Indigenous communities continue to grapple with COVID-19 outbreaks across Saskatchewan, and a doctor leading the pandemic response says they have reached an "intense phase" in the fight.Research indicates that Indigenous people in Saskatchewan are at the highest risk of being hospitalized or dying because of complications from the virus.As of Monday evening, there had been almost 1,160 cases of COVID-19 reported across Saskatchewan's First Nations communities, including 17 active outbreaks and 531 known active cases.Dr. Ibrahim Khan, Saskatchewan's regional medical officer with Indigenous Services Canada, said the increasing numbers represent a critical juncture."We are in the very intense phase of this COVID-19 pandemic," Khan said."We are seeing quite a surge in the number of cases. So there is one big factor that we know by now: that the virus moves with us wherever we move. If we lower our guard down and we are not mindful of masking and distancing, that's what happens."The progression of the virusThe first wave of the virus was most prominent in Saskatchewan's northern First Nations communities, Khan said, but over the summer and into the fall, it began to spread."We're seeing the progression of the virus, the movement of the virus from the northern community to the central communities," Khan said. "Now we see quite intense transmission in the southern First Nations communities. So certainly, that is concerning." Travel between urban centres and rural centres is part of the issue. Khan said it's how the virus comes into Indigenous communities."We have very large family systems, in some households there are 10 to 15 people," Khan said. "It really gets hard to stop the spread in families like that, and particularly within the community."Proactive moving forwardOne southern community that has recently been impacted by COVID-19 is Cega'kin (Carry The Kettle) First Nation.Chief Brady O'Watch said the community has a larger population of vulnerable people and this led him to call a 14-day lockdown on Nov. 30 after an outbreak of eight cases."We have a lot of elders in our community, a lot of children, some people with … medical complications, so it was in our best interest to, I guess, call a lockdown," O'Watch said.Khan said half of the Indigenous people in the province have chronic medical conditions that makes COVID-19 an even greater threat for them, so there is a lot of pressure on families and communities to take quick action.Luckily, he said that Saskatchewan's First Nations are constantly communicating and collaborating with each other."Communities are working very closely together, taking every possible step you can imagine to intervene and to stop the spread and to stop the influx of the virus from urban centres to the rural," Khan said. Khan said chiefs have also been very proactive. For O'Watch, this means actively working to keep people informed within using Facebook and newspapers. He also engages with different levels of government to keep himself up to date."We're always communicating with … Dr. Khan, the province, across Canada, Justin Trudeau, when they have updates," O'Watch said. "I, myself, always make it a priority to be on these calls, to educate myself, so I can educate my membership."Combating COVID fatigueAnother factor that has led to COVID-19 gaining a foothold among Saskatchewan's Indigenous communities — like the rest of Canada — is fatigue.This experience has felt prolonged, Khan said, and as it has continued, resolve has been worn away."The overwhelming majority are observing the COVID precautions," Khan said. "But … there is a complacency, and certainly there is a time that people would want to go out and about."For the holiday season, Khan said he is working with community leaders to remind people that the risk remains extremely high."We are asking everybody to be mindful of this intense transmission, and take all steps to reduce the risk of transmission within the communities, within the households, almost every setting you can imagine — traveling, shopping, everywhere," Khan said. "If you are sick, we are asking everybody to stay home."