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Coronavirus Jumps the Border, Overwhelming Hospitals in California

2020-06-07 09:00:10

EL CENTRO, Calif. — For 32 years, Judy Cruz has cared for patients who showed up in the emergency room in the arid, agrarian valley that straddles Mexico along the California border.

There have been bad flu seasons that caused hospitalizations to spike; weekends when off-road vehicle collisions in the desert resulted in traumatic injuries and scorching summer days when overheated farm workers required intensive resuscitation. Among the patients was always a smattering of Americans who lived across the border.

“We are a teeny tiny hospital but have always been able to manage, calling in staff on their days off or transferring one or two patients out a day to bigger facilities,” said Ms. Cruz, director of the emergency department of the El Centro Regional Medical Center. “We’d get a surge for 24 or 48 hours that required all hands on the deck.”

Then came the coronavirus.

The hospital, which has a 20-bed intensive-care unit, has been overwhelmed with ailing residents of the Imperial Valley, as well as Americans and U.S. green card holders fleeing overcrowded clinics and hospitals in Mexicali, a city of 1.1 million on the other side of the border.

To alleviate the pressure, hospitals in nearby San Diego and Riverside counties began accepting transfers in April. But the intensifying crisis prompted California last week to activate an extraordinary response, enlisting hospitals as far north as Santa Barbara, San Francisco and Sacramento to accept patients from this remote southeastern corner of the state.

Last week, a patient was being transferred from the hospital in El Centro every two to three hours, compared to 17 in an entire month before the Covid-19 pandemic, Ms. Cruz said on a recent morning as a helicopter prepared to airlift a patient and five ambulances dropped off patients near a trio of tents erected outside the hospital to triage new arrivals.

The swelling numbers of Covid-19 patients entering the United States from Mexico comes as many parts of California have pushed down their infection rates, enabling many counties to lift stay-at-home restrictions and reopen businesses.

“We worked hard to flatten the curve in California,” said Carmela Coyle, president of the California Hospital Association, who issued an appeal to hospital systems across the state for help. “Now we have a surge in the Imperial Valley because the situation is so severe in Mexicali.”

Other parts of the border, including San Diego County, also have been scrambling with a wave of patients from Baja California, the state adjacent to California. Border towns in Arizona are experiencing an increase in infections that health officials believe is tied to people coming in from Sonora state.

“Our E.R. is used to receiving patients from Mexico for things like complications from bariatric surgery and plastic surgery, and alternative cancer care, but this pandemic has brought a whole different dynamic,” said Juan Tovar, physician operations executive at Scripps Mercy Hospital in Chula Vista, across the border from Tijuana, which has been hard hit by the pandemic.

“We’re seeing Covid patients arrive at our E.R. who are very ill, whose disease has progressed to an advanced stage because care wasn’t readily available in Baja California,” he said.

The border influx is likely the reason that Chula Vista has more cases per capita than San Diego, a city five times larger.

Chris Van Gorder, the president of Scripps Health, a nonprofit health system in San Diego, reported that nearly half of virus patients who checked into the Chula Vista hospital between May 24 and May 30 had recently been in Mexico. That share rose to 60 percent between May 31 and June 2.

Mr. Van Gorder and other hospital administrators have called on federal authorities to take temperatures at border entry points and to advise quarantine for those with virus symptoms.

“It’s pretty obvious that while the overall county is managing things well, sick people are crossing the border every day,” he said.

A spokesman for U.S. Customs and Border Protection said the agency was following guidelines from the Centers for Disease Control and Prevention and referring travelers who require screening to local health authorities.

The number of cases in Imperial County reached 2,540 on Friday, up from 1,076 two weeks before. The county has the highest infection rate in California, with one in every 71 residents having contracted the virus. Per capita, the El Centro area has reported the second-most cases of any American metropolitan area over the past two weeks.

