For Andrew Rubalcaba's 39th birthday, he wanted to get out of town - but he also wanted to be safe.
So before Thanksgiving, he drove more than 500 miles west from his home in McKinney to visit Marfa and Big Bend National Park.
The popular Texas tourist destinations were appealing in the midst of a still-raging pandemic because they are seemingly in the middle of nowhere. They're rural, sparsely populated, outdoorsy and now - overrun with visitors and saturated with COVID-19 cases.
"If only we knew the locals were saying don't come, definitely we would not have gone. We would not have gone out of respect for the local population," Rubalcaba said.
Presidio and Brewster counties, home to Marfa and Big Bend, along with nearby Culberson County, lead the state in cases per 1,000 residents in the last two weeks, according to a Texas Tribune analysis. In fact, all of West Texas, including Jeff Davis, Hudspeth and El Paso counties, is ablaze with increasing COVID-19 cases and low on hospital beds.
New cases of coronavirus in Texas in the last two weeks
The Texas Tribune is measuring the rate of new coronavirus cases per 1,000 residents in each county in the last two weeks. This shows where numbers are increasing in the state.
Big Bend Regional Medical Center, located in Brewster County, has just 25 acute care beds. Culberson County's 2,200 residents have just Culberson Hospital, where there are 14 beds and two ventilators, but at least one doctor said she doesn't feel adequately prepared to use them.
"It's unlikely we'd be able to help them at this point," said El Paso County Judge Ricardo Samaniego, the county judge of El Paso, where COVID-19 patients occupy more than 35% of hospital beds.
Patients in dire condition are often transferred from the small towns to regional hospitals in larger metropolitan areas. But those closest hospital systems in El Paso, Lubbock and Midland, which have more resources, are already struggling with their own influxes of local cases, leaving doctors and county officials worried a bump in cases from Thanksgiving gatherings will fill beds beyond capacity with nowhere left to send the sickest patients.
Without El Paso as an option to send patients, nearby doctors and officials are scrambling.
"It's a scary feeling to have a critically ill patient with nowhere to go," said Gilda Morales, a Culberson County commissioner and doctor at Culberson Hospital.
She said that in recent weeks, the county has sent struggling patients to hospitals in San Antonio - more than 400 miles away - including Culberson County Judge Carlos Urias, who's been there for nearly four weeks.
If a flood of residents need to be hospitalized quickly, and cases in San Antonio and other metropolitan areas swell, Culberson might not have the resources to treat everyone in need, Morales said.
"We're worried those beds will run out, and then what?" Morales said. "We're all holding our breath because as much as we told people not to get together for Thanksgiving, the holidays and family give a false sense of security."
Hospitals across the West Texas region are "bumping capacity and stretched absolutely to the limit," said John Henderson, president of the Texas Organization of Rural and Community Hospitals. Administrators have struggled to find open beds, in some cases calling 15 or 20 facilities, he said.
"Everyone is headed the wrong direction," he said. "Every week is a little worse than the last one."
In Odessa and in neighboring Midland, the area's three hospitals serve as "referral centers," accepting patients from small-town facilities that are ill equipped to treat serious illnesses.
"All of our outlying facilities, they don't have ICUs or ventilators that can take care of patients long term," said Dr. Rohith Saravanan, chief medical officer of Odessa Regional Medical Center. The hospital in recent weeks added 34 beds for people with COVID-19, and, as of Tuesday, only four were still empty.
"If we see any more sharp rises, I don't think our hospitals will be able to keep up with capacity," Saravanan said.
Scenic Mountain Medical Center in Big Spring is one of those outlying community hospitals. The facility's seven intensive care unit beds are full, as are 18 overflow beds that fill the hallways.
Fueled by tourism
Before Thanksgiving, cases and hospitalizations were already on the rise in the mostly rural region, and locals worried tourism and family gatherings would only make the hot spot worse.
Yet even as cases of the coronavirus have ballooned, tourists from other parts of the state have continued to flock to the region's campsites and small communities, a worrying trend for local officials.
In the tiny desert city and artistic hub of Marfa, tourism never slowed. People still flood the town's hotels and shops. It's a delicate situation for the town of 1,700, which has an economy that relies on tourism but has seen an explosion of COVID-19.
"Our community is fragile," said City Council member Raúl Lara. He buys groceries on Fridays after work and rarely leaves his house during weekends to avoid crowds.
"It's a double-edged sword, because we live on tourism money and we die without it," Lara said.
In response to rising concern that the next two weeks could be catastrophic because of Thanksgiving gatherings, residents of Jeff Davis County, one of the three counties touched by Big Bend, have urged one another to take precautions in a Facebook group. The members discuss the "tourons" - rhymes with morons - a reference to the tourists that continue to visit despite West Texas emerging as a hot spot.
Jeanine Bishop, the admin of the Facebook group Jeff Davis County News & Talk, also said tourism is a "double-edged sword." The county's 2,300 residents are forced to pick between tourism and potentially more COVID-19, or closed businesses and unemployment.
This week, Bishop, who runs the Alpine Humane Society and a thrift shop, laid off all of her staff. As cases rise, she worries about unmasked customers entering her store.
"It's hard. We need the tourist dollars, but we're really scared of what's going to happen because of Thanksgiving," Bishop said. She's frustrated with the government's inaction. Despite shutdowns this spring when COVID-19 was not widespread in her area, neither the state government nor Bishop's local officials have urged stricter precautions this time around.
She feels powerless to stop what feels like an inevitable and sharp increase in cases as she watches more Texans vacation in the region while her community suffers the consequences.
She said last weekend most customers at her store said they were from out of town. Bishop offered them a message: "Please don't. We're going to be devastated in two weeks."
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