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‘Small town, no hospital’: Covid-19 is overwhelming in rural West Texas

ALPINE, Texas – This is one of the fastest growing coronavirus hotspots in the country, but there are no long lines of cars crammed together for drive-thru tests and no rush to appointments to get stamped at CVS.

Indeed, in the rural and rugged expanse of far west Texas, there is no county health department to perform daily tests, nor a CVS store for more than 100 miles. A handful of clinics offer testing to those who are able to make an appointment.

Beyond the rocking oil rigs of Midland and Odessa, where real-life roadrunners fly over two-lane roads and freckled desert shrubs on the long beige horizon, the Big Bend area in Texas is one of the most remote areas in the Americas and one of the least equipped to deal with an infectious disease outbreak. There is only one hospital per 12,000 square miles and no heart or lung specialist to treat severe cases of Covid-19.

But a sign the virus is on the rise almost everywhere, counties that include Big Bend ranked among the top 20 in the country last week for the most new cases per capita.

Big Bend, best known for its sprawling national park and the artist town of Marfa, offers an extreme example of the danger plaguing the country as the virus soars more widely and more furiously than ever before, resulting in deaths in levels never seen since the spring and plunging many places in crisis at the same time. From California to Texas to Mississippi, hospitals are filling up and health officials in rural communities are increasingly worried about being alone.

“There is no neurologist, there is no long-term care specialist,” said Dr JP Schwartz, the Big Bend Presidio County health authority and doctor at a local clinic. “We have no concern of helping them. There isn’t even a retirement home here.

Even as hospitalizations and deaths in Texas approach their summer peaks, local officials fear they will have little power to intervene beyond the measures Gov. Greg Abbott, a Republican, has put in place.

“My hands are tied,” said Eleazar R. Cano, the Brewster County judge, who said he had been advised against imposing a stay-at-home order or other stricter measures that could violate the governor’s order. Mr. Cano, a Democrat, compared governing during the pandemic to driving his truck through the desert with an empty gas tank, without cell phone service to call for help.

“It’s helpless, frustrating, close to panic mode,” he says.

Traveling the long miles between the sparsely populated cities of Big Bend, it’s hard to imagine how a virus that thrives on human contact could erupt in a place with so much open space. Falcons rule the great blue skies. Cell phone service is spotty. The Christmas decorations along the road are not on people’s homes, but on the doors of their ranches.

Yet, one way or another, new cases have exploded in recent weeks.

In Brewster County, a sprawling monster with 9,200 people spread over 6,000 square miles, more than half of the 700 known cases were identified last month. In neighboring Presidio County, which has 6,700 people near the border with Mexico, cases have quadrupled in the past two months, from less than 100 to more than 470. Both communities are older, people 65 years and over representing around a quarter of the population.

“The numbers are rising directly at this point,” said Malynda Richardson, the director of emergency medical services for the city of Presidio, who coughed sporadically as she recovered from the icy chills and crippling fatigue of her own. Covid-19.

There are a number of reasons for the tip.

The area is so remote that local residents have to travel to El Paso or Odessa for doctor appointments and to buy basic necessities at Walmart. With cases soaring in West Texas, the virus may have returned with them. Authorities also cited border trafficking from Mexico, cases among young people at Sul Ross State University and a wave of tourists undeterred by the pandemic.

The number of visits to Big Bend National Park rose 20% in October, park officials said, and on Thanksgiving weekend so many cars clogged the park, causing a traffic jam. In the liberal artists outpost of Marfa, young people from Austin and Dallas roam the city, sipping almond milk lattes and photographing murals that pose existential questions such as “Austerity is- she an illusion? ” A recent art installation caused a stir with a blatant message against tourism during the pandemic: “Everyone here hates you.”

But it turns out that tourism isn’t the biggest part of the problem.

Limited contact tracing in the area shows a more localized spread – in bars, in multigenerational homes, and through people who ignore positive test results and continue to work and socialize normally.

