EL PASO, Texas — Salma Sandoval is a pharmacy student who spends most of her working hours in El Paso hospitals as part of her degree program. Until about a month ago, the impact of the coronavirus was visible, but, for the most part, did not alarm her.

Today, Sandoval said she’s in shock as she’s watched the El Paso hospital floors fill up one by one with COVID patients as the city’s infection rates have surged since the beginning of October. El Paso County recorded 976 new cases on Thursday morning, down slightly from the previous day’s 1,292.

What You Need To Know

  • El Paso County recorded 976 new COVID cases, a slight decrease from the day before

  • Hospitalizations are still high at 1,148, or 51% of the current COVID cases

  • Texas surpassed 1 million cases this week, the first state in the U.S. to do so

With a population of about 680,000, El Paso is now an epicenter of the pandemic as cases rip across the country.

This week, Texas became the first state in the nation to reach 1 million cases, with El Paso leading the way in infection and hospitalization rates. Between the first week of October and the first week of November, 725 people died of COVID in El Paso County.

Many of El Paso’s hospitals have set up tents in parking lots to treat an overflow of COVID patients. In a scene reminiscent of the early days of the pandemic in places like New York, lines of cars snake around traffic cones as they wait at mobile testing sites.

The city’s convention center is being used as a field hospital and will expand by 100 more beds this week. Some 1,400 additional medical personnel have come to the county to help hospital staff who are stretched thin by exhaustion and, in some cases, have themselves been stricken with the coronavirus.

On Monday, the County Medical Examiner set up 10 mobile morgues, five of which are currently in use, while the remaining five stand waiting.

“It’s shocking,” Sandoval, 22, said about watching the hospitals fill up so quickly and her community become gripped with fear. “Seeing it up close is a real eye-opener.”

The cause of the latest surge in El Paso has been difficult to pin down, but there are several factors at play here, said Dr. Kristina Mena, the dean of the El Paso campus of the University of Texas at Houston School of Public Health.

El Paso is a border town that shares close ties with Juarez, Mexico, just over the Rio Grande River. Even in COVID times, there is a significant amount of cross-border action, and thousands of U.S. citizens live on the Mexican side. But that doesn’t fully explain the surge. El Paso shares that dynamic with similar border towns in Texas that are not seeing the same kind of rise in infection rates at this time.

But the cultural, historical, and familial ties to Mexico and other Hispanic cultures certainly is a major factor playing into El Paso’s cases, Mena said. The city is a multicultural society, with Hispanics, Native Americans, and white Texans making up the city’s population. An additional 200,000 live in the more rural parts of El Paso County.

Those deep cultural roots thrive on large family gatherings in which multigenerational households celebrate meals and holidays together.

“It is sort of unavoidable here, even though we have tried,” said Sarah Sandoval, Salma’s 24-year-old sister. “We’ve had to stay away from our older relatives for a long time, and it’s difficult. We can’t just stop seeing each other. It’s not natural for us.”

Mena said more research needs to be done on the role of inner-household transmission in the community.

“The challenge is that, if one member of the household starts showing symptoms, by the time they confirm positive for the virus through testing, they have likely transmitted to another person in the household, who has now been going out into the community for work or other reasons and possibly transmitted it to another family,” she said.

Given that scenario, it’s hard to tell who was the index case, Mena said. The hard part comes for a household that is told to isolate or quarantine the COVID patients, two ideas that are often seen as the same thing, she said. Many families may not have the space to isolate a COVID patient.

While a lot of attention is given to the ways to mitigate the virus in the community, such as social distancing, hand washing, and wearing a mask, Mena argues that attention has drifted away from how households should function during the pandemic.

“There’s so much emphasis about staying at home to stop the spread, but that shouldn’t mean it’s a free-for-all once we are home.”

For example, in many cultures, it’s not unusual for an entire household to wear a face mask inside the home if one person becomes sick with a respiratory illness, Mena said. While that’s not often practiced here in the U.S., we would benefit from more messaging on reducing transmission in the home.

On Wednesday, El Paso County Judge Ricardo Samaniego extended a countywide shutdown and curfew until Dec. 1, an order that has been unpopular since it was first put in place on Oct. 29.

The order requires all non-essential businesses to close immediately. Restaurants could remain open for take-out and delivery only.

The order has been controversial and caused tensions between the city and county leadership. Many local businesses have joined with the Texas Attorney General in a lawsuit aimed at overturning the order because it does not comply with Gov. Greg Abbott’s previous rulings on COVID restrictions. A ruling on that case could come on Nov. 13.

El Paso Mayor Dee Margo argued Thursday that the city’s economic health should be considered as important as its public health. The city has recorded a loss of nearly 27% of its small- and medium-sized businesses from January to October of this year, Margo said in a press conference held at city hall.

