Face masks, isolation gowns, surgical caps, and small, medium and large gloves — 500 of each. These were the first State of Texas Assistance Requests from the Rio Grande Valley that fell, at first, as raindrops and, weeks later, as a deluge into the office of the Texas Division of Emergency Management during the COVID-19 pandemic.

By July 9, the requests, which had been mostly for personal protective equipment, shifted.

Cameron County needed to expand morgue space in their refrigerated trailer. They asked for help obtaining four-tiered cadaver storage racks — 30 of them.

Records obtained by AIM Media Texas show the Valley’s real-time reaction of a border community in crisis.

Over 1,900 State of Texas Assistance Requests were made to the Texas Division of Emergency Management from the Rio Grande Valley during the pandemic.

MARCH

COVID cases: 0-68
COVID deaths: 0

Starr County’s hospital submitted the first set of requests on March 15 to the Texas Division of Emergency Management, or TDEM, for incident 20-0003 nCoV20, the code referring to the pandemic. There were no cases of COVID-19 reported in the Valley yet, but the first death in the U.S. was reported at the end of the previous month, Feb. 29.

About 130 requests were sent to the state from the Valley’s counties in March.

The urgency and frequency peaked on the 23rd when 43 requests were sent that day alone. Hidalgo County and the Harlingen City Warehouse placed most of those requests asking mostly for PPE and cleaning supplies like Lysol disinfectant spray, hand sanitizer, paper towels and facial tissues.

By that time, the Valley had seen its first case, a Cameron County resident who traveled to Spain and Ireland and came back positive for COVID-19 on March 19.

All counties declared a state of disaster; restaurants, bars, gyms and schools were closed by the governor; the CDC closed the northern and southern border, and Starr County announced the Valley’s first mobile testing site.

Starr County opened the site March 22 with help from the state and local leaders. That same day, they requested barricades, cones and swabs from the state to test residents free of charge. The day before they opened, Hidalgo County reported its first case. Now, with testing, Starr would likely follow.

“It doesn’t mean that there are no cases in our community,” Dr. Jose Vazquez, then the Starr County health authority, said at the time. “It’s just that we haven’t been able to test enough to be able to identify those cases.”

Four days later, Starr County reported its first case.

Shelter-in-place orders were implemented by the end of the month.

As March came to a close, leaders warned of the danger ahead.

A tsunami is coming,” Hidalgo County Judge Richard F. Cortez accurately foretold on March 31.

He said, “There is a tipping point when our health care will be overwhelmed. We have to avoid reaching that tipping point.”

On March 30, Rio Grande Regional hospital requested 50 body bags from the state in “preparation for the expected surge and care of patients with COVID-19.”

APRIL

COVID cases: 78-747
COVID deaths: 0-30

Death trickled into the Valley, at first. So slowly, Texas Gov. Greg Abbott began reopening the state for business. Request records, which grew to total over 210 in April, show leaders were distrustful of the optimism.

The virus claimed its first victim in the Valley on April 4, that of a 60-year-old Willacy County man. Two days later, Hidalgo County’s first death was announced. Cameron County followed on April 7.

Only Starr County would be spared for a few more months.

Shelter-in-place restrictions kept the number of cases from reaching 1,000 across the Valley. Hospitals across the region saw 68 people taking up residence at the peak during April. Testing became more accessible on April 17 when Weslaco opened its drive-thru site.

That same day, Abbott announced the formation of a task force via executive order to help reopen the state for business in phases.

Judge Cortez said at the time, “I think we need to be careful how we move forward.”

Politically, there was little space to maneuver; the executive orders overpowered any county government’s countering response.

In the background, county leaders kept preparing for the pending “tsunami.” And requests reflect strategic logistics planning.

The Texas Department of Public Safety requested on April 2 a Texas military district coordinator and logistical support to “provide direct and/or virtual support to the Disaster District Emergency Operations Center.”

Hospitalizations were still manageable, but on April 7 the Texas Military Department requested facility assessments for alternative care sites at the Pharr Events Center and at an unused Toys ‘R Us store in South McAllen. Records show the request was completed.

Similarly looking ahead, Hidalgo County Health & Human Services submitted a request for 100 ventilators on April 8, though it’s unclear if the state provided them at the time.

In Cameron County, requests were following a burgeoning hot spot among the most vulnerable.

On April 15, the county requested 1,000 testing kits. On April 17, the county then needed two staff members immediately to begin inputting COVID-19 case data on a state database.

Two medical teams from the Texas Army National Guard were sought on April 24 to assist with medical care at three nursing homes with high infection rates; and on April 27, two requests were sent asking for registered nurses, certified nursing assistants and janitorial staff to be sent to the Veranda Nursing Home and Windsor Atrium Nursing Home.

MAY

COVID cases: 768-1,373
COVID deaths: 30-55

Exposure at nursing homes became a primary concern for local and state leaders in May.