In Alpine, the largest city, with a population of 5,900, locals wear masks with their cowboy hats to shop at Porter’s grocery store, but take them to eat indoors at restaurants in the city. There is far from universal agreement on the necessity and effectiveness of masks. In a sign of the dispute that unfolded on and off social media, the county was left without a local health authority when the doctor on duty, a pediatrician working on a volunteer basis, left this fall after being turned away by residents who opposed it. hide controls and other restrictions.

Brewster County, which includes Alpine, has already ordered bars to close and reduce dining inside restaurants by 75% to 50%, as required by the governor’s order for counties with a high proportion hospitalizations with Covid-19. But enforcement is uneven, and the governor has banned local officials from imposing stricter rules than his.

With limited resources, local health clinics are a primary option for testing, but even then the swabs must be driven three hours to El Paso and airlifted for processing in Arlington, outside of Dallas. The National Guard also offers periodic testing and, in response to the growing crisis, new mobile test vans are expected to arrive this week.

For those who fall seriously ill, the hospital, Big Bend Regional Medical Center in Alpine, has only 25 beds and a makeshift Covid ward where patients have been sequestered at the end of the lonely L-shaped hallway. .

Dr John Ray, a family doctor who works shifts at the hospital, said that one day the hospital received back-to-back calls about coronavirus patients. One of them had to be transferred to a larger hospital in Odessa for specialist care.

Soon after, Dr Ray said, he saw the patient’s obituary in the diary.

“I don’t want to see Alpine like the photos you see in New York City, just people dying in the hallways waiting for a bed,” said Dr. Ray, 44, who grew up in the small town of Troup, in East Texas, moved to Wisconsin for his residency and returned to Texas afterward, settling in the Big Bend area in 2013 for Beauty and People. He and his wife, also a doctor, typically treat a large number of cases of strep throat, urinary tract infections, and pregnancy visits. Now he said, “It’s Covid, Covid, Covid.”

In West Texas, top-level care hospitals are also full. El Paso, which has recently been so overrun with the infection that it has caused mobile mortuaries, is still recovering from its own wave of the virus. In Lubbock, up to 50% of beds were recently filled with Covid patients and, on a particularly difficult day last week, the city said it was running out of hospital capacity.

Dr Ray fears that the day will come when more seriously ill patients who would normally be transferred elsewhere will have no options. “To put it bluntly,” he said, “if you can’t go somewhere else, you’re going to die here.

A spokeswoman for the Big Bend Regional Medical Center said the hospital has so far had enough space and has added ventilators, oxygen tanks and nurses to prepare for a surge. Of nine patients at the hospital on Wednesday, four had Covid-19.

Yet many remain worried. Simone Rubi, 46, graphic designer and musician who owns a café in Marfa, about a 30-minute drive from Alpine hospital, hung a poster in front of her take-out window summing up the precarious situation in four words: “Petite city, no hospital.

“There won’t be a place to go if we get sick – that’s the main thing,” she said, sitting on a picnic bench outside her store on a recent Saturday morning.

“We had to drive to Dallas,” said her husband, Rob Gungor, who said he suffered from asthma and had resigned himself to driving nearly eight hours to stay at an Airbnb near to. a large hospital if he contracted the virus. , to be nearby in case it takes a turn for the worse. Like most people in Marfa, who accepted masks more readily than some of the other Big Bend towns, he wore a mask even outdoors.

“Maybe Phoenix,” he added, “because it’s only a nine-hour drive.”

For those who live in even more rural areas of West Texas, navigating the coronavirus peak had consequences far beyond the virus itself.

In the border community of Terlingua, there is only one full-service ambulance for 3,000 square miles. Paramedics have had to drive coronavirus patients three hours round trip to Alpine hospital a few times, leaving the area uncovered for other serious emergencies.

“This has always been our draw – it’s a secluded, beautiful and pure landscape,” said Sara Allen Colando, Terlingua County Commissioner. But with the increase in cases, the wilderness is also its own kind of peril.

“If they have to take someone with Covid to God knows where, how long does it take before the ambulance is back on duty?” she says. “Who will be there to answer the call?”

Mitch smith contributed reporting from Chicago.

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