It seemed like almost every local official had squeezed into the student activity center of the South Texas College Starr County campus on this particular March afternoon, when the affects of the coronavirus still seemed mostly theoretical in the Rio Grande Valley.
That same day, the Texas Department of State Health Services confirmed the first case of COVID-19 in the state. Starr County officials knew then that it was only a matter of time before the disease reached their community, they said before a packed room, so it was crucial to start formulating a plan.
Later that month, the county received confirmation of their first cases of COVID-19. Less than a month later, all those cases — with the exception of two that were reported just this week — were cleared.
This is something no other Valley county can report, along with the fact that Starr County has reported any cases of community spread.
Up until Sunday, April 26, the county had gone three weeks without confirming a single case of COVID-19 and it was the only county in the Valley to flatten the curve of infections. This is especially remarkable when you consider that Starr is considered the poorest county in the state of Texas.
Asked how they were able to accomplish what communities across the world are striving for, county officials credit the work of the community as a whole.
“We wanted to get ahead of the game because we felt, or I felt, that this thing was going to explode and then we couldn’t compete with some of the counties that have more resources that we do,” Starr County Judge Eloy Vera said.
When the threat of COVID-19 became more apparent, all hands were on deck.
“There was conversations all over about the lack of test kits, there was conversations about facility space, bed space; all these other items that normally don’t take on your day-to-day conversations became exactly that for us,” said Rose Benavidez, president of the Starr County Industrial Foundation.
“The more we started to look at how were we going to ensure that a rural community like ours was part of this dialogue, it became really clear that we had to shift a little bit of our focus from economic development to community development and emergency response, working in tandem with the county judge, with the county emergency officials, with the mayors and obviously our health authority, Dr. (Jose) Vazquez.”
Vera said he asked his staff to organize the summit at STC on March 4, which a news release had described as a way “to inform and educate the community of ways to protect and prepare themselves from the imminent threat of the Coronavirus.”
About 270 people showed up, according to the estimation of Vazquez, the county’s health authority and board president of Starr County Memorial Hospital.
People in attendance included county officials, city officials, local doctors and law enforcement authorities, agents from U.S. Customs and Border Protection, media and the general public.
Sam Vale, board chairman of the industrial foundation, was shocked by the size of the audience when he entered the room.
“I saw a lot of very, very tense faces, it looked like people were about to panic,” Vale said.
But then Dr. Antonio Falcon, a prominent figure in Starr County, spoke and commented on the need to pay attention and remain calm, Vale recalled.
Vazquez explained to the attendees the idea to develop a three-tier plan on what measures to take when the first cases would be confirmed in the Valley and in the county.
Each entity within the county — police departments, clinics or school districts — were to formulate their own plans on what they would do when they reached those stages.
“At that point, several different ideas came out from different leaders in the community,” Vazquez said.
One of the most important, he said, was the implementation of phone hotlines.
The county compiled a list of numbers that were operated by the school districts, the police departments, Border Patrol, the hospital and different clinics.
There were as many as 16 different phone lines for which he personally trained the operators over the course of two to three days, screening residents for symptoms and answering concerns.
“I basically instructed them how to answer to the different questions that the public may have in regards to this disease,” he said.
Those were instrumental, he said, in screening people for their symptoms over the phone and keeping them from having to go to the hospital or to clinics if they didn’t need to.
“The phone hotlines worked beautifully in the way that a lot of people stayed in their homes; they were not crowding the doctor’s offices, they were not going to the emergency room for every fever or every cough that they had,” Vazquez said. “They were picking up the phone and making phone calls and being guided and directed and screened by the people who were behind that phone line.”
Around the same time those were being implemented, county officials were having meetings on issues about restricting gatherings of more than 10 people and on March 18, Vera issued such an order, making Starr the first in the Valley to do so.
“Some places in the state started passing a 50-people limit, at that point we started with 10,” Vazquez said who explained they didn’t see the point in just staring with a 50-person limit if they knew that in a few weeks time, they would have to drop it to a 10-person limit anyway.
“So we were always ahead, a couple of weeks or three weeks ahead of the curve, and we were taking measures that sometimes were not very popular,” he said.
By the time the county held the preparedness summit, they had already stopped allowing visits to nursing homes since they were aware of the outbreak at a nursing home in Seattle.
“So we imposed Draconian measures, I mean they were not happy,” Vazquez said. “They were not happy with the measures that we imposed on them but they followed them. As the county authority, I have the power restrict or to limit the visitations and we did it.”
They eventually also imposed restrictions on adult day care centers, requiring employees who had traveled out of town to be in isolation for 14 days before being allowed to return to work and then later suspended activities at those centers altogether.