County Judge Samaniego said the current order is temporary and urged the county and, in particular, the business community, to rally together to help reduce infection and hospital rates.

Some 51% of El Paso County COVID patients are in the hospital, a number that Samaniego said he would like to see decrease to below 30%.

“We need to find a balance between economic health and public health,” Margo said.

On Thursday, an appeals court placed a temporary halt on the local shutdown order. It now awaits a final decision from the Texas Supreme Court, which is expected to rule on Friday. Texas Attorney General Ken Paxton, who called the lockdown “oppressive” because it went beyond restrictions previously put in place by Gov. Greg Abbott, tweeted, "It is important that we do not shutdown the economy ever again, & this decision allows small businesses to continue to operate & pay employees."

The economic toll on El Paso was palpable in the downtown streets and square, where in recent years, a revitalization effort has taken shape. Several large hotels have had makeovers, and their restaurants have become destinations for locals and tourists alike.

The city recently brought back a network of streetcar tracks and rehabilitated its vintage streetcars, which began traveling down Mesa Street to downtown for the first time since 1974. The streetcars carried students from the Univerity of Texas at El Paso, commonly referred to here as UTEP, a state school that has grown its student body and shed its reputation as a commuter school.

The city isn’t a bad place for young people to live, despite the report it gets from the rest of Texas, which sees it as a backwater outpost, the Sandoval sisters said. Before COVID hit the U.S., many more bars, and, in particular, craft beer breweries, had opened up, giving nightlife in El Paso many more options, they said.

With COVID cases putting El Paso in the national news, the city’s reputation is again in question, the sisters fear. So are many things about the future, as across the country, the pandemic continues to disrupt American life.

Sarah Sandoval is applying for a master’s degree in occupational therapy. Part of the prerequisites for admission into a program is a demonstration of hours worked in the medical field. That’s been nearly impossible to do during COVID times, she said.

Sarah Sandoval got engaged on Sunday to her boyfriend, Rafael Ravanera, 26, a sergeant in the U.S. Army at Fort Bliss, a base that is almost a city on its own to the east of El Paso. On a clear night this week, Salma Sandoval was taking photos of her sister and her fiancee to be used in announcing the couple’s engagement.

The couple posed among the hanging lights on El Paso Street, mostly a tourist trap because of its famous quirky pawn shops and Western wear shops. Nearly all the stores were closed, but the setting was scenic nonetheless as the sunset colored the El Paso sky pink.

Depending on how things go with the pandemic, the couple hoped to at least do a legal wedding in March, they said with a smile and hint of the hope stemming from youthful love and a new engagement. 

But they were holding out before announcing a date for a “big, beautiful” May wedding, just in case things take a turn for the worse, Sarah Sandoval said. 

EL PASO, Texas—Salma Sandoval is a pharmacy student who spends most of her working hours in El Paso hospitals as part of her degree program. Until about a month ago, the impact of the coronavirus was visible but for the most part, did not alarm her.

Today, Sandoval said she’s in shock as she’s watched the El Paso hospital floors fill up one by one with COVID patients as the city’s infection rates have surged since the beginning of October. El Paso County recorded 976 new cases on Thursday morning, down slightly from the previous day’s 1,292.

The city of El Paso with a population of about 680,000 is now an epicenter of the pandemic as cases within the U.S. rips across the country.

This week, Texas became the first state in the nation to reach 1 million cases, with El Paso leading the way in infection and hospitalization rates. Between the first week of October and the first week of November, 725 people died of Covid in El Paso County.

Many of El Paso’s hospitals have set up tents in parking lots to treat an overflow of COVID patients. In a scene reminiscent of the early days of the pandemic in places like New York, lines of cars snake around traffic cones as they wait at mobile testing sites.

The city’s convention center is being used as a field hospital and will expand by 100 more beds this week. Some 1,400 additional medical personnel have come to the county to help hospital staff who are stretched thin by exhaustion and in some cases, have themselves been stricken with the coronavirus.

On Monday, the County Medical Examiner set up 10 mobile morgues, five of which are currently in use while the remaining five stands waiting.

“It’s shocking,” Sandoval, 22,  said about watching the hospitals fill up so quickly and her community become gripped with fear. “Seeing it up close is a real eye-opener.”

The cause of the latest surge in El Paso has been difficult to pindown, but there are several factors at play here, said Dr. Kristina Mena, the dean of the El Paso campus of the University of Texas at Houston School of Public Health.

El Paso is a border town that shares close ties with Juarez, Mexico, just over the Rio Grande River. Even in COVID times, there is a significant amount of cross-border action and thousands of U.S. citizens live on the Mexican side. But that doesn’t fully explain the surge. El Paso shares that dynamic with similar border towns in Texas that are not seeing the same kind of surge in infection rates at this time.

