DEL RIO, Texas – On a sweltering afternoon near the Texas-Mexico border, Ximena Colecio donned a powder-blue face mask before walking to a chain-link fence to hang the handmade sign clutched in her tiny fingers. Scrawled in bright neon marker, it reads: "For the best teacher. We will miss you."
There were 27 other such signs hanging at Irene C. Cardwell Elementary on July 22 to mourn the loss of Chavell Gutierrez, 55, who died a day earlier from COVID-19.
Gutierrez isn't the first person to succumb to the virus in this small southwest Texas border town of about 35,000 residents, and officials are certain she won't be the last.
The virus has stretched Del Rio's resources to its limits. As city and county officials scramble to stop the spread of the disease, local health care workers are fighting a war on two fronts: a battle to save their patients' lives and their own.
"We were at 13 cases for a long time until we got to around June," said Dr. Jaime Gutierrez, the local health authority.
As of Friday, there were 1,163 positive cases of COVID-19 in Val Verde County and 14 deaths, according to state data. Gutierrez said local counts place the number of fatalities much higher. Freezer trucks to store bodies arrived in Val Verde County on July 25.
"How many more deaths is it going to take before people decide enough is enough?" Gutierrez asks.
No one in Del Rio knew the answer to that question – but so far, it's not 48. Though many of those deaths are pending review before being classified as COVID-19, all of them died after testing positive for the virus as of July 30, local officials said.
"These people died of COVID-19 pneumonia," Gutierrez said. "My diagnosis on the death certificates says cause of death is 'pneumonia due to COVID-19.' "
'I've never seen anything like it'
Dressed in a dark suit and tie, Rick Robles looked serene for a man who began his workday abruptly at 2 a.m.
"I got that one and another call from the hospital at around 6:45 in the morning," he said. "Some people think (COVID-19) is a hoax. They should spend a day with me."
A lifelong resident of Del Rio, Robles owns and operates Sunset Memorial Oaks Funeral Home, where he's also responsible for embalming the dead. COVID-19 is like nothing he has experienced in his 30 years in the funeral industry, and he wishes more people would take the virus seriously. It's 12:28 p.m. on a Thursday, and Robles hasn't had enough time to eat breakfast.
His funeral home used to average eight to 10 services a week. That's no longer the case.
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"We've had about 18 (funerals) so far this week," Robles said. "Last week it was 22. It's a spike, and the difference is COVID. ... I've never seen anything like it. The situation with COVID-19 has gotten out of hand in this area."
There is data to support Robles' claim.
Val Verde County's population is slightly above 49,000. Its positive cases match counties more than twice its size.
By July 29, Val Verde County had reported up to 1,163 positive cases. Counties similar in size to Val Verde include Burnet, Kendall and Lamar. There were slightly more than 1,260 cases of COVID-19 among the three on the same date.
Speaking as a funeral director, Robles said one tragedy he has witnessed from COVID-19 is how it has stripped away people's ability to seek comfort in one another as they mourn their dead. Chapel and graveside services are limited to 10 people who have to maintain their distance or risk spreading the disease.
"That's hard for families," Robles said. "It's even harder for them to know their loved one passed on by themselves without having (family) there to hold their hand when they shared their last breath."
Alejandra Valadez knows exactly how that feels.
'I don't wish this upon anyone'
"My grandmother was alone when she died. ... There were nurses, but not family," Valadez said.
Dionisia Valadez, 88, had been living in a long-term care facility in Del Rio when staff placed the building on lockdown in March. On July 7, she was rushed into the ICU at Val Verde Regional Medical Center. Dionisia tested positive for COVID-19 and Influenza A and B.
Valadez was able to see her grandmother in the hospital, but not in person. She had to use an online video conferencing app, and the conversation was brief.
"The last time I saw her she wasn't responsive," Valadez said. "I told her I loved her very much, and that we were waiting for her to come home. ... She never did."
Five days after being admitted into the ICU, Dionisia Valadez succumbed to the virus on July 12. She was cremated soon after. There was no funeral service.