Given the vulnerable populations that frequent those centers, Vazquez said he thought keeping them open was a recipe for disaster. The owners, he said, understood.
“This is just one more example of how the different people in our community had put the common well-being ahead of the personal interest,” he said. “This was a big economical hit for all of them.”
Then came the school districts.
When the first case of COVID-19 was confirmed in Laredo, the Roma school district suspended classes. Rio Grande City and the San Isidro school districts soon followed.
“I did not have any kind of opposition with the school whatsoever,” he said. “They were on board 100%.”
As more and more confirmed cases started popping up in the area, Starr County officials were already in talks to set up a drive-thru testing site which came together through two avenues — a private company who would provide the infrastructure and the lab that would provide the testing kits.
Discussions with the private lab, made for a very intense three or four days, Vazquez said.
A representative for the lab, Altru Diagnostic Inc., reached out to Vazquez through a mutual friend, wanting to know if the doctor was interested in acquiring testing kits for his clinic.
Vazquez was worried that it might be a scam; hesitant, he told the man he would think it over.
The representative sent over the company’s credentials and information on the proposed tests which Vazquez reviewed. His interest grew, Vazquez said, so he later went to the hospital and met with Thalia H. Muñoz, the hospital CEO, and Lydia Garza, the lab director to discuss the lab company’s proposal.
He also reached out to Dr. Emilie Prot, medical director for Region 11 of the Department of State Health Services, and they concluded that the company was a reputable lab.
Vazquez then got in touch with Vera and told them he thought they had a unique opportunity to be able to perform tests in their community.
The company offered 600 tests at a time when most clinics were only able to conduct just 10 to 20 tests with a turnaround of about seven to nine days. Altru was offering a turnaround time of about 48 to 72 hours.
When it came to the infrastructure needed to administer the tests, they were fortunate on that front too.
“We happened to have some access to people that work for us under contract and give us advice,” Vale said, referring to former federal officers and employees who serve as consultants for Vale’s private businesses — the Starr-Camargo Bridge Company and the Border Pacific Railroad Company.
That proved useful in identifying that they needed to find contractors who they knew were going to be approved by FEMA, the Federal Emergency Management Agency.
So Vale, along with the industrial foundation and his business associates, went over some suggestions and landed on MLU Services, out of Athens, Georgia, which they were told had a quick response time for physical infrastructure.
Benavidez negotiated the deal which included agreeing on the cost, availability, but also on ensuring that it was a true public-private partnership.
“(One) that could be showcased as a model because right about that point, they were starting to receive all sorts of inquiries from throughout the country about getting involved in setting up their facilities,” she said. “We were serving, almost, as an original template to what needed to be in place for this type of outfit to be successful.”
Another sticking point in the negotiations was that the physical infrastructure required a guaranteed payment for the first month so Vale agreed to contribute $25,000 to fund the first month of testing.
Through her position on the STC board of trustees, Benavidez was able to secure permission to have the testing site at the parking lot of their Rio Grande City campus.
The day after the contract was signed, the infrastructure made its way from Houston and by 6 p.m. that evening, the physical structure was up, Vale said.
While Vale provided the funds for the facility, the county committed to footing the bill for patients that did not have insurance.
With those elements in place, the drive-thru testing site launched on March 22 and has been open seven days a week since the beginning, with the exception of two Sundays.
Part of the motivation for obtaining the testing site was because when there were talks of testing sites at Walmarts or Walgreens, they knew Starr County wouldn’t be a priority area, Benavidez said.
“We knew that if we looked at where hotspots were and we looked at density and population, we didn’t fit the profile of potentially being a site that would be selected to be a location that has priority with testing,” Benavidez said. “That’s why we went a route that worked for us in terms of teaming up with this public-private partnership.”
The site was open to the general public, regardless of whether they resided in Starr County or not.
Vera spoke with Hidalgo County Judge Richard F. Cortez and they agreed that Hidalgo County would help with expenses for their citizens who were tested in Starr.
“At the beginning, Hidalgo County didn’t have a testing site so we were getting a lot of people from Hidalgo coming over here and getting tested. They also had people that were indigent and did not have insurance, so Judge Cortez and myself talked about any person that gets tested in Hidalgo from Starr, he will bill us. Any person that gets tested over here, we will bill them,” Vera said. “However, we have a gentlemen’s agreement that if the federal government reimburses, we’re not going to bill each other. We’re neighbors, and we’re in this thing together, and we want to help each other.”
