Precolombian north america actually had really sophisticated sanitation. In urban areas they pretty advanced waste management. In other areas, a lot of their seasonal mobility was possibly driven by sanitation needs. And they have really in depth practices around the ways they treat waterways and waste placement.
The problem was actually the exact opposite. Compared to Europeans, they were obsessive about soap and cleanliness. But Europeans lived in really dense villages alongside their livestock for many generations and they suffered greatly from it. The history of Europe is basically one outbreak after another. But ofc over time some amount of immunities developed
Maybe if North Americans had less sanitation and kept livestock they would've developed their own deadly diseases too that would've killed Europeans.