AUSTIN, Texas — Two irrefutable facts militate for an immediate re-do of President Donald Trump's original Coronavirus-containment closure order for the U.S.-Mexico border, to better manage growing American hospital bed shortages in border states by also saving a drowning neighbor and ally:
- Mexicans sick with the virus have overrun hospitals in their own cities along the border, such as in Ciudad Juarez, to the point that they are unable to care for the patients they have, let alone new ones, or those who have died.
- Left with no possibility of care in Mexican border states, Covid-sick patients with green cards, dual citizenship, or border-crossing passes are legally exploiting loopholes riddling President Trump's March 2020 emergency border closure to reach U.S. hospitals in El Paso and elsewhere.
A Federal Problem, Not for the States
As perhaps the nation's reddest hotspot, the city of El Paso represents an emblematic case in point as hospitalizations doubled since September to 59,940 patients as of November 10, averaging 1,800 new cases a day, twice the number in more populous Dallas County. El Paso's hospitals are so overwhelmed they are having to ship patients to hospitals in the interior of the United States to keep beds open while the city issues mandatory business closures that leave entirely unaddressed the fact that Mexico is at least one major source of patients.
As I reported two weeks preceding this state of affairs, on October 27, it was no coincidence that Juarez's hospitals had by then already collapsed under the strain of their own patients, leaving untended bodies on stretchers packed in hospital storage rooms, patients dying while waiting for care in parking lots, and long lines to buy oxygen. Covid-19 patients in northern Mexico often saw no choice but to go north. One measure of how bad the Juarez hospital crisis has become is that Mexico's 23rd Infantry Battalion of the 9th Cavalry Regiment was forced to set up emergency clinics across from El Paso in Chihuahua State. America's southern neighbor can't keep up with the bodies and burials.
No one seems to work very hard to maintain exact numbers of patients crossing from Mexico to the U.S. for care. But El Paso County officials and hospital administrators have known about the Mexico patient flow into local hospitals for months.
"People are coming to the ports of entry in very dire conditions," Vince Perez, El Paso County commissioner told local TV station KFOX-14 as long ago as May.
More recently, in November, El Paso city ambulance drivers, health administrators, city officials, and U.S. Customs and Border Protection all have admitted that ill Mexicans are crossing the international bridges from stricken Juarez, often calling El Paso Fire Department medics to pick them up and deliver them to El Paso's packed-to-capacity hospitals.
"There's some days where it's only three or four times and other days when it will be 13 or 14 responses. You'll be there for one patient and [CBP] customs will let you know, hey there's another one right behind them and another one ... sometimes there are four or five waiting in line," the city's local television station, KFOX-14 News quoted an anonymous fire department whistleblower on October 28. "Multiple times in this pandemic we will be in a complete system overload where there are no ambulances available" because they were picking up patients at El Paso's international bridges.
Deputy Fire Chief Jorge Rodriguez told the city council in early November that "Once they are on U.S. soil, we have a legal responsibility to provide services to anyone who is inside the city limits, and we continue to do that."
El Paso's hospitals, in turn, had become so full by mid-November that an airlift had to be ordered to transport Covid-19 patients to hospitals throughout the Texas interior. Texas A&M University's Transportation Institute believed this problem was so pronounced that it even proposed a plan for Mexican ambulances to cut to the front of long lines at ports of entry so Covid-19 patients could reach American hospitals faster.
Similar circumstances are reported in California's border-hugging Imperial Valley and in Arizona and New Mexico, where infected patients are fleeing overwhelmed Mexico-side hospitals to facilities on the U.S. side. One doctor in an Arizona hospital system, in an off-the-record interview, estimated to me that at least 75 percent of their Covid-19 patients had fled overwhelmed Mexican hospitals in neighboring Sonora State.
Clearly, Mexico is at least one significant source of Covid-19 hospitalizations in border cities, though almost certainly in addition to local spread.
But while border state governors and local officials are responding with lockdowns to bring the local spread under control as a means to protect hospital systems, nothing is being down about the Mexico source because that is entirely a federal matter.
How could this be happening if President Trump closed the border to contain spread of the disease?
"Thousands of People" Exploit Loopholes in President Trump's Border Closure
By all accounts, the president's border closure only prohibits inbound pedestrian crossings by those traveling "for tourism purposes, such as sightseeing, recreation, gambling or attending cultural events". Everyone else, including "individuals traveling for medical purposes" (e.g., to receive medical treatment in the United States), is pretty much free to cross at will with any one of a panoply of visas.
Although an emergency border closure could have done so, the March 20 closure orders did not prevent U.S. expatriates, green card holders, Mexican dual citizens, and anyone claiming to be an "essential worker" from returning and heading to the hospitals. Gustavo Sanchez, president of the El Paso regional union representing U.S. Customs officers, was quoted on November 2 saying that thousands of people with regular border-crossing cards (issued by U.S. consulates and valid for 10 years) come and go as they please, with or without Covid-19, making the essential-travel order difficult for the agency to enforce.
"We got thousands of people crossing. The hospitals in Juarez are full to capacity. Any little thing that's even non-life threatening, they're bringing them over here because they're saturated. Their hospitals are saturated," Sanchez said.
An American Medical Aid Operation with Tight Border Closure Is Essential
An easy argument can be made that the United States holds a national interest in preserving its hospital space and treatment resources for American citizens inside its own borders who suffered months of lockdowns and restrictions for the sole purpose of preserving that resource for U.S. citizens — and to not see it substantially repurposed for those sickened in other countries, without even an official acknowledgement that it is happening.
The U.S. government must close most of the loopholes in its original emergency order, blocking for a time even American expatriates in Mexico, who of their own accord chose to live abroad and shoulder the risks that decision entails during the pandemic. The U.S. president has the authority to do so. However, the American government must balance any tightening of the border with a responsibility not to condemn its own citizens, or even Mexicans living just across the border, to a collapsing Mexican hospital system, with no recourse to life-saving care.
The dual solution is obvious: The United States should immediately help Mexican border cities expand their healthcare capacity and, perhaps employing the military, provision it with necessary equipment and personnel to ensure that our neighbor to the south can cope with the pandemic crisis on its side of the border. Only then could the United States suture shut the border closure loopholes that now enable thousands to push American border-state hospitals toward their own crises.
Assisting Mexico with its Covid-19 crisis, with emergency airlifts and overland convoys, is in the American national interest in that it protects and preserves U.S. systems while easing the humanitarian crisis of a close partner.
Yet, in the bizarre absence of official acknowledgement that Mexico is a significant source of Covid-19 patients, the U.S. government is instead sending aid to U.S.-side hospitals that does nothing to address the problem at its Mexican source or preserve U.S. beds and financial resources to care for U.S. citizens. The U.S. Department of Defense, for instance, recently deployed 60 medical personnel to El Paso's overflowing hospitals while all the border loopholes requiring their assistance in the first place remain wide open.
The United States has sent hundreds of millions of dollars and equipment to China, Iran, Southeast Asia, and elsewhere — spare masks, gloves, and ventilators — but has fallen short of doing what is necessary to expand the capacity and capability of hospitals right across the border in Mexico.
The time has come to reassess all of the policy scripts that were initially written for a medical problem that has gone drastically misdiagnosed and, as a result, is now endemic.