The Lubbock Singularity

In nursing school you get these assignments, they’re more like projects really and usually involve working in groups of two or three students, maybe more. My teammate last semester was Veronica, who is a labor & delivery nurse on the Gulf Coast and our assignment for Population Health was to look at a county in Texas—there are 254 to choose from. And examine outcomes in light of the pandemic. 

It's easier read in a syllabus than done, let me and Veronica tell you. 

We chose Galveston County for a couple of reasons, one being that we are both graduates of Medical Branch, on Galveston Island, the state’s oldest School of Nursing, btw. Also Medical Branch takes care of health needs for the vast majority of the nearly 150,000 inmates in the state prison system, the Texas Department of Criminal Justice as it is euphemistically called, or just plain TDCJ. Where COVID-19 was said to be running rampant at the time, last semester. So, like—long story short—Veronica told me one day in March that there were about 250 deaths, at that point, on the Galveston County COVID-19 dashboard. Which is run by the Galveston County Health District.

Which struck us as strange actually. Because in order to judge our stats, we had been instructed by our Professor to make a comparison to another county in the state and we’d chosen Lubbock, on the High Plains. And there were a couple of good reasons to choose Lubbock, actually—or so we thought. There were similarities to Galveston and differences as well. One, Lubbock is the other side of the state, the High Plains versus the Gulf Coast, polar opposites and all that. Whatever might influence healthcare outcomes during the pandemic in one county might not be important in the other, across the humongous Lone Star State. It was a roll of the dice but our idea was that Galveston and Lubbock would serve as experimental controls for each other.

The two counties are also very close in population, like Numbers 13 and 14 on the Lone Star list of counties, both just over 300,000 inhabitants, so it seemed fair, whether it made scientific sense or not. 

We were instructed to check a University of Wisconsin website that tracks health data in counties across the country and it showed that Lubbock and Galveston were very close in terms of healthcare resources and outcomes, with a slight edge maybe to Lubbock. Both counties are home to large academic healthcare institutions, btw, Medical Branch and Texas Tech Health Science Center in Lubbock, respectively—the latter institution where our schoolwork was taking place.

So, like, long story short, both hospitals take care of state prisoners, although Medical Branch cares for eighty percent of inmates in the state while Texas Tech handles the remainder. Anyway—long story short again—at the same time that Galveston County was reporting about 250 deaths from COVID-19 (a figure which included any prisoners who died at Medical Branch), Lubbock County was reporting 750 deaths from COVID-19 (including state prisoners), three times as many, which seemed a lot, in our not-yet-scientific view. For two similarly sized counties. And it didn’t make sense. A few percentage points, sure—between two equally-populated places—but two hundred percent seemed a tad extreme, in our graduate student view. According to our limited understanding of statistical probability, p-values and all that. Informing our instructor of these numbers, of these data, she wrote back, ironically, that maybe it was the cotton gins around Lubbock. On the heavily-agricultural High Plains, an area that runs from the Panhandle to the Pecos River. There had to be something in the air, you might say.

Lubbock is famous for dust storms. This would be something carrying COVID instead. As compared to the briny ocean air of Galveston County, down on the Gulf of Mexico. Our instructor pushed us to inquire further. The Lubbock County health authority did not respond to our queries, nor the City of Lubbock Health Department which apparently handles the local public health operation and runs the dashboard. Where we were getting our information. 

A further dive into the data pointed to a gross healthcare outcome discrepancy, actually. Between Lubbock County and the state prison system. If you were looking to do that comparison. 

At the same time that Galveston was reporting about 250 deaths (the numbers change, obviously, every day, but that was the level when this was happening, about halfway thru last semester, in my unscientific recollection) the state prison system was also reporting 250 deaths from COVID-19. That figure has to be normalized because the total number of inmates in Texas prisons hovers around 150,000, half the population of Galveston or Lubbock County. So. Like, if the prisons were the same size as the two counties, the number of dead prisoners (and one supposes guards) who died would be closer to 500. To set the scene. 

In sum, we had three rates of COVID-19 deaths in Texas: about 250 for Galveston County, from start of pandemic, about 500 for TDCJ and about 750 for Lubbock County. If there's something wrong with that math let us know, but that meant to us, to misquote Apollo 13, “Lubbock, we have a problem.”

It’s just a snapshot in time, of course, what the dashboards were showing that day, but the picture is not good, if accurate. And the extreme nature of the Lubbock figure, higher even than for the state prisons, was more pronounced when you consider that state inmates are housed cheek by jowl and did not have quick access to vaccines, for example, and they couldn’t self-distance, as a free-world population can. Lubbock’s death rate was higher than in prison cells, really? That’s a scary thought. And certainly didn’t sound hygienic. And, btw, the Health Authority for the state prisons, where one-fifth of the inmates go to Lubbock if they need to be hospitalized, and the rest go to Galveston? He said TDCJ’s infection numbers in the Lubbock sector were not particularly high and were not the reason for any possible high incidence of COVID-19 deaths on the High Plains. 

One’s first inclination is to blame poor adherence to guidelines, such as mask-wearing—and not to blame cotton gins or “something in the air,” the famous Lubbock dust, or whatever. As nurses we can educate the public but we have to respect cultures and if people in Lubbock County are really really really opposed to masks, for example, and willing to die for it (as students we don’t know the full extent of the danger, because we haven’t seen the data) but a lot of people in Lubbock County apparently are like that, according to news reports. Just as in many other parts of the country.

 Or if the people of Lubbock are very conservative socially, as evidenced by the city’s recent official rejection of abortion, is it really our role as caregivers to object? You just take care of people and answer any questions they may ask. You can teach but you can't lecture.

You may say, well, some of the 750 people who died—if they died because of the community’s poor masking for example, what then? They themselves may not have rejected masking and died only because others did. In other words they were infected by someone whose healthcare practices were different from their own. Healthcare outcomes are not always fair, it seems. Local standards are local. 

Choices made by a cultural group—or a population, as in our just completed class Population Health—may well influence the welfare of individuals who do not agree with the choice. That’s what we learned by doing our project for the School of Nursing.