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How coronavirus spread across the state

By Stephen Paulsen, The Big Bend Sentinel
stephen@bigbendsentinel.com

TRI-COUNTY — Local officials across the Big Bend took proactive steps to slow the spread of COVID-19, closing bars and restaurants while the disease was still relatively far away. And by some measures, those efforts appear to be working.

Historical data from the 1918 Spanish flu and other outbreaks show that diseases often reach rural areas about two weeks after they hit nearby cities, according to Ekta Escovar, a local health authority in Brewster County and a member of the local COVID-19 task force. But more than a month after El Paso’s first case in early March, the Texas Department of State Health Services is still reporting no coronavirus cases in Presidio, Brewster or Jeff Davis counties.

Granted, the official zero-case count should be treated with skepticism; Texas has some of the lowest per capita coronavirus testing rates in the country. The Big Bend Sentinel reported on local testing issues as early as March.

And since many COVID-19 patients show mild or moderate symptoms and therefore don’t qualify for testing, doctors are now presuming local patients positive without testing them, as Marfa Public Radio reported last week.

Because these presumptive positives rely on individual patient recommendations rather than medical tests, there is no official tally of these cases. In an interview, Dr. Escovar said there is “no way” to determine how many presumed positive cases there are in the tri-county.

Escovar called the testing protocols in Texas “really disappointing.”

“Texas as a whole hasn’t made a ton of progress on testing,” she said. She thinks the state is “slowing down” testing too soon.

Still, the number of local residents tested for the virus continues to slowly climb — and with it, no confirmed positive results. Forty tri-county residents have been tested, with no pending results and no confirmed cases, Ekta Escovar said at a Brewster County meeting on Wednesday. That’s up from 32 tests earlier this month.

And even without better testing, there are still clear signs that the coronavirus isn’t widespread in the area, said Katie Ray, a doctor at Preventive Care Health Services.

“We haven’t had a single severe case,” she said. “That does tell us the caseload in the region is low.”

That’s the good news. The bad news is that social distancing could be the norm for a while — and that even with such measures, people in the Big Bend could become infected and die.

“We don’t expect to significantly decrease the number of people ever exposed [to coronavirus] in their lifetime,” Ray said of social-distancing efforts — predicting that a “huge percentage of the population will be exposed at one point or another.” Rather, the goal is simply to slow the spread of the coronavirus enough that our first severe cases don’t overwhelm the healthcare system.

Week by week and day by day, the coronavirus has inched closer to the Big Bend and become more of a reality for the people who live here.

What started as a far-off disease outbreak in Seattle and New York, and then in Houston and Dallas, has now spread to nearby cities like El Paso. And while bar closures and stay-at-home orders may seem extreme enough already, measures like those in Presidio — where city officials are now advising residents they “should” wear masks in public — could foreshadow stricter rules to come.

El Paso reported the first case in the region on March 13, a man in his 40s. Like many of the early cases around the country, officials said the infection was linked to travel — in his case, to California.

Crane County reported its first case on March 19 — the first case in the Permian Basin, and the first case in a rural county of Far West Texas. That patient is an employee at the University of Texas of the Permian Basin in Odessa, health officials said.

Midland and Odessa soon confirmed their first cases — with Midland’s Midland County reporting one on March 25, and Odessa’s Ector County reporting a day later, on March 26.

Less than a month later, those case counts have ballooned, according to data from the Texas Department of State Health Services. At press time on Wednesday, El Paso has confirmed over 500 cases, while Ector and Midland County have reported a total of over 120 combined.

Meanwhile, the disease has continued to spread into neighboring rural counties — bringing confirmed cases of the disease closer to the Big Bend. Crane County now has at least two cases, and Pecos County has at least five.

In Reeves County, meanwhile, the Pecos County Memorial Hospital now says it’s found at least three confirmed cases of the disease. But those numbers aren’t reflected in Texas state figures, which still show zero cases in Reeves County.

The hospital declined to comment on the discrepancy, but one explanation is likely: the patients split their time between Reeves and another county, and were instead added to the count elsewhere.

These local counts may continue to rise, but don’t expect much more information anytime soon. While low testing rates are preventing state officials from understanding the true scope of the coronavirus spread, sparsely-populated West Texas has another factor working against it: patient-privacy rules.

The Big Bend Regional Medical Center for weeks couldn’t release local testing figures, citing HIPAA, the Health Insurance Portability and Accountability Act. Since there are so few people in the tri-county — and even fewer people are getting tested — hospital officials said they couldn’t release information without breaking privacy rules.

Those same rules are also limiting how much information is disclosed on confirmed COVID-19 cases — like in Reeves County, where hospital spokesperson Venetta Seals also cited HIPAA in declining to provide more information on local cases.

“We certainly don’t want a person or family or employer targeted,” Seals said of the Reeves County patients. “It could be unpleasant for them.” She acknowledged Midland, Odessa and El Paso were releasing more information on cases, including ages, genders and details on how people became infected. But she added: “You have a little more anonymity there.”