West Texas overwhelmed.
ALPINE — It is one of the fastestgrowing coronavirus hot spots in the nation, but there are no long lines of cars piled up for drive-thru testing and no rush of appointments to get swabbed at CVS.
That’s because in the rugged, rural expanse of far West Texas, there is no county health department to conduct daily testing and no CVS store for more than 100 miles. A handful of clinics offer testing to those who are able to make an appointment.
Out past the seesawing oil rigs of Midland and Odessa, where real-life roadrunners flit across two-lane roads and desert shrubs freckle the long, beige horizon, the Big Bend region of Texas is one of the most remote parts of the mainlandUnited States and one of the least equipped to handle an infectious disease outbreak. There is just one hospital for 12,000 square miles and no heart or lung specialists to treat serious cases of COVID-19.
But in a sign that the virus is surging nearly everywhere, the counties that include Big Bend ranked among the top 20 in the nation 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 playing out across theUnited States, as the virus blazes more widely and furiously than ever before, driving deaths to levels not seen since the spring and thrusting many places into crisis at the same time. From California to Texas to Mississippi, hospitals are filling up, and health officials in rural communities increasingly fear that they are on their own.
“There is no neurologist; there is no long-term care specialist,” said Dr. J.P. Schwartz, the health authority in Big Bend’s Presidio County and a physician at a local clinic. “We have no care to help them whatsoever. There is not even a nursing home out here.”
Even as hospitalizations and deaths inTexasnear their summer peaks, local officials fear they have little power to intervene beyond the measures that Gov. Greg Abbott, a Republican, has put in place.
“My hands are tied,” said Eleazar R. Cano, the county judge in Brewster County, who said he had been advised against imposing a stay-at-home order or other strictermeasures that could violate the governor’s order.
Cano, a Democrat, compared governing through the pandemic to driving his truck through the desert on an empty gas tank, with no cellphone service to call for help.
“It’s helpless, frustrating, close to panic mode,” he said.
‘Going straight up’
In Brewster County, with 9,200 people spread across 6,000 square miles, more than half of the 700-plus known cases have been identified in the past month. In neighboring PresidioCounty, with 6,700people near the border with Mexico, cases have quadrupled in the past two months, from less than 100 to more than 470. Both communities skew older, with people 65 and older making up about a quarter of the population.
“The numbers are going straight up at this point,” said Malynda Richardson, emergency medical services director for the city of Presidio, who coughed sporadically as she recovered from the icy chills and knockout fatigue of COVID-19.
There are a number of reasons for the spike.
The area is so remote that local
residents have to travel to El Paso or Odessa for doctor’s appointments and to buy necessities at Walmart. With cases soaring across West Texas, the virus may have traveled back with them. Officials also cited border traffic from Mexico, cases among young people at Sul Ross State University and a surge of tourists undeterred by the pandemic.
The area’s limited contact tracing showsmore localized spread — in bars, in multigenerational homes and through people who ignore positive test results and continue to work and socialize as normal.
In Alpine, the largest city, with a population of 5,900, there is far from universal agreement about whether masks are necessary and effective. In a sign of the dispute that has played out on and off social media, the county was left without a local health authority when the doctor in the position, a pediatrician working on a volunteer basis, quit this fall after facing pushback from residents who opposed mask orders and other restrictions.
With resources scarce, local health clinics are a primary option
for testing, but even then, the swabs have to be driven three hours to El Paso and flownfor processing in Arlington. The National Guard also offers periodic testing, and in response to the growing crisis, new mobile testing vans were scheduled to arrive this week.
Running out of options
For those who do get seriously sick, the hospital, Big Bend Regional Medical Center in Alpine, has just 25 beds and a makeshift COVID ward where patients have been sequestered at the end of the lone, L-shaped hallway.
Dr. John Ray, a family practitioner who works shifts at the hospital, said the hospital on one recent day got back-to-back calls about incoming coronavirus patients. One of them had to be transferred to a bigger hospital in Odessa to receive specialized care.
Not long afterward, Ray said, he saw the patient’s obituary in the paper.
“I don’t want to see Alpine like the pictures you see in New York, just people dying in hallwayswaiting for a bed,” said Ray, 44.
Across West Texas, higher-level care hospitals are also full. El Paso, which was recently so overrun with infection that it brought in mobile morgues, is still recovering from its own virus surge. In Lubbock, as many as 50 percent of beds were recently filled with COVID patients, and on a particularly bad day last week, the city reported that it had run out of hospital capacity altogether.
Ray fears theremay come a day when more seriously ill patients who would normally be transferred elsewhere will run out of options.
“To put it bluntly,” he said, “if you can’t go somewhere else, you are going to die here.”
A spokeswoman for the Big Bend Regional Medical Center said that the hospital has had enough roomso far and has added ventilators, oxygen tanks and nurses to prepare for a surge. Of nine patients in the hospital Wednesday, four had COVID-19.
For thosewho live in even more rural parts ofWest Texas, navigating the coronavirus spike has come with consequences far beyond the virus itself.
In the border community of Terlingua, there is just one full-service ambulance for 3,000 square miles. Paramedics have on a few occasions had to drive coronavirus patients three hours round trip to the hospital in Alpine, leaving the region uncovered for other serious emergencies.
“That has always been our draw — it’s an isolated, beautiful, unadulterated landscape,” said Sara Allen Colando, county commissioner in Terlingua.
But with cases rising, the wilderness is also its own kind of peril.
“If they have to take someone with COVID to God knows where, how long is it before that ambulance is back in service?” she said. “Who is going to be there to answer the call?”