Requests more than doubled from April to May with a total of 474 sent to TDEM. It began with an urgent call for help.

At 7 p.m. Friday, May 1, the Texas Department of State Health Services’ Region 11 requested aid from the Texas Emergency Medical Task Force, or TX EMTF. The task force is “capable of activating resources on behalf of Texas on a state mission that provides a custom, scalable approach to medical disaster response,” according to its website.

They were requesting a rapid assessment quick response force to help Weslaco and Harlingen nursing homes.

“These facilities require assistance in testing providers and residents, training/re-training in proper PPE use, donning and doffing, and decontamination best practices,” the request read. “Additionally, facilities require assistance in creating a plan for continued care education infection control advice and potential staffing while providing a safe environment for both providers and patients.” 

State records show the request was completed. Many more would follow after the governor’s mandate on May 11 to test 100% of residents and staff at nursing homes.

In the coming days, nursing homes, many based in Cameron County, asked for thousands of COVID-19 tests and the medical teams who could help administer them.

Others were sought to help disinfect nursing facilities. Even the Texas Military Department and National Guard were called upon.

Meanwhile, the University of Texas Rio Grande Valley was working fervently to help detect the virus even as their supplies dwindled. They asked the state for 26,000 testing swabs and 50,000 pipettes.

By the end of May, Hidalgo County managed to cross the 500-case threshold. Overall, more than 1,300 cases were reported across the Valley.

JUNE

COVID cases: 1,391-6,570
COVID deaths: 56-183

Bed space, staff and equipment, even transportation grew scarce at local hospitals in June.

“A recent surge in CoVid related cases has caused extreme pressure to the entire healthcare system,” read one request from Hidalgo County to the state asking for ambulance strike teams.

“Every single hospital has increased their bed availability,” Dr. Ivan Melendez, Hidalgo County health authority, said June 24.

An upward curve was beginning to take shape at the start of the month, but by the end of it every metric tracking the pandemic locally — hospitalizations, deaths, cases, STAR requests — indicated the arrival of the first wave. 

Requests for state assistance soared with over 650 that month, many in late June. They revealed the extent of need among Valley hospitals.

Severe depletions were illustrated best on June 26.

That day, 17 requests poured in from Rio Grande Regional, Hidalgo County’s Community Service Agency, Cameron County Emergency Management, Mission Regional Medical Center, South Texas Health System, McAllen Medical, Edinburg Regional, and DHR Health, the largest hospital in the Valley — no health system was spared.

DHR Health requested a medical staff of monitor techs, registered nurses, certified nurse aides, emergency room techs, phlebotomists, lab couriers, janitors, clerks, physicians and respiratory techs totaling 396. 

Records show that request was completed. Others were not. A request from DHR Health for 160 ventilators and 60 ventilators for Rio Grande Regional was “not filled.” 

Inside the hospital, a lack of space pushed Cameron County’s Emergency Management to turn to the VA. On June 18, they requested to use “25 beds/rooms within VA-Harlingen for increase med surge of patients of local hospitals.” State records don’t reveal the outcome of the request.

Shortages inside the hospitals formed a deadly bottleneck outside. 

Hidalgo County’s request for two ambulance strike teams on June 30 summarized the problem: 

“In the last five days, fourteen TDEM STAR request(s) have been made for critically needed medical equipment and hospital staff. Shortages of both staff and equipment have resulted in ten (10) of the twelve (12) hospitals diverting EMS traffic due to high volume of patients. Hospital delays create a shortage of ambulances as they wait at the hospitals for extended periods of time. On 29 June 2020, Five Mission Fire Department engines were on scenes of medical calls waiting for ambulances to become available to transport patients. Engines on EMS calls are unavailable for Fire / Rescue calls. To compound the issue public safety agencies are reduced in staff by up to thirty (30%) percent due to CoVid related illness or quarantine. Request for 9-1-1 medical services has increased over four-hundred (400%) percent. Hidalgo County request the State of Texas assist public safety in providing timely pre-hospital medical care to its citizens in this unprecedented time.”

A similar request was filed in Cameron County for two ambulance strike teams. Both requests were completed by TDEM.

Attempts to prepare for the consequences of a health system in crisis were made early in June. 

On June 8, when hospitalizations were growing but not yet alarming, Eddie Olivarez, the chief administrative officer for Hidalgo County Health & Human Services, requested a “State Identified Alternative Care Site with BCFS medical logistics and operations staff.” They needed it by July 6, but the prescient request went unfilled. 

As cases turned to deaths, the problems inside Valley hospitals would soon begin spilling over to the mortuaries. 

JULY

COVID cases: 7,179-29,173
COVID deaths: 202-1,637

On July 3, Mission Regional Medical Center sent a request for 500 body bags “to put deceased patients into.” The “tsunami” had arrived, Cortez, the Hidalgo County judge, would later announce.

