EL PASO – Coronavirus patients were filling up one-story beds. Then two. Then the University Medical Center, a teaching hospital in El Paso, set up tents to treat patients in a parking lot. A downtown convention center has become a field hospital. To free up even more space, the state began airlifting dozens of intensive care patients to other cities.
Local leaders have argued over what to do to quell the growing coronavirus crisis. The county’s senior official has ordered a lockdown and curfew. But the mayor disagreed and police said they would not enforce it. Then the state attorney general spoke out – a lockdown was unnecessary and illegal, he said.
And the patients kept coming.
“We refer one patient, and there are two arriving,” said Wanda Helgesen, executive director of the local council responsible for emergency and disaster preparedness.
El Paso, a border town of 680,000 residents, now has more people hospitalized with Covid-19 than most states – 1,076 as of Tuesday – and has more than doubled its mobile mortuary supply from four to 10.
The pressure on the city, as it grapples with the deadly third wave of the pandemic, is reflected across the country. The number of hospitalizations for Covid-19 in the United States reached a record 61,964 on Tuesday, overtaking the terrible first days of spring in New York and summer in the south and west.
Hospitalizations have more than doubled since September, according to the Covid Tracking Project, surpassing the previous peak of 59,940 hospitalized patients in mid-April. But as previous peaks have abated, public health experts fear the pace of new hospitalizations will continue to rise with new infections, which average 111,000 per day nationwide and show no signs. slowdown.
States that seemed to control the spread, like New Jersey and New York, are experiencing a resurgence. At the same time, rural hospitals in North Dakota and Idaho are in desperate need of doctors, nurses and technicians to keep up with rapidly growing patient populations.
And risk factors that public health officials have long warned could spread the virus and taint hospitals in the fall and winter – more indoor activity, the onset of flu season and gatherings during the winter holidays – are just beginning.
“Things are not just bad, there is no end in sight,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “If we stop all transmission today, which we can’t and don’t want, we are probably looking at a month of overcapacity in many communities in America.”
Texas recently passed one million confirmed cases of the virus, with 19,000 deaths. Of the 6,100 patients hospitalized across the state, one in six is in El Paso. Dr Mario Rascon, the chief medical examiner for El Paso County, said on Tuesday that his office had 154 bodies. “It’s exhausting,” he says.
The city has brought in more than 1,400 health workers from across the state and about 60 more arrived over the weekend in three teams sent by the Department of Defense. But new patients have even exhausted these additional resources. Half of all the city’s patient beds are now occupied by people with Covid-19.
“Things are not going well,” said Mayor Dee Margo. But he said he was also worried about the impact of the new closures on families struggling to survive. “I’m trying to walk this tightrope.”
The situation reflects the larger difficulty of trying to tackle a national crisis in the absence of a national strategy. In El Paso, a remote urban island in West Texas between the borders with Mexico and New Mexico, this absence was keenly felt.
A pandemic response philosophy focused on local control and personal accountability, starting with the Trump administration and reinforced by Republican Texas Gov. Greg Abbott, has at times left local leaders at odds over how to handle serial epidemics.
After shutting down in the spring, Abbott quickly began to reopen the Texas economy. In the summer, as the virus was on the rise again, he suspended the reopening, then clashed with local leaders in Houston and other cities who wanted to curtail activity but were prevented from doing so by his orders. He told Texans to wear face masks. In October, he eased more trade restrictions.
By this time, in El Paso, hospitals were already feeling strained.
Senior county official Ricardo A. Samaniego issued a stay-at-home order and strict new limits on businesses on October 29. But Mayor Margo did not believe Mr Samaniego had the power to do so and initially opposed it. While local county gendarmes tried to enforce the lockdown, the much larger El Paso Police Department said no.
“Huge, huge confusion,” said Laura Rayborn, who owns a spa and other local businesses. “The mayor went on radio and television and said, ‘Stay open’.” Ms. Rayborn decided to do it.
Restaurants continued to serve, despite orders to stop everything except take-out and delivery. “We decided to do what we had to do,” said Aaron Means, who owns a restaurant near the University of Texas at El Paso campus.