So far, about 50% of their testing has been for Hidalgo County people, Vazquez said. Additionally, they’ve also tested people from Harris County, San Antonio, Webb and Zapata counties.
When Starr County announced its first positive cases of the coronavirus on March 26, the Rio Grande City school district canceled classes for the remainder of the semester.
Since then, Starr County has reported a total nine confirmed cases of COVID-19, six of which were confirmed through the drive-thru testing site and three of which were confirmed through private health care providers.
The first seven cases have since been cleared and the patients were released from isolation.
“We have flattened the curve at (near) zero. This is something unheard of, it’s just like a dream,” Vazquez said. “You can’t get any better than this.”
Testing has also gone down significantly over the last two weeks compared to during the first three weeks of testing when they were performing between 25 and 30 tests a day.
He also noted that generally, clinics in the county are not seeing many patients with upper respiratory infections.
“I do my rounds every day, I speak with the different doctors every day in the community and that’s the message that I have every day,” he said. “We are not seeing people with cough; we are not seeing fever; we are not seeing sore throats.”
‘LOSING WAS NOT AN OPTION’
With such a quick, positive turnaround, Vazquez said officials needed to start thinking about how they were going to begin reverting back to normal life.
Through discussions with Vera, Benavidez and the city mayors, it became clear that testing would be fundamental in doing that, Vazquez said.
On Friday, businesses started opening back up and counties were no longer able to enforce orders to stay at home and requiring the use of face masks due to an executive order signed by Gov. Greg Abbott. However, Benavidez stressed that the danger hadn’t disappeared.
“We’re trying our best to ensure people don’t get too comfortable,” she said. “By no means does that translate into this coronavirus threat being any less of a problem at this point.”
How various communities begin opening back up will vary throughout, Benavidez said, but they will all be driven by testing.
“Until we test everybody, I think that’s when we’ll have a much better idea of where communities are,” she said.
Testing will also be vital in obtaining a profile of the community of who has been exposed versus who is still susceptible to the disease, Vazquez said, which will help determine what the future of their community would look like.
“And I believe that that crystal ball is the testing,” he said. “The testing is going to allow us to know how many people have been infected, how many people are at risk and how many people are perhaps infected right.”
To that end, the county has acquired the rapid tests. Though not meant to provide a definitive diagnosis, the serological tests will help determine if an individual has developed antibodies.
“That’s going to be important because that will be people who could go back to a somewhat normal lifestyle without the fear of getting infected,” Vazquez said.
Slowly, Vazquez said, they will begin mass testing to develop that community profile, starting with the 300 employees of the Starr County Memorial Hospital.
“We believe it’s important for us to have the profile of who is working for us and who is infected, who was infected, who has immunity, who doesn’t have it,” he said. “This is going to allow us to make informed decisions about the way that we are going to be back in business versus going blind — versus going with just luck ahead of us.”
Right now, they’re trying to develop a method to fund tests that require out-of-pocket pay for their first responders, Benavidez said.
“The biggest challenge is that right now, the CDC guidelines still require you to have symptoms to be tested and we’re hopeful that that may change,” she said.
In comparison to counties of like and larger size, Starr County’s response to the virus has been noted for being faster and arguably more aggressive than that of its neighbors.
“I believe the key to our success is our particular characteristics of our community,” Vazquez said. “We do not have beaches here, we don’t have big malls where people come from everywhere — we are in a smaller community.”
More people travel to McAllen from Starr County than the other way around, he said. Additionally, Hidalgo County has many more hospitals and cities to contend with.
“I give them all my recognition because I know that their path is a lot more complex than ours here,” Vazquez said.
Still, officials didn’t want to minimize the efforts of the people of Starr.
“We’re grateful and blessed,” Benavidez said. “But more importantly, I think it was this community coming together.”
When Vazquez first read about the statistics of the disease, he saw that it was affecting people dealing with morbid obesity, diabetes, hypertension, heart disease and kidney disease.
“And I thought, well that’s exactly the mix that I have in Starr County,” he said. “We are the poorest county in the state, we have all of those ingredients needed for a disaster recipe.”
Because of their lack of resources, he knew there could have been a disaster on their hands if they weren’t aggressive at the outset about combating the spread of the disease.
He pointed out that Starr County only had one hospital with just 48 beds, and only 13 primary care physicians in the entire community.
“We needed to either tackle this and fight it and defeat it, or basically succumb to it,” he said. “And that was not an option. Losing was not an option.”
Vera echoed that sentiment.
“In a nutshell, the reason Starr County reacted quickly was out of necessity more than anything,” he said.
“We don’t have the economic resources to wait … we needed time to do this and thank God that we started early.”