COVID-19 hospitalizations peaked to form the first wave in the region. By July 22, 1,606 people were in Valley hospitals, the most recorded by the state in the Lower Rio Grande Valley Trauma Service Area. 

June’s voluminous requests began bearing fruit in July, but TDEM still received about 400 STARs this month. 

Every part of the process — testing, treatment, death — faced challenges during this period.

On the first day of the month, Starr County asked for registered nurses, certified nursing assistants, respiratory techs, lab technicians, paramedics, intermediates, and an ER nurse practitioner. Similar requests including ICU nurses, X-ray technicians, and EMTs from other health systems followed. 

Staffing levels grew the most in July as demand increased.

Resources began flowing into the region. 

Surge testing began at Bert Ogden Arena on July 8. Two days before they opened, regional officials requested 16 pallets of bottled water, “refrigerated if possible.” The water would be needed “to support COVID-19 walk-up federal testing site,” the request read, further noting: “Temperatures in the Edinburg area are forecast to be in the high 90s to 100 degrees.”

The response to the testing was so “overwhelming” the site closed two hours earlier than expected. County officials later said many of the medical personnel were exhausted by exposure to high temperatures.

Limited space in hospitals led to a Catch-22 with oxygen shortages; four oxygen-related requests were sent to TDEM in July. 

“Long hospital ER wait times are increasing the use of oxygen by (COVID-19) patients in ambulances,” Rolando Casas with the Cameron County Emergency Management wrote in his July 3 request for 200 oxygen tanks. “EMS providers and hospitals are reporting a shortage of oxygen in our area.”

Hospitals were holding onto patients longer due to a shortage of oxygen concentrators

DHR Health officials said concentrators for discharged patients were hard to find. 

As a response to the increased hospitalizations and lack of bed space concerns, Samaritan’s Purse, a faith-based organization, was invited to the Valley by U.S. Rep. Vicente Gonzalez, D-McAllen. The organization assessed the region to determine whether to deploy their field hospital in the area.  

The group eventually withdrew from the Valley, which prompted political criticism from Gonzalez, expressing he was “disappointed and saddened” by the governor “disallowing” Samaritan’s Purse to establish a field hospital. But Gov. Abbott said he favored hotels to field hospitals.

On July 24, state officials began housing convalescent patients at the La Quinta hotel in Pharr, according to Cortez.

Plans to find an alternative care site — the kind requested a month ago by Hidalgo County — continued. On July 20, the county tried again.

A request for an alternative care site, or ACS, with a 100-150 bed capacity was submitted to TDEM.

“The request is for a facility in which hospital patients with COVID-19 can be transferred from a hospital setting to an ACS so the patient can continue to receive medical care for the duration of their isolation period,” the request read, adding the need for wrap-around services, staffing and site management.

That request would be fulfilled

Managing recovering patients was on the positive outcome of the COVID-19 spectrum. On the other, mortuary industries were struggling to keep up

On July 26, The Monitor printed four pages full of obituaries and death notices. 

Requests turned grim. 

Body bags were in demand. Mission Regional requested 500, Cameron County needed 200, and Hidalgo County asked for 800 the following month. 

Starr and Hidalgo counties requested refrigerated morgue trailers. Thirty cadaver racks with four tiers and a Disaster Mortuary Operational Response Team were requested in Cameron County where services were backed up 5-10 days and crematoriums were 3-5 days backlogged; and a funeral director management team was requested to help inventory and distribute fatalities to appropriate facilities around Hidalgo County. 

Valley residents would close July in grief and devastation. Hurricane Hanna made landfall on July 25.

WHERE WE ARE NOW

AIM Media Texas’ public information request from TDEM reached only into October.

Public data shows deaths grew in August, while hospitalizations began their descent from the first wave. 

Requests for assistance followed. They fell drastically after July. In August, less than 30 were filed; five in September, and fewer than that in October. 

Research and resources have enhanced the public and private sector’s coffers. Some hospitals have wards and wings dedicated to the treatment of COVID-19 patients. And a variety of treatments range from plasma-derived options, antiviral drugs, to antibody therapy.

Aside from public testing in the county and in schools, the FDA also approved home-testing kits to make testing more accessible and contain the spread more easily.

Before the year ended, the long-awaited tool against the virus arrived in the Valley. The initial shipments of the first COVID-19 vaccine approved by the FDA were received on Dec. 16.

“I’m very, very optimistic about our ability to get some control,” Dr. Carlos J. Cardenas, DHR Health chairman of the board and chief administrative officer, said at the time.

As of Thursday, 3,000 souls and counting have been claimed by the disease, with Hidalgo County on the brink of confirming in excess of 50,000 cases. Billboards have been erected with faces of the dead, a reminder of the casualties incurred. A presidential election has come and gone, and a region is left to pick up the pieces.

Hospitalizations are again on a steady and clear ascent across the Rio Grande Valley.

Vigilance is still advised. 

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Monitor reporter Mark Reagan contributed to this report.