AUSTIN, Texas – In late October, the El Paso television station KFOX-14 aired video of fire department ambulances lining up at the international bridge picking up Covid-19 patients who had just crossed from Mexico and driving them to hospitals, the ones now filled to crisis proportions.
Along with the video footage, the local TV station quoted one of the fire department's paramedics describing an assembly-line operation where the whole ambulance fleet at times was pressed into transporting Mexicans from the international ports of entry to El Paso hospitals. Projecting one of the nation's reddest Covid-19 hotspots, El Paso and its filled-beyond-capacity hospitals are now at the epicenter of national news coverage that rarely reflects testimony like this:
"There's some days where it's only three or four times and other days when it will be 13 or 14 responses. You'll be there for one patient and [CBP] customs will let you know, hey there's another one right behind them and another one. Sometimes there are four or five waiting in line," the fire department employee explained. "Multiple times in this pandemic we will be in a complete system overload where there are no ambulances available" because they were picking up patients at El Paso's international bridges.
Pieced together over a six-month period, such isolated accounts from hospital administrators, local officials, and federal officials in the border states reveal a significant northward Covid-19 patient migration that has gone neither broadly recognized nor considered for containment policy responses to address it. In a nutshell, here is what is happening in U.S. states that border Mexico:
Mexicans sick with the virus have overrun hospitals in their own cities south of the border since at least May 2020 to the point that Mexican facilities became unable to care for new patients. Left with no care on the Mexico side, unknown but significant numbers of Covid-sick patients with green cards, dual citizenship, or border-crossing cards have exploited legal loopholes in President Trump's March 2020 emergency closure so they can reach US hospitals. Other ill crossers are American expatriates, while some were Mexican patients illegally crossing outside of the ports of entry.
At issue — in the general national failure to recognize this contribution to the U.S. hospital crisis — is whether American policy-makers might finally consider it when implementing lockdowns, social-distancing requirements, and other local U.S. policies intended to preserve hospital systems in hard-hit border states like Texas. In ordering measures that would only control for local spread that occurred inside the United States — policies that do not, of course, influence spreading behaviors in Mexico — U.S. leaderships risk repeating a consequential public health mistake that occurred during the summer and is underway again.
The Evidence
As early as May, when virus cases began the last major surge in border states, the Washington Post, the New York Times, and the Wall Street Journal all reported that many thousands of infected people from Mexico were fleeing their own collapsing hospitals to facilities in Arizona and California, adding to American counts of hospitalization and deaths.
The publications reported that most appeared to be "essential workers" with visas or border-crossing cards, American expatriates, dual citizenship holders, and Mexican legal permanent residents allowed to cross under the Trump border closure exemptions. Border Patrol sources said many other infected patients had entered illegally and that agents often transported them to U.S. hospitals. From the border, they were moved into the American interior.
The June 7 New York Times story "Coronavirus Jumps the Border, Overwhelming Hospitals in California", reported so many sick patients had crossed that California was forced to activate the "extraordinary response" of transporting them to San Francisco, Santa Barbara, and Sacramento in a helicopter airlift and by ambulance fleets. The same story cited state health officials attributing a massive influx into Arizona border communities to "people coming in from Sonora state".
The patient transports from border hospitals to interior ones may well have created the false appearance of greater local spread in interior cities. In an interview with California Pastor Tim Thompson, who produces a YouTube video program titled "This is Our Watch", registered nurse Megan Hill, who is working with Covid patients in Riverside County, Calif., said her patients were arriving by helicopter from border facilities.
"According to my patients, they are coming over from Mexico because they're not getting treated in Mexico. They are flying helicopters every hour — bam, bam, bam — constantly flying them. It's definitely happening."
A May 11 Wall Street Journal story citing all of the same circumstances noted that the crisis of Covid-19 patients swamping hospitals south of San Diego posed "a new threat" distinct from spread that might arise from the easing of social-distancing restrictions. The Washington Post's May 27 story reported that the traffic "posed an unprecedented challenge" to California as patients fled packed Tijuana hospitals. It estimated that about half the coronavirus patients in several California border hospitals had come in from Mexico, many of them shipped to Los Angeles hospitals to keep beds available for more Mexicans on the border.
