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FAQs - Federal Response in Indian Country

Q: Where can I find the most-up-to-date information?

A: The Centers for Disease Control and Prevention’s website Exit Disclaimer: You Are Leaving www.ihs.gov  is the best place to find comprehensive updated information and guidance on COVID-19, including information on symptoms, treatment, schools, quarantine, travel, etc.

Q: How is the IHS working with federal, tribal, and urban Indian health facilities to promote awareness of changing guidelines, protocols, and processes related to COVID-19?

A: IHS headquarters is holding weekly conference calls with tribal and urban Indian health organization leaders from across the country to provide updates, answer questions, and hear concerns from tribal communities. Additionally, IHS area offices provide technical assistance and support to tribal and urban Indian programs. For federal staff, IHS headquarters is holding regular all-employee conference calls and communicating through email updates. Area chief medical officers are in regular communication with clinical directors at all IHS facilities. We are actively extending outreach to all within the federal, tribal and urban clinical communities regarding webinar and similar resources as they become available from the CDC Exit Disclaimer: You Are Leaving www.ihs.gov  .

Q: How is IHS working across the Departments of the federal government to ensure a comprehensive holistic approach to addressing COVID-19 in Indian Country?

A: The IHS is in constant communication with the CDC and other operating divisions across the Department of Health and Human Services. In addition, the IHS is in close communication with the White House and other non-HHS Departments across the federal government to ensure comprehensive communication is shared with Indian Country.

Q: What is IHS doing to ensure the protection of their providers as they test and treat individuals for COVID-19?

A: The IHS is following CDC guidance Exit Disclaimer: You Are Leaving www.ihs.gov  for health care professionals. Many of our service units are screening individuals for COVID-19 prior to entering our health facilities to determine their risk for COVID-19 and to prevent additional infections within our facilities. Individuals suspected of having COVID-19 will be given a mask and cared for separately from other patients in a designated area with a provider. The National Supply Service Center is distributing personal protective equipment (PPE) and other supplies to regional centers and to IHS, tribal, and urban facilities as quickly as possible to address supply shortages. We are exploring every avenue to acquire more supplies.

Q: Is it safe to travel?

A: The CDC continues to provide regular updated travel guidance Exit Disclaimer: You Are Leaving www.ihs.gov  .

Q: Does IHS have access to rapid point-of-care testing for COVID-19?

A: The Indian Health Service has been given priority access to rapid point-of-care COVID-19 test systems Exit Disclaimer: You Are Leaving www.ihs.gov  as part of White House efforts to expand access to testing in rural communities. The IHS received 250 ID NOW COVID-19 rapid point-of-care test systems. This test allows for medical diagnostic testing at the time and place of patient care, provides COVID-19 results in under 13 minutes and expands the capacity for coronavirus testing for individuals exhibiting symptoms as well as for healthcare professionals and the first responder community. Additionally, this will save personal protective equipment and ensure our critical workforce is safe and able to support the response, as only gloves and a facemask are necessary to administer this rapid point-of-care test.

Q: How were the sites chosen to receive rapid testing analyzers?

A: The Indian Health Service headquarters worked closely with IHS area offices to distribute testing equipment and supplies [PDF – 128KB] where they will have the most impact. There were a number of factors Area Directors took into consideration when choosing sites including user population, whether the site was located in or near a ‘hotspot’, whether the site had the lab capacity, and equitable distribution between tribal and IHS sites.

Q: Do sites that received the analyzers have all the supplies they need?

A: Every facility that received a machine has now received a quality control kit and test kits. This is all that is needed to run the machine. IHS also conducted training sessions for federal and tribal staff on how to use the machines.

Q: What type of collection materials should be used with the Abbott ID NOW?

A: Facilities should refer to instructions, technical briefs, and product notices that issued by Abbott. The Abbott ID NOW COVID-19 is intended for testing a swab directly without elution in viral transport media as dilution will result in decreased detection of low positive samples that are near the limit of detection of the test.

Q: Has the IHS validated the Abbott ID NOW analyzer?

A: The Gallup Indian Medical Center performed a correlation study comparing the accuracy of the Abbott ID NOW analyzer with that of another analyzer. The Abbott ID NOW analyzer has been found by the IHS to be acceptable for patient testing. The Abbott ID NOW analyzer tested at 98.9% accuracy to that of the other instrument.

