WASHINGTON - Urging people to wash their hands frequently with soap and water to avoid the coronavirus had limited effect in Navajo Nation lands, where one third of the population lives without electricity and running water.

For them, water has to be trucked in.

This week, the Native American (sometimes called American Indian) Navajo people on their land surpassed New York and New Jersey for the highest per-capita coronavirus infection rate in the US.

Across the country, the pandemic has laid bare the systemic neglect and vulnerabilities of minority communities. Total deaths are nearing 100,000, and Native Americans, African Americans and Hispanic people are disproportionately suffering.

In Washington DC, African Americans make up roughly 47 per cent of confirmed cases in the city, in line with their share of the population - but are 80 per cent of people who have died from the coronavirus.

As of last week, Ward 8 of the capital city, east of the Anacostia river, where African Americans make up 89 per cent of the ward (which is also the city's poorest), had the highest per capita death rate in the District of Columbia - six for every 10,000 residents.

"In DC and across the country, the confluence of inequities in health access, health outcomes, and socioeconomic conditions has… contributed to disproportionate outcomes by race, with particularly poor outcomes for black residents," Ms Sunaina Kathpalia and Ms Kathryn Zickhur of the non-partisan think tank DC Policy Centre wrote in late April.

In Milwaukee County, Wisconsin, black people represent 26 per cent of the population but 70 per cent of deaths. In Chicago, black people are 40 per cent of the population but represent 70 per cent of the dead.

According to an analysis from the American Public Media Research Lab, of 39 states and the District of Columbia reporting the race and ethnicity of those who have died of Covid-19, African Americans make up about 13 per cent of the population but 27 per cent of Covid-19 deaths.

In California, Hispanic people make up 53 per cent of the state's cases, despite making up 39 per cent of its population, according to the California Department of Public Health.

In North Carolina, Hispanics make up 32 per cent of coronavirus cases, while being only 10 per cent of the population.

Ms Julia Lockamy, a family nurse practitioner at a clinic in Durham, North Carolina, told ABC: "The people in the Hispanic community, a lot of these patients that I'm seeing are the people who... pick the lettuce that goes on the grocery store shelf.

"They're the people who are actively making the things in the factories. They're people who are building the construction for these new buildings that are going on downtown.

"For a lot of people in the Hispanic community, they may not have, necessarily, access to healthcare so they might have underlying conditions that have been untreated, like maybe diabetes or high blood pressures," she told ABC.

"Or it could be their work environment, where maybe they're afraid to call out sick for work because they don't have any protections from their employer and they might feel pressured to go to work sick and so the people around them at their workplace might be more vulnerable to disease in that way."

In Arizona, Ms Ginger Sykes Torres, 39, a Navajo who lives in Phoenix with her husband Javier Torres, formed a group of citizens, Navajo and others, with friends and relatives living on Navajo Nation land to buy hand sanitiser and other necessities to supply to first responders in the reservation.

Ms Torres told The Straits Times she was astonished when emergency medical teams asked her for fabric masks because they did not have any.

Roughly 170,000 people live in the defined territory of the Navajo Nation, which spans parts of Arizona, New Mexico and Utah. With 4,002 cases, the Native American territory has 2,304.41 cases of Covid-19 per 100,000 people - compared to New York State's 1,806 per 1,000.

This does not come as a complete surprise. As in the African American population, underlying health issues are rampant. The Centers for Disease Control and Prevention notes that "American Indians/Alaska Natives (AI/AN) have a lower life expectancy, a lower quality of life, and a higher prevalence of many chronic conditions".

Analysis of 2017 data from Arizona found "significantly higher prevalence of sugar-sweetened beverage consumption, being overweight or having obesity, diabetes, hypertension, fair or poor health status, and leisure-time physical inactivity and a lower prevalence of having a personal doctor among AI/AN compared to whites".

The virus also spread readily through a population where, unlike the smaller family units of white people, Navajo live in multi-generational households - much like in rural Asia - with grandparents often under the same roof as grandchildren and teenagers.

"It's hard to keep families separated because they are close-knit and go from one house to the other, it's hard to communicate separation of boundaries," Ms Torres told The Straits Times. "Isolation in those circumstances is difficult.

"The virus has just exacerbated all of the existing issues prevalent on the reservation before the virus. Even before this happened the healthcare system was not ideal," she said.

"Also, on the reservation, due to historical conditions, there are a lot of people with underlying conditions that make Covid-19 more dangerous; those have histories that go way back to when the US was colonised.

"Their problems have been there for decades, it's an area a lot of people have worked very hard to bring to the forefront," Ms Torres said. "But it's never really come to people's awareness outside the Navajo Nation until now."