At half past one on the morning of July 1, my 60th birthday, I awoke shivering. Since summertime chills are rare in South Texas, I immediately grew concerned. As the director of public affairs for Hidalgo County, just one county removed from the bottom of the state, I had been spending my days urging people to be on the lookout for symptoms that might indicate a COVID-19 infection. Chief among them were chills and a fever. Looking at my sleeping wife, a committed germaphobe, I crawled out of bed to hunt down a thermometer.
Ninety-nine degrees; a low-grade fever. Crawling back into bed, I knew my life was about to change: Part of the public-health-education message I’d been hammering was Self-isolate if you begin showing symptoms. Over the next hour, my temperature continued to rise. I woke my wife and told her to leave the room. That was the last time we would share a bed for two months.
I had already learned enough about the virus to be worried. I knew I would have to self-isolate for two weeks. I had started my government job less than six months earlier, after 37 years as a journalist. As a new employee still in my probationary period, would I lose my job? Would I lose my health insurance at the time I needed it most? Would my wife and children get infected? Would my elderly father-in-law, who was living with us, get sick? Would he die? Would I? Within two weeks I would be hospitalized, feverish and delirious, dependent on supplemental oxygen to breathe. But I didn’t know that yet. I also didn’t know how much the lives of the people in my county were about to change. The virus was about to tear through the Rio Grande Valley.
My part of the country doesn’t get much attention—not from the government, not from the media, certainly not from President Donald Trump (except when he’s ranting about his big, beautiful wall). We’re much closer to Mexico City and Monterrey than we are to New York City and Washington, D.C. People here laugh when the national media describe San Antonio as “South Texas”; Hidalgo County lies three hours farther south. Our county is more than 90 percent Hispanic; we are disproportionately poor, disproportionately susceptible to debilitating disease, disproportionately living without health insurance. But we are also human beings, and what happened to us this summer—what is still happening to us, in fact—shouldn’t happen to anyone. What happened to New York and its 8.3 million residents at the start of the pandemic drew global attention, and I’m glad it did. But the impact of COVID-19 on my county and its more than 850,000 residents is going mostly unnoticed. My community is brutally vulnerable to this disease. People are dying, and as far as we can tell, the world doesn’t really seem to care.
[Read: How the pandemic defeated America]
When I woke up shivering that July morning, “only” 3,982 people in Hidalgo County had tested positive for the disease, and “only” 46 people had died in the three months since the start of the pandemic. Over the next month, part of which I would spend in two desperately overcrowded hospitals, another 13,024 Hidalgo County residents would test positive for COVID-19, and another 598 would die from it (217 of them during the 10 days I was hospitalized), as the entire South Texas medical system got overwhelmed with coronavirus patients. In the first two weeks of July, while Houston was logging two deaths per 100,000 people, and Texas overall was logging three deaths per 100,000, Hidalgo County was logging 17 per 100,000.
I was offline for much of the time I was hospitalized, drifting in and out of consciousness.
But I was able to glean some sense of how badly hit the county had been from the nurses who treated me, some of whom had been summoned from as far afield as Georgia, Mississippi, and Alabama to help local hospitals contend with the overflow of patients. I began to realize that the crisis I was witnessing firsthand as a patient was echoing what New York City had gone through in March and April, when the virus first hit America.
In the 10 days I spent in the hospital, Hidalgo County became a scary place.
Historically, the highest-ranking elected local official in Texas is the county judge. This is a powerful political position. Texas law gives county judges massive authority as the jurisdiction’s head of emergency management. On March 17, my boss, Judge Richard F. Cortez, declared a local health emergency, as counties across the nation began to prepare in earnest for the pandemic. Four days later, Hidalgo County had its first COVID-19 patient, a resident who was believed to have contracted the infection during a trip to Las Vegas. The initial emergency declaration lasted for seven days and was extended by a vote of the Hidalgo County Commissioners Court. At the urging of health advisers, Cortez implemented several safety measures that eventually included a prohibition on mass gatherings; a curfew; and shutting down all but essential businesses.
These aggressive measures are believed to have kept the initial spread of COVID-19 in check and held down coronavirus-related deaths through March and April. But in April, Governor Greg Abbott, under pressure to buoy the state’s faltering economy, issued sweeping executive orders removing local authority. He established May 1 as the beginning of what he called “Open Texas,” which nullified many of the public-health mandates that had been implemented locally. The use of facial coverings became voluntary. Nonessential businesses such as restaurants, which had been allowed only to transact pickup-and-delivery business, now had permission to open their dining rooms at partial capacity.