Q: Are IHS, tribal, and urban facilities able to test for COVID-19?

A: IHS facilities generally have access to testing for individuals who may have COVID-19, however there are nationwide shortages of supplies that may temporarily affect the availability of COVID-19 testing at a particular location. In addition to using rapid point-of-care testing systems, clinicians, including those at IHS, collect samples with standard synthetic fiber specimen collections swabs and access laboratory testing through public health laboratories in their jurisdictions. The IHS also utilizes commercial and other approved laboratories to test specimens as those services are available.

Q: Can tribes, tribal organizations, and urban Indian organizations request test kits for their clinics?

A: For the next several weeks, the IHS National Supply Service Center, in partnership with the HHS Office of the Assistant Secretary for Health, will receive and distribute rapid testing kits to federal and tribal facilities that received the ID NOW analyzers. For other testing supplies, tribes should first follow their usual process for ordering supplies. If that is not possible, and they have other regional relationships with state or other suppliers, they should contact them. If tribes are not able to access supplies through their usual method, then they should contact their IHS Area Office who can access supplies through the IHS National Supply Service Center.

Q: What protocols or instructions are IHS following to test for COVID-19?

A: The IHS relies on CDC guidance Exit Disclaimer: You Are Leaving www.ihs.gov  and consultation with public health departments to determine patients suitable for testing for COVID-19. Clinicians are strongly encouraged to test for other causes of respiratory illness, including influenza and strep throat.

Q: How long does it take to test for COVID-19?

A: Rapid point-of-care testing can provide results in under 15 minutes. Results sent to outside labs may be available in as little as one day, but timing may vary by location. Priority for the rapid testing follows CDC guidelines [PDF] Exit Disclaimer: You Are Leaving www.ihs.gov .

Q: What should individuals do while they wait for their test results?

A: Individuals should follow the advice of their health care provider. For a majority of individuals with mild symptoms, the CDC generally recommends staying home, using a separate bathroom, and as much as possible, staying in a separate room and away from other people in the home. Patients with more severe symptoms may be hospitalized for care while awaiting test results.

Q: When should you see a doctor if you suspect you may have contacted or contracted COVID-19?

A: If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice. The CDC has additional guidance Exit Disclaimer: You Are Leaving www.ihs.gov  on what symptoms to look out for.

Q: If going to an IHS facility should tribal citizens call ahead if they suspect they may be infected with COVID-19?

A: Patients are encouraged to call their local IHS facility if they think they may have COVID-19 symptoms or may have been exposed to the virus for medical advice. The IHS Find Health Care Tool includes contact information for IHS, tribal, and urban Indian health facilities.

Q: Are there different requirements between the state and tribes to access COVID-19 testing?

A: Each state and tribe will likely have different priorities for testing based on available supply of test kits (used to run the test) and testing materials (swabs, transport tubes, etc. used to collect and transport the test sample). The IHS recommends following guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  published by the CDC. The requirements for test samples for local, reference lab, or state public health lab testing may differ based on the type of COVID-19 test that the testing facility will be utilizing.

Q: Should non-tribal members, who may live on a reservation or within a tribal community, go to an IHS facility for care?

A: IHS is the health care system for federally recognized American Indians and Alaska Natives in the United States. Non-beneficiaries may be able to receive care under a few different legal authorities. Specific questions about getting health care should be discussed with the health facility which you are looking to get care from. IHS has provided guidance [PDF - 161 KB] regarding the treatment of non-IHS beneficiaries as necessary to prevent the spread of a communicable disease or otherwise deal with a public health hazard.

Q: How can tribes, tribal organizations, and urban Indian organizations acquire materials such as personal protective equipment and sanitizers?

A: Tribal governments seeking assistance should first refer to Coronavirus (COVID-19): FEMA Assistance for Tribal Governments. These guidelines are intended for Indian Health Service, tribal health programs, and urban Indian organizations. I/T/U programs should continue efforts to obtain needed supplies, especially Personal Protective Equipment (PPE), through their established local processes, including any existing established relationships with state, city and county emergency operation centers.

Tribal Health Programs can access the Strategic National Stockpile (SNS) in one of two ways once all local efforts have been exhausted:

Q: What is the Strategic National Stockpile and do tribes have access to it?

