Grissel Franco, clinical coordinator, Cristian Franco, lead medical assistant and Brenda Vargas, medical assistant with Vo Medical Group in Calexico perform testing with patients wanting to know if they are COVID-19 positive on April 7, 2020. Omar Ornelas/The Desert Sun

April 8, 2020

In the rural southeastern corner of California, preparations for the spread of coronavirus may be complicated by a familiar foe: tuberculosis.

The rate of tuberculosis in Imperial County is 25 per 100,000 people, more than eight times the national average of 3 per 100,000. Equipment vital for treating coronavirus—such as isolation rooms and ventilators — is also needed to treat patients with highly infectious tuberculosis.

An airborne bacterial disease, tuberculosis usually attacks the lungs. Its prevalence is often higher in crowded, poor communities with malnutrition issues — all of which are common in Imperial, the state’s most impoverished county.

The county, which stretches over 4,500 square miles, has just two hospitals to serve a population of about 200,000. Combined, the hospitals have 24 isolation rooms, and at one pointlast month, 11 of those rooms were occupied by patients suspected to have TB (although tests later showed they all had other ailments), according to the chief nursing officer at El Centro Regional Medical Center, Louise Kenney.

“Even the rule-outs can occupy an isolation room for several days while awaiting test results,” said Angela McElvany, infection control practitioner at Pioneers Memorial Hospital in Brawley. “If they are positive, they could be admitted for weeks or months.”

In preparation for the anticipated surge of COVID-19 patients who will also require isolation, Pioneers has recently modified its ultrasound room to create five more isolation rooms. They did so by renting six exhaust vans with HEPA filters for $7,000 for four weeks, and did modifications themselves.

Ryan Kelley, who sits on the Imperial County Board of Supervisors and works in administration at Pioneers Hospital, said the hospital will seek reimbursement from the county but he doesn’t know how long that would take.

As of Tuesday, there were 73 positive cases in Imperial County, and 596 patients had been tested for the virus. Three people had died.

Imperial County has fewer than 1.5 hospital beds per 1,000 people, about half of the national average of 2.9 per 1,000.

Patients suspected of having TB or COVID-19 should be isolated to prevent transmission, experts say.

“If they’re showing symptoms and the chest x-ray looks suspicious, we will isolate them because we don’t want that TB to spread around,” said Kenney. “We have enough of that already.”

It’s not just that TB patients occupy the few aerosol isolation rooms, but “pre-existing TB is a risk factor of having a worse outcome with coronavirus,” said David Lo, senior associate dean for research at the University of California, Riverside, School of Medicine. “So the number of people who are going to require hospital beds in the ICU units is going to be much higher here.”

TB is not the only ailment the county has to worry about. Asthma rates in Imperial County are up to three times the national average, as the county has some of the most polluted air in California.

The air pollution comes from factory emissions in the Mexican city of Mexicali, a manufacturing hub of 1.1 million people just across the border, plus dust from the desert floor, pesticides blown off fields, and chemicals from the drying lakebed of the polluted Salton Sea.

Hospitals in the county have experience dealing with respiratory illnesses and infectious diseases, but “you don’t buy equipment and staff for things you don’t need every day, so [hospitals] really aren’t prepared for these kinds of emergencies,” said Lo.

Health care experts in the region are worried not only about a surge of coronavirus patients, but also the type of patients they will see.

“We may see a very high incidence of complicated cases in that area because of the diminished function of the respiratory system,” said Conrado Barzaga, CEO of the Desert Healthcare District and Foundation.

Already, Imperial County hospitals have sent coronavirus patients who need critical care to San Diego for treatment.

Kenney says there are concerns about whether it will be possible to continue to transfer Imperial’s COVID-19 patients to San Diego for treatment if hospitals in San Diego start to fill up. But as for the cases that were sent there so far, Kenney’s hospital didn’t have a choice.

“We didn’t have a pulmonologist, that’s the reason,” she said. (El Centro Regional Medical Center has one part-time pulmonologist on staff, and he commutes from Hawaii.)

“Having the medical subspecialties available to manage those patients is going to be an issue, especially in an area that’s already underserved,” said Lo. “And that doesn’t even take into account the difficulty getting testing.”

Kelley, the county supervisor who works at Pioneers Hospital,agreed that even “a small surge would inundate the system.”

Imperial’s population is 85% Latino and the county is home to many undocumented immigrants who come to work in the fields that produce the bulk of the nation’s winter vegetables.

Farmworkers are considered essential workers under the state’s current stay-at-home orders. Sandra Ramirez, director of the community group Coachella Valley Parents in nearby Riverside County, said some farmworkers are continuing to work even when they have coronavirus symptoms for fear they will lose their jobs and income.

In general, she said, farmworkers are not getting enough information, and in some cases, the information they are getting from their bosses isn’t accurate. The United Farm Workers labor union is organizing Facebook live events in Spanish to answer coronavirus-related questions from farmworkers.

“Most people speak Spanish, so the information in English isn’t making it here,” she said.