EDINBURGH, Texas – On a stifling day last week near the southern tip of Texas, where high rates of poverty and chronic disease have increased the ferocity of the coronavirus, Dr. Renzo Arauco Brown made his rounds, reviewing patients facing serious complications. . from the virus and barely clinging to life.
The now-chaotic special infectious disease unit where he works has been the subject of new admissions in recent weeks. Doctors sweat under layers of protective gear and scream over constantly sounding alarms.
Standing next to a 63-year-old man whose lungs were taking dangerous amounts of oxygen from a ventilator, Dr. Brown ordered medications to paralyze the man in hopes that it would fix the problem. But it was one of many. The man had also suffered a severe stroke and blood clots from the virus.
At the end of the hallway, a nurse pulled a cushion from under the head of a 39-year-old woman and found it covered in blood. Dr. Brown rushed. He turned to the nurse, who was already on the phone asking for supplies for a transfusion. “Tell them to bring it, like, now,” he said.
As the coronavirus expands its destructive path through the United States, it is affecting some of the places most vulnerable to its devastation, places like the southernmost wedge of Texas, on the border with Mexico, which has seen an increase punitive of infections.
In the Rio Grande Valley, more than a third of families live in poverty. Up to half of residents do not have health insurance, including at least 100,000 undocumented people, who often depend on under-resourced community clinics or emergency rooms for care.
Check the list of risk factors for developing serious complications from the virus, and you’ll have described this country range: More than 60 percent of residents are diabetic or prediabetic. Obesity and heart disease rates are among the highest in the country. More than 90 percent of the population is Latino, a group that is dying from the virus at higher rates than white Americans.
There had been a disturbing calm during the first months of the pandemic. Many public health officials attribute the initially low number of cases in the valley to previous closure orders. That changed quickly after Governor Greg Abbott allowed the shelter-in-place requirement to expire in May.
“We knew this was a time bomb because the percentage of obesity, hypertension, diabetes is very high,” said Dr. Adolfo Kaplan, a critical care physician who works with Dr. Brown at DHR Health in Edinburg, Texas. “We knew that if the hospital was hit, it would be a disaster, and that is what we are experiencing.”
More than 57,000 people are now hospitalized across the country, according to the Covid Tracking Project, reflecting a sharp increase approaching the previous national peak in April, when the center of the US outbreak was in New York. .
The three facilities this hospital is using to treat patients with Covid-19 have been full to capacity since the first week of July. Sometimes a dozen or more ambulances have waited outside for beds to be available.
Reclining chairs and hallway beds were moved to emergency rooms, where some patients wait more than a day to be transferred to an intensive care unit.
With 10,000 infections active in the region, public health officials estimate that hospitalizations could double in two weeks. But with all the nearby hospitals also full, it’s unclear where the patients will go. On Wednesday, Mr. Abbott announced that an increase in funds, medical workers and supplies would be sent to health care facilities in the area.
“Our curve is a straight path right now. There is no flattening. There is no relief, ”said Sherri Abendroth, the hospital’s safety and emergency management coordinator.
DHR Health administrators say they have kept their main hospital largely free of the coronavirus to treat patients with serious non-pandemic-related conditions, such as heart attacks and strokes, as well as some elective procedures.
Months ago, Ms. Abendroth started buying additional dialysis machines for patients with kidney failure, as well as for those who would develop it due to the virus. She recruited additional practitioners with experience treating the complications that are common in the valley.
But there were factors beyond their control that would add to the challenge of fighting the virus: many in the community avoid medical care at all costs, for fear that this could lead to a bill they cannot pay or, for some, put in jeopardize your immigration status.
“They don’t seek medical attention until they are much sicker,” he said. “So when we receive them, they are longer hospital stays, more intensive treatment.”
Even babies in the Rio Grande Valley are particularly vulnerable. The high rates of diabetes among pregnant women hinder the development of the lungs in the womb. Even before the pandemic, many babies were put on small fans until they were strong enough to breathe on their own.
A section of the organization’s women’s hospital that has been closed for pregnant women infected with the coronavirus has been expanded twice. Some women have had to start the first part of their work in their cars because the unit was full.
In a community known for its strong multi-generational family ties, where doctors joke that some pregnant mothers could fill a rostrum with relatives who wish to be present while giving birth, the process of having a baby infected with the coronavirus has been remarkably grim.