A: The HHS Assistant Secretary for Preparedness and Response’s Strategic National Stockpile Exit Disclaimer: You Are Leaving www.ihs.gov  is the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out. When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency. The stockpile is organized for scalable response to a variety of public health threats. Strategic National Stockpile requests are limited to supplies and equipment for healthcare purposes only, and require that existing supply and other acquisition options be exhausted. For requests for personal protective equipment that are not healthcare related (law enforcement or other), please contact your FEMA Regional Tribal Liaison. Exit Disclaimer: You Are Leaving www.ihs.gov 

Q: What funds are available to tribes to address COVID-19?

A: HHS announced upcoming action to provide funding to tribes for COVID-19 response. Exit Disclaimer: You Are Leaving www.ihs.gov 

Q: What financial resources will be available to help tribes and urban Indian organizations recoup administrative costs associated with closures and overtime costs for our providers?

A: We encourage tribes, tribal organizations, and urban Indian organizations to work through all local, state, and federal avenues for any potential resources. We also encourage tracking costs associated with COVID-19 response activities. This information will help identify needs across the Indian health system and inform discussions about any potential additional resources that may become available.

Q: What technical support is available for tribes to develop Emergency Planning protocols? Should our tribe enact an emergency declaration to address COVID-19?

A: The Federal Emergency Management Agency (FEMA) has developed a Frequently Asked Questions tool for tribes Exit Disclaimer: You Are Leaving www.ihs.gov  to use in determining how to request a presidential emergency or major disaster declaration independently of a state.

Additionally, Ready.gov, an official website of the Department of Homeland Security includes specific content geared toward Indian Country for general emergency preparedness Exit Disclaimer: You Are Leaving www.ihs.gov  , including ready-made resources that may be of value:

Q: What resources are available to tribal communities for technical assistance in disinfection and/or sanitation protocols?

A: CDC has developed recommendations Exit Disclaimer: You Are Leaving www.ihs.gov  around environmental cleaning and disinfection protocols for health departments and other employers.

Q: If there is an outbreak in my tribal community, how do we conduct an effective quarantine operation?

A: CDC has provided guidance about community mitigation plans Exit Disclaimer: You Are Leaving www.ihs.gov  for schools, workplaces, and community locations.

Q: How can my community issue communications about COVID-19?

A: CDC has prepared guidance on how to develop a communications plan Exit Disclaimer: You Are Leaving www.ihs.gov  before an outbreak of COVID-19 in your community, during an outbreak, as well as post-outbreak communications.

Q: Does IHS have a seat on the White House coronavirus task force? To what degree is IHS involved in White House discussions on the response?

The IHS is in close communication with the White House and other federal agencies to ensure comprehensive communication is shared with Indian Country. The White House Office of Intergovernmental Affairs is coordinating the Indian Country COVID-19 Response Team in unison with the Department of Health and Human Services to ensure there is a united front across federal agencies with jurisdiction in Indian Country. The Indian Country COVID-19 Response Team is part of the President’s Coronavirus Task Force. The response team includes various organizations across the federal government including the White House Office of Intergovernmental Affairs, HHS, FEMA, Department of Interior, VA, the Centers for Disease Control and Prevention, and the Indian Health Service. The White House Indian Country COVID-19 Response Team recently hosted a nationwide, all-tribes conference call to support tribal leadership in driving readiness to prepare for and respond to COVID-19 in Indian Country.

Q: What other federal resources are available to assist tribal communities?

A: Tribal governments and their members are an essential part of our nation’s emergency management team. FEMA is committed to supporting Indian Country in its efforts to build more resilient and better prepared communities. For additional questions, begin by contacting the FEMA Regional Tribal Liaisons Exit Disclaimer: You Are Leaving www.ihs.gov  in your Area. FEMA's liaisons help build relationships with tribes in their area, helping them understand and use FEMA's programs -- especially during times of disaster.

Q: Are there telehealth resources available for tribal citizens in rural area and areas distant from healthcare services?

A: IHS recently announced the expansion of telehealth services during the COVID-19 response Exit Disclaimer: You Are Leaving www.ihs.gov . Expanding telehealth allows more American Indians and Alaska Natives to access healthcare they need from their home, without worrying about putting themselves or others at risk. IHS service units and their clinicians who are using the system will obtain verbal consent from patients who meet with their provider via a telehealth appointment. Health care providers are required to verify the patient at the beginning of each encounter and are not authorized to record the session.

