get us into even more trouble. "the washington post" reporting, quote, as daily covid-19 deaths climb to levels not seen since early in the pandemic, nine states have hit one more grim marker. more than one in every 1,000 people dead of coronavirus-related causes. on friday south dakota became the latest state to reach that unwanted marker, including new york, new jersey, and neighboring north dakota which currently has the highest covid mortality rate in the world. it's early morning here outside the badlands region of south dakota. we're traveling to key locations across the country, areas that have been hard hit by the coronavirus, even before the arrival of covid-19 native americans had the country's lowest life expectancy. now south dakota is reporting some of the highest deaths per capita. residents are fighting for their very lives. with a positivity rate of 24%, south dakota and neighboring north dakota have the highest incidence of covid-19 cases nationwide over the past week, a stark illustration of the problem facing many rural communities from coast-to-coast in america. quote, the dakotas have the most people in hospitals per capita, according to data from the covid tracking project, that's a shift from the spring when urban regions were overflowing with patients. that's from "the wall street journal." a south dakota nurse made national headlines recently and spoke with cnn about a series of tweets she posted, noting she has treated covid-19 patients who still don't believe the virus is real even as they're hospitalized with it. >> i think the hardest thing to watch is that people are still looking for something else and they want a magic answer, and they don't want to believe that covid is real. they should be spending time facetiming their families. they're filled with anger and hatred. it made me really sad the other night and you just can't believe those will be their last thoughts and words. >> now, as a motorcycle rider myself, i have always dreamed of coming to the annual motorcycle rally in sturgis, south dakota, held not far from here. in august more than 400,000 people packed the streets, a key contributor to the growing outbreak. "the new york times" reports south dakota's republican governor, kristi noem, gave her blessing. local leaders set aside their misgivings and thousands of people from every state in the nation rolled down sturgis' main street. one study estimated that the ten-day event, deemed a super spreader by some experts, may have been responsible for more than 250,000 new coronavirus cases. meanwhile, in north dakota, as of this morning, covid-19 has infected more than 77,935 people and claimed over 915 lives. in late october, the mayor of fargo, the state's largest city, started requiring all people to wear face coverings while indoors with people not in their households. while there is no actual penalty for violating the mandate, officials there believe it has curbed further spread. joining me is tim mahoney, the man who helped put those restrictions in place. you are a vascular surgeon, which helped informed your views, because the dakotas have not been on the cutting edge of doing the right thing in the coronavirus. >> yes, it took a while for people to catch on that masking would help quite a bit, and also social distancing and hand washing. we're pleased, in the last two weeks our numbers are starting to jump. we were at a high but we're starting to come down and our incidence is coming down as well. we're seeing good compliance in the community and throughout the state. a lot of other mayors followed our lead. 77% of the state did that and the governor last friday declared a mask mandate as well. so we're seeing good compliance and seeing our numbers drop. >> and we don't have a mask mandate where i am in south dakota, but like south dakota, much of north dakota is rural. as a result, cities like yours are not just important because of the residents of fargo but because of the fact that people in more rural areas of the state, once their hospitals are overwhelmed, they have to come to places like yours, which then overwhelm your hospitals. >> absolutely. we have the largest health care system in the state, with two big systems that are here. we have adapted to be ready for transfers from throughout the state. our health care systems have done a good job of that. and so far, we have not hit a capacity surge so far. and we're able to handle all the cases that we need throughout the state. >> what is the situation that we've been hearing about in some states were you have shortages of nurses, of health care providers generally, front line workers, nurses and doctors? what state are you in with that in north dakota? >> well, what we have is approximately 10% of the people that are infected in the health care field. we're trying to get travelers and other people into our community. it's a challenge in rural states because we don't have a lot of other people to place in those situations. what it does is changes the shifting in the hospital as far as cases and things they can do so they can have enough people to take care of the covid patients. we're at surge level 1 at this point and we have the capacity to handle what we have coming our way. >> mayor, we will keep a close eye on fargo, north dakota and your state, and we wish you well in your fight against this new surge of coronavirus. tim mahoney is the mayor of fargo, north dakota. thank you for joining me, sir. >> thank you very much, sir. i'm going to let this number sink in for you watching at home. one in 1,000. that's the number of south dakotans who have died from the coronavirus. let me say that again. one in every thousand people living in south dakota