text: Kami Kandola wasn't about to wait for the Northwest Territories to get its first case. On March 18, in response to her urging, the territory declared a public health emergency—an order it would go on to extend at least fourteen times. As the N.W.T.'s chief public health officer, and someone who had been working in the North for more than seventeen years, Kandola knew the vast expanse of land wasn't particularly populous. In fact, at just under forty-five thousand people, the entire territory was smaller than most suburban cities in Canada. Some of the N.W.T.'s thirty-three communities are home to only about a hundred people; one, Kakisa, has fewer than fifty residents. Many of them are only accessible by plane, and few of them are linked to major roads. In some ways, their remoteness made them seem like the safest places in Canada to avoid community transmission. Certainly, that's why in March 2020 one misguided Quebec couple sold their possessions and attempted to flee to Old Crow, an Indigneous community of 250, located in Yukon, one territory over from the N.W.T. The community's chief, Dana Tizya-Tramm, politely told them to get lost. Old Crow could barely house the residents it did have; there was no space for the couple. More than that, though, he had the same fear as Kandola: that one COVID-19 case could raze a far-flung Indigenous community in the North. Their protection was in their isolation; break it and, potentially, break everything.
  
  "I know how outbreaks can be started," said Kandola. "When it comes to infectious diseases Indigenous communities bear the brunt of the burden." That has been true for more than three hundred years, starting when settlers first brought tuberculosis (TB) to the southeast. By the 1930s and '40s, the TB death rate among those living on reserves was the highest ever reported in a human population. The next decade, at least one-third of Inuit were infected. By 2008, the TB rate among Indigenous people was six times higher than the overall Canadian rate. In Nunavut, it was thirty-eight times the national average. And while tuberculosis provides one of the starkest examples, it's well documented that Indigenous peoples across Canada experience higher rates of heart disease; certain sexually transmitted infections, including HIV/AIDS; some cancers; and even dementia. Rates of diabetes are staggeringly higher—a particular concern during the COVID-19 outbreak, as the disease has been reported to drastically elevate risk of serious damage from the virus.
  
  For a recent example of the unique vulnerabilities of Indigenous communities, Kandola and others tasked with protecting such populations could also turn to the 2009 H1N1 pandemic. Those living in First Nation communities were 2.8 times more likely to be hospitalized from the flu strain, and had an ICU admission rate that was three times higher than that of non-Indigenous people. Or, put another way: while Indigenous people represent only 4.3 per cent of the population, during the first wave of H1N1 they accounted for 27.8 per cent of hospitalizations and made up 25.6 per cent of critically ill patients in ICUs across Canada. A history of colonialism and the resulting and persistent inequities, together with the very isolation that could potentially protect communities from SARS-CoV-2, hold much of the blame for such poor health outcomes—both directly and indirectly. Colonial policies and legislation in Canada are, as many Indigenous rights advocates have said, a pandemic unto themselves. For centuries, this complex web has perpetuated countless socio-economic, cultural, and political injustices, many of which, in turn, make it hard to fend off an unyielding killer virus.
  
  Chronic disease is a risk factor. Crowded, multi-generational housing is a risk factor. Poverty is a risk factor. Dirty water is a risk factor. Poor nutrition is a risk factor. Lack of access to dependable health care is a risk factor. Discriminatory and racist health care is a risk factor. Low trust is a risk factor. Delayed and badly communicated public health information is a risk factor. A history of low and no resources is a risk factor. The remoteness that made the region seem so attractive to naive southerners is a risk factor. As Kandola herself acknowledged, most communities in the North don't have easy access to a hospital. A number of them don't even have a permanent nurse on site every day. Treatment would be slow, if it came at all. "If we get the novel coronavirus in our communities," Kandola asserted, "it will spread." Unless, of course, she acted quickly and decisively.
  
