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Fifty-three kilometres south of highway 11, a small checkpoint blocks a bridge that enters Lac La Croix First Nation to track community members who come and go to help reduce the spread of COVID-19.

DAVID JACKSON/The Globe and Mail

At least nine First Nations have confirmed cases of COVID-19, raising concerns about further transmission and prompting calls for greater responses from the federal and provincial governments.

Cases have been reported in Ontario, Quebec and Saskatchewan. Both urban and remote communities have been affected, from Six Nations of the Grand River near Hamilton to the Cree Nation of Nemaska, more than 1,000 kilometres northwest of Montreal, to Onion Lake Cree Nation, about 300 kilometres northwest of Saskatoon.

The developments have some communities taking steps to limit traffic in and out of their territories and declaring states of emergency. Some have said they do not have the health-care infrastructure and resources, including test swabs and personal protective equipment, to prevent an outbreak or respond to cases, if necessary.

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Canada’s Chief Public Health Officer Theresa Tam has not minced words about her own level of concern about cases in Indigenous communities, noting even a single case is extremely serious and that First Nation, Inuit and Métis communities face a higher risk of severe outcomes owing to health inequities and the higher prevalence of underlying medical conditions, as well as the unique challenges of remote and fly-in communities.

‘We are not prepared’: Inuit brace for coronavirus to reach remote communities

The chief of a remote First Nation tries to fend off the coronavirus

The coronavirus must be seen as an existential threat to nearly one million First Nations people, said Assembly of First Nations National Chief Perry Bellegarde, adding that many communities have modified or postponed ceremonies and gatherings that are vital to their cultures.

In an opinion piece for The Globe and Mail, Mr. Bellegarde also said the federal government moved quickly to provide $305-million for an Indigenous community-support program and that this is an important start, but he said there is considerable ground to make up including in access to health services.

On Thursday, Indigenous Services Canada said there were 15 COVID-19 cases in First Nations but department officials said this did not capture those off-reserve, nor those in Inuit and Métis communities.

Indigenous Services has not provided an updated figure since releasing the Thursday figure. There are challenges for the federal department to get a full snapshot of the extent of the virus in First Nations across Canada. The department says tests for COVID-19 can be done in communities, but swabs are then sent to provincial labs to be analyzed.

Six Nations of the Grand River, a large community of about 13,000 on-reserve members near Hamilton, has confirmed eight cases.

“COVID-19 is here," said Six Nations Chief Mark Hill in a statement on Thursday, as he called for a redoubling of efforts to slow the spread of the virus and to save lives.

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At the end of March, the community had closed down entry to most non-residents with several exceptions, including those delivering goods to the community. Those wanting to buy gasoline and cigarettes are being turned away. Barriers have also been erected, with checkpoints run by community members.

Most of the confirmed cases of COVID-19 on reserve are in Ontario and Quebec.

A positive test was recorded in The Chippewas of Kettle and Stony Point First Nation, northeast of Sarnia, Ont., at the end of March while another was documented in the community of Akwesasne, which straddles Ontario and New York State.

As the number of confirmed cases climbs, several First Nations leaders have also voiced concern about access to testing.

In an update in late March, Temagami First Nation, located on Bear Island northeast of Sudbury, said its community health centre had no test swabs, while a nearby off-reserve health unit had a limited number.

Last Monday, Neskantaga First Nation, a fly-in community about 270 kilometres northeast of Thunder Bay, declared a state of emergency owing to insufficient medical services, including test kits.

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Niisaachewan Anishinaabe Nation, a community in Northwestern Ontario, which has set up a check point to limit movement to members and those providing essential services, also does not have a single test kit, Chief Lorraine Cobiness said.

“We don’t have the capabilities here in the community to actually do any testing,” she said, adding the community is heavily relying on an assessment site that recently opened in Kenora.

For its part, Kettle and Stony Point First Nation also does not have any testing capacity at its own clinic and it is relying on the local county health department, Chief Jason Henry said.

Chief Henry said he recently asked the First Nations and Inuit Health Branch, part of Indigenous Services Canada, to provide test kits directly to the community.

When asked how many test kits had been provided to on-reserve communities, Indigenous Services Canada said in March that provinces were responsible for providing test kits to public-health units and nursing stations.

When asked for clarification on communities that lack swabs, Indigenous Services Minister Marc Miller’s office said the federal government will work to ensure no community falls through the cracks when it comes to testing on reserve.

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Department officials said Thursday that swab kits are typically provided through provincial labs to communities but the federal government has put in an order into the National Microbiology Lab to distribute kits to communities.

Indigenous Services is also working with nursing stations, public-health authorities and provinces and territories to make sure communities have the swabs required to test symptomatic community members and the ability to transfer tests to laboratories, said Mr. Miller’s press secretary, Vanessa Adams.

Dr. Tam has said testing capacity in communities is a gap that must be filled, noting some samples also have to be flown vast distances to referral laboratories.

The National Microbiology Lab is looking at testing mechanisms that can be done much closer to patients, she added.

NDP MP Niki Ashton said she has heard from First Nations leaders in northern Manitoba who have received some swabs but are concerned about the availability of personal protective equipment to conduct the tests.

Without that equipment, Ms. Ashton said that some patients on reserve have been directed to the provincial system for testing, adding they have then encountered a massive bottleneck in that stream.

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“We need to make sure all First Nations have the testing swabs, have the equipment to do the testing, the PPE [personal protective equipment] and we need to make sure they are being tested in a way that avoids the provincial backlog," she said.

As of the beginning of April, the federal government said it shipped 275 orders for personal protective equipment including hand sanitizer, N95 masks, isolation shields and gloves to Indigenous communities. It did not specify how many communities received the shipments.

Prime Minister Justin Trudeau told reporters Friday that the Canadian Rangers, who are a part of the Canadian Armed Forces reserves, will be deploying to Inuit communities of northern Quebec to assist with the public-health response to COVID-19.

While the COVID-19 pandemic spreads, many frontline health-care workers are forced to isolate as they care for patients infected with the virus. See how Dr. Kanna Vela is coping with being away from her family as she treats patients in Ajax and Scarborough, Ontario hospitals.

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.

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