Valadez said she feels traumatized and infuriated after losing her grandmother to the virus. She wasn't able to hold her grandmother who lay dying in the hospital, and she's upset by the number of people who still aren't wearing masks. She too has a message for those who think COVID-19 is a hoax.
"It's real. It's here. And you don't know who could be a carrier. Wearing a mask could save someone else," Valadez said. "I don't wish this upon anyone. My grandmother helped raise me. ... It's hard watching someone you love fighting for their life and not being able to do anything about it."
Valadez continues to urge people to be responsible and do what they can to stop the spread of the virus, a mission shared by city, county, and Del Rio health care officials who have likened COVID-19 to a viral hurricane.
County sheriff: 'People need to be mindful'
One institution that has weathered the COVID-19 storm well so far has been the Val Verde County Jail, which hadn't reported a single case of the virus as of July 28. Val Verde County Sheriff Joe Frank Martinez aims to keep it that way.
"People are dying," Martinez said. "To slow this down, I think people need to be mindful of what's going on around them."
Martinez and officials with the Texas Commission on Jail Standards were aware of the virus early on. Since February, inmates at Val Verde County jail have not been allowed to see family members in person. They instead communicate on video through electronic devices. The jail has one entrance, and everyone is screened upon entry for signs of COVID-19.
Fogging machines spray an alcohol-based chemical throughout the facility two to three times a week. Border Patrol apprehensions are handled elsewhere, and the jail no longer holds misdemeanor offenders. Felony offenders and inmates charged with family violence are placed in a restrictive housing unit where they're closely monitored.
Outside the jail, Martinez said county and city law enforcement agencies have responded to complaints of people who aren't wearing masks, which have included food service employees at restaurants.
"I can't stress enough that we need to be respectful toward one another," Martinez said. "I think people need to be responsible for their actions, and in my opinion, they need to be held accountable for them. ... A person who's not respecting someone's space ought to be considered a deadly weapon."
It's Martinez's contention that COVID-19 is so prevalent in Del Rio that it's impossible to know who's contagious at this point, and failing to social-distance or wear a mask could very well kill someone.
"In the beginning, this community thought that (COVID) was just hype," said Val Verde Chief Deputy Waylon Bullard. "The majority are wearing masks now. ... There are still a few who say: 'It's my right. I don't have to,' but they're becoming fewer and far between."
One city official said those who insist on not wearing a mask are trying to hold on to some degree of "normal" amid a global pandemic, but "normal" is a relative term depending on whom you ask.
Del Rio City mayor: 'Please stay home'
"Everybody's trying to find some kind of normalcy. ... We're never going to go back to how it was before; it's not going to happen," said Del Rio City Mayor Bruno Lozano.
Seated in his office at City Hall, Lozano said he's worried that the reason the city's positive cases are so high is because people who are asymptomatic for COVID-19 are passing the virus to older, more susceptible residents at an alarming rate.
Visiting family and friends often is part of Del Rio's small-town culture – something Lozano is now trying to change.
On July 15, he made an urgent request in a video posted to the official City of Del Rio Facebook page asking people to voluntarily stay home for 21 days to limit the spread of the virus.
"We're currently experiencing an emergency crisis like never seen before," Lozano said in the video. He encouraged Del Rio residents to shop online whenever possible, use delivery apps to support local businesses, and, if necessary, designate only one family member to go to the grocery store.
In his efforts to educate the public, he has gone so far as to encourage the Del Rio community to tell their children not to hug their grandparents.
"We need to teach our children why it's important to save Grandma and Grampa's life," Lozano said. "Personal responsibility is everything."
Lozano is concerned Del Rio residents are ignoring calls to practice social distancing — spreading the virus with little thought for whom it might affect.
On the day Lozano pleaded with residents to stay home, there were as many as 455 positive cases of the coronavirus in Del Rio, according to hospital data. A week after his message, the case count had risen to 567.
'I don't think people are listening'
"There are no secrets in Del Rio. Everyone knows everyone," said Liz Williams, a waitress at the Malinda Restaurant inside the Ramada Inn. "The mayor asked people to stay home. I don't think people are listening to him."
