The Rio Grande Valley stretches along more than a hundred and twenty miles of deep South Texas. It encompasses cities from South Padre Island to Rio Grande City, and includes McAllen, Brownsville, and Harlingen—not to mention Reynosa and Matamoros, on the Mexican side of the border. Yet despite being home to more than 1.3 million Texans, it’s an often overlooked part of the state. 

Part of the problem is geography: the region is a long drive from San Antonio, the closest large Texas city, and it’s not on the way to any other part of Texas. Many Texans seem to barely be aware that one of Texas’s most important regions even exists. Politically, the Valley has been treated as an afterthought by outsiders from both parties for decades. (In the weeks leading up to the 2020 Texas Democratic presidential primary, not a single candidate visited the solid-blue Valley.) The region is more than 90 percent Latino, with a vibrant music scene, a slew of multigenerational households, and one of the youngest populations in the state. The Valley is also the poorest urban region in Texas, with a poverty rate in some counties as high as 39 percent, and the largest percentage of uninsured Texans, at 31 percent. Now that COVID-19 is rampaging through the Valley, the decades of neglect and isolation are being keenly felt. 

Hospitals are overwhelmed. Patients here are twice as likely to die from COVID-19 as patients in the rest of the state. Health care staff are stretched thin. Bodies are being stored in refrigeration trucks, awaiting cremation or burial backlogs. One local hospital was forced to set up an ethics committee to triage whether certain patients should receive care at all. Local leaders are desperately seeking more resources from state and federal officials. Here’s what you should know about the current state of COVID-19 in the Valley.

There’s No Worse Place to Have COVID-19 in Texas Right Now Than Hidalgo County

By almost every metric, Hidalgo County—the most populous county in the Valley and home to McAllen, Edinburg, and Mission—is the center of the COVID-19 crisis in Texas. It’s undertested, has one of the highest per-capita case counts in the state, and is seeing a larger percentage of patients die of the disease than any urban county in Texas. 

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Perhaps the most alarming figures indicate just how deadly COVID-19 is in the area. Hidalgo County accounts for just 3 percent of Texas’s population, but since July 16, it’s represented 21 percent of the state’s deaths. In just the last week, Hidalgo County has seen 217 COVID-19 patients die—two and a half times the number in Harris County, which has more than five times the population. Statewide, the case fatality rate hovers at around 1.2 percent, while in Hidalgo County, it’s currently 2.9 percent. Medical experts have said that the alarming death rate correlates to the prevalence of comorbidities like diabetes, high blood pressure, and obesity, as well as a rich family life. Many Valley households are multigenerational, including not just parents and children, but grandparents, great-grandparents, and other kin, and the culture of the region has a robust social component.

“It’s hard to find colleagues whose family hasn’t been touched by death,” one Valley doctor told the Los Angeles Times. “We look at life down here in terms of holidays, because families get together Mother’s Day, Father’s Day, Cinco de Mayo. Anytime there is an excuse for our gente to have a party, a pachanga, we worry.”

Funeral Homes and Crematoriums Are Overwhelmed

With the alarming death rate has come terrible strains on those tasked with handling the dead.

Last week, the Daily Beast profiled Juan Lopez, whose Elite Transportation and Cleanup has the Hidalgo County contract for transporting dead bodies in his black Cadillac Escalade. When a person dies in their home, Lopez arrives to retrieve the body. According to the Beast, he’s been getting just a few hours of sleep a night. “I’m 24/7,” he told the publication.

In a Texas Tribune story published on Tuesday, funeral directors in the Valley said they were struggling to keep up with the increased workload. Aaron Rivera told the Tribune that he bought a refrigerated trailer to store bodies; a funeral home’s supplier said that there was a weeks-long wait to get gurneys to transport bodies. A woman whose father died in a nursing home told the Tribune that she had to wait a week for his body to be cremated, as the ovens had broken down from overuse.

Hospitals Are Struggling to Keep Up

Across the Valley, hospitals are on the verge of being overwhelmed. In rural Starr County, the upper Valley community’s only hospital began instituting an ethics committee on Tuesday to determine how to ration care. According to ValleyCentral.com, “Those deemed too fragile or sick or elderly will be advised to go home to loved ones” instead of receiving care, a startling acknowledgment of how resource-starved the region is. 

Earlier this week, the New York Times published a story detailing the conditions inside the DHR Health hospital in Edinburg, the seat of Hidalgo County. The paper described frantic conditions in three ancillary Severe Infectious Disease Units (SIDUs) opened by the hospital that are located across the street from the hospital itself, inside buildings including the former hospice ward. There, patients wait for more than 24 hours for ICU beds, and ERs are stocked with recliners for patients without beds. According to the Times, “Some women have had to begin the early part of their labor in their cars because the unit was full.” The paper also noted that “DHR Health administrators say they have kept their main hospital largely free of the coronavirus to treat patients with serious conditions unrelated to the pandemic like heart attacks and strokes, as well as some elective procedures.”

A Twitter thread (now locked) about conditions at DHR by a Florida nurse named Sarah went viral over the weekend. When Texas Monthly reached her by phone on Monday, she explained that though she wasn’t on the ground in South Texas, she had collected stories from traveling respiratory therapists who had worked at the SIDUs.

Dr. Carlos Cardenas, chairman of the hospital’s board of managers, declined to go into details about the main hospital’s capacity or the number of elective procedures being performed. But he told Texas Monthly that the hospital had sufficient stores of PPE and oxygen, contrary to the stories collected on Twitter. “I don’t pay attention to anonymous sources in general,” he said, noting that the hospital had been open and transparent in inviting the Times and Tribune to observe operations.

Local Officials Have Their Hands Tied

Given the dire situation, local officials are desperate to flatten the curve and to get COVID-19 under control, but they are finding that they have few tools at their disposal.

On Monday night, Hidalgo County Judge Richard Cortez issued a new stay-at-home measure, requiring residents to shelter in place during this deadly stretch of the pandemic. Cortez’s order, however, is rendered toothless by state guidelines, which prevent enforcement of the rule. According to the Texas Tribune, a spokesman for Governor Greg Abbott responded to the requirement by reassuring Valley residents that Cortez’s “order has no enforcement mechanism, which makes it simply a recommendation for those to stay home if they can,” adding that the governor supports that recommendation.

On a policy level, there’s little that local officials can do to slow the spread of the disease in the Valley at the moment other than hope that the governor’s statewide mask order is enough to drive down new cases soon.

Abbott Has Called in Military Medical Teams for Help

Though Abbott’s current order ties the hands of local officials, he is offering help in treating, if not preventing, the disease. On Sunday, Abbott ordered the Navy Rural Rapid Response Team to Rio Grande City, a rural community in Starr County (as well as to the border communities of Del Rio and Eagle Pass, outside of the Valley). He also announced that the U.S. Navy Acute Care Team would be supporting hospitals in the lower Valley city of Harlingen, in Cameron County, and that the U.S. Army Urban Augmentation Medical Task Force would be deployed throughout the region. On Tuesday, at a virtual meeting with local leaders, Abbott also announced that the state would be contracting with a local hotel to provide recovery facilities to COVID-19 patients in the region.

All of this comes as the crisis continues to escalate in one of the poorest and most underserved communities in Texas. The additional resources will be much-needed, but at this moment in the COVID-19 pandemic, there are few encouraging signs emerging in the Rio Grande Valley.