"Many health issues that can increase COVID-19 mortality rates occur at high levels among Native Americans. These underlying and preexisting conditions – things like hypertension, diabetes, obesity and cardiovascular disease – are linked to diet and stem from disruption and replacement of Indigenous food systems. Meanwhile, housing shortages on reservations and homelessness in urban Native communities make social distancing to reduce COVID-19 transmission impossible. These factors have clear health impacts. On the Navajo reservation, for instance, through May 27, 2020, 4,944 people out of a population of 173,000 had tested positive for COVID-19, and 159 had died. This infection rate per capita exceeds those in hot spots such as New York and New Jersey. Importantly, however, it may also reflect a much more proactive approach to testing on reservations than in many other jurisdictions."