Featured, from left: McAllen Mayor Jim Darling and Congressman Vicente González on Thursday, August 20, 2020, during the City of McAllen’s Census Telethon, hosted by the mayor and the McAllen city commissioners at McAllen City Hall.
Photograph Courtesy CITY OF MCALLEN FACEBOOK
Congressman González: “We have seen the devastating effects of this virus up close and personal, and we understand that it is not over.”
Although the Rio Grande Valley has less than five percent of the population of Texas, as of mid-October 2020, the region accounted for about 17 percent of COVID-19-related deaths in the Lone Star State, according to Congressman Vicente González, D-McAllen.
“We have seen the devastating effects of this virus up close and personal, and we understand that it is not over,” González said on Wednesday, October 14, 2020 during a panel discussion – hosted by the University of Texas Rio Grande Valley School of Medicine – that featured the experienced views of physicians from Texas, California and New York.
Along with González, the South Texas contributions to the event, which was streamed(televised)live on the Internet, were Robert D. Martínez, MD, Chief Medical Officer for DHR Health, Iván Meléndez, MD, Hidalgo County Health Authority, and John H. Krouse, MD, PhD, MBA, Executive Vice President, Health Affairs, University of Texas Rio Grande Valley, and Dean, UTRGV School of Medicine.
The videotaped recording of the 90-minute session, which was coordinated by González, Krouse, and Congressman Adriano Espaillat, D-New York City, is available by scrolling down the Facebook page of the medical school to the October 14, 2020 posting at:
Among the key points made by Martínez and Meléndez were:
Robert D. Martínez, MD
Chief Medical Officer
• Hispanics and other minorities are seriously underrepresented in clinical trials for finding effective vaccines against COVID-19 and many other major illnesses and diseases. Clinical trials are research studies that determine whether medical products like medicines, vaccines, or devices are safe and effective for people, according to the U.S. Federal Drug Administration (FDA). This is a concern because people of different ages, races, and ethnicities may react differently to medical products, according to the FDA.
• DHR Health is working with area physicians to educate patients about the importance of clinical trails.
Commonly, Hispanics do not participate because they are unaware of trial opportunities, lack of transportation, mistrust research and the medical system, and have other family considerations, according to a June 2016 analysis, “Mexican-American perspectives on participation in clinical trials: A qualitative study”.
• There are studies being done at DHR Health regarding plasma, and other therapeutic treatments, such as monoclonal antibodies, which are man-made substances used by a person’s immune system to recognize and destroy dangerous foreign substances. Nationally, treatments are being developed for outpatients (someone who receives medical treatment without being admitted into a hospital) afflicted with COVID-19.
Iván Meléndez, MD
Hidalgo County Health Authority
• By December 2020, Hidalgo County is going to see a significant increase of COVID-19 cases. (As of Friday, October 30, 2020, the total number of deaths in Hidalgo County from this disease was 1,955, and the total number of known positive cases was 35,945, according to the Office of the Hidalgo County Judge.)
• The lack of affordable health insurance for many South Texans places the area at higher risk for COVID-19 infections. Meléndez cautioned that people with health insurance should not have a false sense of security because it is believed COVID-19 is spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).
• People can protect themselves from the virus that causes COVID-19 by staying at least 6 feet away from others, wearing a mask that covers their nose and mouth, washing their hands frequently, cleaning touched surfaces often and staying home when sick.
The other prominent speakers who participated in panel discussion were:
• R. Graham Barr, MD, PhD, Hamilton Southworth Professor of Medicine, Professor of Epidemiology Chief, Division of General Medicine, Columbia University, New York City;
• Ramón Tallaj, MD, Chairman of the Board of SOMOS Community Care, New York City;
• Andrew Phillips, MD, Intensive Care Unit Physician, Fremont, California; and
• Joseph Varon, MD, Cardiovascular & Pulmonary Disease Specialist, Houston.
“The rate of uninsured combined with our increased rate of chronic diseases like obesity and diabetes, which have proven to increase a person’s risk of contracting a severe case of COVID-19, multigenerational housing, and one of the highest poverty rates in the state, made for a perfect storm in South Texas this summer,” the congressman reflected.
In Hidalgo County, Texas, located at the southernmost portion of his Texas Congressional District 15, approximately 92.5 percent of the population is Hispanic or Latino, about 32 percent of people under 65 do not have health insurance, and about 30 percent of the population is living in poverty, González said.