Williams used to serve coffee, toast and scrambled eggs to a group of older residents she said would frequent her restaurant every morning. Williams is worried for their safety; she hasn't seen them in four months since the outbreak.
"I do know a few are OK, though," Williams said. "I got a text once with a photo. They were eating breakfast at someone's house. The text said, 'Hey, could we get some coffee over here, please?'"
That Williams is receiving texts at all from restaurant patrons she hasn't seen in months underscores how tightly woven the Del Rio community is. Williams said it's a small town, and people like to hang out no matter what's going on.
She suspects that is the reason the coronavirus has become such a problem in Val Verde County.
All the things that make small-town living worthwhile: its connections and relationships, handshakes and hugs – like blood in the ocean to a hungry shark – it creates a feeding frenzy for COVID-19.
During April, May and early June, Del Rio's positive cases hovered in the low teens. By mid-July, there were hundreds of positive cases.
"I live over near Comstock," Williams said. "Driving past the lake on Mother's Day and on Father's Day, the lake was filled with people."
It can't happen here ... until it does
Dr. Gutierrez and other officials agree with Williams. The lack of social distancing in Del Rio has made COVID-19 worse and likely cost people their lives.
For awhile, Del Rio was an abnormality. While the virus raged around the rest of the country in March, April and May, doctors and nurses at Val Verde County Regional Medical Center saw few cases. A hospital employee said people in Del Rio took the virus seriously at first.
"There were lines at H-E-B and Walmart with people 6 feet apart. Everybody had their masks on," she said.
Then in May, Texas began to reopen gradually, and things in Del Rio changed over the course of the summer holidays.
"Sure enough, 10 days after Mother's Day, we started to get a couple ... 10 days after Father's Day, then 10 days after the Fourth of July. ... It started to snowball," Gutierrez said.
Gutierrez said the summer is when Del Rio adults want to be at Lake Amistad and Del Rio teenagers want to visit San Antonio. In early June, Bexar County reported more than 2,800 positive cases of COVID-19, according to state data. By Father's Day the virus had ballooned to more than 6,800 cases in the San Antonio area.
"We saw a lot of teenagers driving to San Antonio, getting infected and coming back," Gutierrez said. "It set off a huge wave of positives and it hasn't let up. ... It's been ungodly. ... Fortunately, the medical community here has really stepped up."
The medical community in Val Verde County had little choice otherwise.
Del Rio Hospital is a COVID-19 war zone
The Val Verde Regional Medical Center has become a COVID-19 war zone, with actual soldiers from the U.S. Army and Navy fighting the disease alongside rural doctors and nurses. It's a battlefield where health care workers have displayed uncommon valor, bravery and sacrifice – and have suffered causalities.
There are green zones and red zones – places on the hospital floor marked with bright red tape where not even the hospital CEO can walk – not safely, not without a plastic suit of Personal Protective Equipment, and those places are growing larger every week because of the coronavirus.
On July 23, nurses at Val Verde Regional Medical Center were preparing a section of the hospital – its surgical services department – to become another COVID-19 unit, its fifth such unit in three weeks.
"For about three months, we sat on the fringes of COVID," said hospital CEO Linda Walker. "We were preparing here at the hospital. ... When things ramped up, they ramped up very quickly."
The Val Verde Regional Medical Center's initial capacity for COVID-19 began with seven beds. As cases grew, health care workers expanded from the ICU into an empty pediatric unit to create enough space for 19 beds.
A third, fourth and fifth unit soon followed. Of the 72 total hospital beds and the 50 patients who occupied them July 23, there were 30 COVID-19 patients. Those hospitalized afflicted with COVID-19 have ranged in age from their mid-90s to 6 years old.
Walker said many rural hospitals like theirs are struggling to avoid becoming "COVID hospitals." She said as more people infected by the coronavirus are admitted, other patients have to be housed safely in places like the emergency department, which is creating a strain on the local health care system.
The toll is also creating a strain on the health care workers.
