Talia Quandelacy, A07, uses her expertise as an epidemiologist to help raise awareness of inequities that affect health in urban areas and reservation communities
One of the things that the pandemic has shown is that existing inequities are magnified when confronted with an infectious disease like COVID-19. That’s certainly been the case with Native American communities in the U.S., a group whose health and welfare is often overlooked.
Talia Quandelacy, A07, an assistant professor of epidemiology at the Colorado School of Public Health, has been studying those effects, and wants to bring attention to efforts to alleviate them, too. She’s a member of the data team for a study of six urban Indian health programs that are associated with the Indian Health Services.
The team is evaluating the testing trends for COVID in clinic clients, trying not just to learn more about who has been affected, but to understand the many factors that play a role in disease transmission—and what can help people stay healthy.
Part of an NIH program called the RADx-UP, it’s intended to provide support to investigate populations that have been understudied regarding the impact of COVID, which includes Native American populations.
“There are people who live on their tribal homelands, but I think a lot of times urban Indian populations tend to get overlooked, just because sometimes their data is not reported when looking at data by race/ethnicity within state and local reporting systems,” Quandelacy says.
“When the vaccine became available, we began to look at vaccine uptake in these urban centers, and then also providing surveys to evaluate the impact that COVID has had on these urban populations, asking about barriers to testing that they experienced,” Quandelacy says.
The project also is examining other impacts on this population as a result of the pandemic. This includes if they’ve experienced higher risks of infection if they’ve had to continue going to work, and also risk mitigation, such as if they have access to masks. “Are they able to isolate if they test positive or are there certain constraints within their household that prevent them from doing so?” That’s just one of many related questions the group is trying to understand.
Tracking the Pandemic
As the pandemic began, Quandelacy was wrapping up a postdoc with the Centers for Disease Control and Prevention in Puerto Rico, modeling the spread of dengue fever and Zika virus, both mosquito-borne diseases.
But as a member of the Zuni community in New Mexico—she grew up on the Zuni reservation—she at the same time wanted to help Native Americans and the health disparities they encountered in the pandemic.
In addition to her CDC work, she used her skills as an epidemiologist to help map data about the spread of COVID-19 among Native American communities, using case counts from a number of tribes gathered by a journalist at Indian Country Today, to understand where cases were increasing across different tribes.
Soon the Center for American Indian Health at Johns Hopkins, where Quandelacy earned a Ph.D. in epidemiology, took over the work as part of a larger project, and she helped early coordination efforts to make that into a regularly updated online map for researchers and policymakers.
Quandelacy, who also has a master’s in epidemiology from Harvard and an M.P.H. in global health from Emory, began teaching at the Colorado School of Public Health in December 2020, as the pandemic was raging.
Creating Models for What’s Coming Next
When Quandelacy was approaching the age for high school, she left the Zuni reservation and moved to Albuquerque where her father lived and attended the Albuquerque Academy, which offered more educational possibilities for her.
She studied biology and decided she wanted “to do something related to health,” she says. She was attracted to Boston, and decided on Tufts for college.
Once there, she learned about the School of Arts and Sciences’ community health program, “my real foray into learning more about public health,” she says. An epidemiology course taught by Mark Woodin, a research assistant professor in civil and environmental engineering, provided an early introduction to studying health effects at a population level, which also intrigued Quandelacy, and has become her abiding academic passion.
Early on as an M.P.H. student, she was involved in research at the CDC’s viral special pathogens branch, where she worked with a medical ecology researcher studying hantavirus outbreaks in New Mexico and other parts of North and South America.
“Hantavirus outbreaks were occurring in the area that I grew up in, so that had a personal interest for me,” Quandelacy says, “Learning about the type of research they did and working with epidemiologists really spurred more of my interest in studying infectious disease epidemiology.”
Epidemiology is often about doing the detective work to track diseases. Quandelacy specializes in infectious disease modeling, trying to use data to predict what’s coming next. Now she’s also part of the Colorado School of Public Health’s COVID modeling team that advises the state.
The Importance of Community
That same epidemiologic public health approach—and her personal experience—helps her explain how COVID spread so quickly among Native Americans. According to a report in February 2021, Native Americans died of COVID at almost twice the rate of white Americans.
Quandelacy notes that for those living on reservations, there are many factors that create conditions for an infectious disease like COVID-19 to thrive. For starters, access to health care can be tenuous. Critical care hospitals are often far away. “So sometimes it can be a challenge to get adequate and timely care, especially for people in remote areas,” she says.
Likewise, having access to clean water is another thing that most Americans take for granted, but on reservations that isn’t always the case. With COVID, not having water to wash your hands in general “makes it a lot harder to do preventative measures,” she says. “It really is a call to recognize that people are still dealing with these issues in 2021, and that we really need to fix these basic access issues.”
Access to healthy food is harder, too. When Quandelacy was growing up on the Zuni reservation, the closest large grocery store was an hour away in Gallup. “You do that once a week, stocking up on what is freshest at the time, but you also stock up on a lot of things that aren’t perishable, that you can have readily available,” she says.
Many Native American households tend to be multi-generational, and that meant that COVID infections spread more quickly early in the pandemic—“it’s hard to isolate while taking care of children or elderly parents in the same house,” Quandelacy notes. “I think that’s one of the challenges that contributed to the high rates that the Navajo Nation and other Indigenous communities experienced.” Early in the pandemic, the Navajo Nation experienced the highest infection rate in the country.
But those community traditions can also help. For example, the vaccination rate in the Navajo Nation is above 70% for eligible people, far higher than the U.S. national average of 58%.
“I think for a lot of Indigenous people, we’re very much more communally oriented than other communities in the United States,” Quandelacy says. “That was one of the really helpful motivations for people getting vaccinated, because they understood what was at risk for not just them as an individual, but for their family and their culture.”