Seventy-two death notices sprawled across an entire page of the Monitor newspaper in Hidalgo county recently.
The small-print entries, stacked in five tidy columns, didn’t mention Covid-19. But 27 residents of the south Texas community had died from the virus that day, 22 the day before, and 35 the day before that.
“I’ve never seen that ever in my life,” recalled John M Kreidler, a local funeral director, whose family has run Kreidler Funeral Home in McAllen for over a century.
That was earlier this month, but things have worsened since. The coronavirus pandemic haunts almost everything in this part of the Rio Grande valley, where more than 92% of the almost 900,000 strong population identifies as Hispanic or Latino.
Hand-sanitizing machines and big bins with masks and gloves surround shoppers at the regional grocery store. Outside of Nomad Shrine Club, a rundown event space turned drive-thru pop-up, residents join a long line of people in cars in search of a Covid-19 test with rapid results. Even Tex Mex, a gentlemen’s club, has a somber message for patrons: “Clothed Again.”
“The Rio Grande Valley has become the hotspot of a hotspot of a hotspot,” said Ivan Melendez, Hidalgo county’s health authority and a practicing clinician. “We’re at the epicenter of the coronavirus in the United States.”
Melendez recalled recently encountering a critically ill patient with an alarmingly low pulse. He tried to warn someone, but nurses informed him that a different doctor had already decided not to intervene because they “didn’t expect for [the patient] to survive”.
In the United States, where the prevailing mantra for physicians is “do no harm”, that kind of ruthless calculation strikes deep, especially when so many of the lives at stake are medically vulnerable and easily exploited.
In Hidalgo county – “a poor, fat, diabetic population”, Melendez said bluntly – nearly one in three people under age 65 lack health insurance. Thirty per cent live in poverty, and a 2020 WalletHub report found that three local cities hold the distinction as the “fattest” metropolitan area in the nation.
Type 2 diabetes and obesity are among the pre-existing conditions listed by the Centers for Disease Control and Prevention as risk factors for “severe illness” related to Covid-19. Meanwhile, concern over exorbitant hospital bills deters some who don’t have insurance from seeking medical care. These and other socioeconomic factors have caused the virus’s greatest tragedies to disproportionately affect minorities in the US, with Latinos hospitalized at more than four times the rate of their white counterparts.
Hidalgo county also sits along the US-Mexico border, and an estimated 102,000 unauthorized immigrants who may be afraid to seek care exist within its margins. Large families serve as an ideal vector for the virus, as do those who still flock to beaches and flea markets on weekends.
Already, 467 members of the community have died from Covid-19, according to the county, most of them since Texas reopened in May. But the state government has actively thwarted efforts to go back into lockdown, prioritizing economic vitality even as the death toll soars.
Leonardo Tremari worries about going to his job inside a Walmart supercenter in McAllen, but he – and countless other employees – still have to work. “I don’t have a choice,” he told the Guardian, laughing tensely.
Last week, Hidalgo county judge Richard F Cortez ordered residents to stay home and encouraged non-essential businesses to limit their services. But a spokesperson for the Texas governor, Greg Abbott, quickly undermined Cortez’s authority, saying it was “simply a recommendation”. The dizzying policy ping-pong is an extension of a larger politicization of the pandemic nationwide during an election year, where just suggesting wearing a face mask has become a partisan dog whistle.
Some people in Hidalgo county remain convinced that the current health crisis is made up or overblown, despite the fact that by now, everyone is at most a few degrees of separation from someone who has suffered or died because of Covid-19, Melendez said. More than 15,000 people have tested positive in the county, and last week, hospitals teemed with over a thousand patients stricken by the virus.
In a matter of weeks, Melendez has put his sixth-grade teacher on life support, opened up a body bag to play a son’s farewell video for a patient who had already died, and stumbled upon a gravely ill nurse he’d known for 30 years, whom he didn’t even recognize at first glance. Harrowing personal moments abound, as do thorny gray areas.
“There’s a moral, ethical dilemma at every place that we turn,” he said.
Hospital emergency departments are struggling to cope, so other wings have morphed into Covid units – even when they aren’t equipped to do so. One healthcare worker at DHR Health in Edinburg, who spoke on the condition of anonymity, described patients in hallways, two people to a room and “everything askew at all times” in a rehabilitation facility that has been converted amid the health emergency. The building isn’t made to provide so much life-sustaining oxygen, they said, and one time, it simply shut off.
“Everybody here who is a healthcare professional feels very powerless,” they said. “We’re just trying to help do what we can with the horrible resources we’ve been given.”
The explosion of cases gets bigger by the day as new infections number in the hundreds, if not the thousands. Although Texas’s reopening plan banked on a symbiotic relationship between testing and contact tracing to curtail the virus’s spread, Hidalgo county’s contact investigations have been rendered ineffective, Melendez explained. There are too few contact tracers, and too many positive test results.
But anxious locals seek out diagnoses anyway. At Nomad Shrine Club, where results take minutes instead of days, members of the public arrive as early as 2 or 3am just to nab one of 300 daily tickets available for a test. A few blocks down the road, another, competing tent operation fielded so much demand that it rented out a larger parking lot.
Both testing services charge fees, either $75 or $125. Neither takes insurance.
Most patients just say they’re feeling down, said Genesis Gonzalez, a medical assistant who works at the tent. “Next thing you know, they come back positive.”
As Gonzalez baked under the Texas sun, she wore short-sleeved scrubs and a mask, her hair tied back neatly. She and her colleagues have access to more comprehensive protective gear, she said, but some of them get dizzy or faint if they wear it in 101-degree weather.
At yet another testing site, Daniela Garza reaches through car windows with her stethoscope. Her job is to swab for tests, but she simultaneously prescribes nebulizers, antibiotics, inhalers or Z-Paks because some patients don’t have primary care physicians, or can’t get in-person appointments right now. Around 40-50% of the tests from the drive-thru come back positive, Garza said. Sometimes, she sees people who just lost family members or loved ones.
“I tell ’em, you know, ‘I have no idea what your loss feels like, and I’m so incredibly sorry for that loss,’” Garza said. “But I’m proud of them for coming themselves to get tested so that they won’t go out and expose other people. That’s really hard to do.”
At Kreidler’s funeral home, corpses wrapped in sheets, then double-bagged and wrapped again lie across tables in the preparation room because there’s no space left in the cooler. The crematory is fully booked up to 10 days in advance.
Kreidler and his staff, including his wife and son, sometimes work into the night without much sleep or regular meals. They’re constantly in a rush, and every time a body leaves, it just means another spot has opened up.
“We’re wanting the pandemic to go away,” said the weary funeral director, who’s fed up with how the crisis has been manipulated as a “political football”.
“We need to get this stopped – and stopped now.”