The clinic, which is the primary source of care for many of the 4,200 members of the Fond du Lac Band of Lake Superior Chippewa, started preparing for the virus in January and last week started offering drive-through testing. Providers haven't confirmed a case yet, but odds are they will.
"Sadly, yes, that's what's going to happen: We're going to see a surge," said Dr. Charity Reynolds, the band's medical director. "Right away, because of our community being so vulnerable, we started thinking, what do we need to do?"
Native Americans have higher rates of heart disease, high blood pressure and diabetes — conditions that can make a coronavirus infection more severe and more likely fatal.
"We are already observing troubling signs that this pandemic may disproportionately sicken and kill Native people at a much higher rate than the general U.S. population," the National Congress of American Indians wrote to the Trump administration last month.
The hard-hit Navajo Nation in Arizona, New Mexico and Utah has so far seen more than 2,600 cases of COVID-19 and 85 deaths.
Though Minnesota's stay-at-home orders do not apply to reservations, tribal governments around the state have implemented similar measures to slow the spread of the virus, including closing government offices, schools and casinos and postponing routine and nonemergency medical care.
Spreading the word about the virus and the tribe's own stay-at-home order has meant making phone calls, blitzing social media and mailing letters to every household on the Fond du Lac Reservation, Reynolds said.
"You want to hear it from your community; you don't know if 'the whole nation' applies to you," she said.
So far the message has been well-received — Reynolds says many people they've reached have hunkered down and leave only for necessities or have relatives deliver them.
Fond du Lac Band Chairman Kevin Dupuis said he's proud to see band members wearing masks in stores around Cloquet. "What we're doing is showing our community cares for one another," Dupuis, wearing his own mask, said in a video public service announcement last month.
As of Monday there have been at least 69 confirmed cases among tribal populations in Minnesota, Wisconsin and Michigan, according to data voluntarily reported to the federal Indian Health Service.
Due to limited testing, that may be vastly underestimating outbreaks. There have been nearly 400 cases in Minnesota counties that have reservations, according to the Great Lakes Inter-Tribal Epidemiology Center.
The Upper Midwest has seen a smaller number of tests for Indigenous populations compared with other areas so far; Reynolds said resources were initially focused on the outbreak at the Navajo Nation and are now being redirected to other parts of the country.
Curbside testing at Min No Aya Win started April 28, and some tests can be processed on-site with results back in 20 minutes.
"Those are still limited, but we have a pretty open testing criteria, as long as you're symptomatic and you have a check-in with a provider," Reynolds said.
The clinic, which doesn't have beds or ventilators, will refer the most seriously ill patients to local hospitals, where the band's physicians are able to care for them.
For patients who can recover at home or do not need to be hospitalized — the majority of cases — providers will stay in touch and the band's human services division can help provide necessities.
The expected surge most threatens the clinic's ability to protect staff and patients due to the shortage of protective gear and the risk of an outbreak at the facility that could stem from even routine care.
"COVID-19 has changed our normal operations," Reynolds said. "Once that surge hits, a lot of people are going to want to be tested and want to be seen."
Dr. Arne Vainio sat down at a desk in an exam room and fired up his computer for his first-ever video appointment last Friday.
Vainio, a member of the Mille Lacs Band of Ojibwe, has been a family practice physician on the Fond du Lac Reservation since 1997. He says many patients have limited access to video conferencing technology, so he's been making many routine check-ins by telephone.
"Social distancing is really, really working," he said, and a delayed outbreak on the reservation is proof of that.
Later Vainio donned full protective gear as he worked a respiratory shift that included testing 2-month-old Eden Smith for COVID-19. He had just one other patient that day.
After limiting in-person visits in March, the clinic now handles about 15 patients per day — mostly by phone or online — down from an average of 40 daily visits.
Reynolds said some folks may be nervous about getting medical care during the pandemic for fear of catching the virus, but she said it's more important than ever to stay on top of chronic conditions.
"We can handle a lot of that over the phone," she said. "Our population is more vulnerable to having to be hospitalized [for COVID-19]. Other issues can get worse, or vice versa, it can make [a coronavirus] infection worse."
The clinic is always looking for donations of face shields, masks, surgical gowns and other protective gear. If dental services were to fully resume, there is less than a two-week supply on hand.
Reynolds said services will slowly start reopening over the next several weeks in line with Gov. Tim Walz allowing elective procedures to resume in the state.
"We want to make sure we're doing it safely," she said. "We continue to plan for that worst-case scenario and fine-tune our plans, not only as a health division but as a tribe."