have died from this illness. the number is even worse among certain groups including those who live right behind me. native americans have been hit the hardest by the virus than any other ethnic group. they make up 9% of south dakota's entire population but represent 15% of all deaths. cases of coronavirus in south dakota are the second worst in the nation. north dakota is the worst. in both states hospitals, as we've been discussing, are getting close to capacity. when north dakota's hospitals reached 100% capacity, its governor, as we just heard, allowed nurses who tested positive but asymptomatic to continue working in covid units. it's gotten so bad there that 60 air force nurses were sent to help the health care workers. these courageous front line workers are fighting the battle against the disease. our next guest is a nurse in aberdeen, south dakota, about 200 miles to the northeast of where i am. kathy, thank you for being with us. give us some sense of what the situation is in aberdeen, who your patients are and where they're coming from. >> so certainly we are in our surge right now, something that we have been preparing for for months. our patients are coming from all over the state of south dakota and we have had patients from other states as well. >> you do work in palliative care so you're familiar with things that your colleagues have not had to become familiar with, the idea that you're dealing with patients at the end of their lives and who may be passing without the benefit of their family around them. in some cases, we've been hearing, people who are still not at peace with the idea that they have coronavirus. how has it been treating patients? >> you're exactly right. and it's been hard. it's been very difficult, as i'm sure many health care workers across the state and the nation would agree. people are surprised that they can be this sick from covid and are surprised that they're going to end up being in the hospital for weeks, and family members who can't see their loved ones on the other end are scared and fearful, and yet hopeful that their loved one will make it through. it's very challenging to have to share when someone becomes very ill and we don't feel they will make it. >> and normally in palliative care it's because somebody has some illness that their family will have become accustomed to. you're dealing with both patients and families, where you're not just dealing with the normal stuff, trying to get them comfortable with how things are going to go, but you're convincing, to some degree, or having to sort of make people understand, both families and patients, how serious this is, that their family member could die. >> that's exactly right. there's a fair number of patients that come in and think this is going to be like a typical pneumonia, they'll be in for two or three or four days, and i'll be outta here in just a few days and i'll go back to my life as normal. and part of my role has been helping prepare families and patients that this might be an america marathon, this might be a three- to-fi five-week stay. we have to talk about the tough stuff, do you want to be put on a ventilator if your breathing gets worse, what do you want us to do if your heart stops. there are people who are shocked when we have those conversations. >> we've talked to a lot of nurses, we all accept you're im impa empathic people. >> many of us who have been in health care for a long time are seeing things we've never seen. you're right in that we can't predict how one person's covid hospitalization is going to go. it's not like a heart failure or a cancer patient. as you said, it can be very un pri unpredi unpredictable. these patients can end up with multiorgan failure. it doesn't matter if you're young and healthy and fit and been exercising. >> what a thing. kathy, thank you to you and to all the nurses, not just at your hospital in aberdeen but frankly across south dakota and north dakota and across this country who do what you do every day to keep us safe and to keep our families comforted. kathy is a nurse in aberdeen, south dakota, about 200 miles northeast of where i am now. coming up next, i may be in south dakota right now but next i'm going to acknowledge whose land this truly is and what needs to be done to fight for the rights of the native american community. take another look at this beautiful land that i'm in right now. we're at the movies and we need to silence our phone. who knows where that button is? i don't have silent. everyone does -- right up here. it happens to all of us. we buy a new home, and we turn into our parents. what i do is help new homeowners overcome this. what is that, an adjustable spanner? good choice, steve. okay, don't forget you're not assisting him. you hired him. if you have nowhere to sit, you have too many. who else reads books about submarines? my dad. yeah. oh, those are -- progressive can't protect you from becoming your parents, but we can protect your home and auto when you bundle with us. look at that. transitions light under control. ♪ upbeat music transitions signature gen 8, available now in 4 new style colors. transitions. it's time you make the rules. so join the 2 million people who have switched to xfinity mobile. you can choose from the latest phones or bring your own device and choose the amount of data that's right for you to save even more. and you'll get 5g at no extra cost. all on the most reliable network. so choose a data option that's right for you. get 5g included and save up to $400 dollars a year on the network rated #1 in customer satisfaction. it's your wireless. your rules. only with xfinity mobile. i want to acknowledge that the ground on which i am standing