FLAGSTAFF, Ariz. -- Sharon Bahe has made her home on the Navajo Nation a refuge, placing cedar branches and burning sage to help purify the space and praying for protection for herself and her children home from boarding school and a toddler with severe asthma.
Her community of about 500 in northern Arizona has become a hot spot for the new coronavirus, with several cases confirmed. While other kids play outside, she tells hers they can't “until the virus goes away.”
Officials on the Navajo Nation, the largest Native American reservation, on Friday broadened a stay-at-home order from Chilchinbeto to the entire reservation: No visitors in, and residents can't leave their homes except for essential tasks, including to get food and medical supplies.
The order is among the strictest yet in Indian Country, though tribes across the U.S. for weeks have been preparing amid worries that the outbreak could quickly overwhelm a chronically underfunded health care system and affect a population that suffers disproportionately from cancer, diabetes and some respiratory diseases.
They've shut down casinos, hotels and tourist destinations — often their primary revenue sources — and reminded citizens of the resiliency of their ancestors.
“Tribes are really just big families in a lot of ways," said Matthew Fletcher, a law professor at Michigan State University. "The threats to your family are something you're going to take seriously.”
Tribal elders, revered for their knowledge and cultural guidance, are the biggest concern, and outreach and other efforts are underway on the Navajo Nation, which spans three states in the U.S. Southwest. Many families there live miles apart in homes that hold multiple generations but can lack electricity, running water and reliable internet.
For most people, the coronavirus causes only mild or moderate symptoms. But for the elderly and people with existing conditions, it can cause more severe illness. The vast majority of those who are infected recover.
A federal funding package in response to the virus included $40 million for tribes for epidemiology, public health preparedness, infection control, education and other things.
But the money hasn't reached tribes because there's no mechanism for the Centers for Disease Control and Prevention to get it to the Indian Health Service, the agency responsible for providing primary medical care to Native Americans. Tribes and tribal organizations run some hospitals and clinics under federal contract.
“Everyone is on high alert right now. They're waiting, they're asking us,” said Stacy Bohlen, executive director of the National Indian Health Board who is from the Sault Sainte Marie Tribe of Chippewa Indians.
In the meantime, tribes are taking action to slow the spread of the virus.
In South Dakota, Oglala Sioux Tribe President Julian Bear Runner prohibited church groups from bringing volunteers to help repair homes on tribal land. The Rosebud Sioux Tribe canceled about 300 spring turkey and prairie dog hunting permits for non-tribal members.
In Montana, the Northern Cheyenne and the Crow tribes enacted a 10 p.m. curfew, partly to ensure law enforcement isn't bogged down, and restricted movement on and off their land. They also asked residents who attended hugely popular basketball tournaments off the reservation to self-quarantine.
The Bay Mills Indian Community has special hours for the elderly at a grocery store on the densely populated reservation in northern Michigan and a gas station with full service to limit exposure to the pumps, said tribal Chairman Bryan Newland.
It also is among tribes nationwide that have closed casinos and is paying its 400 employees. The National Indian Gaming Association has asked Congress for at least $18 billion in federal aid over six months to address shortfalls from closing casinos, which tribes depend on because they don't have a property tax base.
For others, it's tourism, but those operations, too, are shutting down. They include Monument Valley on the Navajo Nation and the famed blue-green waterfalls of the Havasupai reservation in northern Arizona.
Tribal leaders say all tribes are at risk but some face unique situations. Of the country's 574 federally recognized tribes, 229 are in Alaska where supplies must be flown in or shipped on barges. Kevin Allis, chief executive of the National Congress of American Indians, said that could expose isolated Alaska Native villages and create a disaster.
The villages have clinics, but residents must travel to regional hubs or farther for serious medical issues.
“This is a very scary situation for them,” Allis said.
Some health care clinics and hospitals that serve Native Americans have closed or scaled back services to focus on the coronavirus. Community health representatives on the Navajo Nation have been driving long distances to people's homes to teach them about the virus and what to do if they exhibit symptoms.
They're using a new Navajo phrase that translates to “a step above the big illness,” said Mae-gilene Begay, who oversees the program.
The Navajo Nation had at least 14 confirmed cases as of Friday evening. Others have been confirmed at health care facilities for Native Americans in the Portland, Oregon, area and in the Great Plains. The Cherokee Nation of Oklahoma said one of its citizens has died from COVID-19.
Bills in Congress seek to create parity for tribes, giving them direct access to a federal drug repository and gear if they exhaust their supplies, and the ability to apply directly to the CDC for a health emergency preparedness program. A federal funding package signed Wednesday gives $64 million to IHS.
But Democratic U.S. Sen. Tom Udall of New Mexico said that "can't be the end of the work.”
Bahe was busy Friday getting supplies to stay home for the long term. Her children kept themselves occupied on electronic devices while she stressed frequent hand-washing and general cleanliness. She said she already had enough oxygen and medication for her toddler.
“I was telling my kids we have to keep doing what we're doing because we're not sick yet,” she said.
Navajo Nation President Jonathan Nez wore a mask and gloves Friday while addressing tribal lawmakers. He said the tribe was preparing food packages for elders and will take over all billboards on the 27,000-square-mile (69,930-square-kilometer) reservation to enforce CDC guidelines. It's also considering roadblocks.
“I love you, Navajo Nation, but please listen to authorities, leadership when they say, ‘Stay home,’” he said. “That's the best way to fight this virus.”
The Indian Health Service is talking weekly with tribes to keep them informed. The agency said all of its facilities can swab patients for COVID-19, though supplies are depleted nationwide, and testing is done at outside labs. Chief medical Officer Michael Toedt highlighted a drive-up testing location in northwestern New Mexico and the replacement of office visits with calls and video conferencing.
Newland and other tribal leaders said they're still not assured they will get needed resources that should be guaranteed through acts of Congress and treaties with the U.S. from generations ago.
“What we really want to know is where can we get our test kits, where do we get economic relief, and we want information as close to real time as possible about how closely we are affected in terms of concerned cases,” Newland said. “Other than that, we can figure it out.”
Associated Press writers Stephen Groves in Sioux Falls, South Dakota, Paul Davenport in Phoenix and Rachel D'Oro in Anchorage, Alaska, contributed to this report. Fonseca is a member of the AP's Race and Ethnicity team. Follow her on Twitter at https://twitter.com/FonsecaAP