Local doctor answers residents’ questions on coronavirus

“Statistically speaking," it's “very likely” that coronavirus is already in the tri-county, Ekta Escovar, a member of the local COVID-19 task force, told Marfa residents.

MARFA — Dr. Ekta Escovar, a doctor at the Big Bend Regional Medical Center and  member of the local COVID-19 task force, called in to a virtual Marfa City Council meeting last week to brief locals on the deadly pandemic.

Escovar started on a dire note. “Statistically speaking,” she said, it’s “very likely” that coronavirus is already in the tri-county.

“It’s a matter of time before we catch our first case” through testing, she said. “That doesn’t mean we’re case-free in our area.”

Coronavirus, she said, has “slowly crept over the West Texas area” from San Antonio and Austin to places like Midland and Odessa, which are now reporting cases. And spring break travel likely accelerated its spread, she said.

After localized outbreaks in New York and Washington State, the coronavirus has been gaining a foothold in Texas over the past weeks, with virtually every major Texas city — including El Paso — now reporting a steady rise in cases. On Saturday, Houston’s confirmed coronavirus tally more than tripled from 69 to 232 cases, the Houston Chronicle reported. As of press time Houston’s Harris County is reporting 563 cases.

As coronavirus gets closer, locals will need to take more precautions, especially when it comes to weekend trips to cities like El Paso, she said. “The chances of doing a quick run for the weekend and coming back with COVID is a lot higher” and will continue to grow.

Escovar also addressed issues with the limited supply of tests, which The Big Bend Sentinel reported on last week. She said BBRMC has been testing for coronavirus for weeks and was “ramping up.” But she acknowledged testing capacity is still “limited” and that the process is “not perfect.”

But accessing tests is not the only problem. As testing sites deal with a steady rise in demand, the average turnaround to get results has gone from around two to four days to around six to eight, she said.

“In my ideal world, I would love it if we could test everybody,” Escovar said. Having “something locally on-site” that would allow BBRMC to run its own tests and get results would be a “game changer.”

But Escovar stressed that limited tests and overwhelmed labs aren’t the only problem. The tests itself only have 70 percent accuracy, she said — meaning there’s a 30 percent chance someone with coronavirus could still test negative.

“This is such a new virus and such a new test,” she said. “It hasn’t had time to be developed and improved on.”

Over 100 people tuned in to the Marfa City Council meeting. And when Escovar opened up the call to questions, officials and residents asked her about coronavirus for over an hour.

Councilmember Raul Lara asked her how people could distinguish between symptoms of coronavirus and the regular flu, since both often result in fevers. Councilmember Natalie Melendez similarly asked her what symptoms should “ring alarm bells” for residents and compel them to seek treatment.

Escovar acknowledged that the flu and coronavirus could have “very similar” symptoms in milder cases. About 80 percent of coronavirus patients have a “persistent fever.” But while flus typically lead to wet coughs, coronavirus leads to a dry, hacking cough. She compared it to a cough from allergies.

As for which symptoms prompted a medical emergency, Escovar said common sense still applied. People should seek treatment for symptoms that “normally land you in a doctor’s office or ER for anything else,” she said. And one of the most worrying symptoms is a “cough that has progressed to a shortness of breath.”

“The progression of COVID tends to be pretty obvious,” she added.

Resident Al Davis asked Escovar how many tests BBRMC had run, and whether she was “comfortable we’re testing enough.” Escovar demurred, saying she couldn’t “give out exact details” on testing at the local hospital.

BBRMC has so far been reticent to release info on how many tests it’s run. The hospital has cited privacy rules in HIPAA, the Health Insurance Portability and Accountability Act.

“We’re ensuring that we are following HIPAA and patient privacy laws,” Escovar said at a teleconference with journalists earlier this month when asked about local testing figures.

Clark Childers, another resident, asked how many coronavirus cases the region could handle before local healthcare systems become overwhelmed. “It’s hard to know,” Escovar said.

In part, it depends on how severe the cases are. The BBRMC has 25 beds and has “some allowances” to add more in emergencies, she said. But “if all those folks are severely ill and need ventilators, it doesn’t matter that we have enough beds.” The hospital currently only has two ventilators.

Another factor is density. Residents of New York, who have so far seen the worst outbreak in the United States, encounter countless people throughout the day.

In New York, there are “so many more people than here in West Texas,” she said. But while Marfa’s low density could blunt the spread of coronavirus, it is hard to quantify that impact.

Coronavirus also mutated as it moved to the United States, she said. The U.S. strain is significantly less deadly, with an estimated fatality rate of around 1.7 percent compared to the around 5 percent who died in Wuhan, China, where the disease first appeared.

The downside, she said, is that the less severe symptoms have made the disease harder to find. “That’s what’s added to so many cases in such a short time,” she said.

Around 90 percent of coronavirus patients have mild or moderate cases of the illness, she said. Around 10 percent require hospitalization — and often for weeks.

“Once a hospital bed is occupied, it’s pretty much used and taken for the next month and a half,” she said. The danger of coronavirus is therefore “not just the fatality rate but how long you end up using hospital resources.”

About 85 percent of patients who end up on ventilators never come off them, Escovar said. And with “very slim” chances of recovery, Escovar questioned how the hospital would decide who gets one.

“I don’t want to make those decisions,” she said. “I don’t want to decide who lives and dies.”

“Overreacting and being alarmist now is going to save lives,” she added.

Several residents asked about how long it would be before life returns to normal. Resident Eileen Myles brought up “arbitrary” proposed dates in April to end lockdowns and asked, “Isn’t it probably wiser to think we’re in for a longer haul?”

“The short answer is yes,” Escovar said. To truly slow the spread of coronavirus, the region is looking at “months of social distancing — true, true social distancing.”

Several residents also asked about the distinction between mandatory and recommended health advisories on issues like social distancing and bar closures. Escovar lamented the fact that people in other countries, including Hong Kong, had taken health recommendations more seriously.

If more people listened to health recommendations, a coronavirus lockdown “would never have to go to the place where it’s mandatory,” she said. And she acknowledged that the virus had opportunities to spread so long as people “still have freedom of movement.”

“They’re not being met uniformly, and we never expected them to be,” Escovar said of recommendations from BBRMC. But as long as some people listen, it can still make a difference.

“If 50 percent of folks listen to those recommendations and take them to heart — or if we at least get our vulnerable — then those are lives saved,” she said.