  The N.W.T. confirmed its first case of COVID-19 on March 21, hours before closing its borders to non-essential visitors. Kandola told me she'd already made the decision to shut the territory to air, road, and port travel before a resident in Yellowknife tested positive. She had been watching the case counts climb in the provinces to the immediate south and wanted to be proactive. She wanted to make wise use of the time she had before the virus arrived—even if, as it turned out, she didn't have any time at all. By that point, the territory had already administered hundreds of COVID-19 tests, and it planned to keep administering them aggressively, despite the low case count. The first positive test belonged to a person who'd travelled to Alberta and B.C. before returning home, just as Kandola anticipated might happen. The person and their family were told to self-isolate after receiving the diagnosis and did so, immediately. Then, Kandola and her team tracked down seventy people who had come into contact with that person and prescribed another round of mandatory isolation. Over the next few weeks, another four people tested positive in the territory. The last of them recovered without incident in mid-April, and nobody else tested positive for months.
  
  Throughout it all, Kandola remained vigilant. She worked constantly, through evenings and weekends, describing the period as "intense." The idea of 5 p.m. signalling the day's end became laughable; seeing her family, a husband and four children, became near impossible. In a way, it was almost familiar, too: during H1N1, Kandola had missed her youngest son's first birthday; she's missed a lot of stuff this time around, as well. During the non-stop early days, an epidemiologist on her team presented Kandola with a superhero cape, calling her "Super Kami." She hung it on the back of her chair, thinking of all the Avengers movies she'd been watching with her twelve-year-old son. "It's a flavour of how our team is dealing with the pandemic. The mentality is that it's not just about you—you are trying to protect society at large and the people you love and care about need you to be focused," she said. "They need you to put their needs before yours." She took the philosophy to heart as she led her morning huddles, and, as she began making tough decisions to protect her real-life population, she hoped everyone else would too.
  
  At her order, restaurants, gyms, schools, and some offices remained closed until the territory ticked into June. At the end of August, a checkpoint in Hay River, close to the Alberta border, was still refusing entry to at least a dozen vehicles a day. As fall hit, the territory enacted mandatory mask measures at airports, and so too did many stores. By October 9, the N.W.T. had completed over 5,570 virus tests, and the number of COVID-positive results never budged. Nor did Kandola, even as criticism of too-strict measures surfaced in the territory, as it did elsewhere in Canada. Much of that grumbling arrived as she and her team prepared for what Kandola saw as the inevitable second wave—there hadn't yet been a pandemic in history without one. And indeed, after a months-long virus drought, the N.W.T. recorded three new cases in mid-October. Kandola knew they were coming. For her, the previous six months had only been a drill; the real test was still on its way. Standing at the base of another possible mountain, she vowed to put even stricter precautions in place if she had to. After all, she said, examples of worst-case scenarios abounded. In particular, she looked with worry to northern Saskatchewan, a public health failure close to home—and a place similar in both population size and demographics to the N.W.T. "You can never know how much prevention stopped," she said, "but we know by looking at unmitigated public health measures what could have happened."
  
  On April 15, Saskatchewan's far north reported its first COVID-19 case in La Loche, a Dene village that's home to about 2,800 people. Health officials later confirmed that the virus's arrival in the community was linked to travel from an oil sands camp in Alberta. The virus quickly spread. By the time the province restricted non-critical travel to the province's north eleven days later, the area accounted for twenty-five of the fifty-seven active cases. The communities dotted there faced the same challenges as those in the N.W.T., and, arguably, in every Indigenous community and reserve across Canada. When housing is overcrowded and inadequate, self-isolation doesn't work no matter how hard people try, or how responsible they are. The virus pillaged the region for three months. By the time the last active case was deemed recovered in July, the area accounted for nearly one-third of COVID-19 infections in Saskatchewan. More than two hundred people in La Loche got sick, and another sixty-two became ill in nearby Clearwater River Dene Nation. Some died. And it wasn't, of course, simply Indigenous people in remote areas who faced higher risks.
  
