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In the early days of the COVID-19 pandemic, New York Governor Andrew Cuomo tweeted at his brother, CNN anchor Chris Cuomo, saying, “This virus is the great equalizer. Stay strong little brother. You are a sweet, beautiful guy and my best friend.” At the time, Chris Cuomo was quarantining in the basement of his family home after testing positive for COVID-19. 

While the governor’s tweet began with the simple phrase, “This virus is the great equalizer,” Dr. Martine Hackett, director of the Master of Public Health program at Hofstra University, explained that Gov. Cuomo’s declaration is a misstatement. “It’s a seemingly logical understanding that everyone is at equal risk for COVID-19; however, it’s not true because this is not an equal system that we are living in,” Hackett said. In fact, the Center for Disease Control has already identified that “people from racial and ethnic minority groups are at increased risk of getting sick and dying” from the virus.

“A public health perspective says that a person’s health is influenced not by whether or not they have access to health care alone, but also [by asking], ‘Where do they live? Who [do] they live with? What is the environment that they are living in [and] what are the resources that they have access to or they don’t have access to?’” Hackett said. 

Indigenous people in the United States are experiencing the highest rates of hospitalization and second highest death rates among minority populations. Hackett advises that to truly understand the disproportionate impact of COVID-19 on Indigenous people, we must look at the “reasons behind the reasons.” 

The history of the homes in which Indigenous people live must first be taken into account, and Hackett poses the necessary question to be raised: “Are those their lands to begin with?” Beginning in the 19th century, white American politicians created treaties that forced Indigenous nations to cede their land to white expansionists. 

Imposed immigration cost Indigenous nations not only their land but also their people. “And then you layer on top of that, housing conditions [are] also too crowded,” Hackett said. “Housing conditions absolutely will play a role in something like this, a communicable disease.” 

The newly designated areas of relocation lacked infrastructure as well. This deprivation of resources and economic support continue to manifest today as inadequate plumbing, among other things: Indigenous peoples’ households are 3.7 times more likely to not have a complete indoor plumbing system. On the Navajo reservation, for example, approximately 20% of homes face this problem. The U.S. government displaced Indigenous peoples without providing necessary tax-funded utilities, such as running water. 

COVID-19 is an infectious disease spread through respiratory droplets. The risk of infection is therefore greatly reduced when people have access to masks, hand sanitizer and the resources needed to frequently wash their hands. “One of the main ways to be able to prevent the spread of a communicable disease is to be able to wash your hands, as your hands touch your face and then touch other objects that might bring the virus into your body,” Hackett explained. But statistically, Indigenous people live in homes that lack the utilities needed for protection during a pandemic.

We can apply this situation to Hackett’s “reason behind the reason.” A surface explanation for the high COVID-19 rates among Indigenous people is the inaccessibility of proper sanitation – a visible symptom of the U.S. government’s systemic neglect of Indigenous communities. Public health crises are not solely indicative of current issues, but a culmination of historical experiences. Indigenous communities have long faced unequal medical treatment during pandemics. The coronavirus feels like a repeated story of mass illness brought by European colonizers, or the 20th century influenza pandemic that decimated many Indigenous communities.

“I think that [there is] sort of [a] connection between epidemics and indigenous populations and among Black and enslaved people,” Hackett said. “I think that historically in the United States enslaved people certainly were not treated as human beings. And that meant that basic human health needs were not provided for.” Communities that were historically mistreated by the public health system continue to face echoes of that treatment to this day. 

This may be why, despite the overwhelming historical evidence that a pandemic would have devastating effects on Indigenous people, the U.S. government took few preemptive measures that targeted these communities. 

The true failure is in the lack of prevention. Public health is woefully “underfunded and underinvested in,” Hackett explained. Pandemics and other health crises only exacerbate the existing inequalities embedded in the structure of America, and those who already face a lack of access to supplies and treatment are only further endangered. 

“The virus is invisible, but … what’s [also] invisible is that those inequities put people on different levels of risk,” Hackett said. Although it might manifest differently now, racism in the American medical and housing systems have not gone away. 

Above all else, Hackett emphasized that there are no biological differences among minority ethnicities and races. Indigenous people are not dying at higher rates because of some nonexistent biological predisposition. 

“It used to be the height of science that people said that there are literally biological differences to the races. And that’s what everybody understood to be true, and that has not gone away.” 

Instead, Hackett stressed, “It is all about risk. Are you increasing your risk or decreasing your risk?” 

“The idea that you can separate a place, [the] history of a place and the people who live there from the health outcomes is ridiculous,” Hackett concluded. It is the lack of access to proper resources and the history of medical mistreatment that truly puts Indigenous communities at a higher risk of contracting COVID-19.