are the ancestral lands of the seven council fires, that's the proper name for the people referred to as the sioux. most of western south dakota and portions of neighboring north dakota, montana, nebraska, and wyoming were part of what was once known as the great sioux nation. here in south dakota, there are nine federally recognized native nations. cheyenne river, crow creek,ing on what i just did there was a land acknowledgement. where i come from in canada, we started doing that at the beginning of most gatherings. land is central to the identity and culture of native americans and offering a land acknowledgement has come to be seen as an initial step in the reconciliation of america and its indigenous presence. while these land acknowledgements don't change the fact that america has broken virtually every treaty it has ever made with indigenous people, the statement of fact that we are on their native land brings awareness to a history that most americans never learn in school. the history of america's indigenous people dates back thousands of years. the issues over land ownership began with colonization, when colonizers weren't outright killing native americans, they were drastically reducing their access to the land they hunted and fished. ultimately american indians sued. in 1980 the supreme court upheld a claim by the lakota sioux that the united states broke its obligations that the black hills rightfully belongs to the sioux. at the time, $105 million was put in a trust as a settlement. it's thought to have grown to about $1 billion today. the lakota, most of whom now live on reservations like pine ridge behind me, maintain they don't want the money, they want the land back. land was both sustenance and identity for native americans but that came into conflict with the needs of colonizers to occupy from country from sea to shining sea, to access gold and silver, to build rail lines and telegraph lines and mail routes. our wealth would have been their wealth or maybe they would have done something else with their land and water. they have few allies in state and federal governments. they are among the worst off to america with poor access to health care and some of the lowest life expectiancies. they don't even have reliable cell service. whether 2020 represents to you political change, social justices, or a change to your way of life that we have not faced in a lifetime, understand that there remain people among us who have been here longer than most of us who benefit less than we do from this country's riches. land acknowledgements won't change anything for native americans but finding out who occupied and lived off the land on which you now live is a start. once we start, who knows what justice and equity may follow for our native brothers and sisters? it's time for the ultimate sleep number event on the sleep number 360 smart bed. can it help with snoring? i've never heard snoring. exactly. no problem... and done. save 50% on the sleep number 360 limited edition smart bed. plus 0% interest for 60 months. ends cyber monday. i have a mask on which means i've got a guest with me. we're back from the edge of the pine ridge reservation in south dakota. this is beautiful, and it's back there. the ongoing covid crisis in this region has highlighted the sharp contrast between the hands-off approach of the state government, how they've been dealing with the virus, and how aggressively native american communities have fought the spread of the virus. the governor of the state, kristi noem, a republican who has avoided mask mandates, has criticized these checkpoints set up by the local tribes in an effort to protect those living on tribal land from the rampant spread they've already seen. in an ongoing battle back in may, noem asked the white house to help intervene. in june, the cheyenne river sioux tribe sued the federal government, alleging that ever since noem's plea to the white house for help, the trump administration has fought to end the checkpoints. in the meantime the tribe's nine checkpoints remain up. i want to continue this conversation with state senator red dawn foster of south dakota who represents district 27 which is actually not the cheyenne river sioux, she is part of the oglala sioux and navajo tribe. same thing happens here, you've got checkpoints here. what's the controversy? >> thank you for having me. the point of the checkpoints were to limit traffic coming into the reservation that normally wasn't living here. this is a matter of life and death on a reservation. we needed to limit the spread, to limit people coming into our communities and potentially wiping our whole community out. >> i want to make that point. because that sounds extreme, unless you're a native american. the idea of diseases coming into the community and wiping the community out is very real in your institutional memory. >> absolutely, we have the historical memory of that diminishing our whole tribes. as you said, i'm navajo, we saw what happened to navajo nation, it's coming in and running rampant, i believe they're in lockdown right now. it was a very strong attempt to limit that spread and make sure we're doing everything we can, upholding our sovereignty and protecting our citizens here. >> you came here from the reservation, maybe when you go back you'll hit the checkpoint. >> yes. >> they're not particularly onerous. >> no. >> there are a couple of guys who take your car information down, they ask you who you are, how you're feeling, where you're going. the issue is there are state and federal roads that run through these sovereign nation lands and the government is saying, that's interstate commerce, you can't interfere with people traversing through the nation, and the people are saying, come ron, its ours. >> yes, the sovereignty supersedes even the state's existence. this case has already been settled with rosebud versus the state. so it is a moot point. we have the right to have these checkpoints, it's in our best interests, it's about maintaining our health and wellness and protecting our people. >> the issue is, native americans make up 9% of the state's population, 14% of the infections, 15% of the deaths. why so high? >> i think that you see the underlying health issues that are here. there's overcrowding. there's multigenerations living in one single home. then there's a high rate of diabetes. so i think it's 20% of the households lack running water. so that predisposes us to having a harder time with covid. 