Even so, she tried to be careful. A member of the Quinault Indian Nation, she lives in Taholah, a village of about 665 people north of Ocean Shores that lies within the tribe’s reservation borders. In late August, those borders were closed to outsiders in an effort to prevent the virus’s spread. Besides the occasional hike in nearby forests, Ralston stayed home as much as possible.
But earlier that month, she broke this routine after getting an urgent call from a family member. She rushed out of her house before driving to help them, forgetting a mask in the process. Another call came a few days later on a drive home from a hike with her eldest son: That same family member had tested positive for the coronavirus.
The next step was clear. Ralston remembers turning in shock to her son in the car: “I just looked at him and said, ‘We are going into quarantine.’ ”
She wasn’t alone in the experience. Cases throughout Grays Harbor County, where the reservation lies, had started to increase around the same time, with a group of cases in July and a larger spike in August. Ralston and her son were part of what she describes as the “first batch” of people to quarantine on the reservation.
Her two other kids were staying with their father for the week and hadn’t had any contact with her or her son. She quickly realized it would be just the two of them for 14 days.
“It was a hot mess,” she says. “I just didn’t want them to come home because I didn’t want to put them at risk.”
In the months before the virus hit the reservation, the tribe developed strict guidelines for people who became exposed: 14 days of isolation, with food and other necessities delivered to the person’s front step, leaving no reason to leave the house. Ralston also received a thermometer to check her temperature, and was required to report the results to a tribal monitor — essentially, a beefed-up contact tracer who would call daily to check up on her symptoms and any other needs.
Although Ralston’s 18-year-old son was also in the house, for safety reasons the two hardly interacted at all. The tribe’s guidelines dictated that she quarantine in her room if possible, since she experienced direct contact.
It was lonely. The only consistent contact Ralston got was her daily call with the monitor.
“That was really hard for me,” she says. “That was the first time I was away from my kids for that long.”
Since the pandemic first hit the United States last spring, it has brought disproportionate risks for Native communities throughout the country. Data from the Centers for Disease Control and Prevention shows that American Indian/Alaska Native people are almost four times more likely to contract it than white people.
Still, the number of coronavirus cases in Grays Harbor County remained comparatively low before the summer. The tribe used the months prior to solidify their plans.
In April, the tribe established an incident command team to handle the tribe’s response to the virus. From there, the tribe cemented its quarantine protocols and methods to test its citizens on the reservation, working with the county on these guidelines.
M’liss Dewald, the operations chief of the tribe’s incident command team responsible for responding to the virus, says it’s been a huge learning curve. Indigenous nations can enforce stricter, quicker measures to combat the virus than neighboring cities, and a small community has made it easier to address individual needs. But it also requires enormous effort and coordination; along with having its own plans, the tribe partnered with Grays Harbor County to investigate coronavirus cases.
Dewald says the tribe didn’t have a template for dealing with the many unknowns of the pandemic in its early days. But the stakes were high from the start.
“My whole family is here. If my aunt got it, if I got it, I don’t know what I’d do,” Dewald says. “I think that was really the motivation for many of us, asking ourselves how we protect our community any way we can.”
Quarantine spurred Ralston to action. She joined the incident command team and became a monitor herself. Now, her schedule is packed. She makes her first calls early in the morning, going through a list of tribal citizens in quarantine. She schedules the rest in intervals throughout the day.
The calls can take hours, sometimes going late into the night. On top of that, Ralston still works the job she had before as health, nutrition and transportation coordinator with the tribe’s Head Start program.
“It’s hard because I understand, and I have a lot of empathy for how these people are feeling, so sometimes I’m on the phone for hours and hours,” she says. “I just listen. There’s been a lot lately.”
For the first few months of the pandemic, no coronavirus infections were reported on the reservation. But the scene was still worrisome: Tourists continued frequenting the peninsula, especially as the weather warmed, posing an added threat to the tribe.
By summer, the surrounding county saw more and more tourists from parts of Washington with higher case numbers. As a result, the Quinault decided to close their reservation borders in late August, attempting to ward off outsiders who might infect a resident. It didn’t always work.
“We have a sign right at our border, on our main road [that reads], ‘QIN reservation closed, do not enter’ — we have multiple signs,” says Fawn Sharp, who is president of both the Quinault Indian Nation and the National Congress of American Indians. “We still found campers and tourists who just ignored them.”
Sharp says the first positive case of the coronavirus on the Quinault Indian Reservation, sometime in the summer, wasn’t a resident or tribal member. This person had driven from Arizona, intent on self-quarantining in the peninsula’s woods. He was found by the tribe’s forestry crew one morning, walking along a logging road.
After being confirmed positive, the person was quickly taken to the Quinault Sweet Grass Hotel, the tribe’s isolation site, in order to quarantine alone.
Sharp says that she’s personally dealt with tourists herself. A few times, she’s found them walking on the property of her home by Lake Quinault. In September, she says she had to inform everyone, from visiting couples taking photos to families fishing, that they weren’t supposed to be on the reservation. But what she saw was only a small piece of the bigger problem.
“I have a very busy life, leading the nation and the national congress,” Sharp says. “Even in my own little world, I’ve had [multiple] conflicts with people, and I’m sheltered in place on my private property.”
She adds that she’s grateful for allies like those in the county who “understand this disproportionate impact” communities like her own are facing.
It wasn’t until Grays Harbor County opened up to Phase 3 in June that the first spot of cases appeared. The first death from the virus in the county was on July 14. The tribe’s caseload followed suit, and the first positive case of a Quinault citizen living on the reservation occurreds July 24. Then came the larger outbreak in August.
