ALPINE, Texas – It’s one of the fastest growing coronavirus hotspots in the nation, but there are no long lines of cars piled up for drive-through tests and no rush of appointments to be wiped down at CVS.
That’s because in the rugged, rural expanse of far west Texas, there isn’t a county health department that can get daily tests and no CVS business for more than 100 miles. A handful of clinics offer tests for those who can make an appointment.
Behind the teetering oil platforms of Midland and Odessa, where real road runners scurry down two-lane roads and desert bushes freckle the long, beige horizon, the Big Bend region of Texas is one of the most remote parts of the American mainland and one of the least equipped to break out to treat infectious diseases. There is only one 12,000 square kilometer hospital and no heart or lung specialists to treat serious cases of Covid-19.
But as a sign that the virus is on the rise almost everywhere, the counties that Big Bend belongs to were in the nation’s top 20 for most new cases per capita last week.
Known for its sprawling national park and the artist town of Marfa, Big Bend provides an extreme example of the danger that is unfolding across the country as the virus flares further and more furiously than ever, driving deaths to levels seen since spring and push many places into crisis at the same time. From California to Texas to Mississippi, hospitals and health officials in rural communities are increasingly concerned that they are alone.
“There is no neurologist, there is no long-term care specialist,” said Dr. JP Schwartz, Big Bend’s Presidio County health department and a doctor at a local clinic. “We don’t want to help them at all. There isn’t even a nursing home out here. “
Even with Texas hospitalizations and deaths near their summer peaks, local officials fear they have little power to intervene beyond the measures taken by Republican Governor Greg Abbott.
“My hands are tied,” said Eleazar R. Cano, the Brewster County judge, who said he was advised against issuing a stay at home order or other stricter measures that could violate the governor’s order. Mr. Cano, a Democrat, likened governing during the pandemic to driving his truck through the desert with an empty gas tank without a cell phone operator calling for help.
“It’s helpless, frustrating, almost panicking,” he said.
On the long miles between the sparsely populated cities of Big Bend, it’s hard to fathom how a virus that thrives on human contact can flare up in a place so vast. Falcons rule in the great blue sky. Cell phone service is spotty. Christmas decorations along the street are not in people’s homes, but on the gates of their ranch.
But somehow new cases have exploded in the past few weeks.
In Brewster County, a sprawling giant of 9,200 residents in an area of 6,000 square miles, more than half of the 700+ known cases were identified last month. In neighboring Presidio County of 6,700 people near the Mexico border, cases have quadrupled from less than 100 to more than 470 in the past two months. Both communities are older, with 65 and over making up about a quarter of the population.
“The numbers are rising at this point,” said Malynda Richardson, the presidio city ambulance director, who coughed sporadically as she recovered from the freezing chills and knockout exhaustion 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 to schedule a doctor’s appointment and buy essentials at Walmart. With cases popping up across west Texas, the virus may have come back with them. Officials also cited border traffic from Mexico, cases among young people at Sul Ross State University, and an increase in tourists who were not deterred by the pandemic.
Big Bend National Park visitor numbers rose 20 percent in October, park officials said, and so many cars clogged the park over Thanksgiving weekend that it jammed. In the liberal artist outpost of Marfa, young people from Austin and Dallas roam the city, sipping on almond milk and photographing murals that ask existential questions such as, “Is austerity an illusion?” A recent art installation caused a stir during the pandemic with an obvious message against tourism: “Everyone here hates you.”
However, it turns out that tourism isn’t the biggest part of the problem.
The limited contact tracing in the region shows greater local penetration – in bars, in multi-generational homes, and by people who ignore positive test results and continue to work and socialize as usual.
In Alpine, the largest city with 5,900 residents, residents wear masks with their cowboy hats to shop at Porter’s grocery store, but remove them to eat inside at local restaurants. There is no general consensus on whether masks are necessary and effective. In a sign of the controversy that has played out on social media and off-social media, the county was left without a local health authority when the doctor in the position, a volunteer pediatrician, resigned this fall after being told by local residents who opposed, had been pushed back mask orders and other restrictions.
Brewster County, which also includes Alpine, has already ordered bars to shut down and reduce food in indoor restaurants from 75 percent to 50 percent, as the governor’s order for counties with a high percentage of Covid-19 hospital stays prescribes. However, enforcement is incomplete, and the governor has prohibited local officials from imposing stricter rules than his own.
Because of the scarcity of resources, local health clinics are a prime option for testing, but even then, the swabs must be driven to El Paso for three hours and flown out of Dallas for processing in Arlington. The National Guard also offers regular tests. In response to the growing crisis, new mobile test vehicles should arrive this week.
For those who get seriously ill, the hospital, the Big Bend Regional Medical Center in Alpine, only has 25 beds and a makeshift Covid ward where patients were confiscated at the end of the lonely, L-shaped hallway.
Dr. John Ray, a family doctor who works shifts at the hospital, said the hospital had received consecutive calls for incoming coronavirus patients on a final day. One of them had to be taken to a larger hospital in Odessa to receive special care.
Not long after that, said Dr. Ray, he saw the patient’s obituary in the newspaper.
“I don’t want to see Alpine like the pictures you see in New York, just people dying in hallways and waiting for a bed,” said Dr. Ray, 44, who grew up in the small town of Troup, East Texas, Wisconsin for his residency and then returned to Texas to settle in the Big Bend for Beauty and People area in 2013. He and his wife, also a doctor, usually treat a lot of sore throats, urinary tract infections, and pregnancy visits. Now he said: “It’s Covid, Covid, Covid.”
Higher-level hospitals are also full across West Texas. El Paso, which was recently so inundated with infection that it created mobile morgues, is still recovering from its own virus deluge. Lubbock recently had up to 50 percent of beds filled with Covid patients, and on a particularly bad day last week, the city reported that overall hospital capacity was depleted.
Dr. Ray fears there may be a day when critically ill patients who would normally be moved to another location run out of options. “To be very clear,” he said, “if you can’t go anywhere else, you will die here.”
A spokeswoman for Big Bend Regional Medical Center said the hospital has had room so far, adding ventilators, oxygen tanks and nurses to prepare for a surge. Of nine patients in the hospital on Wednesday, four had Covid-19.
Even so, many remain concerned. Simone Rubi, 46, graphic designer and musician who owns a café in Marfa, about 30 minutes by car from the Alpine hospital, hung a poster in front of her to-go window and summarized the precarious situation in four words: “Small town, no hospital . “
“There will be no place for us if we get sick – that’s the bottom line,” she said, sitting on a picnic bench outside her shop on a Saturday morning.
“We’d have to go to Dallas,” said her husband Rob Gungor, who said he had asthma and was resigned to making the nearly eight-hour drive to an Airbnb near a major hospital if he contracted the virus to get it to be around in case it turns bad. Like most people in Marfa, who accepted masks more easily than some other cities in Big Bend, he also wore a mask outdoors.
“Maybe Phoenix,” he added, “because it’s only a nine-hour drive.”
For those living in even more rural parts of West Texas, navigating the coronavirus spike has consequences that go well beyond the virus itself.
There is only one full-service ambulance covering 3,000 square miles in the border community of Terlingua. In some cases, paramedics had to drive coronavirus patients to Alpine hospital for three hours to clear the area for other serious emergencies.
“That has always been our draw – it’s an isolated, beautiful, pristine landscape,” said Sara Allen Colando, Terlingua District Commissioner. But as the cases rise, the wilderness is also its own peril.
“If you have to take someone to God with Covid, where, how long does it take to get this ambulance back up and running?” She said. “Who will be there to take the call?”
Mitch Smith contributed to coverage from Chicago.