Dr. Dakotah Lane, M.D. '13, and Dr. Cristina Toledo-Cornell, M.D. '13, have spent the pandemic partnering to reduce the toll of COVID-19 in one Native American tribal community, their efforts helping to minimize hospitalization and death and encourage high vaccination rates among the Lummi Nation of Northwest Washington State.
Dr. Lane, director of the tribe’s health clinic, and Dr. Toledo-Cornell, public health director of the Lummi Tribal Health Center until July 2021, returned to Weill Cornell Medicine to describe their pandemic experiences during a virtual town hall held in November by the Weill Cornell Medicine Office of Diversity and Inclusion. Key to their success, they said there and in subsequent interviews, was a preventative, public health strategy that anticipated community-specific needs, such as opening locations for infected members of multi-generational households to safely isolate, and providing clear information in response to concerns about vaccines. Such a response was only possible, they emphasized, because of proven trustworthiness and close communication with the tribe and its political leadership early in the pandemic.
Dr. Dakotah Lane
“The best thing we could do is be as transparent as possible, even when we didn’t know something, or when we made a mistake, because there would come a time when we had to ask the community to make a hard decision, and in order for them to do that, they have to trust our opinions,” said Dr. Lane, who is an enrolled member of the Lummi Tribe.
In early 2020, when COVID-19 was just becoming a concern in the United States, Dr. Toledo-Cornell and Dr. Lane were already preparing for an outbreak. After the country reported the first case of COVID-19 on Jan. 22, just one hour south of Lummi Nation in Whatcom County, they briefed the Lummi Indian Business Council, the elected body that represents the tribe and the community, about the virus in a town hall. They would continue to meet with the community at Saturday morning general council meetings, which eventually went virtual.
“The two things the council wanted us to focus on is ‘no life is expendable—every life is sacred’—and full transparency,” said Dr. Toledo-Cornell, who is now an instructor in medicine and hospitalist at Brigham and Women’s Hospital in Boston. “Having their support day in and day out was fundamental.”
The two doctors and their team started acquiring personal protective equipment (PPE) for their staff and testing supplies. They also set up “quarantine homes” at a closed dorm in a nearby community college, where meals and services like trash pickup were provided to make it easier for people to isolate from their families if infected. In Lummi Nation, multiple generations often live under the same roof—with an average of seven per household, and as many as 16.
Dr. Cristina Toledo-Cornell
If there is one positive case in the household, it just explodes,” Dr. Lane said.
The council followed their recommendation to declare a state of emergency March 3, ten days before the federal government’s; to close the Lummi school, before the state of Washington; and to close the tribal casino. The council also allocated $1 million to pandemic response, which helped them add staff. Because Lummi set up testing early, they identified the first case on March 12, and could isolate and quarantine right away. They have also prevented transmission of COVID-19 to medical staff in the clinical setting, which they credit to securing PPE early on.
Although Native Americans have been hard hit by COVID-19, with four times more hospitalizations than whites, according to the Indian Health Services, Lummi Nation has a .74 percent death rate, compared to 1 percent in surrounding Whatcom County, and 1.6 percent in the United States. That’s an achievement given that 12.6 percent of Lummis have tested positive for COVID-19, compared to 7.4 percent in Whatcom County, as of October 15, 2021.
The tribe has also vaccinated 69 percent of tribal members with at least one dose as of Dec. 8, 2021, which is on par with the U.S. population and the surrounding county. They even expanded their vaccine campaign early on to include teachers and other school staff in Whatcom County because the tribe had more vaccine than surrounding areas.
Dr. Toledo-Cornell and Dr. Lane pushed for Lummi to participate in trials of vaccines, so there would be a better understanding of the vaccine’s safety and efficacy for Native Americans—who have been historically underrepresented in clinical research and who, for the most part, weren’t enrolling in COVID-19 vaccine trials. They had to gain the trust of tribe members, who were wary of past ethical breaches of Native Americans in medical research.
Working with University of Washington Department of Medicine and U.S. National Institutes of Health Coronavirus Prevention Network, the Lummi tribe completed a trial of the Novavax vaccine, which showed 93 percent efficacy against the virus, and was recently approved in Europe and India.
Dr. Lane credits his ability to build and advocate for clinical trials in his community with rigorous medical school coursework in his first and second year that focused on ethics in medical research. “What’s unique about Weill Cornell is that you have access to a lot of the best doctors in the world, and you learn their thought processes,” he said.
When he was considering medical schools, then-Assistant Dean of Diversity and Student Life Elizabeth Wilson-Anstey, and then-Associate Dean for Student and Equal Opportunity Programs Dr. Carlyle Miller, M.D. ‘75, took the time to make him feel welcome as a prospective student of color. The difference between Weill Cornell Medicine and another top New York City medical school, he recounted from his visits, was that the students at Weill Cornell Medicine “had smiles on their faces.”
He and Dr. Toledo-Cornell had met and became fast “study buddies” in their first year at Weill Cornell Medicine, and later shared baby-sitting duties for one another’s children. As a Weill Cornell Medicine student in the summer after her first year, Dr. Toledo-Cornell conducted malaria research not far from where she grew up, in an Amazon riverbank community in Rondônia, Brazil.
After her third year, Dr. Toledo-Cornell spent a year in the Brazilian state of Bahia researching the neurologic effects of HTLV-1, a virus endemic in some Amerindian tribes, on a Fogarty International Clinical Research Scholarship she received through Weill Cornell Medicine. She worked with Dr. Warren Johnson, the B.H. Kean Professor of Tropical Medicine; Dr. Marshall Glesby, professor of medicine and population health sciences, and Dr. Edgar Carvalho Filho, adjunct professor of medicine.
There – and while earning a Master’s in public health from Harvard T.H Chan School of Public Health – she learned how to collaborate with local populations to maximize medical interventions.
After graduating from Weill Cornell Medicine and doing a family medicine residency in Daytona Beach, Florida, Dr. Lane returned to his tribe, inspired by the memory of his grandfather Vernon Lane Sr., a Lummi leader and national advocate for tribal sovereignty, who always encouraged him to “come back and serve.”
On his birthday in 2018, Dr. Lane received a message from his good friend: “Cristina says: ‘Happy birthday, Doc,’ By the way do you have a job for me?’” Dr. Toledo-Cornell was eager to use her global health training but stay in the United States. Months later, she started as director of the new public health department for Lummi.
The Lummi Tribe’s success at building a public health response founded on good faith communication and trust is something that others could learn from, said Dr. Toledo-Cornell. "What the tribe has to teach is that if you develop local talent and resources and have people who are very passionate about and come from the community they are serving, it’s a potent thing. I think that’s why Native American tribes did incredibly well compared to a lot of places, where people are on their own.”