Rural nurses pushing themselves to breaking point
"I've had employees in my office sobbing," said Chief Nursing Officer Jessica Nuutinen. "They say, 'I'm going to pick up this extra shift,' and tears are coming down their face. They say: 'I'm so tired but I know it's the right thing to do. This is my family, my community. I'm going to pick up this shift.'"
Opening more COVID-19 units has forced many changes at Val Verde Medical Center, and Nuutinen has helped guide hospital staff through the anxiety and the uncharted waters the virus is forcing onto its overtaxed workforce.
"I'm a nurse, and nurses get into this profession for a reason," she said. "What I truly admire about my staff is how we're all coming together to overcome (the virus). ... I've never been so proud of my team."
Still, there have been casualties.
Hospital loses one of its own to COVID-19
Irma Santellanes worked at Val Verde Regional Medical Center for 43 years. She was a unit secretary, and one of the first people to volunteer to screen those who entered the hospital by taking their temperature and placing a paper armband around their wrist.
"She did it with honor – 'Whatever you need, Miss Jess. Whatever you ask of me, I will do'" Nuutinen said.
Santellanes contracted COVID-19 and died days later on July 16. She was 62.
"This hospital has never seen anything like (COVID-19)," Walker said. "Most hospitals haven't, but particularly here in the rural areas ... this is not the flu, and it is incredibly contagious."
When hospital staff talk about their work family, they are speaking more than figuratively about what binds them together. Santellanes' daughter is a nurse who also works at Val Verde Regional Medical Center. Her sister works in the radiology department.
Many hospital employees wear a picture of Santellanes on their work badge. A table draped in white with a memorial is set up near the hospital entrance where Santellanes worked. A book with blank pages has been placed on the table to allow her work family the chance to share their memories of her and their grief over the death of one of their own.
Walker said of the roughly 570-person hospital workforce, about 32 employees were out sick July 23 with the coronavirus. Seven others had recovered from COVID-19 and returned to work despite fearing they might get the virus again.
One of them is Lucinda Renee Martin, director of Surgical Services.
What it's like to have COVID-19
Martin said her battle with COVID-19 began on a Monday toward the beginning of July.
"You never think it's going to happen to you ... until it does," Martin said. "You want to brush it off as, 'Oh, I have a little itch in the back of my throat – it's allergies.' That's how it started. Just a little scratch, like you need a cup of water."
Martin said she felt fine otherwise but the scratch continued into Tuesday. On Wednesday at about 3:45 p.m., Martin felt suddenly dizzy, then experienced a heat flash followed by the chills. Her energy quickly plummeted and she needed to rest.
"I sat down and thought, 'Something's wrong with me,'" she said.
All hospital staff get their temperature checked before entering the building. Martin said she felt healthy that morning. A colleague screened her again. Her temperature had spiked to 103 degrees. Now symptomatic for COVID-19, she took a swab test and immediately went home to quarantine for 14 days.
Martin is married and has five children, ages 17 years to 20 months old. She told her husband that something was wrong, then secluded herself in a bedroom and went to sleep.
"I pretty much slept for 13 days. It's scary. ... It was exhausting," she said. "I would wake up at 8 o'clock in the morning, look at the time, and then I'd wake up again and it would be 4 p.m."
Martin lost her sense of taste and smell, both symptoms of the virus. She had no appetite. Her bed was soaked in sweat. Her back ached and she continued to lose track of time. It was difficult to breathe. It was difficult just to exist.
In the evenings, Martin would tell her children "good night" using a mobile phone. Despite never leaving her room, her husband and her children began displaying symptoms of COVID-19 and needed to quarantine themselves.
July 23 was Martin's second day back at the hospital after recovering from the illness. She said her family is better, and understands the risks of what returning to work at a hospital with five coronavirus units could mean.
"I'm worried about getting COVID again, but I was worried before," Martin said. "Being a nurse, that's what we're here for. ... What we're fighting is a biological warfare, and everybody is fighting for their lives."
To help Martin and her colleagues win that battle is the U.S. military.
Soldiers are helping fight the disease
In mid-July, the U.S. Navy Rural Rapid Response Team 1 arrived at Val Verde Regional Medical Center. Their presence has been described as "a godsend."
