With Crumbling Public Well being Infrastructure, Rural Texas Scrambles to Reply to Measles

By Pooja Salhotra, The Texas Tribune

“With crumbling public health infrastructure, rural Texas scrambles to respond to measles” was first printed by The Texas Tribune, a nonprofit, nonpartisan media group that informs Texans — and engages with them — about public coverage, politics, authorities and statewide points.

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5 years in the past, Melanie Richburg used a roll of duct tape, a HEPA filter and a conveyable fan to attract contaminated air out of a hospital room the place sufferers had been examined for the coronavirus.

Now, because the state’s largest measles outbreak in three a long time sickens an rising variety of Texans within the South Plains area, the Lynn County Hospital District, the place Richburg serves because the chief govt officer, continues to be with out specialised isolation rooms to deal with sufferers.

So, she’s ready to convey out the duct tape once more.

“If we see the volume of patients exceeds the number of beds available at children’s hospitals, we’re going to need a contingency plan,” mentioned Richburg, whose county is 30 miles south of Lubbock and has had two measles instances. “The biggest struggle we have is the same struggle we had during COVID.”

The coronavirus pandemic underscored the necessity for strong public well being infrastructure. And it delivered to gentle a outstanding urban-rural divide in entry to fundamental well being companies. Within the months after the virus ravaged the nation, federal {dollars} flowed to native public well being districts, and insurance policies concentrating on well being care deserts noticed a renewed push.

But as a illness that had been declared eradicated from the U.S. in 2000 makes a resurgence, rural West Texas communities and state officers are scrambling to reply. Growing older infrastructure, a dearth of main care suppliers and lengthy distances between testing websites and laboratories plague a lot of rural Texas, the place the measles outbreak has concentrated.

At the very least 198 folks in Texas have been contaminated with measles since late January, and one baby has died from measles, the primary such loss of life within the nation in a decade.

Extra measles instances are anticipated, and the outbreak might final for months, state well being companies commissioner Jennifer Shuford instructed lawmakers final week.

Although totally different from COVID in some ways, measles is equally revealing how an absence of public well being assets leaves rural communities susceptible. What’s left are native leaders pressured to scrape collectively the few instruments they’ve to answer an emergency, contending with years of lackluster funding from the state and federal degree to proactively forestall rising public well being threats.

“We’re in a public health shortage area,” mentioned Gordon Mattimoe, director of the Andrews County Well being Division.“ You have to think outside the box.”

Lack of infrastructure

Some 64 Texas counties don’t have a hospital, and 25 lack main care physicians, in line with the Texas Division of Agriculture. Twenty-six rural Texas hospitals closed between 2010 and 2020, in line with a rural hospital commerce group, and though closures slowed within the years since, these nonetheless standing are sometimes in crumbling buildings with few medical suppliers.

Swaths of Texas have scant assets for public consciousness campaigns. And so they lack enough medical employees with experience to supply the one-on-one training wanted to encourage vaccination and common visits to the physician.

“We have a difficult time in our area finding pediatricians for our newborns,” mentioned Sara Safarzadeh Amiri, chief medical officer for Odessa Regional Medical Heart and Scenic Mountain Medical Heart. “That’s a problem. If you can’t find a pediatrician, then when a serious question comes up, who do you ask?”

Most of Texas’ measles instances are in unvaccinated school-aged kids and are concentrated within the Mennonite group in Gaines County. Circumstances have additionally been confirmed in eight different counties spanning Dallam close to the Oklahoma border all the way down to Ector, south of Gaines.

Chief Medical Officer Sarah Safarzadeh Amiri, MD, sits in a meeting room in the Odessa Regionl Medical Center in Odessa talking about the recent measles outbreak. Sara Safarzadeh Amiri, chief medical officer for Odessa Regional Medical Heart and Scenic Mountain Medical Heart, discusses the measles outbreak on March 6, 2025. Credit score: Mark Rogers for The Texas Tribune

To include the sickness, rural well being care groups have cordoned off areas to conduct measles testing, used social media to blast residents with details about vaccination efficacy and schlepped throat swabs throughout counties to ship them to a state lab in Austin — the one public state facility that was conducting measles testing till the Texas Tech College Bioterrorism Response Laboratory, a part of a nationwide community of CDC-funded labs, started measles testing final Monday.