But the cultural, historical, and familial ties to Mexico and other Hispanic cultures certainly is a major factor playing into El Paso’s cases, Mena said. The city is a multicultural society, with Hispanics, Native Americans, and white Texans making up the city’s approximately 681,000 population. An additional 200,000 live in the more rural parts of El Paso County.

Those deep cultural roots thrive on large family gatherings in which multigenerational households celebrate meals and holidays together.

“It is sort of unavoidable here, even though we have tried,” said Sarah Sandoval, Salma’s 24-year-old sister said. “We’ve had to stay away from our older relatives for a long time, and it’s difficult. We can’t just stop seeing each other. It’s not natural for us.”

Mena said more research needs to be done on the role of inner-household transmission in the community.

“The challenge is that if one member of the household starts showing symptoms, by the time they confirm positive for the virus through testing, they have likely transmitted to another person in the household, who has now been going out into the community for work or other reasons and possibly transmitted it to another family,” she said.

Given that scenario, it’s hard to tell who was the index case, Mena said. The hard part comes for a household that is told to isolate or quarantine the COVID patients, two ideas that are often seen as the same thing, she said. Many households may not have the space to isolate a COVID patient.

While a lot of attention is given to the ways to mitigate the virus in the community, such as social distancing, hand washing, and wearing a mask, Mena argues that attention has drifted away from how households should function during the pandemic.

“There’s so much emphasis about staying at home to stop the spread, but that shouldn’t mean it’s a free for all once we are home.”

For example, in many cultures, it’s not unusual for an entire household to wear a face mask inside the home if one person becomes sick with a respiratory illness, Mena said. While that’s not often practiced here in the U.S., we would benefit from more messaging on how to reduced transmission in the home, she said.

On Wednesday, El Paso County Judge Richardo Samaniego extended a countywide shutdown and curfew until Dec. 1, an order that has been unpopular since it was first put in place on Oct. 29.

The order requires all non-essential businesses to close immediately. Restaurants could remain open for take-out and delivery only.

The order has been controversial and caused tensions between the city and county leadership. Many local businesses have joined with the Texas Attorney General in a lawsuit aimed at overturning the order because it does not comply with Gov. Greg Abbott’s previous rulings on COVID restrictions. A ruling on that case could come on Nov. 13.

El Paso Mayor Dee Margo argued Thursday that the economic health of the city should be considered as important as its public health. The city has recorded a loss of nearly 27% of its small- and medium-sized businesses in the period from January to October of this year, Margo said in a press conference held in city hall.

County Judge Samaniego said the current order is temporary, and urged the county and in particular the business community, to rally together, to help reduce infection and hospital rates.

Some 51% of El Paso County COVID patients are in the hospital, a number that  Samaniego said he would like to see a decrease to below 30%.

“We need to find a balance between economic health and public health,” Margo said.

The economic toll on El Paso was palpable in the downtown streets and square, where in recent years a revitalization effort has taken shape. Several large hotels have had makeovers and their restaurants have become destinations for locals and tourists alike.

The city recently brought back a network of streetcar tracks and rehabilitated its vintage streetcars, which began plying down Mesa Street to downtown for the first time since 1974. The streetcars carried students from the Univerity of Texas at El Paso, commonly referred to here as UTEP, a state school that has grown its student body and shed its reputation as a commuter school.

The city isn’t a bad place for young people to live, despite the bad report it gets from the rest of Texas, which sees it as a backwater outpost, the Sandoval sisters said. Before COVID hit the U.S., a lot more bars and in particular, craft beer breweries, have opened up, giving nightlife in El Paso many more options, they said.

Now with COVID cases putting El Paso in the national news, the city’s reputation is again in question, the sistered feared. So are many things about the future, as across the country the pandemic continues to disrupt American life.

Sarah Sandoval is applying for a master’s degree in occupational therapy. Part of the prerequisites for admission into a program is a demonstration of hours worked in the medical field. That’s been nearly impossible to do during COVID times, she said.

Sarah Sandoval got engaged on Sunday to her boyfriend, Rafael Ravanera, 26, a sergeant in the U.S. Army at Fort Bliss, a base that is almost a city on its own to the east of El Paso. On a clear night this week, Salma Sandoval was taking photos of her sister and her fiance to be used in announcing the couple’s engagement.

The couple posed among the hanging lights on El Paso Street, mostly a tourist trap because of it’s famous, quirky pawn shops and Western wear shops. Nearly all the stores were closed, but the setting was scenic nonetheless as the sunset colored the El Paso sky pink.

Depending on how things go with the pandemic, the couple hoped to at least do a legal wedding in March, they said with a smile and hint of the hope stemming from youthful love and a new engagement.  

But they were holding out before announcing a date for a “big, beautiful” May wedding, just in case things take a turn for the worse, Sarah Sandoval said.