IHS is also working to rapidly deploy telehealth services to IHS hospitals as needed to respond to the potential surge in hospitalized and critically ill patients. This would allow critical care consultation for patients managed in an IHS intensive care unit, and for critically ill patients receiving care at hospitals without an ICU in the process of transfer to a higher level of care.

Many IHS facilities continue to use telehealth services by replacing office visits for things such as prescription refills for chronic conditions with phone calls for some patients. Service units are also screening individuals for COVID-19 either by phone or prior to the patient entering our health facilities to determine their risk for COVID-19 and to prevent additional infections within our facilities.

The expansion of telehealth services is in response to HHS announcing unprecedented steps Exit Disclaimer: You Are Leaving www.ihs.gov  to expand Americans' access to telehealth services during the COVID-19 outbreak. CMS expanded Medicare coverage for telehealth visits and the HHS Office for Civil Rights announced it will waive potential HIPAA penalties for good faith use of telehealth during the emergency.

Q: Can tribes and urban Indian organizations utilize PRC to pay for quarantining, testing, or hospitalization of COVID-19 patients?

A: All Indian Health Service Purchased Referred Care programs are treating COVID-19 testing and treatment as medical priority one (emergent or acutely urgent care services) until further notice. Tribal health programs are not required to follow IHS medical priorities, but may choose to use them as guidelines. Urban Indian organizations do not participate in the PRC program but, consistent with the terms of their agreements with IHS, may use their existing funds for awards to subcontractors.

Q: How many Commissioned Corps officers from I/T/U programs have been cleared to deploy and how many have deployed?

A: As of May 18, 2020, approximately 176 officers assigned to the IHS have deployed for COVID-19 response activities.

Q: Who pays for the Commissioned Corps while they are deployed?

A: The salary and benefits for a deployed Corps officer will continue to be paid by the federal, tribal, or urban Indian program to which the officer is assigned. The Assistant Secretary for Preparedness and Response (ASPR) pays for the travel and transportation costs of the officer to and from the location of the deployment.

Q: What is the process for screening and quarantining Commissioned Corps personnel before they return to active duty at ITU sites?

A: A: Officers who are returning or have returned from COVID-19 field missions must be monitored appropriately and receive medical and other assistance as needed. Commissioned Corps Headquarters has delegated administrative control to the Assistant Secretary for Preparedness as the incident commander to monitor the health conditions of officers and provide assistance as needed. Additionally, if an officer is returning to work in a healthcare setting, the officer must adhere to the CDC guidance for healthcare providers Exit Disclaimer: You Are Leaving www.ihs.gov  . This guidance requires a 14-day quarantine before returning to their official duty station.

Q: What mental health resources are available for individuals who may enter quarantine or become presumptive positive for COVID-19?

A: CDC has provided guidance on stress and coping with anxiety related to COVID-19 Exit Disclaimer: You Are Leaving www.ihs.gov .

Q: What is the plan for ensuring individuals living in remote areas still have access to their medication?

A: At this time, there is no indication that IHS pharmacies will need to alter their current practices. Should the CDC recommend reducing the number of people visiting their local healthcare facilities, the IHS Pharmacy Program will explore alternative delivery options for medications, such as the Consolidated Mail Outpatient Pharmacy Program.

Q: Can I order medications two months out? And if so, can they be mailed to my home address?

A: You would need to check with your local IHS facility to determine their refill policies and participation with the Consolidated Mail Outpatient Pharmacy Program. A tribal health facility may have its own mail out program. Patients of tribal health facilities are encouraged to contact them about this refill request.

Q: Are Community Health Representatives (CHR) trained on how to look for COVID-19 symptoms? Are CHRs equipped with personal protective equipment?

A: Given that this is a new virus, the impact on Community Health Representative activities is dependent on public health guidance from individual state departments of health and CDC guidance on identification of COVID-19 signs and symptoms and appropriate use of PPE.

Q: How will tribal citizens who are under quarantine access food, water, and other necessities during quarantine?

A: We encourage tribes, tribal organizations, and urban Indian organizations to work through all local, state, and federal avenues for any potential resources. We also encourage tracking costs associated with COVID-19 response activities. This information will help identify needs across the Indian health system and inform discussions about any potential resources that may become available.

Q: Does the IHS have the capacity needed to treat COVID-19?

