower SARS-CoV-2 transmission than in the community. K–12 schools should continue implementing these measures and following CDC isolation and quarantine guidance to minimize secondary transmission in schools.

Other Resources

• CDC COVID-19 Data Tracker
• CDC Updated Resources for alcohol and substance use
• CDC and ASPR Five COVID-19 Pandemic Planning Scenarios
• CDC Updated Communications toolkit for COVID-19 vaccines
• CDC Holiday tips with safer ways to observe religious holidays
• CDC Staffing resources
• CDC Different COVID-19 Vaccines
• CDC Myths and Facts About COVID-19 Vaccines
• CDC Frequently Asked Questions About COVID-19 Vaccination

Please don’t hesitate to contact us if you have any questions!

Tribal Affairs Team

Office of the Secretary | Intergovernmental and External Affairs

Department of Health and Human Services