When the COVID-19 virus swept through Montana in 2020, the multisymptomatic disease disproportionally affected tribal nations. Although Native Americans make up about 6.6% of the state’s population, by the end of July that year they comprised at least 17% of the state’s coronavirus cases and 32% of total deaths at that point.
The Blackfeet Nation enacted stringent measures to prevent the virus’ spread and protect elders, minimizing outbreaks and mortality early on in the pandemic, according to the Centers for Disease Control and Prevention (CDC). Still, the disease inevitably impacted those on tribal lands. By July 2022, the Blackfeet COVID-19 Incident Command reported around 4,000 cases and 67 deaths.
The lingering effects — both financial and medical — are part of what spurred Dianna Arnoux-Whiteman, a science instructor and pre-nursing advisor at Blackfeet Community College (BFCC), to pose a research project studying long-COVID, a chronic condition that can materialize after coronavirus infection.
“I just feel like, well, what about those families? How are they surviving now?” Arnoux-Whiteman asked.
“We have a unique population on our reservation,” she continued. “My question is, well, how is it affecting our community as opposed to how it’s affecting the people nationally? Is there a difference?”
Long-COVID is a multi-system disease, with the ability to impact the brain, heart, nervous system, among a variety of other organs. It can linger for a few months or persist for years, with fluctuating or relapsing symptoms. The CDC recognized long-COVID as a condition that could result in a disability under the Americans with Disabilities Act in 2021, and still considers long-COVID a serious health concern.
Arnoux-Whiteman proposed her project in 2022. After passing rigorous examination through the Blackfeet Nation Institutional Review Board, a prerequisite to ensure ethical treatment in research involving human subjects, she received a small grant through the National Institutes of Health (NIH) to begin collecting existing covid-related data from the Blackfeet Tribal Health Department, Southern Piegan Health Center, Blackfeet Community Hospital, and other health programs.
Last year, when the Trump Administration began introducing sweeping federal funding cuts, Arnoux-Whiteman’s grant joined thousands of other NIH grants terminated. So, she looked for funding elsewhere, applying for support through the Montana IDeA Networks of Biomedical Research Excellence (INBRE). Natalie Malaterre, the Native American Research Centers for Health (NARCH) grant coordinator, and Betty Henderson-Matthews, the chair of BFCC’s math and science department, helped her write the grant.
At the end of February, Montana INBRE awarded Arnoux-Whiteman $45,000 for her research project, dubbed “The Residual Effects of Long COVID on the Blackfeet Indian Reservation.”
Brian Bothner, Montana INBRE’s director and principal investigator, is tasked with overseeing the program’s network of colleges and universities around the state, including at the University of Montana, Montana State University (MSU), a number of undergraduate institutions, and all seven tribal colleges. The NIH-funded program finances a variety of biomedical research through grants. For the approval process, applications are reviewed by health experts around the country.
“Essentially we’re trying to develop a research community in Montana that one, directly impacts the people of Montana and number two, is competitive on a national level,” Bothner said.
Part of what stands out to Bothner about Arnoux-Whiteman’s project is “the connection to community,” Bothner said. The project falls squarely in the category of Community Based Participatory Research, or CBPR, a research framework coming to the forefront of public health that prioritizes projects and research questions originating within a community based on what the community needs.
“This is the sort of research question where you have a clear gap in knowledge and there may be some straightforward solutions that come out of this project,” he said. “We sometimes call these low-hanging fruit — the project is doable and there’s real potential here to have a positive impact.”
Given the history of research involving unethical practices in Native American communities, Henderson-Matthews, of BFCC, said the opportunity to conduct studies “by the community, for the community” is particularly impactful.
“It’s one of those projects that are very valuable for a community,” she said. “They’re not just theoretical that somebody’s going to stick on a shelf.”
BFCC President Brad Hall noted that as a period “marked by profound loss, hardship, and resilience,” the pandemic continues to shape the lives of those on the reservation.
“As the Blackfeet Nation continues to navigate persistent health and wellness challenges in the post-pandemic period, this study will help illuminate the specific needs, barriers, and opportunities involved in identifying and treating long COVID among Blackfeet people,” Hall said.
“In doing so, it will not only support more responsive care and resources within the community but also offer insights that may guide other Native communities across Indian Country as they respond to the emerging realities of long COVID diagnoses.”
Arnoux-Whiteman grew up on the Blackfeet Reservation. At 35 years old, she received a bachelor’s degree in microbiology from MSU while raising five children. She went to work for the Indian Health Service (IHS), eventually retiring in 2017 as a laboratory supervisor after 22 years. After a short break, she started working at the community college.
During her years at IHS, Arnoux-Whiteman said she observed labs struggling to fill technician shortages, forcing them to contract with out-of-town techs. The experience helped her realize she wanted to be a part of helping train students at the college for local positions. Now a science instructor and pre-nursing advisor, Arnoux-Whiteman oversees students preparing for a variety of health sciences.
“The fun part about it is when I go up to the hospital and I see my former students up there working,” Arnoux-Whiteman said.
Funding for the year-long grant will officially start on May 1, Bothner said. With guidance from Bothner and help from BFCC interns, Arnoux-Whiteman will begin the process of formulating surveys for her project this summer.
The study aims to identify how many people on the reservation continue to experience long-COVID symptoms and work with the community and health care workers to raise awareness of what long-COVID looks like and how to improve care. An initial survey will likely focus on determining the severity of long-COVID effects, followed by a second survey that will likely dig into the details of more serious cases, Arnoux-Whiteman said.
“I’m hoping it is a positive outcome for our tribal members and for our community,” she said. “I hope it helps even one person to say, ‘okay, this is something real. I’m not just making things up.’”
The one-year grant will help set the project up, Bothner said, and allows for the potential to receive funding in the future so that the research can continue for a few years, “when the real findings will start to come out.”
In addition to the local impact, Arnoux-Whiteman hopes to publish the study in a medical journal and, by doing so, encourage scientists in other tribes to consider similar research.
“We deserve to be counted and that’s the main goal of this, to get our people counted,” Arnoux-Whiteman said.