“Today, we are here to discuss not only how COVID-19 has impacted our communities, but also to exchange information and strategies on what we learned during the first wave of cases and how we may best prepare for a resurgence in the fall,” González explained the purposes of the online panel discussion.
Among the alarming developments in deep South Texas that have occurred since May 2020, according to the McAllen-based U.S. representative, were:
• There was a 4,000 (four thousand) percent increase in hospitalizations from May 2020 to July 2020;
• The Valley’s health systems were quickly overwhelmed with patients in need of intensive care;
• Intensive care units (ICUs) intended to treat 50 patients were expanded to house 200;
• Ambulances had to wait for hours in hospital parking lots, waiting for a bed to open up; and
• As of Wednesday, October 14, 2020, Hidalgo County, which is the most populous Texas county south of San Antonio, had suffered the loss of more than 1,868 South Texans from COVID-19. (At the end of October 2020, that figure had increased to 1,955 deaths, according to the Office of the Hidalgo County Judge.)
“That is entirely unacceptable and to put it simply, South Texans deserve better,” González said. “That is why tonight’s discussion is so important. Your experiences remain invaluable as we continue working to understand this virus and why it has devastated certain regions.
“Looking to the future and how we may best prepare for a resurgence (increasing again of COVID-19), it is clear to me that collaboration (working together) between experts like you all will be integral to a successful response,” he added.
Iván Meléndez, MD: “Around December, I expect in the Rio Grande Valley a significant increase (of COVID-19 cases).”
As Hidalgo County Health Authority, Meléndez’ duties include aiding the state with quarantine, sanitation enforcement, public health law enforcement, reportable diseases, and vital statistics collection. He expressed serious concerns about more COVID-19 infections in deep South Texas.
“I expect in the Rio Grande Valley, because of the schools opening up against our recommendations, because of the bars threatening to open up, because of the holidays coming up – by December (2020) we’re going to see a significant increase (of COVID-19 cases),” he cautioned. “I’m concerned that we still have a lot of people who have not learned that we are not out of the danger zone.”
He agreed with González’ statements that ongoing medical issues in South Texas before COVID-19 hit the region, as the congressman put it, “made for a perfect storm in South Texas this summer”, then added more key reasons for the spread of the virus in the region.
“Remember, our population down here is 29 years old. That’s our average. ‘We need to get out in the world. We’re 29,’” Meléndez said.
“One out of every 10 households in Hidalgo County is multi-generational. (In) one out of every three households in Hidalgo County, there are more than two people living in one bedroom,” he further noted. “Fourth of July (2020), Memorial Day (2020), they were disasters (for spreading the COVID-19 infection). You would have hundreds and thousands of people at the beaches and public areas.”
The lack of affordable health insurance for many South Texans put the area at higher risk for COVID-19 infections.
“I believe the reason our area was hit the hardest is because our patients, our community was sicker than most. Why are we sicker? Not because we were more obese, diabetic, hypertensive. We were more sick because 40 percent of our people are uninsured or underinsured,” Meléndez said. “People in our three – (only) three – free (Hidalgo County government) clinics for 1.2 million people, they just weren’t going to the doctors or to the hospital unless it was a crisis. So when the pandemic hit us, we had a very, very, very sick group of community members, and that’s why I believe our outcomes were so bad.”
He cautioned that people with health insurance should not have a false sense of security.
COVID-19 spreads through respiratory droplets or small particles, such as those in aerosols, produced when an infected person coughs, sneezes, sings, talks, or breathes. These particles can be inhaled into the nose, mouth, airways, and lungs and cause infection. This is thought to be the main way the virus spreads, according to the U.S. Centers for Disease Control.
“Most people think, “I have a job. I have insurance. I’m doing OK. I have access.” But they forget that if your neighbor doesn’t (have those benefits), it doesn’t do you or your kids much, because if they’re (people without those benefits) infected, you’re going to get it, too,” Meléndez warned. “So we need to develop an identity in the community that the health care of the community is everyone’s responsibility. From our elected officials, from our health department, from our hospital partners, from our medical schools, from our (medical) residency programs, we need to establish more primary care, so when it comes, we’re best prepared for it.”
Robert D. Martínez, MD: Some reasons why Hispanics don’t participate in clinical trials
Krouse, the UTRGV School of Medicine dean, brought up concerns that Hispanics and other minorities were seriously underrepresented in clinical trials for finding effective vaccines against COVID-19
According to the U.S. Federal Drug Administration (FDA):
Clinical trials are research studies that determine whether medical products like medicines, vaccines, or devices are safe and effective for people. Participants in clinical trials should represent the patients that will be using the medical products, though this is often not the case.
