‘Small Town, No Hospital’: Covid-19 Is Overwhelming Rural West Texas

The Four Percent

ALPINE, Texas — It is one of the fastest-growing coronavirus hot spots in the nation, but there are no long lines of cars piled up for drive-through 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 mainland United 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.

“It’s helpless, frustrating, close to panic mode,” he said.

Driving the long miles between Big Bend’s sparsely populated towns, it is hard to fathom how a virus that thrives on human contact could flare in a place with so much wide-open space. Hawks reign in the big blue skies. Cellphone service is spotty. Christmas decorations along the road are not on people’s homes, but on their ranch gates.

Yet somehow, new cases have exploded in recent weeks.

In Brewster County, a sprawling behemoth with 9,200 people spread across 6,000 square miles, more than half of the 700-plus known cases have been identified in the last month. In neighboring Presidio County, with 6,700 people near the border with Mexico, cases have quadrupled in the last 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.

Not long afterward, Dr. 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 hallways waiting for a bed,” said Dr. Ray, 44, who grew up in the small East Texas town of Troup, moved to Wisconsin for his residency and returned to Texas afterward, settling in the Big Bend region in 2013 for the beauty and the people. He and his wife, also a doctor, usually treat a caseload of strep throat, urinary tract infections and pregnancy visits. Now, he said, “it’s Covid, Covid, Covid.”

“We’d have to drive to Dallas,” said her husband, Rob Gungor, who said he had asthma and had resigned himself to making the nearly eight-hour drive to stay at an Airbnb close to a major hospital if he contracted the virus, to be nearby in case he took a turn for the worse. Like most people in Marfa, which has accepted masks more readily than some other Big Bend towns, he wore a mask even while outdoors.

“Maybe Phoenix,” he added, “because it’s only a nine-hour drive.”

For those who live in even more rural parts of West 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, the 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?”

Mitch Smith contributed reporting from Chicago.

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