14% of the population, we just buried three elders that were fluent language speakers last week. >> that's your culture, your oral history, your institutional memory. >> yes. >> you said houses that don't have running water. hard to get cell signals, high speed internet, broadband. if we're fixing things because of coronavirus, which we've been learning a lot of stuff is broken, too many people working for too little money, lots of kids at home without high speed internet. >> absolutely, we have to have housing, water, infrastructure, wi-fi, basic access. it really is a utility. it's not about a luxury anymore. and our kids are falling behind without that basic service of having access to wi-fi. >> red dawn foster, thank you for being here. a state senator from south dakota. we'll continue to wish you the best and thank you for the work you're doing trying to keep this community safe. >> thank you. next, small business experts to answer your questions on how to navigate the next wave of the covid pandemic. send your questions to mystory@vels mystory@velshi.com. we'll have more after this but for now we'll leave you with a beautiful picture from above where i'm standing. -well, audrey's expecting... -twins! grandparents! we want to put money aside for them, so...change in plans. alright, let's see what we can adjust. ♪ we'd be closer to the twins. change in plans. okay. mom, are you painting again? 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tattoo salons, hair salons, things like that, those are some of the toughest to convince your patrons that you're safe and to convince your staff. how did you reopen safely? >> you know, we just followed all the guidelines from the cdc and whatnot, as far as maintaining distance from possible -- we've certainly gotten into a policy where we recommend masks for everyone in the building. we've had to cut down on some things. a lot of people want to show up with a friend or friends to get tattoos and we've kind of reduced it to where it's just one artist and one client at a time in the shop. >> and does that get you back, get you at least close enough to the revenue that you're used to in order to stay alive? or are you still suffering? >> we're definitely having a bit of a dip this year. i think we're managing. it's kind of hard to quantify when we look at the numbers, when we were closed, the numbers weren't nearly as bad as they are now. it's kind of doing some mental gymnastics, i guess, to justify why we're open with things being the way they are. >> what's the best thing that could happen for you right now, other than that we get a vaccine and life gets back to normal? >> i guess i hadn't thought of it in those terms. i hate the thought of seeing us shut down, i think we would prefer to just maintain our safety practices and be able to work through this. you know, there's really no safety net financially for most of the people i work with and myself. so it's hard to a couple a shutdown, i guess, when we all have bills to pay. >> jeff, thank you for joining us and thanks for sharing what you're going through, we appreciate it. jeff mann is the owner of a tattoo salon in sioux falls, south dakota. we want to talk more about the kinds of problems jeff and others are facing across america. back with me is my panel, ashish batia and kim weissel. thanks to both of you for with us. kim, because i'm talking to business owners and workers, i have a question from hannah who says, i'm a freelance writer whose income was already uncertain pre-pandemic, and of course is now more precarious. though i found some modest ways to keep afloat, it's tenuous. i have no savings and no supportive family and i'm currently single. someone suggested i look into applying for back pay of unemployment. i haven't had time to do this, as i've been so busy surviving. what do you suggest for a situation like mine? this is a much larger issue here, kim, that we're talking to a lot of businesses about. small businesses don't have accountants and lawyers on hand. regular individuals have difficulty navigating around what's actually available to them. and in a community like i am, the community's impoverished. if you go out of business or you're out of a job, you don't really have much to rely on otherwise. what do you recommend for hannah? >> so we deal with a lot of freelance writers at inc., i have throughout my career. i completely understand what she says, it's tenuous, work comes, work goes. one thing different about unemployment now is that you are eligible for it as what we call a 1099 worker. that's probably how she gets paid, on 1099 forms, which means she is eligible for unemployment. if her business has really suffered which i'm sure it has from her letter, she absolutely needs to look into that. frankly there are not that many other options available to her. it's relatively new that someone in her situation could apply for this and this pandemic shows