Hundreds of Mexicans and Americans who live south of the border enter southern California's hospitals every day.
A worker disinfects a market which prepares to reopen amid the COVID-19 outbreak in Mexico City, Mexico, on May 23. Photo: Xinhua
But these are not the patients - they are medical workers and support staff keeping a saturated healthcare system running amid the coronavirus pandemic.
Over 1,000 nurses, medical technicians, and support workers who live in the Mexican border towns of Tijuana, Tecate and Mexicali work in the US, Mexican census data shows. They staff emergency rooms, COVID-19 testing sites, dialysis centers and pharmacies.
Well over 1,000 more clean contaminated hospital rooms and biotech labs; wash doctors' scrubs and patients' bed sheets; and provide in-home care to the elderly and others vulnerable to the virus.
"From the receptionist to nurses, doctors, surgeons and pharmacists, there're cross-border workers in every single stage," said Paola Avila, vice president of international business affairs at the San Diego Regional Chamber of Commerce.
In recent weeks, US officials and California hospitals raised alarms about US citizens living in Mexico crossing the border for treatment as COVID-19 cases surged in Tijuana and Mexicali. At El Centro Regional Medical Center, the largest hospital in California's Imperial Valley, which employs dozens of cross-border workers, a wave of such patients helped saturate the intensive care unit and forced the hospital to begin airlifting people to hospitals over 160 kilometers away.
The healthcare workers are a reminder that in the interconnected region the state also benefits from cross-border travel, at a time when US President Donald Trump has warned that infections in Mexico are a risk for the US and senior US Department of Homeland Security officials have expressed concerns about dual nationals living in Mexico.
"This is a workforce that is needed in the hospital," said Dr Andres Smith, medical director of emergency services at Sharp Chula Vista in San Diego.
Angel Esquivel, El Centro's base hospital trauma manager, who coordinates the flow of patients with ambulance and helicopter services, said living in Mexico enabled him to prepare better for the recent rise in patients crossing the border.
It gave him first-hand knowledge of how that outbreak was unfolding, he said.
Emerald Textiles, the largest healthcare laundry service in San Diego, said more than half of its employees live in Tijuana. "Without my people being able to cross the border it would be very, very difficult for us," said President Jaye Park.
That concern was echoed by representatives of two hospital systems in the San Diego area who sent a letter to Trump administration officials in April warning of a brewing public health crisis at the border, yet acknowledging the healthcare system's dependence on cross-border workers. "It is critical that our healthcare personnel be able to move freely," the letter stated.
Newspaper headline: Workers living in Mexico offer help in California