“When there was an outbreak in Grays Harbor County, that’s when we started seeing cases for us as well,” Dewald says. “So much of our population lives within the county or does all our shopping within the county, so that piece of it impacts us differently.”
Cases slowed down in September and October, but a major spike arrived in November. While the tribe had seen about 10 cases of the coronavirus between July and October, they found 13 cases in November alone. There were around 60 people in quarantine that month, all of whom had been exposed to someone with the virus. Most of the 60 lived on the reservation.
While the colder months had discouraged tourists from visiting, Dewald says a new problem had arisen: As more people stayed indoors and began to gather with family, she saw more cases.
“Traditionally, we’re a very people-centric community, and we might be following the guidelines of just talking to our immediate family — but our families are large,” she says.
That can make it hard for members to truly isolate. Gina James, a tribal council member who’s also on the incident command team, says many on the reservation live in multigenerational households. Those houses could include everyone from infants to grandparents living under the same roof. The deep connections typical of Native families also make it harder to stay away from each other.
“It’s just so hard for us to not be with each other and be part of the family,” James says.
Quarantine on the reservation
With an uptick in cases came more people who needed to isolate. By the time cases started growing, the community had isolation procedures down pat: quarantine at home, get supplies delivered to your home, take your own temperature at home and report it to the monitor.
“We do quarantine a little bit stricter than the state guidelines at this point,” Dewald says. “A big piece of it is we’re allowing people to quarantine their whole house versus quarantining an individual, and providing services to the whole house so everyone gets our daily check-in calls and everyone gets access to food boxes or [other] services.”
The tribe has even gone so far as to personalize groceries, asking people in quarantine what they want delivered.
“That piece of it has really been a gift to our community, having the capacity and team members to make sure that our community members are getting what they need,” Dewald says. “It’s not offered everywhere — that’s something we’ve heard from people who are nontribal members who’ve been through this process.”
But even with custom-delivered groceries, staying in strict quarantine can be difficult. Ralston says she fell into the pattern that she’s now witnessed many others go through. At first, she treated her time alone as a break. She read books, watched lots of TV and paced around her house, or ran laps around it, to keep active.
After a few days, the isolation got to her. She remembers making drives just to be out of the house, knowing she couldn’t leave her car.
She ended up looking forward to the check-in calls from the monitor. “I think she was the only other human I talked to,” she says. “I probably talked her ear off.”
It’s the same for the people Ralston talks to now. She’s bonded with some quieter people in quarantine who initially did little more than answer her questions clinically before hanging up. But for many, those minutes-long calls became longer as the days grew.
“I’m learning a lot from them too — like, I’ve learned about algae, I’ve learned about things I’ve never looked into,” she says. “Some of the books they read, I’ve written down and read them.”
Ralston sees this connection as an important, if unspoken, part of the job. Technically, all she really needs to do is ask them the basics: What’s their temperature? Are they having any symptoms? What do they need?
The answers aren’t always enough on their own. Ralston says some of the people she’s called, especially the men, underreport their symptoms. She’ll try to dig in a little more or look for clues in their voices.
“They’re going to say they’re OK … but you’re talking to this person daily,” she says. “You can notice changes, like their voice. Is it hoarse? Does it sound dry?”
It’s important that she gets it right. Citizens without symptoms can leave quarantine after 10 days and a negative test, while those with symptoms require a negative test and the full two-week quarantine before being cleared to leave.
“You really have to listen,” Ralston says.
Vaccinations arriving for tribes
During the November uptick in cases, Ralston talked to 30 or 40 people a day. She makes about six to eight calls a day now, although that often means talking to more than six to eight people.
“You’ve got to understand the whole concept,” she says. “We live on the reservation, so these calls could have multiple people at the same household.”
In December, the tribe also announced penalties for people in quarantine who break protocol. James says no one has been fined yet and that the penalties were created mostly to encourage people to follow the guidelines. The number of cases in the county have continued to rise, she says, so there’s a need to be careful.
But change is on the horizon. The Indian Health Service was prioritized for distributing vaccinations to tribes, and in December, Native communities throughout Washington were among the first to receive them. The Quinault received 500 doses of the Moderna vaccine in late December. Staff have since worked to distribute them, finishing up the first 500 in mid-January, and they received a second shipment of 500 doses on Jan. 15.
James says it’ll take a few shipments to offer vaccinations to everyone. There are a little over 3,000 people enrolled in the tribe and about 500 government employees.
She’s also seen hesitance from some members. Right now, she’s working with others to educate tribal members about the vaccination process and alleviate fears about its effects.
Some recent events have added urgency. In November and December, seven members died as a result of the coronavirus. One was a man in his early 50s who had worked as a tribal police officer on the reservation for over 30 years. He was the first tribal member to die from the coronavirus on the reservation.
For many, it felt sudden; he was well known in the community, and he hadn’t been sick for long. His death was deeply felt.
“People finally woke up about ‘Wow, this could happen to me,’ ” James says. “ ‘Maybe I should be more cautious.’ ”
Like other tribal government employees, Ralston was vaccinated in early January. Still, she’s trying to be careful, and after a recent trip off the reservation, she is in quarantine again — this time, with her children. She notices the hesitancy among tribal membership to get the vaccine, too. She doesn’t know when this will end.
So for now, she turns each day to her phone to make headway on her call list. It’s one way she can make sure other tribal members are safe.
“I ask them, ‘Do you have everything? Do we need to get anything to you?’ ” she says. “Just making sure we get them everything they need for them to be at home.”