just how much that's needed. so i hope she does it right away. >> and that's a change, right? the idea that freelance workers, 1099 contract type workers can apply for unemployment? >> yes, it's absolutely new. there are also, depending on her business, she should also look into the ppp program, which is not happening right now, but she should be prepared, if it gets re-upped in the new year, because again, that's a change. self-employed individuals have never been able to apply for programs from the sba. and more recently they have been able to. so that's something she should be prepared for but she should hop on the unemployment right away, and as you said, that's new. >> ashish, let's talk about controlling how much you're spending. that's terrible, for most businesses the number one thing they spend money on is labor, and they've had to let people go. robert asks, my wife and i operate a tanning salon, we're hanging by our fingernails, we'll be completely out of business soon. the ppp was useless to us, we weren't eligible for grant money. what sustained us was the pandemic unemployment assistance. that will expire and things will become dire at that point. what is your advice for us? >> yeah, this is a real challenge. we find ourselves in this place where so many of the stimulus programs are no longer available and we're heading into winter. i think one thing that i've been noticing or thinking about is, you know, thinking about how we can leverage, again, our resources that already exist. one of those resources are loyal customers. so i imagine as a tanning salon, you have many loyal customers. the question is, are you able to maybe reach out to them, maybe do a survey and find out, what is it that you can do to make the conditions in the salon such that people are going to come back in. and i'm surprised that -- i've definitely seen some businesses put out these kinds of surveys and questions and i think that could be an opportunity to kind of get the customers coming back in a safe way and a transparent way for them. >> and kim, lots of businesses, and again, it tends to be businesses with more resources to be able to figure out what the best practices are and implement them, but lots of businesses are marketing themselves now on, a, the steps they're taking to keep their employees safe, b, the steps they're taking to keep customers safe, and c, the idea that they're a small business that needs your support otherwise they will disappear. >> this is super important. and, i mean, we've seen this in our community. i've got several surveys from businesses i work with regularly saying, if we did this, would you be willing to come back, if we did this other thing, would you be willing to come back, and if you're going to cancel your membership, would you be open to some sort of alternative arrangement so we don't have to take the hit as a small business all at once. i'm very happy to fill those out because i care about those businesses, i value the role they play in our community and i want to see them succeed. i think a lot of businesses benefit from that kind of loyalty. so i would encourage them to reach out to customers in any way they can and get the answers to those questions and start to work with those customers, work with those relationships to see if there's something that will be good for everyone. >> and ashish, in business school they'll tell you to stick to your knitting, to stay aligned with your principles, if you're a bakery, don't sell underpants in your store. but you may have to think about the fact that if the demand is for underpants and you sell cookies, you may have to do that, throw out some old business rules and say this is what i need to do to get to the next stage. >> absolutely. a lot of our practice, what we teach in business school, often focuses on planning and thinking forward, where we have more certainty. but we're currently in a situation where the level of uncertainty is so high that those long term planning tools, we have to throw them out the window. instead, ways to build your level of control, the level of strength of your kind of decisionmaking, is by using the resources that you have, who you are, that means like what are you most passionate about, if you're going to be passionate about pivoting your business, then go for that. if not, maybe it's time for you to actually just focus on cutting costs. but then also to focus on what it is that you're really good at. and lastly, who is it in your network that can be supportive of you and help you get through this crisis where we're dealing with so much uncertainty. >> and, you know, kim, the business that i was talking to, the owners i was talking to yesterday, one of their businesses is a movie theater. there are no movies, they've been closed since march, but they open for a few hours a day to sell concessions, believe it or not, people still want movie popcorn, people like me. it's not bringing in enough money for them but it's bringing in something because they still have the ability to make and sell popcorn. >> yeah, and this is absolutely the heart of entrepreneurship, right? a lot of these business owners, if you think back to the beginning of their business, maybe the first thing they did didn't work out that well, maybe it wasn't that profitable, maybe over time they kind of adjusted and found the thing that worked for them and they've been doing that now for a number of years. this is really going back to the beginning for a lot of people in a lot of ways. and kind of harnessing that passion and that flexibility and that desire to innovative that got them going in the first place, and say, okay, this isn't working, what's the related thing that