A June 29 CNN report seemed to be the first to report Mexican-to-American ambulance hand-off operations like the one more recently described in El Paso. The CNN story quoted Carmela Coyle, CEO of the California Hospital Association, calling what was underway as "an unprecedented surge across the border". It also quoted California's emergency medical services authority head Dr. David Duncan describing "the steady stream" coming into Imperial County as "gas on the fire" that will "continue to escalate and fuel the Covid pressures that we see."
At about the same time, Covid patients overwhelmed almost every hospital along the Texas border after hospitals collapsed in Matamoros across from Brownsville, in Reynosa across from McAllen, in Nuevo Laredo across from Laredo, and in Juarez across from El Paso. Texas A&M University's Transportation Institute saw the problem as so pronounced that it proposed a plan for Mexican ambulances to cut to the front of long lines at ports of entry so that Covid-19 patients could reach American hospitals faster.
In Texas's Rio Grande Valley on the Mexico border, Dr. Ivonne Lopez, medical director of the McAllen Hospital Group at the McAllen Medical Center, told local media that "many" patients from Mexico were adding to the bed-shortage crisis.
"They are coming in because their resources over there are also limited so they are coming in to our area seeking medical attention and, by law, we have to provide it," Dr. Lopez said. "The patients that cross the border say, 'we don't have hospital space over there. The oxygen is gone. We don't have medications, so we cross the border.'"
As in California and Arizona, patients on the Texas border were airlifted to empty beds as far north as Amarillo in the Texas Panhandle and by ground transport to Houston, Dallas, San Antonio, and small rural hospitals throughout the state, where all were presumed to reflect regular local community spread.
Flashing forward to the new outbreak making national headlines, almost every hallmark of Covid-19 medical migration from Mexico is once again evident in El Paso and elsewhere along the border. El Paso Deputy Fire Chief Jorge Rodriguez told the city council in early November of Mexican Covid patients crossing over that "Once they are on U.S. soil, we have a legal responsibility to provide services to anyone who is inside the city limits, and we continue to do that."
And also like in the summer, El Paso hospitals once again had become so full by mid-November that another airlift was ordered to transport patients to hospitals in the Texas interior.
A Federal Solution, Not for Cities or States
An enabling factor for all of this is the president's March 2020 border closure. It only prohibits inbound crossings by those traveling "for tourism purposes, such as sightseeing, recreation, gambling or attending cultural events". Everyone else, including "individuals traveling for medical purposes (e.g., to receive medical treatment in the United States)", is pretty much free to cross at will with a variety of visa types.
Gustavo Sanchez, president of the El Paso regional union representing U.S. Customs officers, was quoted November 2 saying thousands of people with regular border-crossing cards (issued by U.S. consulates and valid for 10 years) come and go as they please with or without Covid-19, making the essential-travel order difficult for the agency to enforce.
"We've got thousands of people crossing. The hospitals in Juarez are full to capacity. Any little thing that's even non-life threatening, they're bringing them over here because they're saturated. Their hospitals are saturated," Sanchez said.
Why Knowing Matters
State and local leaders need to work with federal officials on future containment remedies mainly because the border closure is a federal matter, while local spread belongs to state and county elected officials.
Knowing of the unseen second river of patients from Mexico — and why it is able to reach U.S. hospitals despite a "border closure" — are foundational for leaderships to know so that they can knowledgeably collaborate on a cocktail of policies that more precisely address the problem. Only then might decision-makers consider options such as capacity-building medical assistance to Mexico and a tightening of the border closure loopholes.
In the absence of any acknowledgement that Mexico is a source of U.S. hospitalization strains and also its scope, U.S. leaderships risk repeating the same mistake with the same problem in an endless loop.