In a pandemic, trouble comes in all sizes

By Jorjanna Price

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For the "COVID-19 and the Texas Health Care System" session during the virtual TAC Legislative Conference, the panel discussion could have been framed as "A Tale of Two Counties." One would be a highly populated business center in the dynamic Rio Grande Valley; the other would be tiny in comparison and relatively isolated in the Panhandle. For health professionals in each, 2020 probably felt like "the worst of times" as the global pandemic found entry into their jurisdictions.

In Edinburg, Eduardo Olivarez drew on his 30 years of health care experience to address the challenge of COVID-19. As chief administrative officer of Hidalgo County Health and Human Services, he oversees programs such as indigent health care, preventive health care, and infectious diseases and prevention. His county's population is about 900,000.

Dr. John C. Howard is not only Donley County judge but also the only practicing physician in his sparse county of 3,400 people southeast of Amarillo. When the novel coronavirus appeared, his instinct as a doctor was to protect his patients, and as county judge, he knew he had to prepare his county for all contingencies. 

Clockwise from upper left, Donley County Judge John C. Howard, M.D.; TAC Legislative Consultant Rick Thompson; and Eduardo Olivarez, chief administrative officer, Hidalgo County Health and Human Services, participate in a panel discussion during the "COVID-19 and the Texas Health Care System" session at the TAC Legislative Conference.

Both men would spend 2020 waging war on a health threat that challenges all of their personal and professional skills.

Olivarez knew he had his hands full when he learned that combating COVID-19 would require social distancing. About 90 percent of his county's residents are Hispanic, and most grew up with a tradition of large family get-togethers. After Mother's Day, high school graduations, Memorial Day and Father's Day, Olivarez watched the climbing numbers of coronavirus infections and fatalities. Unfortunately, many early deaths were the grandparents who had hosted those family gatherings, he said. "It wasn’t until this got very personal and lots of people lost their love ones that they started to realize getting together in these crowds is actually deadly. It’s been a very unfortunate situation."

By the end of August, Hidalgo County ranked sixth in the state with more than 27,000 cases and 1,100 deaths.

In mid-March, Howard submitted his medical clinic's first test for COVID-19. Within days, he personally visited businesses and restaurants along U.S. Hwy. 287, a heavily traveled corridor between Dallas and Denver, and asked everyone to take voluntary measures to mitigate risk. 

Establishments complied by closing in-house dining and sanitizing gas pumps — all before the state's mandatory shutdown.

At the medical clinic, the doctor began aggressively administering tests for the coronavirus. Positive results were relatively few, but they placed Donley County far ahead of surrounding counties, some of which had not even begun testing. With his county showing unusual numbers of infection, Howard found himself taking calls from CNN, The Wall Street Journal and NBC Nightly News, all asking what was going on in Donley County.

To keep residents informed, the county judge began writing newspaper articles and held his first live news conference, taking questions on Facebook. By the end of August, Donley County had recorded 55 cases of COVID-19 and one death.

Olivarez said that one of the keys to addressing the pandemic is sending consistent messages throughout the area. This has been a challenge because of Hidalgo County’s 22 municipalities and 16 school districts. "It is essential to cooperate closely with all the different partners in the county," he said. "Form a joint information center to bring in all city, county and school district leadership and form a unified message for media and the community. Conduct regular briefings, daily or weekly. This way you can focus on education and awareness."

Olivarez said the next big hurdle will be flu season. "That's why we're pushing a big continuity program for fall because we already have people in the hospital with corona and flu. The good news is everything we do to prevent coronavirus will prevent flu. We use the same protocols."

Howard said tapping into established relationships has proved to be pivotal in his county. For instance, he was able to persuade the local college board to halt students from returning from spring break and to offer online classes instead. 

One day, he got word that a woman who tested positive for COVID-19 was not staying in quarantine. Soon she got a surprise visit. "When the sheriff and county judge coming knocking on your door and explain your need to isolate, you might well pay attention," he said. 

This time she listened to the doctor, as well as the judge.