Although H1N1 has proven less deadly than originally anticipated, it has taken a serious toll on American Indians.
According to a recent report released by the Centers for Disease Control and Prevention, the mortality rate from the virus is four times higher among American Indians and Alaska Natives than any other racial or ethnic group.
Phil Stago and his family were hit particularly hard by the virus.
They live in a tiny house in the tiny town of Winslow, Ariz., just outside the vast Navajo Nation. On a recent morning, his 2-year-old watched cartoons and snuggled with her dad. The baby rocked in a swing.
The mellow day was quite a switch from the drama the household experienced in September, when Stago says swine flu wiped out his family for a whole month.
Stago's son got it first — itchy throat, fever and aches. Then 2-year-old Alicia picked up the virus. She's feeling much better now, but when her newborn sister, Gabriela, caught swine flu, things got scary.
Stago took her to an Indian Health Service hospital nearby when her fever hit 100 degrees.
"They secluded us from her, and they put her in a little tent of oxygen," Stago says. "[We] had to wear the whole full isolation gowns and gloves and mask. That was pretty scary."
Indigenous People More Vulnerable
When patients require more intensive care than Gabriela did, they're sent to Flagstaff Medical Center, about an hour west of Winslow.
One day during the peak of the second wave of the swine flu virus, the intensive care unit was almost full of American Indians on respiratory ventilators.
The scene reflects a statewide trend. In Arizona, of the more than 1,500 people who have been hospitalized for swine flu, 13 percent have been American Indian. Yet American Indians make up only 5 percent of Arizonans.
Aboriginal Australians and First Nations groups in Canada have reported similar disproportionate findings.
There are plenty of theories as to why indigenous people are more at risk. John Redd, an epidemiologist for the Indian Health Service, says that crowding and poor housing, both risk factors for influenza, are more present in indigenous populations around the world.
In addition to poverty, Redd also points out that American Indians are prone to diabetes and asthma. When you combine swine flu with these pre-existing conditions, the outcomes are worse.
Access to health care is also an issue. There are a dozen Indian health care centers scattered throughout the Navajo Nation, but the reservation is the size of West Virginia.
Cindy Galloway, who works at a family health center that serves American Indians in the Flagstaff area, believes there are other factors contributing to the higher mortality rates.
"They are more stoic people. They don't complain, frankly," Galloway says.
She says it's typical for American Indian patients to wait until their symptoms become severe before they seek treatment.
"People will tolerate feeling bad longer and thinking it's going to go away," Galloway says. "When finally after four or five days they can't even take a deep breath, then they realize that this could be more serious."
Indian Health Service officials say many people have been exposed to swine flu or have been vaccinated now, so there's hope that the next possible wave of the virus, which could come as early as January, won't be as severe.