could? and hopefully that will either open up a new long term revenue stream for them, which would be great, or get them through this very difficult period until we achieve some sort of normalcy again. >> thank you to both of you, it is a real service to get out here and give some encouragement, if we don't have all the answers for everybody, and in the end some of these answers will come from new government programs that will extend grants or very, very low interest loans to some of these workers and businesses to help them get through. until the time that we have a vaccine. there is light at the end of the tunnel but it might be a few months away. ashish is a professor of management and entrepreneurship. kim is the editor at large at inc. there is light at the end of the tunnel and it might have gotten brighter this week with the announcement that key covid vaccines could soon hit the market. the question is how do they get distributed widely across the country, how do they get to places where i am right now, on a native reservation? i'll talk with a global health expert, dr. peter hotez, after this. you're looking at the pine ridge indian reservation. two medical societies have strongly recommended to doctors to treat acute, non-low back muscle and joint pain with topical nsaids first. a formulation they recommend can be found in salonpas. a formulation they recommend can be found in salonpas. salonpas. it's good medicine. hisamitsu. secret stops sweat 3x more ♪yo yo yo yo yo yo start your day with secret. than ordinary antiperspirants. with secret you're unstoppable. no sweat. try it and love it or get your money back. secret. ♪ all strength, no sweat if you have postmenopausal and a high risk for fracture, now might not be the best time to ask yourself, 'are my bones strong?' life is full of make or break moments. that's why it's so important to help reduce your risk of fracture with prolia®. only prolia® is proven to help strengthen and protect bones from fracture with 1 shot every 6 months. do not take prolia® if you have low blood calcium, are pregnant, are allergic to it, or take xgeva®. serious allergic reactions like low blood pressure, trouble breathing, throat tightness, face, lip or tongue swelling, rash, itching or hives have happened. tell your doctor about dental problems, as severe jaw bone problems may happen. or new or unusual pain in your hip, groin, or thigh, as unusual thigh bone fractures have occurred. speak to your doctor before stopping, skipping or delaying prolia®, as spine and other bone fractures have occurred. prolia® can cause serious side effects, like low blood calcium, serious infections, which could need hospitalization, skin problems, and severe bone, joint, or muscle pain. don't wait for a break, call your doctor today, and ask about prolia®. for bathroom odors that linger try febreze small spaces. just press firmly and it continuously eliminates odors in the air and on soft surfaces. for 45 days. coronavirus cases emerging every single week across the country americans are more desperate than ever for a covid vaccine. in recent weeks there have been some promising candidates, pfizer and moderna were the first two out of the gate with late stage trials which showed both vaccines were about 95% effective. there was finally hope the world believing there may soon be an end to this pandemic, then came along astrazeneca which claimed its vaccine would be 90% effective, turns out that depends on how you look at the data, the 90% was based on a half a dose first given to a group of participants followed by a full dose they got a month later. the vaccine appeared to be 62% effective in another group that got two full doses. it was apparently a mistake because the first group was accidentally given the half-dose instead of the full shot as initially land and astrazeneca still can't completely explain why the results differed so widely to we are still waiting to find out how effective that vaccine may be. but it's something. probably about 70% effective, that's still actually pretty good. then comes the question, the big one, how do you distribute a covid vaccine once we have one? pfiz pfizer's vaccine requires two doses and a very specific storage requirement, about 94 -- minus 94 degrees fahrenheit, and that doesn't cover the network and the resources necessary for a mass rollout of vaccines. joining me now is the renowned dr. peter hotez, he is an expert on vaccines, he is the co-director of the texas children's hospital center for vaccine development. he is a professor of pediatrics, molecular virology and microbiology at baylor college of medicine. dr. hotez, good to see you. i wanted to speak to you specifically about the situation i find myself in now with the pine ridge reservation behind me, they have a clinic, if anybody gets particularly sick here they have to go off the reservation to a hospital in rapid city or places further. they have a clinic that has a pharmacy, i don't know if that pharmacy has a fridge that can handle the pfizer medication, maybe they can get one, but how do medications get to people like this, people in impoverished communities, people in very rural communities, even if you are not impoverished but you're where i am, you're far from a city? >> you're asking all the right questions, ali. we know that the native american population in the u.s. is a especially vulnerable to covid-19, with very high death rates in people under the age of 65. the narrative out there is everybody is over the age of 65, it's simply not true. especially among african-american, hispanic and native american populations, about a third of the deaths occur under the age of 65 so it's especially important to reach these