American Indian and Alaska Native People: Social Vulnerability and COVID‐19

The Centers for Disease Control and Prevention (CDC) describes racial and ethnic minority groups and people living in rural communities as specific groups needing to take extra precautions related to COVID‐19.1 According to 2010 Census data, 5.2 million individuals in the United States were identified as American Indian and Alaska Native (AIAN) people, either alone or in combination with one or more other races (1.7% of the US population), a 39% increase since 2000.2 Further, 2.9 million identified as American Indian or Alaska Native alone (0.9% of the US population).2 According to Dewees and Marks, 54% of AIAN people live in rural and small town areas.3 Compared to all other US races, AIAN people have a lower life expectancy by 5.5 years and experience higher rates of death from many chronic illnesses including chronic liver disease and cirrhosis, diabetes mellitus, and influenza and pneumonia.4 According to the CDC, social vulnerability factors that may weaken a community's ability to prevent suffering and loss in a disease outbreak include poverty, lack of access to transportation, and crowded housing. The Social Vulnerability Index (SVI) was created by the Agency for Toxic Substances and Disease Registry's Geospatial Research Analysis & Services Program with the focus of aiding public health officials identify and map communities that were most likely to need support before, during, and after a hazardous event.6 CDC's SVI uses US Census data to determine the social vulnerability of every census tract and county.5 The SVI assesses 15 social factors comprising 4 themes: (1) Socioeconomic Status (percentage of residents below poverty, unemployed, and with no high school diploma and per capita income), (2) Household Composition & Disability (percentage aged ≥ 65 years, aged ≤ 17 years, aged > 5 years with a disability, and single‐parent households), (3) Minority Status & Language (percentage minority and who speak English “less than well”), and (4) Housing Type & Transportation (percentage of multiunit structures, mobile homes, crowding, no vehicle, and group quarters). While the SVI includes the just mentioned variables, it also calculates rankings for relative vulnerability based on percentiles if adequate data are available. Since the relative vulnerability ranking values are not computed for tribal tracts, this commentary will focus on social vulnerability percentage values. The remainder of this commentary is organized as follows: current COVID‐19 sta