Overcrowding, a flow of migrants, lack of resources — so many reasons Indigenous communities in Canada and elsewhere are vulnerable to COVID-19.

Members of Indigenous communities in Canada are proving more likely to contract COVID-19 and to fall seriously ill than other Canadians, reflecting economic and social disparities that afflict many Indigenous populations elsewhere in the world.

Last month in the central province of Manitoba, nearly half of all patients with COVID-19 in intensive care units were from First Nations communities, even though they make up about one-fifth of the region’s population.

Northern Manitoba communities, which reported virtually no cases of COVID-19 in the first wave of infections last year, now have the highest infection rates in the province.

On and off reserves, one in four members of Indigenous communities in Manitoba have tested positive for the disease stemming from the new coronavirus — double the rate for the province as a whole. Generally, epidemiologists consider a 5% positivity rate — the share of those tested who have the sickness — too high.

Various factors raise the risk of COVID-19 for Indigenous communities in Canada.

Indigenous populations in Canada face many of the vulnerabilities that place some individuals at a higher risk for contracting and even dying from COVID-19.

Josée Lavoie, a professor with the Department of Community Health at the University of Manitoba and director of Ongomiizwin Research, used the risk profile of First Nations in Manitoba to conduct infectious disease modelling at the beginning of the pandemic to help predict how many ventilators hospitals would need.

To model their predictions, Lavoie and her team used the H1N1 virus, an influenza virus that struck the United States in 2009 and then spread around the world. “The conditions on reserves have not changed dramatically,” Lavoie said. “For example, only half of First Nations have access to safe water. We also know that overcrowding has not been addressed, nor has food insecurity, marginalization and racism.”

The team predicted that the same conditions that promoted the spread of H1N1 would likely contribute to the transmision of COVID-19, even though they are very different viruses.

The risk of infection can be greater in remote communities, Lavoie said. Many of these communities are close to natural resources, such as dams or mines, which often attract migrant workers. Even when Manitoba’s borders with neighboring provinces were closed, exceptions were made for migrant workers, including Americans. Some communities responded with protests and blockages to stop road traffic.

The movement of migrant workers exposes remote communities to COVID-19. Yet, the natural resources being extracted are often for the benefit of major cities, like Winnipeg, as opposed to the Indigenous reserves. “The burden is borne by a community that is under-resourced and has been neglected for many years by government,” Lavoie said.

It would be easier to control the movement of individuals who fly into the region and thus to reduce the risk of the coronavirus spreading, the professor said.

It is difficult to isolate the ill in overcrowded households.

“If you have an infected member in your family, they should use their own bathroom and isolate themselves in a part of the house,” Lavoie said. “But with 10 members in a house that was built for six and with only one bathroom, this is just not possible.”

Given the realities of inadequate infrastructure and overcrowded households, authorities are increasingly urging individuals who live on reserves and need to isolate to do so in dedicated isolation facilities, including hotels, in larger city-centres.

Because in many cases decision-making authority lies with the reserves, communities have responded in different ways. In close-knit populations, it can be difficult to isolate individuals, especially the elderly.

“You have communities that may have been more stringent and have lower numbers, but have more people that have been in distress, mentally and emotionally,” Lavoie said.

Communication is key to helping Indigenous peoples.

Indigenous communities will have a say over any vaccination campaign. Although Manitoba plans to prioritize vaccinating Indigenous peoples, Lavoie says “there has been a distrust within Indigenous communities of Western healthcare.”

She attributed the distrust to “years of mistreatment, denial, interpersonal racism, neglect and medical experimentation of Indigenous peoples in residential schools.” Consequently, Indigenous peoples may not rush to be vaccinated.

Indigenous populations around the world face similarly high infection rates. Many of the risk factors in Manitoba hold true for Indigenous communities elsewhere, including in the United States, Brazil and Australia.

But Indigenous communities in Manitoba have the advantage over similar groups in many other areas of the world of enjoying open communication between with local chiefs, health authorities and the government.

Questions to consider:

1. Why are members of Indigenous communities in Canada proving more likely to contract COVID-19 and to fall seriously ill than other Canadians?
2. What distinguishes Indigenous communities in Canada from similar communities elsewhere in the world in fighting COVID-19?
3. Are certain groups of citizens in your country more likely to contract COVID-19 than others? If so, why?

Natasha Comeau is a former fellow in global journalism at the Dalla Lana School of Public Health at the University of Toronto. She holds a Master of Global Affairs from the Munk School at the University of Toronto. She currently works at Grand Challenges Canada, a nonprofit based in Toronto, where she supports global health innovations in low and middle-income countries.