populations. it's really tough, this could be a pretty remote area and some of the reservations are like that. that and the fact that historically native american populations are especially vulnerable to infectious diseases in general and often don't respond as well to vaccinations. so you put all that together and you've got a big issue. you're right, the pfizer vaccine has a daunting logistical challenge because it's minus 9 had to minus 100 degrees fahrenheit storage required. it's doable, that's the answer. we know that the operation warped speed and general perna have been working hard to make freezers accessible. it may be that this one and especially the rural areas may be better suited for the moderna vaccine. even though that also requires frozen storage it's typical household freezer temperature. i think that one may be better suited, but we will see how the logistics roll out. a lot of this is being coordinated now between the states and the indian health service. so the indian health service is a branch of health and human service and i know there's been a lot of consultation with various tribal members across the country this year so hopefully this is all coming together to provide access. >> there's also another problem, when i note that in south dakota native americans are 9% of the population, 14% of the cases, 15% of the deaths. they have high concentrations in households, some households do not have running water and there are lots of comorbidities, there are a lot of people here who have existing conditions that complicate things. if you contract coronavirus despite their efforts to stop it from coming into the reservations if they get it there is a higher chance of them dying from it. >> yeah, no, it's the perfect storm because you're right there are high rates of comorbidities underlying obesity and diabetes, that's a factor, and that's one of the reasons why you're seeing high death rates among native american populations and younger age groups. often multi-generational households. so, you know, a 20-year-old who is working on construction sites is then bringing that illness home to -- or other essential workers bring that illness home to their 40, 50-year-old parents and also bringing that home to their 70, 80-year-old grandparents and things really snowball very quickly. so this is yasmin vossoughian the national academy has now rolled out a plan to emphasize the importance of underrepresented minorities in the vaccination program, but a lot of this is going to be left up to the states and the state health department, probably in consultation with the indian health service. >> dr. peter hotez, it is a pleasure to see you again. thank you. you are giving america some of the most important information that they need right now and you will continue to do so with us. thank you. dr. peter hotez is the co-director of the texas children's hospital center for vaccine development and a professor of pediatrics, molecular virology at the baylor college of medicine and one of the best sources. that does it for me. thank you for watching. velshi across america. catch me next under i will be in portland, oregon, to speak with local small business units about their plight. "a.m. joy" with maria teresa kumar is up next. stay with us, you are watching msnbc. with us, you are watching msnbc. - [announcer] welcome to intelligent indoor grilling with the ninja foodi smart xl grill. just pick your protein, select your doneness, and let the grill monitor your food. it also turns into an air fryer. bring outdoor grilling flavors indoors with the grill that grills for you. good morning, mr. sun. good morning, blair. [ chuckles ] whoo. i'm gonna grow big and strong. yes, you are. i'm gonna get this place all clean. i'll give you a hand. and i'm gonna put lisa on crutches! wait, what? said she's gonna need crutches. she fell pretty hard. you might want to clean that up, girl. excuse us. when owning a small business gets real, progressive helps protect what you built with customizable coverage. -and i'm gonna -- -eh, eh, eh. -donny, no. -oh. of the financial system. le have been shut out eh, eh. [music playing throughout] my grandfather founded industrial bank in 1934 so black people would have a bank that would work with them. because our doors are open, other doors are opening to more opportunities for our community. we're excited to work with citi, so we can realize our dreams of expanding our reach and impact. citi is committed to working with black-owned banks like industrial, so they can continue to support their clients and communities. it's time you make the rules. so join the 2 million people who have switched to xfinity mobile. you can choose from the latest phones or bring your own device and choose the amount of data that's right for you to save even more. and you'll get 5g at no extra cost. all on the most reliable network. so choose a data option that's right for you. get 5g included and save up to $400 dollars a year on the network rated #1 in customer satisfaction. it's your wireless. your rules. only with xfinity mobile. what we expect, unfortunately, as we go for the next couple of weeks into december, that we might see a surge superimposed upon that surge that we're already in. you know, when i give that message, i don't want to frighten people, except to say it is not too late at all for us to do something about this because, as we travel back to be careful, when we go back to where we are, to just continue to do the things that we've been talking about. good morning, and welcome to "a.m. joy." i'm maria teresa kumar. dr. fauci is forcefully falling calling for americans to stay

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