SAN DIEGO _ From smallpox to the 1918 flu pandemic, Native Americans have been decimated by viral outbreaks. And that gives them good reason to be alarmed about the latest foe: COVID-19.
Native Americans have higher rates of chronic health conditions, such as diabetes and asthma, that can make them more susceptible to infections. And tribal members often have limited access to health care.
Only seven tribal members have tested positive for the coronavirus in San Diego County as of April 26, according to county statistics. Their remote locations in the backcountry may have shielded them from the brunt of the pandemic.
But even if local tribes never see a major outbreak _ there are about 43,000 Native Americans living in the county, according to U.S. Census estimates _ the economic and cultural impacts of the pandemic could be long-lasting.
All casinos have been shut down since at least March 20 to align with California's shelter-in-place order. For many of the tribes, the gambling operations are the only source of revenue. Without it, tribal governments find it hard to make ends meet.
"Because of a variety of barriers that exist, including the geographic distance, issues with transportation, issues with health literacy, a high burden of chronic disease, it's taxing enough on a community, not only socially, but also from a health standpoint," said Dr. Dan Calac, the chief medical officer for Indian Health Council, which serves nine reservations in the county.
"Then you don't want a pandemic on top of that," said Calac, a member of the Pauma Band of Luiseno Indians. "You can really see the overall extreme burden on a community that lives in these areas."
With its 17 federally recognized tribes, San Diego County is home to the greatest number of tribes in the country.
Unlike state, county and local governments, which can collect sales, income and property taxes, tribal governments use business operations to raise revenues. Since the 1970s, gaming operations have been the most successful and reliable government revenue stream across Indian Country, Kate Spilde said.
Spilde is a tribal gaming professor at San Diego State University and the endowed chair of the Sycuan Institute on Tribal Gaming.
Throughout the state, there are 65 tribal gaming facilities, nine of which are in San Diego County, according to the California Gambling Control Commission. The National Indian Gaming Commission reported $9 billion in revenue from tribal casinos in California and Northern Nevada for fiscal 2018.
Although tribes receive some federal funding, successful economic developments like casinos are critical for tribal nations.
"Schools, hospitals, education, housing, infrastructure _ all of these basic services that tribes provide _ must be paid for out of economic development enterprises rather than from a tax base like a state or local government would have," Spilde said.
Sycuan Casino Resort accounts for more than 80% of the budget for the Sycuan Band of the Kumeyaay Nation, Chairman Cody J. Martinez said.
When the Sycuan Casino closed March 20, employees received two weeks of pay, and the majority of them furloughed after.
"The impacts are starting to become more severe as the time goes on," Martinez said.
For the Rincon Band of Luiseno Indians, Harrah's Resort Southern California pays for about 85% of its budget, Chairman Bo Mazzetti said.
Harrah's closed March 16, but employees will continue being paid at least through the end of April.
"We look at our employees like extended family of the tribe, and we want to protect them just like we do for our tribal members, so no one's laid off," Mazzetti said.
The long-term economic impact of the casino and business closures is unknown, but the communities are already feeling effects.
Carlene A. Chamberlain, the 65-year-old historian for the Jamul tribe, says the gaming operation has given members a higher quality of life.
In her earlier years, members of the Jamul Indian Village lived in shacks, some with dirt floors and all without electricity and running water. Later, families moved into trailers, which were eventually replaced by manufactured homes funded by the Bureau of Indian Affairs.
"It was a hard life, but it also made me appreciate that time," Chamberlain said. "Then, I think I was the only kid here by myself. I played by myself and went on hiking trails by myself, but it also makes you appreciate later on in years when you have a concrete floor and a real roof over your head."
The 13 houses on the reservation were displaced by the casino, which opened in October 2016, said Chamberlain, who is also the mother of Erica M. Pinto, Jamul Indian Village chairwoman.
Now, members of the tribe rent or own homes off the reservation, and they and members of other local reservations benefit from the casinos' profitability.
But the economic steps tribes have made are threatened as casino doors remain shuttered.
"It's just a much more profound threat to really 30 or 40 years of improvement of economic conditions since tribes started gaming," Spilde said. "There's been a steady improvement as they've really built their native nations and institutions of government and communities.
"The health and education gains that we've seen have been incredible, and all of that is being threatened by this crisis."
In addition to the economic impact casino closures have on tribal governments, there are many employees, both native and non-native, who are being impacted as well.
The tribal gaming industry employs 825 people at Jamul, 2,800 at Sycuan and 1,500 at Harrah's alone.
Jamul Casino continued to pay employees up until April 11, but they have since been furloughed and are receiving benefits through the end of May, Pinto said.
Through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, $8 billion will be provided to tribes across the country to help with financial impacts. It has not yet been decided how that money will be divided among tribes, or if it will be based on population, budgetary needs or evenly split.