Some went to court to fight the lockdown and were joined by Tory State Attorney General Ken Paxton, who called the county’s action “oppression” and vowed to end it. After a week of back and forth between three levels of Texas government, a state court ruled on Friday in favor of the new restrictions on business. Mr. Paxton is handsome.
By then, frustration and confusion had spread widely, mitigating the immediate benefits of business closures and virtually ensuring that a longer downtime would be necessary.
“One thing almost worse than closing is not knowing if you’re closed,” said David Jerome, president of the El Paso Chamber of Commerce. “I’m a big fan of 50 experiments with democracy, but not when it comes to a pandemic.”
The county’s two-week lockdown order, which is due to expire on Wednesday, has yet to show any appreciable effect on hospitalizations, officials said. “We don’t seem to have reached our peak,” Ms. Helgesen said.
As of Tuesday, the city was recording an average of 1,800 new cases of coronavirus per day, nearly double the number in the more populous Dallas County, the second hardest-hit in the state.
Mr. Samaniego, the county executive, has said he would like to extend the closing order, possibly through Thanksgiving. He feared that too few people had followed him and that the holidays would bring new risks.
“We really never rolled out a real stay at home,” Samaniego said. “We never got to see the full impact.”
The governor’s office said Samaniego and other local officials should focus on enforcing existing regulations, including restaurant capacity limits and mask requirements, not closures. “This strategy has been effective in slowing the spread over the summer and containing Covid-19, while allowing businesses to operate safely,” said Renae Eze, spokesperson for the governor.
Like the country as a whole, El Paso has now entered an uncertain period. Officials hope enough people are now following the lockdown order to slow the spread of infections. The police have started to coerce companies that don’t comply.
On Monday, city officers driving tired Segue vehicles and sheriffs in patrol cars could be seen driving through a nearly empty shopping district and visiting businesses near the border with the Mexican city of Ciudad Juárez.
Some officials and residents have blamed travel to Juárez for the spread of infections in El Paso, even as cross-border travel has been almost entirely limited to US citizens. The two cities have long been a trade hub in the mountainous desert, and Americans who live in Mexico have often traveled to El Paso to use its better-resourced hospitals.
This continued during the pandemic, officials said, as Juárez saw its hospital infrastructure warp under the pressure of its own severe outbreak. The extent of the pandemic in Juárez is not known due to inadequate testing, but even the mayor has been hospitalized with the virus.
The majority of infections in El Paso come, health officials say, from local community transmission, especially among multigenerational families who often live together or meet frequently to shop or visit.
“We have seen several family members arrive, usually on different days,” said Dr. Edward Michelson, chief of emergency medicine at University Medical Center and professor at Texas Tech University Health Sciences Center.
Hector Balderrama, 55, a seller of medical supplies, saw his immediate family contract the virus in mid-October: first his adult son. Then his wife. Then his eldest daughter.
“It shut us down completely,” he says. His wife was hospitalized and his son, who has diabetes, spent days in an intensive care unit. They finally recovered. Mr. Balderrama never caught it. “Thank goodness we are here and we are improving, but we are not 100%.”
Vast swathes of the city are eerily empty, with indoor malls surrounded by desolate parking lots. The afternoon wind whips through the deserted downtown streets, tossing plastic bags like tumbleweeds in a spaghetti western with few actors.
Adriana Salas, 48, has kept her small clothing store open despite the small number of customers and the new restrictions. “I’m very late with the rent,” she says. “I came to open because I needed the money.”
The activity that continued in the city could be found in big box stores along Interstate 10, in winding lines of cars at drive-thru restaurants, or by people trying to find space. to be outside in a generally quiet outdoor mall.
“We were all sick,” said Xavier Gonzales, 45, of his wife and 6-year-old son, who at the time were running with the family dog on a piece of artificial grass.
Mr Gonzales, a singer who has been mostly out of work since March, has had the worst – “I couldn’t get up” – and emergency room doctors said he had viral pneumonia. But since he could breathe on his own, he was sent home to recuperate to make room for other more seriously ill patients.
He didn’t look to Mexico, like some Texans, for the source of the El Paso pandemic problems. “I think that’s an excuse for people looking to blame someone; it’s not us, it’s them, ”he says. “But that’s us. We are the ones who don’t follow the rules.
Neil MacFarquhar contributed to the New York report, and Mike Baker from Seattle.