So far, more than 100 cases have been reported in counties with only one—or no—licensed physician.

The first reported COVID-19 death in Texas arrived unexpectedly in a rural hospital with just six beds in its tiny ICU. Eddie Roberts, a 97-year-old funeral home owner and World War II veteran, died March 15 at Matagorda Regional Medical Center, a nonprofit hospital operated by a public health district.

Roberts’ death provided an early and rapid introduction to COVID-19 for the small staff of the Bay City hospital. Since then, a total of 55 Matagorda County residents have been diagnosed with the novel coronavirus. As of April 21, reported COVID-19 cases had spread to 198 Texas counties.

Because of the low number of licensed primary care physicians (only 19), Matagorda County remains among one of the state’s hardest-hit rural counties.

But other small counties are even worse off. More than one-fifth of all Texas counties have only one or no primary care physician. So far, more than 100 cases have been reported in counties with only one—or no—licensed physician.

Here’s a map showing the COVID-19 cases reported statewide, including the number of cases diagnosed per licensed primary care physician.

Cases appear to be growing quickly in some areas with limited medical resources: in East Texas, where all of the state’s more than 20 rural hospital closures have occurred in the past seven years, and in the Panhandle, where many counties have no doctors and residents often have to travel hours for medical care.

Compounding the risks to rural counties is the fact that it’s likely that cases may be going untested.

A doctor in Shelby County in East Texas, which has one of the highest per capita rates of COVID-19 cases in the state, told the Observer that “we know it’s underreported.” Tiny Donley County out in West Texas has 24 cases—and one of the state’s highest rates—in part because the county judge happens to be a physician.

County judges in areas with few or zero confirmed cases, like Hall County in the Panhandle and Red River County in northeast Texas, have indicated the same. Case numbers in rural areas and in the state overall are likely far higher than the state health department is reporting, because of Texas’ limited coronavirus testing.

At the time Roberts entered his hometown hospital, public health officials were emphasizing COVID-19 testing for only very sick travelers, Aaron Fox, a spokesperson for the hospital, told the Observer. Roberts, at 97, had not traveled and had other medical issues.

But staff members at the Matagorda Regional Medical Center eventually ordered tests for COVID-19 for him and his caregiver, a woman in her 60s who was also hospitalized. The results arrived after his death; both Roberts and his caregiver tested positive. Fox said the small hospital then had to deal quickly with exposure to other patients and staff, an urgent cleanup, and a public health investigation.

“The biggest thing for us in any small or rural hospital [is that] people wear multiple hats,” said Fox, who is also chief business development director for the medical center. “Unfortunately, there were a lot of people who were exposed early on in our hospital because regulations hadn’t been set up yet.”

Officials at the hospital, which has just 58 total beds, have actively used its website both to share information about the virus and to distribute basic statistics about other local residents who already tested positive. So far, its six-bed ICU has not yet been overwhelmed by demand, Fox said, but about two dozen people have been hospitalized there for COVID-19. Its staff has urged all but the sickest patients to stay home, relying on telemedicine as much as possible.

Two others have died in Matagorda County, both older men, according to data posted as of April 21. Neither state nor county officials have indicated how many of those diagnosed or who died were African American, like Roberts.

Roberts was born in Bay City, where he owned and operated Duncan-Roberts Funeral Home for more than 50 years. Roberts was a member of a local church and the widower of a longtime schoolteacher and considered a pillar of the community. “Everybody knew him,” Fox said.

As an undertaker, he’d spent his life helping others deal with tragedy. But when he died, his family was unable to hold services because of the outbreak. “At the request of the Roberts’ family, and out of respect and concern for those who knew and loved Eddie F. Roberts, there will be no funeral service,” his obituary said.

— Sophie Novack, Christopher Collins, and Sunny Sone contributed to this report.

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