“I wanted everything to be different,” said Marisa Ponce, who was expecting twins, as she prepared to be taken to an operating room for a cesarean section. Ms. Ponce’s entire pregnancy had been made grim by the pandemic. Most days, she stayed in her room to avoid getting sick. She skipped a baby shower and asked her boyfriend’s mother to choose jumpsuits and a crib. She somehow contracted the virus.
According to hospital security procedures, she was unable to bring anyone with her to give birth. Her doctor had advised her to isolate herself from the babies for two weeks after they were born, until two tests showed that she had fully recovered.
During the caesarean section, Ms. Ponce was stoic, surrounded by doctors who tried to comfort her through layers of protective clothing and glasses. They looked dressed to go into space.
When the babies emerged, a noisy filtering device that was cleaning the air of coronavirus particles muffled their cries. Within seconds, a respiratory therapist quickly took them to the neonatal intensive care unit. Tears ran down Mrs. Ponce’s face.
Another future mother with the coronavirus and a self-proclaimed drama queen, Kimberly Muñoz had imagined herself screaming and grabbing the hands of her husband and sister-in-law until the moment her newborn son arrived.
Instead, Ms. Muñoz worked alone, her cell phone flashing next to her with messages from family members who were eager to receive news. For the half hour it took to get the baby out, she was quiet. When her doctor held her son above her, Ms. Muñoz instinctively searched for him, but then stopped. A minute later, he was gone. “It broke my heart,” she said.
Similar to about 75 percent of people in the valley with health insurance, both Ms. Ponce and Ms. Muñoz are covered by Medicaid because of their low income. Doctors say poverty exacerbates coronavirus complications even in recovery. Many locals live in multi-generation homes that share close quarters. It is difficult to find a free room where a sick person can isolate herself.
Last week, in one of the coronavirus units, José Alemán Saucedo, 77, was released from his modest apartment in the nearby city of Donna after two weeks in hospital. That same day, a nurse had called half a dozen members of her family to ask if anyone could take her. Neither said yes, so Mr. Saucedo would have to go home alone.
“I am afraid,” Saucedo said, adding: “I prefer to stay here, but I am occupying a room that is necessary for other people.”
Doctors and nurses are taking extra shifts to keep up with tireless admissions. For many, the devastation feels personal.
“It’s not even about the money,” said Christian Gonzalez, a 25-year-old nurse, born in the valley, who has worked 12-14 hour shifts six days a week since coronavirus cases increased in July. “The people I grew up with: this is her mother, this is her sick father.”
At the start of a shift last week, Mr. González noticed a man sitting on the bed. The man’s stomach contracted and his body trembled as he struggled to take oxygen. His skin was turning purple.
When Mr. Gonzalez rushed in, he realized the man’s face was familiar: He was a 62-year-old supervisor in the hospital cafeteria, known for his big smile and the delicious chicken wraps he made. Like almost all the patients around him, he was also diabetic.
Mr. González called a doctor and then called the man’s family on the loudspeaker to obtain permission to put him on a ventilator. Within two minutes, the cafeteria supervisor was unconscious with a machine pushing air into his lungs.
González said he hoped the intervention would save his life, but he knew that most older patients with pre-existing health problems do not recover from intubation. “Their results are generally poor,” said González. “His kidneys fail. It’s like a waterfall of sadness. “
For patients who were seriously ill before contracting the coronavirus, there is even less chance of survival. Dr. Brown had an expression of pain under two layers of eye protection when he called the son of one of his patients. The woman had arrived with congestive heart failure, high blood pressure, and liver cirrhosis.
Next to her bed were two joyous signs that family members had left. They showed the woman smiling, wrapped in the center of a large group of hugs. In Spanish, the signs read “Come home mom!” and “We are waiting for you, grandma.”
Dr. Brown had to explain to the woman’s family that he did not expect her to be able to breathe on her own again.
For hospital staff members, the death toll has been devastating.
One afternoon, with tears in their eyes, three nurses in the intensive care unit huddled around an 84-year-old woman who had been speaking just days earlier. “It seemed like he was really going to make it,” said one of the nurses.
That morning, it had become clear that the woman’s heart was going to give way. The nurses called her daughter and promised that the woman would not die alone. One sat next to him, holding a phone to the woman’s ear with his daughter on the line. With her free hand, the nurse stroked her patient’s forearm during her last moments of life.
When the machines indicated that the woman was gone, the nurses stood up slowly. They closed their eyes and placed a blanket over her, preparing for another sick patient to take her place.
