With more than 1,500 active COVID-19 cases in Comal County as of Thursday — the most the county has seen to date — New Braunfels-area urgent clinics and freestanding emergency rooms are inundated with patients.

And they’re having an increasingly hard time finding hospital beds for their sickest patients, either in New Braunfels or San Antonio.

Dr. Gerardo Ortiz, chief medical officer and director at Lonestar ER in New Braunfels, said his clinic has had to hold emergency patients for up to three days before being able to secure them a hospital bed. At other times, staff has added beds in hallways to handle the overflow. New Braunfels EMS has even asked to bring patients to his freestanding ER to help alleviate nearby hospital overcrowding, he said.

“That’s not normal for us,” Ortiz said. “It’s been a real challenge.”

When patients need to be sent into San Antonio, it takes up an inordinate amount of the clinic’s resources, Ortiz said.

“We need people making phone calls to try to find beds, and we have nurses directly at the bedside with the patient; doctors continually checking on the patient,” Ortiz told the San Antonio Report. “I’m exhausted, and … the staff is exhausted times ten.”

Over the past few weeks, counties surrounding Bexar County have been hit especially hard by the delta variant. With lower vaccination rates, plus smaller hospitals with fewer ICU beds, these counties are sending more patients than usual to San Antonio hospitals, which are already facing their own tight conditions.

Eric Epley, executive director and CEO at the Southwest Texas Regional Advisory Council (STRAC), said that while typically up to a third of patients in San Antonio hospitals are from outside Bexar County, there has been an “increased volume of requests” to place patients from outlying areas into San Antonio hospitals over the past few weeks. Because the process is decentralized, with rural facilities calling multiple hospitals to place patients, he couldn’t quantify the increase.

With fewer staff and limited resources, local rural hospitals and emergency rooms are stretched to their limits, said Dr. Jeremy Gabrysch, a physician who works in that community’s only freestanding emergency room in La Vernia, in Wilson County. He said the ER’s daily volume of patients “is probably three or four times” normal levels.

Dr. Jeremy Gabrysch, a physician at The Emergency Clinic in La Vernia, enters a patient’s room on Wednesday.
Dr. Jeremy Gabrysch, a physician at The Emergency Clinic in La Vernia, enters a patient’s room on Wednesday. Credit: Nick Wagner / San Antonio Report

According to data from the Texas Department of State Health Services, 13 of the 22 “trauma regions” in the state had 10 or fewer ICU beds available as of Wednesday. The data show the San Antonio trauma region, which includes 21 other counties, serves 2.9 million residents, has just 70 available ICU beds.

The city’s COVID dashboard confirms that San Antonio remains in the “severe risk” category, with less than 8% of the total number of “staffed beds” — about 300 — available in area hospitals.

New Braunfels hospitals are also feeling the pinch, said Dr. Nicole Malouf, an emergency medicine physician with Resolute Health Hospital, who said that roughly two-thirds of her patients are sick with COVID-19.

As in Bexar County, the vast majority of those hospitalized for COVID-19 treatment — about 9 out of 10 — are unvaccinated, Malouf said. She declined to speculate why so many patients have chosen not to get vaccinated, but did note some told her they thought the virus was “going away” before they got sick.

Ortiz said patients tell him they regret not getting the vaccine. He said he’s frustrated that politics has played such a large role in people’s decision to get the jab or not.

The Texas Tribune, which analyzed demographic and geographic trends of Texans who have yet to be vaccinated, found that rural counties’ vaccination rates are consistently lower than in metro regions, in large part because of mistrust of the federal government.

Indeed, all the counties surrounding Bexar County have lower vaccination rates by several percentage points, according to state data.

In addition to lower rates of vaccination, several other factors put residents in rural communities at greater risk for COVID-19, according to the Centers for Disease Control and Prevention. Rural communities often have a higher proportion of residents who lack health insurance, live with other medical conditions or disabilities, are over 65 years old, and have limited access to health care facilities with intensive care capabilities.

Oxygen tanks are a vital tool for COVID-19 patient care at La Vernia’s lone healthcare clinic on Wednesday.
Oxygen tanks are vital for care of patients suffering from COVID-19. The medical grade gas typically travels with the patient when they are transferred to area hospitals. Credit: Nick Wagner / San Antonio Report

San Antonio officials said they are turning to STRAC, which is responsible for coordinating responses to emergencies like the pandemic, to help handle the increased load of patients. Of the 600 out-of-state nurses who have been deployed to the San Antonio area over the past few weeks, “a couple hundred” have been sent out to the city’s surrounding rural areas, Mayor Ron Nirenberg said.

“It’s not an equipment issue so much as it is a staffing issue,” he said. “We’re needing personnel just like the rest of the state is. We have equipment but we need people to run it.”

Lindsey Carnett covers the environment, science and utilities for the San Antonio Report. A native San Antonian, she graduated from Texas A&M University in 2016 with a degree in telecommunication media...