Illness is suffering from something that makes one sick. Illnesses span during a precise period of time, meaning they have a beginning and an end. In layman’s terms, an illness is basically termed as an unwell or unhealthy state of mind or body.
Disease falls under an entirely different classification. A disease is defined as suffering from a malfunctioning organism or function within the body itself. A disease is not something that can occur from an incidence, event, or from an external element or behavior.
Racial and ethnic minorities are underrepresented in clinical trials. This is a concern because people of different ages, races, and ethnicities may react differently to medical products. If a person thinks a clinical trial may be right for them, talk to their doctor.
“What’s your thought about the trajectory about vaccines? What might we be expecting? Secondly, how are we going to make sure that we have adequate representation of minorities in vaccine development? I think that’s a critical need, and I know you at DHR Health are very interested in how you can expand clinical research among the Hispanic population,” Krouse asked Martínez. “Could you address both of those, please?”
DHR Health’s Martínez’ expertise and influence in the medical field extend statewide, as he is an appointee of Gov. Greg Abbott, and is currently serving on the Texas Medical Board, whose mission is to protect and enhance the public’s health and safety.
“Those are very, very important points for us to be able to move forward,” said Martínez. “This is a learning bridge for things to come. Most people understand that of all the research done around the world, maybe three percent, maximum, is actually on minorities. That’s staggering when you consider that in most cases, for whatever disease, minorities are the majority of the treatment group.
“It’s most important to understand how medications and/or vaccines affect those particular groups of people. It’s paramount (most important) that those folks are involved in the beginning in the trials to see how those things work. We are trying hard here, as much as we can,” said Martínez. “Traditionally, it has been very difficult for any number of reasons – culturally – to have people involved in research.”
“Mexican-American perspectives on participation in clinical trials: A qualitative study”
Commonly, Hispanics do not participate because they are unaware of trial opportunities, lack transportation, mistrust research and the medical system, and have other family considerations, according to a June 2016 analysis, “Mexican-American perspectives on participation in clinical trials: A qualitative study”.
The summary of that article stated:
“Clinical trials are essential to advancing knowledge to reduce disease morbidity and mortality; however, ethnic and racial minorities remain under-represented in those studies. We explored knowledge and perceptions of clinical trials among Mexican-Americans in Texas. We conducted focus groups (N = 128) stratified by gender, language preference, and geographical location. This paper presents four emergent, primary themes: 1) knowledge and understanding of clinical trials, 2) fears and concerns about participating, 3) perceived benefits of participating, and 4) incentives to participate.
Results suggest that lack of knowledge and understanding of clinical trials leads to misunderstanding about research, including fears and lack of trust. Participants indicated that fears related to perceived experimentation, harm, immigration status, and lack of clinical trial opportunities within their communities were barriers to participation.
On the other hand, free healthcare access, helping family members in the future, and monetary incentives could facilitate participation. We also found differences across themes by language, gender, and place of residence. Findings from our study could inform the development of interventions to enhance recruitment of Mexican-American participants into clinical trials.”
Martínez noted the importance of the world coming up with vaccines for COVID-19, adding that developing therapeutic treatments are very important as well.
In general, the difference between a vaccine and therapeutic treatment is that a vaccine is administered to a person as a precautionary measure to avoid the infection or disease while a therapeutic treatment is designed to treat an illness or to improve a person’s health, rather than to prevent an illness.
DHR Health is working with area physicians to education patients about the importance of clinical trails, not only on potential COVID-19 vaccines but also on therapeutic treatments to help manage diseases, he explained.
“We are encouraging all of our primary care doctors in the area to please participate. We’ll help them in any way possible, but we’re trying to help them recruit patients, and do away with all the misconceptions regarding vaccines. Vaccines save lives. It is what it is – like any other medicine, there are potential side effects. That’s why we study them. It has to be right,” he said. “It’s absolutely paramount science for us to do. How wonderful would it be for us to find and help in coming up with a vaccine to save a lot of lives here? It’s important and we’re getting involved there.”
There are studies being done at DHR Health regarding plasma, and other therapeutic treatments, such as monoclonal antibodies, which are man-made substances used by a person’s immune system to recognize and destroy dangerous foreign substances.
“A lot of folks have mentioned in-patient treatments, but there also is an outpatient portion of this. We know a lot of patients who test positive for coronavirus not necessarily need to be hospitalized, but they still would benefit from some treatment,” said Martínez. “There are companies coming up with monoclonal antibodies that you can treat folks with it as an outpatient (someone who receives a medical treatment without being admitted into a hospital).”