[Read: Essential, and no longer disposable]
By the end of May, COVID-19 cases were climbing in Hidalgo County—as were deaths. Hospitals warned that their capacity was starting to run short. On June 29, Cortez invited the CEOs of all five major hospital groups in the Rio Grande Valley to participate in a press conference to warn the public of the oncoming hospital crisis and to ask people to stay home.
I organized that press conference, which included not only the hospital executives but also our own county’s director of health and human services, Eduardo Olivarez, as well as Dr. Ivan Melendez, Hidalgo County’s top-ranking health adviser and the person responsible for coordinating the medical response between local doctors and hospitals. Among my jobs that day was to ensure social distancing for the media: Everyone was mandated to wear a mask, and a nurse stood sentry at the entrance of the room to check everyone’s temperature.
Arriving late, Melendez whizzed past me to get to his assigned seat. He joined others in urging caution and warned against politicizing or downplaying the virus. “When people say it’s a conspiracy, or it doesn’t exist or is really [exaggerated], my response would be: ‘Come to our emergency department, where we have five people on ventilators for three days,’” he said. “‘Come to the three floors we’ve had to use to put these people on. Come to all the health-care workers that go home every night, every little cough they’re sure they have it.’ We’re in tough times.”
A few minutes after Melendez spoke, he received a text message and abruptly got up to leave, passing me again on the way out. His office had just learned that he’d tested positive for COVID-19.
Two days later, I was celebrating my birthday by lying in bed and watching my fever climb. It’s impossible to say for certain that I got the infection from Melendez. But as I was to tell state and local contact tracers weeks later, he was the only person I knew who had tested positive for COVID-19 who had been in the same room as me.
When I first moved to Hidalgo County, it felt like home. The culture, the economic and family ties with Mexico, the Rio Grande flowing through—all of this reminded me of the city where I grew up, El Paso, an 11-hour drive north. After my wife and I spent time in Hidalgo County, we agreed we would retire here. (The Rio Grande is even more beautiful in South Texas than it is in El Paso.) But Hidalgo also felt familiar to me because it suffers from the same kind of provincial low self-esteem that afflicts El Paso—both regions are chronically underserved by the state capital in Austin (and by Washington); both have high rates of poverty. Hidalgo County is home to a hundred thousand undocumented migrant farmworkers who have limited resources, little education, and virtually no political clout.
The region’s political and social problems are deeply rooted in its racial history—in particular by tensions between white landowners and the Hispanic agricultural workers who outnumber them. A local historian once told me that, from the county’s founding in 1852, white landowners protected their power by intentionally balkanizing the region with dozens of independent jurisdictions to create constant conflict among them. Today, Hidalgo County has 22 incorporated municipalities, the largest being McAllen, with a population of roughly 150,000.
The political structure of the area has helped produce or exacerbate a raft of social problems. Migrant farmworkers, always poorly paid and highly mobile as they followed harvesting jobs as far north as Michigan, began building homes in this region without government approval, or the proper infrastructure. These so-called colonias often have no electricity or running water, and they’ve created a slew of health challenges. A 2015 study by the Dallas Federal Reserve found that 38,000 colonia residents did not have access to safe drinking water. The study noted further that 40 percent of Hidalgo County residents rely on food stamps. Though agriculture has long been a principal economic engine for the region, a 2018 study by Texas A&M University concluded that 52 percent of the region’s census tracts could be considered food deserts, defined by the federal government as places where a person must travel at least 10 miles for fresh fruit and vegetables. The combination of poverty and the unavailability of fresh produce leads residents to rely heavily on cheap processed foods. This in turn has led to high rates of obesity and diabetes. Since at least 2011, the McAllen metro area has ranked among the most overweight cities in America.
[Read: How obesity became a disease]
All this has been compounded by weaknesses in our medical system. Hospitals throughout the four-county Rio Grande Valley struggle with a shortage of doctors. Nationwide, the country has 278 doctors per 100,000 people, according to a 2019 report; the Rio Grande Valley has about half that.
These were the underlying conditions that COVID-19 feasted on when it came to my county—and what the medical system was straining to contend with when the coronavirus made me, too, part of the burden.