Testing is essential for measles, specialists say, as a result of contaminated people might be contagious for a number of days and should isolate themselves to keep away from spreading it additional.

In Gaines County, runners have needed to drive specimens as much as 70 miles to get to a FedEx workplace the place they might ship the specimen to the state laboratory. It might then take one other 48 hours to get take a look at outcomes. Throughout that point, public well being officers would ask sufferers suspected of measles to quarantine — however they don’t know in the event that they adopted by means of.

“Some people need the test to say ‘I’m positive’ before they actually do something or follow the directions given,” Amiri mentioned. “Having that testing available is very important.”

In Andrews County, simply south of Gaines, Mattimoe is utilizing the outdated Metropolis Corridor constructing as a testing website as a result of he doesn’t have a reverse stress room.

These rooms forestall contagious illnesses from spreading to different folks, and the Facilities for Illness Management and Prevention recommends suspected measles sufferers are handled there when attainable. Within the absence of such areas, rural counties together with Lynn and Yoakum have improvised a room for measles testing, hoping they don’t get overrun with extra sufferers they will deal with.

Mattimoe, who mentioned he’s anticipating extra instances, opted to open up Metropolis Corridor for testing since that constructing occurs to be vacant.

WIthout it, Mattimoe mentioned, he’d should “shut down the entire department for two hours between suspected cases.”

Andrews Health Department Director Gordon Mattimoe looks over the supply of refridgerated measles vaccines in the Old City Hall building where they vaccinate people. Andrews County Well being Division director Gordon Mattimoe appears to be like over the availability of refrigerated measles vaccines on the outdated Metropolis Corridor constructing in Andrews. Credit score: Mark Rogers for The Texas Tribune
Reactive as a substitute of proactive responses

Public well being is predicated upon prevention, but it’s emergencies that spur probably the most motion, notably in rural communities.

It was solely after a school-aged baby died from measles that state and federal assist intensified. Twenty seven contractors had been introduced into the outbreak space final week to help native well being departments, Shuford, the state well being companies commissioner, mentioned throughout a legislative listening to. A public consciousness marketing campaign with billboards and social media messaging was additionally launched. And, upon a request from the state, the federal CDC despatched “disease detectives” to West Texas.

County officers additionally doubled down their efforts. In Ector County, County Decide Dustin Fawcett made media appearances to debate the efficacy of the MMRV vaccine whose two doses present 97% safety in opposition to measles. And the commissioners court docket accredited the acquisition of a $7,695 freezer to retailer measles take a look at specimens — samples shipped after the date of assortment have to be saved at -70 levels celsius.

Exterior view of the Odessa Regional Medical Center in Odessa. The Odessa Regional Medical Heart in Odessa. Credit score: Mark Rogers for The Texas Tribune

In Andrews County, residents stepped up their communal obligations. Mattimoe noticed a surge of individuals coming into the clinic to get vaccinated. “Unfortunately, the death of a child was one of the things that spurred many people to come in,” Mattimoe mentioned.

At the same time as state and federal officers are sharing extra data on vaccines, specialists say these campaigns wanted to return sooner. They’ve recognized for years that vaccination charges have been declining.

“We shouldn’t be doing it during an outbreak,” Amiri mentioned. “We should be doing it beforehand to prevent the outbreak.”

Getting vaccines in residents is additional sophisticated by the truth that Texas has a principally decentralized system of public well being. Cities and counties can get up their very own public well being departments or districts, however the majority of rural counties can’t afford to have their very own. As a substitute, they depend on one in every of 11 public well being areas.

These areas cowl huge territories with restricted {dollars} and don’t at all times know the ins and outs of native communities, particularly on the right way to encourage residents to get vaccinated. The logistical challenges of touring throughout counties provides one other layer of issue.

“You have to call these tiny towns and figure out who can give you space for free to set up a testing clinic,” Wells mentioned. “Then you’re driving from Lubbock to rural areas and that cuts how long you can keep the clinics open.”

After which, rural public well being departments are having to deal with combined messaging from the federal degree as Robert F. Kennedy Jr., the well being and human companies secretary, has solid vaccination as a private selection whereas downplaying the information of the outbreak.

“I think with the changes that are occurring at the federal level, we need to realize that we do need to strengthen our local public health,” Amiri mentioned.