He credited “the community and the university working well to increase the number of research studies around here, as well as, involving folks of this community who will eventually be treated, who are different than a lot of other people around the world.”
About DHR Health
Anchored in southwest Edinburg, with a growing presence in neighboring McAllen, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.
DHR Health is the flagship teaching hospital for the UTRGV School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 70 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.
DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing South Campus immediately across Owassa Road in northwest McAllen.
About UTRGV School of Medicine
The University of Texas Rio Grande Valley School of Medicine uses innovative, competency-based medical education to train the next generation of physicians who are committed to improving the lives and well-being of their communities through innovative research and compassionate, patient-centered care, as well as biomedical scientists who will lead the charge in advancing research on diseases such as diabetes and infectious diseases that affect the Rio Grande Valley and beyond.
The University of Texas Rio Grande Valley (UTRGV) is accreditedby the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) and the UTRGV School of Medicine was granted preliminary accreditation from the Liaison Committee on Medical Education (LCME) on October 19, 2015. As a new medical school, the UTRGV School of Medicine is in the process of obtaining required provisional and full accreditation.
UT HEALTH RGV CLINICAL TRIAL RECEIVES SCIENCE GRANT OF ALMOST $875,00 FOR EXPANDED COVID-19 TESTING IN UNDERSERVED SOUTH TEXAS COMMUNITIES
The University of Texas Health RGV Clinical Lab has been awarded a Clinical and Translational Science Award (CTSA) partnership grant for expanded research in COVID-19 testing.
The grant is part of a multi-institutional approach designed to address COVID-19 testing disparities among vulnerable populations in Texas.
Dr. John Thomas, Associate Professor in the UTRGV School of Medicine’s Department of Human Genetics and Director of COVID-19 operations at the UT Health RGV Clinical Lab, said the grant will help regional efforts to identify a more precise number of COVID-19 cases.
“One of the troubles we’ve been having is trying to get testing deployed to cover a good percentage of the population and have a better idea of how many people are infected, positive, negative,” he said, “as well as predicting if there are certain pockets of the population that are more susceptible to the COVID-19 infection than we are actually aware of.”
The approximately $875,000 grant will allow UTRGV School of Medicine medical providers to conduct testing in rural areas of South Texas, where COVID-19 tests may not be readily available to the community.
“With this grant we will have a number of ‘promotoras,’ who are community health workers. They essentially will be the bridges between our efforts in colonias and other underserved Valley communities,” Thomas said. “Many in the Valley’s underserved populations speak only Spanish and might be hesitant to seek medical attention.The promotoras will communicate the availability of our COVID-19 testing services to them.”
The UT Health RGV Clinical Lab will be conducting COVID-19testing over the next two years and will cover the region south of San Antonio. UT Health Science Center in Houston will cover east Texas and the UT Health Science Center at Tyler will cover the northwest part of the state.
Since March, UT Health RGV has been screening and testing COVID-19 samples in the region. To date, the UT Health RGV Clinical Laboratory has tested some 65,300 COVID-19 samples through its four drive-thru testing sites, at a capacity of 2,200 samples a day.
“We are prepared and ready to move into this project,” Thomas said. “Over the past six months, we have been the entity in charge of the state’s efforts for COVID-19 testing in South Texas. UT Health RGV has been part of the state’s task force in charge of testing down here, so we are already set up to do this. We have already demonstrated that we have the capabilities for testing of this magnitude.”
UT Health RGV will begin the testing in December 2020.
The University of Texas Rio Grande Valley (UTRGV) was created by the Texas Legislature in 2013 as the first major public university of the 21st century in Texas. This transformative initiative provided the opportunity to expand educational opportunities in the Rio Grande Valley, including a new School of Medicine, and made it possible for residents of the region to benefit from the Permanent University Fund – a public endowment contributing support to the University of Texas System and other institutions.
UTRGV has campuses and off-campus research and teaching sites throughout the Rio Grande Valley including in Boca Chica Beach, Brownsville (formerly The University of Texas at Brownsville campus), Edinburg (formerly The University of Texas-Pan American campus), Harlingen, McAllen, Port Isabel, Rio Grande City, and South Padre Island. UTRGV, a comprehensive academic institution, enrolled its first class in the fall of 2015, and the School of Medicine welcomed its first class in the summer of 2016.
Dimitra Trejo contributed to this article. For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).