IHS facilities have existing purchased and referred care agreements with a vast network of specialty care providers across the country, with multiple such contracts in place at each facility. If one or more referral partners reach capacity, we can access other referral providers. IHS facilities are communicating and coordinating with their local and regional partners to ensure continued access to care for our patients. IHS also is able to elevate requests for assistance (including augmenting patient transport and accessing additional referral centers or alternate care sites if they are needed) through FEMA, which is coordinating the national response effort. IHS facilities are prepared to triage patients and implement emergency and disaster preparedness plans if necessary.

Q: Are there codes in the IHS Resource Patient Management System (RPMS) for COVID-19?

A: Following the Centers for Medicare & Medicaid Services and Centers for Disease Control and Preventions guidance, IHS is adding diagnostic and testing codes to RPMS to capture data regarding COVID-19 as they become available. Pending the release of specific International Classification of Diseases 10th modification (ICD-10) coding for COVID-19, the CDC has issued interim ICD coding guidance Exit Disclaimer: You Are Leaving www.ihs.gov  to guide current efforts.

Q: How can tribes, tribal organizations, and urban Indian organizations escalate staffing resource requests through FEMA if they are unable to find critically needed staff through their usual resources?

A: The first and best method for tribal and urban Indian organization health programs to seek supplemental staffing is to follow their usual process for hiring and contracting staff, as well as their processes for onboarding volunteers. Staffing companies and recruiting firms should be utilized first. If tribal and urban Indian organization health programs are not able to access critical staffing through their usual method, they should inquire if state and local government partners can perform or contract for the performance of the requested work. If an organization desires to request Direct Federal Assistance, and the request for personnel is a result of the COVID-19 emergency and not a pre-existing condition, then they should contact their IHS Area Emergency Management Point of Contact (EMPOC) who can facilitate submission of a FEMA Resource Request Form [PDF] Exit Disclaimer: You Are Leaving www.ihs.gov  for a request for staffing. This is done through a request for a Mission Assignment. 

Q: How do tribes, tribal organizations, and urban Indian organizations request deployments for USPHS Commissioned Corps officers?

A: During the COVID-19 national emergency, requests from tribes, tribal organizations, and urban Indian organizations for deployments of USPHS Commissioned Corps officers should also be elevated through the IHS Area Emergency Management Point of Contact (EMPOC). This would be considered a request for Direct Federal Assistance. The IHS Area EMPOC can facilitate submission of a FEMA Resource Request Form [PDF] Exit Disclaimer: You Are Leaving www.ihs.gov  for a request for a Mission Assignment.

Q: Who should prospective health care practitioners contact if they are interested in working or volunteering?

A: Health care practitioners interested in working or volunteering for the Indian Health Service should contact an IHS recruiterCurrent vacancies are also posted in the Career Opportunities section of the IHS website.

Q: What impact will COVID-19 have on the IHS Scholarship Program and Loan Repayment Program?

A: Please see the frequently asked questions on the IHS Scholarship Program and Loan Repayment Program websites for more information.

Q: What impact will COVID-19 have on National Health Service Corps and Nurse Corps participants?

Please see the National Health Service Corps and Nurse Corps: Coronavirus (COVID-19) Frequently Asked Questions Exit Disclaimer: You Are Leaving www.ihs.gov  for information about these programs and their response to COVID-19.

Q: What is remdesivir?

A: Remdesivir is an investigational antiviral medicine to treat certain people in the hospital with COVID-19. Remdesivir is investigational because it is still being studied. There is limited information known about the safety and effectiveness of using remdesivir to treat people in the hospital with COVID-19. Remdesivir was shown in a clinical trial to shorten the time to recovery in some people. There are no medicines approved by the FDA as safe and effective to treat people in the hospital who have COVID-19. Therefore, the FDA has authorized the emergency use of remdesivir for the treatment of COVID-19 under an Emergency Use Authorization.

Q: How many doses of remdesivir did IHS receive? How many patients will this treat?

A: IHS received 6,000 vials of remdesivir. The recommended dosing and course of treatment varies, but this would be anticipated to treat about 750 patients.

Q: Where were these doses distributed?

A: The majority of the remdesivir allocated by IHS to date has been distributed to the IHS Navajo Area and Phoenix Area. Other areas receiving remdesivir are the Alaska Area, Albuquerque Area, Great Plains Area, Oklahoma City Area, and Tucson Area.

Q: Where can I find more details on the distribution and use of remdesivir in the Indian health system?

A: IHS has developed a fact sheet with more information [PDF – 153KB].