Keeping Elders Safe During COVID-19 is a Community Effort

by Dr. Melvina McCabe

The Coronavirus (COVID-19) is a global pandemic, and some of our Native communities are already experiencing high rates of infection while many other Tribes are bracing for the impact of COVID 19. According to the Centers for Disease Control and Prevention (CDC), elders age 60 and older are at the highest risk for hospitalization and death when they are infected with COVID-19, particularly patients age 80 and older. Nursing homes are also at high risk for infections. As a Diné physician, I join a community of health care workers who are greatly concerned for the elderly.

Here’s a glimpse into an elderly patient’s scenario: R.T. is a 66-year-old American Indian who has diabetes, high blood pressure and was recently treated in the hospital for a heart attack. R.T. returns to his home where he lives alone with no running water or electricity. When his daughter who is wearing a mask comes for a visit, he tells her that he has a cough and sometimes feels like he cannot catch his breath. The daughter checks his temperature and it is 99.8 Fahrenheit (normal temperature is 98.6). The daughter was able to find a place where her cell phone could catch reception and called R.T.’s doctor.

Why are AI/AN elders, like R.T., at high risk for getting COVID-19?

  1. Elders may be immunocompromised, which means they will have difficulty fighting off infections. The immune system helps the body fight infections and other diseases. Chronic diseases such as diabetes, heart/lung/kidney disease and cancer can lead to an immunocompromised status.
  2. According to the Indian Health Service, 17% of AI/ANs homes lack adequate sanitation facilities with approximately 1.9% with no access to a safe water supply. Some Tribal members must haul water from several miles away from their home.
  3. Elders may not have the same symptoms when they are sick as younger persons. While coughing, shortness of breath and a fever are the most common symptoms of COVID-19, elders may also have other symptoms that may be more serious, like chest pressure, blue lips or confusion. Call a doctor if an elder has questions or concerns about their health.
  4. AI/AN elders often call on family members or a caretaker to run errands like getting medications, groceries and supplies. Caretakers are also transporting elders to hospital check-ups or telehealth appointments. It is important for all family members and caretakers to follow hand washing and cleaning guidance.


Everyone in the family, like R.T.’s daughter, can help lower the risk of getting COVID-19 and passing it onto elders.

  1. Wash hands often with soap and hot water for at least 20 seconds. If unable to wash hands, use hand sanitizers or hand wipes that contain at least 60% alcohol.
  2. Wear a mask when out in public. Make sure the mask covers the nose and mouth and is loose enough to breath comfortably.
  3. Practicing good physical distancing means staying home during this time by limiting in-person activities and errands. If gathering in a group, be sure to observe the guideline of less than 10 people, stay at least six feet apart and avoid shaking hands. It may be necessary for members of inter-generational households to self-isolate, which can be difficult in overcrowded homes.
  4. Cover sneezes and coughs with a tissue or elbow. COVID-19 droplets/particles from people’s mouths when they cough, talk or exhale are less likely to land on another person if people stay at least six feet apart from one another.
  5. Do not touch the face, eyes or nose to reduce the likelihood of the virus entering the body.
  6. Clean and disinfect household surfaces with solutions like Lysol, diluted bleach or Clorox wipes as COVID-19 can live from hours to days on different types of surfaces.


Caring for elders’ mental health is every bit as important as caring for their physical health. Native physicians learned from SARS, another life-threatening infection, that higher rates of depression and anxiety were found. Community and cultural practices are important to the elders, and physical distancing can make it quite hard for them to deal with the isolation and not being able to participate in person. Physical distancing does not necessarily mean social distancing. Relatives can help elders adjust with social interactions by writing letters, having grandchildren make homemade cards or caretakers can help elders use technology to video call loved ones or watch online church services. Tribal communities across Indian Country must be on alert for mental health issues in elders.

Now, think about R.T. and his daughter and how it takes every community member to keep our elders safe. In Indian Country, our elders are our wisdom keepers and our cultural teachers. They are the tie that holds families together and keeps them strong. Our elders are the guidance for our youth. Our cultures and our wisdom are what gives us resilience in this world. We must do all we can to protect our elders during this time.



Dr. Melvina McCabe

Melvina McCabe, MD, is a Professor Emeritus in the Department of Family and Community Medicine at the University of New Mexico. Dr. McCabe is also a member of the Association of American Indian Physicians and sits on the organization’s policy and legislative committee. Dr. McCabe is Diné.