For a dozen days after my fever first spiked, I endured the illness in my bedroom at home. These were days of isolation spent working via Zoom through a fever that scraped 101, despite round-the-clock Advil. Each day, I grew more fatigued. Every night, I suffered febrile nightmares. As the days passed, the fever, chills, and body aches became relentless. I began assigning more of my tasks to my staff. By the twelfth day, a Sunday, I was scared and exhausted. I called Dr. Melendez. (His own case of COVID-19 was mild, and he was working from isolation at home.) Early in the pandemic, I had sat down several times with him and Olivarez, the health-department administrator, as they patiently explained what was known about the virus, so I could determine how best to convey sound public-health messaging to a skeptical community. Now I needed help for myself. Listening to my symptoms, Melendez asked if I was having trouble breathing. “Yes,” I said, “but that’s because I’m exhausted.” In a firm voice, he told me to go to the hospital immediately.
For the first time since I began self-isolating, I opened my bedroom door. Wearing a mask that Melendez had given me weeks earlier, I started toward the front door, passing my family in the dining room. Like so many families with Millennial and Gen-Z children, my two sons—one living in Washington, D.C., one living in San Antonio—had returned home to join their younger sister to ride out the pandemic.
“Where are you going?” my wife asked, obviously not happy to see me breaking my in-home isolation.
“I called Dr. Melendez,” I said, looking for my car keys. “He told me to go to the hospital.”
I have few memories of my first night in the hospital beyond being exhausted and frightened. It marked the beginning of a week in which I seemed to fade in and out of reality. I remember my stay more as a series of sometimes frightening vignettes than as a narrative.
That first night, a friend called from Austin. He’d had a mild case of COVID-19 during the early days of the pandemic, and he wanted to check on me.
“I’m dying,” I said.
My friend immediately called my wife and began making plans to drive south five and a half hours to donate his antibody-filled plasma to administer to me. (He gave up after learning that current protocol forbids that type of direct donation.) He and his wife later described how shocked they’d been when I said I was dying, and how frightened they’d been for me.
To this day, I don’t remember the conversation.
I was initially put in a small room that had been jerry-rigged with an exhaust fan blowing out of an open window to prevent outside air from entering—one of the “negative pressure” rooms that I’d heard about. A nurse took my vital signs, then started an intravenous line in my arm and placed tubing around my nose to supplement my breathing with pure oxygen. She told me she was from Mississippi, the first of many nurses I’d encounter who had been sent in from other parts of the country to supplement the overwhelmed local staff.
[Read: America’s hospitals have never experienced anything like this]
Unfortunately, the hospital in which Melendez had been able to find me a room was not properly equipped to treat COVID-19 patients. So my wife, after consulting with Melendez, began working the phones. All the local hospitals were full. A journalist herself for more than 30 years, she began dipping into her contacts and enlisted three members of Congress, a state senator, and, soon, my boss, to help find me another hospital bed. She worried about the ethical issues attached to using personal work contacts to help, so she called a veteran journalist friend for advice.
“You do what’s best for your husband,” the friend said.
Ultimately, my boss reached out to his son-in-law, who is a doctor in San Antonio, and they began making arrangements to get me a bed in a hospital there.
At the time I knew none of this. I learned about it when—as one nurse was checking my vitals and another staffer was bringing me something to eat—a social worker told me a bed was waiting for me in a San Antonio hospital; all I had to do was agree, which would set the transfer in motion.
“No!” I said emphatically. I dreaded the prospect of a four-hour drive in the back of an ambulance.
Fortunately, while my wife and boss had been working the San Antonio angle, Melendez had been methodically calling local hospitals. Finally, he found one that could free up space for me—as it happened, just a block away from the one I was in. But despite the proximity, getting there would not be straightforward. I still required supplemental oxygen, and hospitals in South Texas were in full-blown crisis. Waiting times for ambulances were averaging four hours.
Eventually, I was placed on a gurney and loaded into an ambulance. I remember the ambulance being excessively hot, but the ride was blessedly brief. As I was wheeled into the emergency room, I felt a soothing rush of cool air.
To limit the chance of spreading infection in the ER, I was told, I would have to be covered completely with a sheet. (This despite the fact that I was wearing a mask.) So I was wheeled in, under my sheet, and parked in a hallway, where I must have looked like a dead body awaiting delivery to the morgue. I spent the better part of an hour there, amid the chaos of the overwhelmed emergency room, listening to screaming patients and the hospital staff trying to reassure them while whispering among themselves. Finally, my room was ready and I was wheeled away—still covered by a sheet. The only available bed turned out to be in the pediatric wing, another room jerry-rigged with an exhaust fan to blow out the air. When they removed my sheet, the first thing I saw was a mural of a monkey on the wall.
