The combination of severe winter weather and electricity outages across the state has dealt a devastating blow to the health care system in Texas, which is already under enormous stress because of the coronavirus pandemic. COVID-19 has caused 2.6 million infections and nearly 42,000 deaths in the state.

Accounts from around the state reveal hospitals on the brink of collapse.

A source at Dell Children’s hospital in Austin shared with Matt Largey, a local news correspondent at KUT 90.5, Austin's NPR station, the following yesterday:

“There is still no water or update on water. I know there was a broken pipe on the fourth floor, and I don’t know if that’s the primary cause of the outage. The toilets are filling up and won’t flush, so the nurses are using kitty litter in trash bags to dispose of waste. The temperature in our rooms seems stable, but the main areas are very cold. We are waiting on a surgery, but I’m not sure when it will be or if they can operate without water.”

Winter Storm Uri, as it was unofficially dubbed by the Weather Channel, formed on February 13, placing a vast expanse of the United States, affecting 170 million Americans, under a winter storm alert. More than five million people from North Dakota to Texas have been thrown into frigid darkness, although power was restored to the majority of these victims by late Thursday.

So severe has the weather system’s impact been, health systems are collapsing again, but this time due to lack of electricity and potable water and non-functioning plumbing caused by frozen or burst pipe mains. The crises faced by medical centers in the summer and winter during the pandemic’s surges are reemerging throughout the region.

The dangers of hypothermia from the power outages have led many to use desperate means to stay warm. More than a million people lost power in Houston, Texas, as electricity demand soared during the unprecedented freeze. People quickly jumped into their cars, running the engines in the garage, or even bringing barbecue pits and generators indoors, anything for a source of heat. Immediately, hundreds of cases of carbon monoxide poisoning began to pour into emergency rooms throughout the city. Such patients require immediate supplemental oxygen or aggressive treatment in hyperbaric chambers.

Dr. Samuel Prater, a UTHealth emergency physician, told the Houston Chronicle, “With the number of patients going in, it’s turning into a mini mass casualty event.” Half the patients he was treating were children. Several have died. A grandmother and three children perished in a Sugar Land house fire when using the fireplace as a warmth source. Only the mother of the children survived. In Sharpstown, another mother and her eight-year-old daughter asphyxiated from carbon monoxide poisoning sleeping in their car. An unidentified man was found dead in a north Harris County parking lot, succumbing to the frigid cold.

Fort Worth and communities across north Texas have opened impromptu warming centers though most are only open during the day. Some have had to close due to power outages. Residents must find their way to these shelters and bring with them bedding and food only to return to their homes in the coldest hours of the night.

St. David’s South Austin Medical Center, nationally recognized for its cardiac program and providing comprehensive obstetric care, lost water pressure on Wednesday. As a result, the hospital’s boilers are not functional, which means they can’t generate heat to keep rooms and hallways warm. Stable patients are urgently being discharged home, but this begs the question, is it safe there?

Hospital administrators are also scrambling to locate rooms at other facilities. David Huffstutler, CEO of St. David’s HealthCare, told the Texas Tribune, “Because this is a statewide emergency situation that is also impacting other hospitals within the Austin area, no one hospital currently has the capacity to accept transport of a large number of patients.”

Meanwhile, patients and families staying in impacted medical facilities, such as at Dell Children’s in Austin, Texas, are asked to use hand sanitizers and not flush toilets. A letter addressed to staff warned that as temperatures outside dropped, the temperature in the building would be difficult to maintain. There is also a limited supply of fleece blankets.

Many nurses in Austin have been trekking miles to work. Frozen roads and massive amounts of snow the city cannot dispose of have made driving extremely hazardous. Hospitals have to stay open regardless, and need staff. Brook Wilson, a labor and delivery nurse at St. David’s Women’s Center of Texas, told KHOU11, “I bundled up, and I put on my boots, and I changed my shoes, and I already packed a bag thinking I was going to be staying here for a while. So, I packed a bag, and I headed out, and I started walking.”

Hospitals in San Antonio are on backup generators to keep the lights on. The frigid temperatures have driven water pressures down at Baptist Health Systems, impacting their dialysis center. Water shortages have led to rationing across the region as well.

The cold reduces the thirst drive leading many to become severely dehydrated, which further exacerbates acute medical conditions caused by the freezing temperatures. Many patients are coming in with frostbite and very low body temperatures—hypothermia. Dr. Lillian Lao, who works at the Pediatric Trauma Medical Director of University Hospital, warned, “You’ll start to get very cold, and then you may lose consciousness. Some of the signs that’s different in very young children, babies, is that though their bodies will be cold, but their skin color will become reddish.”

More than just trying to save patients, doctors are trying to figure out how to protect the multiple doses of the COVID-19 vaccines, which require even lower temperatures than the frigid arctic cold temperatures outside. In Harris County, the health department could not maintain the 8,430 Moderna vaccines’ refrigeration temperature when their backup generators failed. According to NPR, they managed to deliver 5,410 doses to three hospitals, the Harris County Jail and Rice University. However, vaccine distribution has come to a standstill, and vaccination centers have closed their doors, for now, citing safety concerns.

The Galveston medical examiner has requested refrigeration trucks to store bodies as a consequence of the sudden rise in deaths due to the inclement weather. County Judge Mark Henry stated to ABC Eyewitness News, “We were notified of an emergency request about lunchtime today that the medical examiner needed a capacity of at least 20 and as many as 50, in addition to the standard storage.