Howthe pandemic devastated the Valley
The COVID-19 pandemic forced the nation to witness the devastating impact that social determinants of health have on under-resourced communities and ethnic minority groups. At the epicenter is the Rio Grande Valley, located at Texas’ southern tip along the border of Mexico and the United States. Greater than 90 percent of the Rio Grande Valley’s residents are Hispanic — a group disproportionately affected by COVID-19. Studies reported higher hospitalization rates and risk of death in Hispanic adults due to complications of COVID-19.
The pandemic serves as a wake-up call for more robust health care infrastructure and equal distribution of resources. We are slowly flattening the curve of COVID-19 cases, but another wave is coming with the impending influenza season. We must take action now to prevent another mass casualty of the Rio Grande Valley community.
Earlier this year, the community had a remarkably lower than the anticipated number of COVID-19 cases. Few patients required hospitalization because of stayat-home social distancing campaigns, initiation of night curfews and distance from major coastal hot spot cities. A delay in testing equipment, available screening sites and social deterrents of seeking care may have resulted in an underreporting of cases.
On May 1, Gov. Greg Abbott’s executive order to stay at home expired. Afterward, a lack of adherence to wearing masks in public and an increase in large gatherings spurred a spike in COVID-19 cases. Although much of Texas suffered, the Rio Grande Valley has been disproportionately affected. On Sept. 21, Harris County, the largest county in Texas, had 123,817 confirmed cases and 2,504 deaths with a fatality rate of 2.02 percent. Hidalgo County, a population that is a fifth of the size of Harris County, had 30,577 confirmed cases and 1,510 deaths with a fatality rate of 4.94 percent. The higher mortality rate stems from exceeding the hospital system’s patient capacity and the insufficient number of providers per patient.
Hospitals rapidly converted hospital floors and emergency rooms to COVID-19 units. The expansion could not keep pace with the exponential growth of COVID-19 cases, resulting in overwhelmed facilities. The month of July was constantly running between COVID-19 units and resuscitating patients with cardiac and respiratory arrest. Despite optimizing treatment and adjusting the ventilators to meet protocols, patients passed away with many health care providers experiencing learned helplessness. Healthy people, young and old, would suddenly become very sick. One day you worked side-by-side with someone, the next day you cared for them. The pandemic manifested the effect of the Rio Grande Valley’s social determinants of health.
Socioeconomic factors significantly influence border health. The Valley has one of the highest rates of obesity and diabetes. It contains the five Texas counties with the highest poverty rates. As a result, the uninsured rates in Cameron and Hidalgo are 30.2 and 32.1 percent, double the national average. Uninsured residents are less likely to have a primary care physician and more likely to be deterred from accessing services like COVID-19 drive-thru screenings. Many minority populations with low socioeconomic status are considered essential workers and cannot afford to work from home. They are at increased risk of contracting the virus themselves and spreading the disease to those they live with at home. Furthermore, undocumented patients may not have reliable access to primary care or may fear jeopardizing their immigration status, and therefore delay seeking medical attention until they are gravely ill.
Texas contains 2,300 colonias with an estimated population of 500,000, with the Rio Grande Valley containing the most in the Unites States. Colonias are residential areas along the U.S.-Mexico border that often lack basic living necessities such as sewer systems, drinkable water, safe housing and paved roads. Colonias include the aforementioned risk factors, consequences of low socioeconomic status and health disparities. The more than 1,400 colonias in the Valley likely contribute to the spread of COVID-19. Adhering to a self-quarantine in colonias may be especially challenging. There may not be enough room for an ill person to isolate himself in a tightspaced home where multiple family members and relatives live.
These past months, the swell of COVID-19 cases pushed hospitals and funeral homes to the limit, causing them to reroute patients and the deceased. Last month, Hurricane Hanna exacerbated the already stressed health care system as flooded roads impeded patients and health care workers from reaching hospitals. Hospitals operated at capacity with a diminished workforce, which resulted in decreased patient safety. The Rio Grande Valley will endure the pandemic, but the price of survival is uncertain.
Hidalgo and Lim are fourth-year medical students, and Kwang is an assistant professor of internal medicine at the University of Texas Rio Grande Valley School of Medicine.