The next few days passed in a haze. Mainly I remember the exhaustion. The headache. The interminable sound of the exhaust fan. The moment I would finally slip into a fitful sleep, someone would wake me to take my vital signs or X-ray my chest. To prevent blood clots—a common problem among COVID-19 patients—I got a daily injection of anticoagulant via a needle into my stomach.
“How do you feel?” each nurse who came in would ask. “How is your breathing?” At one point Melendez told me with friendly candor that I had a 70 percent chance of survival. Those odds were better than most of my fellow coronavirus patients, but to have a doctor tell you that you have a 3 in 10 chance of dying in the next few weeks is jarring.
At some point—I don’t remember when—I was awakened in the middle of the night and told a bed had opened up for me in the regular COVID-19 wing. My good fortune, I would later learn from the nurses, was the result of someone else’s bad news: Another coronavirus patient had died.
The nurses and other attendants were my only source of information from the world outside. All of them had come from beyond South Texas, most of them from out of state. None of them had any idea what it was actually like to live here because their existence didn’t extend beyond caring for the ill in the hospital and then collapsing into sleep at a hotel. I couldn’t see their full faces—they always wore personal protective equipment that included an N95 face mask and a plastic shield—so I learned to read their eyes. One night, I saw sadness in the eyes of a nurse from Georgia, and I asked if everything was all right.
“I’ve had three patients code on me tonight,” she said, using the medical term for cardiopulmonary arrest.
“How many survived?” I asked.
“One,” she said.
On another night, I was awakened by a nurse checking my vital signs. As I chatted with her, she leaned forward and whispered to me, “You have to get out of here. This place is dangerous.”
Throughout my own ordeal, I remained largely oblivious to the magnitude of the medical crisis that was enfolding Hidalgo County. Of course I had listened dutifully to the hospital CEOs during that June press conference, but I don’t think anyone then comprehended the magnitude of what was about to hit the county—we hadn’t gotten our heads around how quickly this disease can spread and kill, especially in a population like ours.
Between the time the first coronavirus patient was admitted to a Hidalgo County hospital in April and the end of June, area hospitals housed an average of 47 COVID-19 patients a day. Over the course of July, that number spiked to 813.
Inside these numbing statistics lurked grisly human tragedies. Because of the outbreak, hospitals were not allowing family members to visit patients, so one young man recorded a video for his mother, telling her he loved her, and sent it to Melendez, who was a family friend, for delivery. Melendez didn’t make it to her in time. Still, he located the woman, whom he had known since he was five, unzipped the body bag that contained her, and played her son’s recording before closing the bag.
By my fourth day in the second hospital, my temperature had finally subsided, and, although I was still being fed oxygen, I was beginning to feel better. That was the day I was given plasma containing the antibodies of another COVID-19 patient. I knew that doctors held out great hope for this treatment; before I had entered the first hospital, Olivarez had told me about a coronavirus patient in South Texas who, on a ventilator and fading fast, responded immediately when given the plasma antibodies, and had eventually left the hospital weakened but alive. The plasma was a psychological boost, and I immediately felt better. But plasma, like hospital space, was in short supply; despite many promises that I would get another dose, it never materialized. In any case, this treatment is still in the clinical-trial phase. It is not the “breakthrough” that Trump once suggested it was.
In recent weeks, I have spoken with many people who contracted the virus. While each describes a different set of symptoms, the common denominator is exhaustion. That was certainly true for me. Going to the bathroom left me winded. I spent most of my days sleeping. During the 10 days I spent in the hospital, I experienced great fear—another common effect of the disease. But I knew from the nurses who were caring for me that many patients were much worse off than I was. One nurse admitted to me that she liked checking on me because I was easy, despite my difficulty breathing. Too many other COVID-19 patients, she told me, required a lot more from her physically.
As I began to feel better, I was eager to get home. Easier said than done. Although I was assured that my blood-oxygen levels were better, I still had tubes pumping oxygen into my nose. Because X-rays showed scarring in my lungs, doctors wouldn’t release me until I could be set up with supplemental oxygen at home—and local oxygen companies were as overwhelmed as the hospitals. Even if this problem could be solved, Melendez warned my wife and me, my going home would pose a great risk to her 86-year-old father. “If he gets COVID, that’s almost certainly a death sentence,” Melendez said.