Composed of Cmdr. Sean McKay, a U.S. Navy Doctor; Lt. Cmdr. Sarah Jagger, an ICU/Critical Care Nurse; and Capt. Stephanie Corsaro with the 62nd Medical Brigade, they're providing rural hospital staff with critical knowledge in how to combat COVID-19.
A specialist in the U.S. Army, Juron Toliver, and other service members provide additional support.
McKay works directly with COVID-19 patients in Del Rio. He's stationed in Maryland, where he has served in various hospitals as a pulmonary critical care doctor. He said the Navy developed medical teams about a month ago to support rural communities dealing with the coronavirus.
"We're being sent wherever we're needed," McKay said. "Other Navy teams have gone to New York. We have Navy critical-care teams in places like Virginia, Jacksonville, Florida, San Diego, Okinawa and Guam."
McKay said everyone has been welcoming and helpful while his team works alongside rural caregivers to slow the spread of the virus. He said his team will stay in Del Rio as long as the Department of Defense feels they're needed in the area..
Val Verde County Judge Lewis Owens hopes they stay awhile.
How much will it cost to fight COVID-19?
Judge Owens is part of what's referred to as the Val Verde County COVID Task force. He and other locally elected officials and health care providers meet often at the county courthouse to decide what actions are needed to stop the virus.
The county recently hired six contact tracers to track how COVID-19 is spreading through the community. With so many positive cases already, Owens said that the process is often daunting but that he and other officials are doing everything they can.
Deputies are now serving citations to people in Val Verde County who test positive for COVID-19. If they leave their home, if they violate quarantine, if they do not follow social distancing guidelines, the county will fine them up to $250, which could increase at a later date.
"There's no book for this," Owens said. "For a flood, you have a template. For a tornado, you have a template – you have things you follow. But for COVID-19? Things we thought were right two months ago we're having to rethink."
Owens likens COVID-19 more to a viral hurricane, and at the end of the day, Val Verde County will need more funding if its going to weather the storm.
A month ago, when COVID-19 began to skyrocket, Val Verde County had more than $724,000 it received in relief funds. As of July 22, all but $59,000 had been spent. Owens said the court had set aside $200,000, which officials used purchasing supplies to battle COVID-19 early during the pandemic.
"We bought a machine to make disinfectant, purchased hand sanitizer, handed out food. ... We didn't wait for these other programs to kick in. We started buying stuff," Owens said. "We bought masks, N-95's, and gowns."
Owens hasn't crunched all the numbers, but in consideration to staffing and other ancillary needs, said it might take another $1.2 million a year for Val Verde County to effectively deal with the coronavirus. But with so many unknowns, it's difficult to land on a number.
US coronavirus map: Tracking the outbreak
"I've already looked at the budget for the next fiscal year," Owens said. "We're going to be fine. The problems is that I'm using my reserves 'to be fine.' The problem is also what I'm going to do the following fiscal year, and then the year after that if this continues."
At this point, no one can say. COVID-19 still feels like a puzzle and it remains unknown how many pieces are missing – even when some of the things Del Rio has lost are glaringly obvious.
The absence in Del Rio at San Felipe Creek
San Felipe Creek is a spring-fed oasis along the eastern edge of the city. The water is so clear you can drop a stone off a bridge and watch as it sinks to the bottom of the creek bed.
Ordinarily in July, you would both hear and see Del Rio's children splashing in the water while parents watch from nearby shaded picnic tables – at least until, like so much else, it was closed by the coronavirus.
Yellow caution tape fastened to park benches flutter in the wind, and San Felipe Creek is now defined by absence – by what Del Rio no longer has because of COVID-19.
The absence is as real as the virus itself, as real as the teacher who won't be in the classroom, or the grandparent who will be missing at the dinner table. It wasn't always this way. And its uncertain when things in Del Rio will start to feel normal again.
Follow John Tufts on Twitter: @JTuftsReports
This article originally appeared on San Angelo Standard-Times: COVID-19 in Texas: Del Rio reels from coronavirus deaths