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Starr County's undercounted coronavirus deaths affecting resource availability

1 month 3 days 16 hours ago Saturday, July 04 2020 Jul 4, 2020 July 04, 2020 8:08 AM July 04, 2020 in News - Local

STARR COUNTY -- Resources to help COVID-19 patients are dwindling so fast in Starr County, the health authority warned Friday evening they will soon have to start rationing and considering the patient's odds of survival. The county waits to receive help from the state, but a systemic problem stands in the way -- death undercounting.

Five people suspected of having COVID-19 died in Starr County on Friday. That same day, doctors at Starr County Memorial Hospital were unable to find bed space for two critical patients in any health systems throughout the Rio Grande Valley.

"We are becoming basically New York," Dr. Jose Vazquez, Starr County health authority, said.

Vazquez said 18 people have died in Starr County, so far. Some of the deaths are confirmed to be related to COVID-19. 

FACTORS DELAYING THE COUNTING

There are several factors clogging the pipeline used to officially link the other deaths to the virus.

Paperwork is not moving fast enough from hospitals or nursing facilities to the state, making the death statistics lag. 

Vazquez said when a patient dies at a hospital or nursing facility, the cause of death has to be recorded and certified. Sometimes, sorting out the cause can take longer when other illnesses are present. 

Then, all the information must be made available to the state who officially attributes the death to COVID-19.

"We can't just count the death, we have to actually have the death certificate in hand and we have to  have the medical records in hand. So, if there's a delay in either, or we won't be able to count the death for that specific day," Dr. Emilie Prot, Regional Medical Director at Texas Department of State and Health Services, said. 

A problem starting further into the patient's history can also contribute to the under counting. 

In Starr County, Vazquez said two people have died in their homes. This poses a diagnostic problem.

"If someone dies at home, for example, and they're not evaluated by a physician, that death might not be counted as a COVID death. Maybe they didn't receive a test," Dr. Prot said. 

UNDERCOUNTING EFFECT ON RESOURCES 

So far, the official count of COVID-related deaths is three. Vazquez is concerned with the inaccurate reflection of the crisis facing the county. These statistics are used by the state to distribute human resources to county health systems overwhelmed with cases. 

"My concern with this under-reporting in the number of dead people is that resources are often tied up to the number of fatalities," Vazquez said. 

Currently there's 13 doctors in the county and all have their own practices. 

"We have just one hospitalist, one emergency room doctor at the time. In the evening, our hospitalist goes back to McAllen. The emergency room doctor is the one who takes care of the hospital patients, and at this point, we are running very thin and very short on manpower here," Vazquez said.

He anticipates the hospital will be needing more nurse practitioners, physicians, EMS personnel, and lab techs. That will be challenging to attain without an accurate count of deaths.

"It's important to note that all diseases are undercounted. COVID highlights the shortfalls in the way we count causes of death nationwide. It all comes down to what's noted on the death certificate," Prot said via text message Friday evening.

CURRENT STRAIN ON RESOURCES

As of Friday evening, 18 of Starr County Memorial Hospital's 49 beds were being used. Bed space isn't the problem, Vazquez said. Available doctors and nurses will run out before the hospital reaches its capacity. 

Medical personnel is already in short supply. 

The county's drive-thru testing facility was running at a slower speed this week. Three of the five people hired to run the lab contracted the virus. The National Guard testing site was closed funneling all patients interested in testing to the one site. 

Vazquez said a total of three to four technicians are running the mobile testing site, though it will be closed for the remainder of the weekend. The delays caused by the Fourth of July weekend could cause the samples to spoil during transfer. 

The public is urged not to celebrate with gatherings. 

"We are the point in Starr County where decisions are going to have to be made in the future about rationing resources," Vazquez said. 

The county received 40 more confirmed positive cases on Friday raising the number of active cases to close to 700. 

Vazquez spoke to the nursing facility and hospital to expedite records to help confirm COVID-related deaths. He'll also be writing to the Texas Department of Health notifying them of the situation and lack of resources. 

"That terrible decision that sometimes a health professional has to make about who gets a necessary piece of equipment or a resource... based on the possibility that patient has to survive... We are reaching the point where that may be necessary," Vazquez said.

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