  "I mean, the system is racist everywhere," said Lisa Richardson, an Indigenous internist at Toronto General Hospital. "There is so much systemic racism. There is individual racism. There is structural racism, and there is epistemic racism." Richardson is also the vice-chair of culture and inclusion at University of Toronto's School of Medicine and the lead strategic advisor in Indigenous health for both U of T's Faculty of Medicine and Women's College Hospital. Richardson has thought a lot about what it means to offer trauma-informed, anti-racist, culturally safe care in the time of COVID-19. She knows that many Indigenous people mistrust the healthcare system and the privilege-steeped idea that it is there to help them feel better, to keep their bodies and their minds healthy—and for good reason. Even when they do enter the system, Richardson added, they face major barriers to treatment, including a dearth of humane and culturally safe care. That might mean, for example, a doctor who doesn't understand they are treating a patient who's been to residential school and been forced to undergo medical procedures. Or it might mean hospital staff who are blatantly racist and cruel, callously endangering their patients' lives.
  
  Consider the tragic, deplorable death of Joyce Echaquan. The thirty-seven-year-old Atikamekw woman and mother of seven drove three hours from her home in Manawan to a hospital in Joliette, Quebec, one Saturday morning in late September 2020. Echaquan sought help for her severe stomach pain and also suffered from a chronic heart condition. By Monday morning, she was in even worse pain. She feared she was being given morphine, which she was allergic to, and worried she was over-medicated. Nurses only derided her. So, Echaquan began live-streaming her experience on Facebook. It lasted seven minutes, and in it a nurse can be heard saying, in French, "Are you done acting stupid? Are you done?" Echaquan groans in pain, and another nurse joins in. "You made some bad choices, my dear. What are your children going to think, seeing you like this?" The first nurse responds, "She's good at having sex, more than anything else." Her cousin saw the video and, shocked and worried, sped down to the hospital to pick up Echaquan, to get her out of that place. When she arrived, nobody would let her see her cousin or give her any information. Finally, upon discovering why she was there, a nurse told her, "Oh, you don't know yet? She's died."
  
  Indigenous people know all too well that, despite politicians' protestations otherwise, such incidents are far from rare. So, then, how do you convince communities and individuals that public health measures are trying to keep them safe? How do you convince them that getting tested for COVID-19 is a smart idea? Throughout the pandemic, Richardson worked with Anishnawbe Health Toronto's mobile testing unit to try and do exactly that. The mobile unit was designed to bypass the assessment centre and meet Indigenous people where they were at, literally. It travelled to the city's shelters and homeless encampments, but also outside the downtown core, where pockets of Indigenous people live but don't have access to care. Once people agreed to be tested, Richardson practised clear and kind communication, explaining what she was doing and why. If a patient was still, understandably, apprehensive, she learned to offer to let them do the invasive-feeling test themselves. She'd clasp their hand and, thus joined, help guide the swab inside the nose. If that didn't work, she'd offer a throat swab, always taking her cue from the patient. She cites the mobile unit as one example of Indigenous-led health solutions during the pandemic. But there also were many others.
  
  Plenty of communities did shut their borders, and fast. One Inuit association made their own educational materials to disseminate, written in Inuktitut and using common examples from the daily lives of community members. Richardson helped Women's College Hospital adopt a medicine wheel framework that incorporated elder knowledge and focused on building physical, emotional, mental, and spiritual resilience. Through these measures, many Indigenous communities reversed their expected fate: poor outcomes similar to H1N1, only magnified by the scale and force of COVID-19. First Nations, Inuit, and Métis communities actually had lower rates of COVID-19 in the first six months of the pandemic. Those on reserve had a virus case rate four times lower than the general population, with three times fewer fatalities and a 30 per cent higher recovery rate. And in La Loche, the outbreak finally ended because all levels of government collaborated—prompted in part by a letter from twenty-four Indigenous communities to the province's CMO that read, "We ask you to learn from us, and with us"—and followed a community-crafted response plan. As Richardson put it to me: it's amazing to see the difference power and control can make.