The facility of funding

Years of underinvestment in public well being left Texas in poor health ready for the coronavirus pandemic in 2020. Hospital gear was scarce, and state and native well being departments had outdated know-how that restricted entry to essential knowledge.

The pandemic additionally uncovered the rural-urban inequities in well being care entry. Residents of Texas counties with out hospitals died from COVID-19 at 20% larger charges than residents of counties with hospitals, in line with an evaluation by the Austin American Statesman.

An inflow in federal funding helped shore up native public well being departments and stave off extra rural hospital closures. Texas obtained $35.5 million in grants for enhancements in public well being infrastructure in fiscal yr 2020. An extra $221 million — probably the most of any state — is flowing to Texas by means of the CDC’s five-year Public Well being Infrastructure Grant.

That funding has helped some native well being departments handle the measles outbreak, public well being officers mentioned. The Lubbock public well being division has practically doubled in measurement due to a $2 million grant. These additional staff have been on the entrance strains of testing for measles and vaccinating kids.

“It moved us from undersized to right sized,” mentioned Katherine Wells, director of town’s public well being division. “It got us to the…health department we need for Lubbock.”

In Andrews County, Mattimoe has additionally used grant {dollars} to develop his well being division. 4 new workers, together with an epidemiologist and a social employee, have helped the county full a inhabitants well being evaluation that gives a snapshot of residents’ wants. And its year-round vaccine clinics have helped stave off the worst of the measles outbreak.

“Community immunity has really saved us,” Mattimoe mentioned. “There will be a case eventually, but there’s something to be said about herd immunity.” Andrews County doesn’t have any confirmed measles instances as of Friday.

The inflow of {dollars} that rural communities obtained throughout the top of the pandemic confirmed the significant modifications that officers might do with extra assist, but it surely nonetheless hasn’t been sufficient.

Texas spends much less on public well being per individual than the overwhelming majority of different states, in line with the State Well being Entry Information Help Heart, whose evaluation reveals Texas spent $17 per individual on public well being in 2023. A decade earlier, the spend was $19.

Exterior view of the Lynn County Hospital District building in Tahoka. The Lynn County Hospital District constructing in Tahoka on March 6, 2025. Lynn County is Lubbock County’s southern neighbor. Credit score: Mark Rogers for The Texas Tribune

The low ranges of state funding notably harm rural communities which have larger charges of uninsured Texans and extra senior residents with better well being wants, in line with the Texas Group of Rural and Neighborhood Hospitals. Deteriorating buildings and the scarcity of medical professionals nonetheless persist in rural areas, whereas decrease volumes of sufferers means larger well being care operational prices.

In Lynn County, Richburg, the CEO of the well being district, had hoped the makeshift contraption she made throughout COVID for a reverse stress room wouldn’t be wanted once more in her rural group of 5,500 folks. She tried to cross a bond final yr to pay for infrastructure upgrades, together with a mini intensive care unit with 4 adverse stress rooms.

Voters rejected the proposed tax improve, although, a intestine punch to Richburg.

“We wanted those four specific beds so that when we had situations where we needed to isolate patients, they’d be adequately cared for and not in a room with a broken window with a fan duct taped in it,” she mentioned.

Along with isolation rooms, Lynn County’s well being care system is due for a serious electrical improve, Richburg mentioned. The ability’s backup energy generator doesn’t cowl the MRI machine or the CAT scan. Within the meantime, Richburg and her employees plan to do their finest with what they’ve.

“We’re still here, the lights still come on every morning, and patients still come in for services,” Richburg mentioned. “We’re not going away.”

Disclosure: Texas Tech College has been a monetary supporter of The Texas Tribune, a nonprofit, nonpartisan information group that’s funded partly by donations from members, foundations and company sponsors. Monetary supporters play no function within the Tribune’s journalism. Discover a full checklist of them right here.

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This text initially appeared in The Texas Tribune at https://www.texastribune.org/2025/03/10/rural-texas-measles-outbreak-response/.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and interesting Texans on state politics and coverage. Study extra at texastribune.org.

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Photograph credit score: Indicators let folks know that measles vaccines can be found on the outdated Metropolis Corridor in Andrews on March 6, 2025. Andrews is about midway between Seminole in Gaines County, the place the outbreak originated, and Odessa. Credit score: Mark Rogers for The Texas Tribune

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