This kind of problem was widespread in South Texas, which contains many multigenerational households where grandparents live with grandchildren. While the infection rate of teens and those in their 20s and 30s was rising fastest, those in their 70s and older were the ones who were dying.
[Read: A failure of empathy led to 200,000 deaths. It has deep roots.]
Tensions rose between my wife and me. Fortunately, just as hospital social workers finally found an oxygen supplier that could deliver a unit to my house, the owner of the long-term-care center in which my mother-in-law lived told my wife that the facility included an isolated apartment in which my father-in-law could stay.
When my wife arrived to pick me up, a nurse’s aide came to my room with a wheelchair. When we got to the lobby, she stopped the wheelchair and walked around to face me. With a look of seriousness in her eyes, she told me, “I can’t tell you how happy I am to take you out of this hospital in a wheelchair instead of a body bag.” Then she wheeled me out to my wife’s car.
In the parking lot, a large evangelical group had gathered to pray over the patients fighting for their lives inside. As my wife slowly drove past them with my window rolled down, they realized that a survivor was leaving the hospital, and a cheer went up as I broke down in tears.
I left the hospital on July 21. Three months later, I still suffer from occasional shortness of breath. I also still sometimes weep, though less frequently than in the days immediately following my discharge, when I would sit alone in my dark room crying much of the time, trying to understand my experience. My doctor has been aggressively monitoring my recovery, and my most recent CT scan showed that I still have scarring in my lungs, a common long-term result of a COVID-19 infection. She is also concerned that I am showing symptoms of post-traumatic stress disorder, another long-term by-product. My body just doesn’t feel right.
Earlier this month, when the White House announced that President Trump had tested positive for COVID-19, and then that he’d been helicoptered to Walter Reed National Military Medical Center, I was naturally interested and concerned—all the more so when I learned that he, like me, had required supplemental oxygen. Would his experience be like mine? Would his suffering be prolonged like mine? Would he be traumatized like I’ve been? Would he be shocked into a new understanding of the seriousness of the disease, of the fear and morbidity and mortality it unleashes, of the damage it does to communities like mine?
[Read: What strength really means when you’re sick]
His experience turned out to be little like mine, or like that of the almost 230,000 Americans who have died, or like the hundreds of thousands more who have spent time in the hospital but survived. After three days in the hospital, attended by more than a dozen doctors from some of the best medical institutions in the world, in a private suite at Walter Reed, given a cocktail of drugs—including an experimental treatment available to very few people in the world—at a cost of more than a hundred thousand dollars borne entirely by taxpayers, the president emerged to preen with the bravado of a conquering hero.
“Don’t let it dominate your life,” he said of the disease that has infected more than 44 million people worldwide, killing almost 1.2 million of them so far. Let’s grant him the partial wisdom of those words—better to not allow the virus to dominate us if we don’t have to. But as I write this, record numbers of Americans are testing positive for COVID-19—averaging more than 70,000 cases a day this week. Thousands are still sick in South Texas. Utah is preparing to ration care, turning away patients it can’t accommodate in its intensive-care units. Wisconsin has opened an emergency field hospital and is constructing additional makeshift ICUs in existing ones. With cases spiking sharply, my home town of El Paso has announced a curfew as well as plans to convert a convention center into a COVID-19 hospital.
The demographics of the pandemic continue to be cruel. People of color are still getting sick and dying at rates far greater than their share of population. (What Adam Serwer wrote here last spring—“Black and Latino workers are overrepresented among the essential, the unemployed, and the dead”—remains true.) The Rio Grande Valley holds just 4.7 percent of the Texas population, but it accounts for 17 percent of the state’s coronavirus deaths. COVID-19 is capricious: Some who are infected have no symptoms; some have mild symptoms and then return to normal life; some fall gravely ill and don’t fully recover for months; some die. It’s much easier to not let the virus “dominate” you when you are an affluent person with access to first-rate medical care, like Donald Trump, than when you are an essential worker with diabetes and no health insurance in the Rio Grande Valley.
I certainly had no intention of letting COVID-19 dominate me, but the virus had other ideas. I would tell my fellow Hidalgo County residents not to let it dominate them, but this is unhelpful advice for the more than 1,900 of my people who are already dead.
The Atlantic https://ift.tt/3oBysS6 October 30, 2020 at 04:55AM
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