In nearby Yuma County, Ariz., which also touches the border, cases have more than doubled since Memorial Day, rising to 1,510 by Friday. The county has fewer cases per capita than some eastern Arizona counties where there are severe outbreaks on Native American reservations, but higher rates than the counties that include Phoenix and Tucson.

The health crisis along the border has underscored the deep interconnection between the United States and its neighbor to the south. Billions of dollars worth of goods and millions of people move in both directions each year.

Asylum seekers and other migrants have been barred from entering the United States since March, when President Trump closed the border to all but essential travel. But many among the 275,000 Americans and green card holders who live in Baja California, including retirees and working adults, continue to travel back and forth.

“I am afraid there are no borders when it comes to a pandemic like this,” said Adolphe Edward, chief executive officer of the El Centro hospital. “We are together as one community, whether Americans, dual citizens or Mexicans.”

Among longtime residents of the border communities, there is a sense of shared destiny.

“We are bound together by our economies, families and culture,” said Efrain Silva, the mayor of El Centro, who was born across the border in Mexico and still has family there. “That is mainly positive for us, but also sometimes has negative consequences, like with Covid.”

Mexicali, a manufacturing hub, has been buckling under a spiraling caseload of patients.

A full-blown crisis erupted in late May, about two weeks after families on both sides of the border gathered in large numbers for Mother’s Day. The El Centro hospital was alerted by Mexicali hospital administrators that American patients were going to be diverted to the United States.

“We see individuals who managed to walk or drive themselves to the border crossing,” said Sergio A. Beltrán, the U.S. officer in charge of the ports of entry in Calexico, the California town that abuts the border. Some had arranged for an ambulance to meet them, he said; others called 911.

Paramedics from the Calexico fire department rushed to collect patients. With its intensive-care unit quickly filling up, the regional hospital in El Centro erected tents outside. Those who needed hospitalization sometimes have had to wait two or three hours for a vacant bed.

On a single day in May, the hospital had 65 Covid-19 patients. “We were absolutely hammered,” Ms. Cruz said. “We’d had a small surge after Easter, but this was an explosion.’’

Mr. Edward, a retired colonel who helped oversee medical operations for the U.S. Air Force in Iraq, requested a federal disaster medical assistance team to help cope with the influx. But the lengthy hospital stay of Covid-19 patients, up to three weeks, quickly proved overwhelming.

Amid the escalating crisis, the leadership of the California Hospital Association sent an email appealing to hospitals elsewhere in the state for help.

“The state is averaging 40 phone calls to place just one of these Covid patients in need — that’s at least 400 phone calls daily searching for a receiving hospital,” the email said.

It noted that on May 27, the city of Mexicali had reported 180 deaths, twice the number in all of California.

Ron Werft, the chief executive of Cottage Hospital, a 400-bed teaching hospital in Santa Barbara, which has flattened its curve, was conducting a virtual Zoom meeting with his board and chief medical officer when the email landed.

“We decided in one second we would do it,” he said. “Within 20 minutes we committed to taking one patient per day for the next six days.”

The state’s emergency medical services authority has also transferred patients to Los Angeles, Newport Beach, San Francisco, Sacramento and Palm Springs.

“We prepared for a surge that we didn’t experience,’’ said Randall McCafferty, a neurosurgeon at the Desert Care Network of hospitals in Palm Springs who is coordinating the transfers there. “Now we are quite capable of helping them out with their struggle.”

On a recent day, El Centro Regional was already caring for 49 Covid-positive patients, and helicopters had transported 14 people to other hospitals when the words “Trauma Code Activation” blared over the loudspeaker. A medical team quickly assembled.

Outside, where the temperature surpassed 105 degrees, paramedics in hazmat suits, masks, double gloves and goggles unloaded yet another patient from an ambulance — and then another call came in over the ambulance’s radio.

Diego Favila, chief of the Calexico Fire Department, said his crew members had been working overtime to keep up.

“This Covid crisis is taking a toll emotionally and physically, and it’s not letting up,” he said.

Mitch Smith contributed reporting from Chicago.


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