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Texans recovering from Covid-19 needed oxygen. Then the power went out.

The number of Texans dependent on home oxygen equipment was at “an all-time high” when a storm overwhelmed the power grid, leaving many struggling for air.
Image: Mauricio Marin at his home in Richmond, Texas, on March 3.
After three days with little power, no heat and inadequate oxygen that left him gasping for air, Mauricio Marin told his wife, “Honey, at least I’m going to die with you and my kids and not alone at the hospital.”Brandon Thibodeaux / for NBC News

This article was published in partnership with ProPublica, a nonprofit newsroom that investigates abuses of power, and The Texas Tribune, a nonprofit, nonpartisan local newsroom that informs and engages with Texans. Sign up to receive ProPublica's biggest stories as soon as they’re published, and sign up for The Brief Weekly to get up to speed on essential coverage of Texas issues.

HOUSTON — Mauricio Marin felt his heart tighten when the power flicked off at his Richmond, Texas, home on the evening of Feb. 14, shutting down his plug-in breathing machine. Gasping, he rushed to connect himself to one of the portable oxygen tanks his doctors had sent home with him weeks earlier to help his lungs recover after his three-week stay in a Covid-19 intensive care unit.

Between the two portable tanks, he calculated, he had six hours of air.

Marin, 44, and his wife had heard there might be brief, rolling power outages — 45 minutes or an hour, at most — as a massive winter storm swept across Texas last month, overwhelming the state’s electric grid. After more than two hours without electricity, he started to worry.

Marin tried to slow his breathing, hoping to ration his limited oxygen supply as he lay awake all night, watching the needle on each tank’s gauge slowly turn toward zero. The next morning, his wife, Daysi, made frantic calls to the power company and Marin’s doctor’s office, but nobody was answering in the midst of the storm.

For the next two days, Marin struggled for air and shivered under a pile of blankets. On the morning of Feb. 17, as they were still without power, his wife begged him to return to the hospital. But they feared driving on icy roads, and by then neither of them could get a consistent signal to call for help, as the widespread outages had knocked cellphone towers offline. And Marin didn’t want to go. He was terrified by the prospect of another hospital stay without visitors.

Marin’s skin was slowly turning purple, and he began to cry.

“Honey,” he later remembered telling his wife, straining with each word, “at least I’m going to die with you and my kids and not alone at the hospital.”

Marin said his life was spared when a neighbor showed up at the door with an oxygen tank a few hours later, sustaining him until the power returned. But he said his doctors fear that the weeklong ordeal inflicted additional damage on his lungs and jeopardized his already tenuous recovery.

Medical experts say Marin is part of a particularly vulnerable group who suffered significant hardships and potentially lasting harm as a result of the outages: those recovering at home from Covid-19.

Image: Daysi Marin helps her husband fasten his CPAP machine as he returns to bed
Daysi Marin helps her husband fasten his CPAP machine as he returns to bed at their home in Richmond, Texas, on March 3. Brandon Thibodeaux / for NBC News

At the peak of the outages last month, nearly 4.5 million Texas homes and businesses were without power, sparking calls for investigations of the Electric Reliability Council of Texas, the nonprofit that operates the power grid spanning most of the state, and the Texas Public Utility Commission, which oversees the state’s electric and water utilities. Two board members of the utility commission and six members of the ERCOT board resigned and the ERCOT CEO was fired after sharp criticism that they had not done enough to prepare for winter storms and had ignored warnings about the danger severe weather poses to the state’s electric grid.

Meanwhile, the human toll is still being tallied. Dozens of Texans have filed lawsuits against ERCOT and local power companies. Some of the suits allege that medically fragile children and adults suffered permanent or severe injuries because they were unable to get electricity to power life-sustaining medical equipment. Others have been filed by the surviving loved ones of older residents who died of hypothermia in their homes.

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Among those demanding accountability are some Texans recovering from Covid-19 who say the prolonged outages further imperiled their already fragile health.

One woman said she was diagnosed with a fairly minor case of Covid-19 in early February. But after more than two days in her frigid Houston home without power or heat, she said, her symptoms became severe. She had dizziness and difficulty breathing, forcing her to seek care at an emergency room, according to a lawsuit filed in Harris County that accuses ERCOT and her utility CenterPoint Energy of negligence.

Five hours southwest, in Hidalgo County, another woman was sent home with an oxygen machine to recover from Covid-19 after a three-week hospital stay. As she struggled for days to breathe and keep warm without power, she feared she was going to die, according to a lawsuit she filed against ERCOT and her power company, AEP Texas. After her power was restored, the woman had trouble breathing even with her oxygen machine, forcing her to seek medical care, the complaint alleges.

Mauricio and Daysi Marin have filed their own lawsuit in Harris County district court against ERCOT and CenterPoint Energy.

“I told Mauricio, ‘We've got to do something about this. This cannot happen again,’” Daysi Marin said. “We need to speak out and we need to say something.”

Image: Mauricio Marin's wife, Daysi, helps him with his daily medications.
Mauricio Marin's wife, Daysi, helps him with his daily medications.Brandon Thibodeaux / for NBC News

ERCOT said it had no comment regarding the Marin lawsuit, and did not respond to a subsequent email seeking comment on the two other cases. A spokesperson for AEP said the company does not comment on pending litigation. In a statement, Olivia Koch, a spokesperson for CenterPoint Energy, said that though she couldn’t comment on pending litigation, the company is fully committed to working with stakeholders to address the issues related to the storm.

“We understand the severe impact that the historic weather and generation shortfall emergency had on all Houstonians and Texans,” she wrote in an email.

'Medical disaster'

In an effort to reduce the strain on limited hospital resources during the pandemic, it’s become standard practice for hospitals to send most Covid-19 survivors home before their lungs have fully recovered, said Dr. Jamie McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. Those patients often spend several days or weeks dependent on breathing equipment, such as oxygen concentrators or BiPAP machines, that require electricity.

As a result, McCarthy said, the number of Texas residents dependent on home oxygen was “at an all-time high” as the winter storm hit last month. With statewide Covid-19 hospitalizations peaking at more than 14,200 people in mid-January, medical experts say thousands of Texans like Marin had been sent home with plug-in breathing machines and portable oxygen tanks in the days and weeks before the electric grid failure.

When the power went out for millions of households, many recent Covid-19 survivors were left straining to breathe and unsure where to turn for help, setting back their recoveries, doctors say.

Image: Winter Storm Causes Blackouts In Texas
At the peak of the outages last month, nearly 4.5 million Texas homes and businesses were without power. Chris Rusanowsky / Zuma Press

Unlike other patients with chronic lung problems who’ve spent years dependent on breathing machines and who have endured severe weather events and outages in the past, McCarthy said, patients recovering from Covid-19 likely didn’t have access to backup power sources or other contingency plans.

“Most of the people that had been sent home on oxygen concentrators related to Covid, especially this time of year, we were not sending them all home saying, ‘OK, you need to be prepared to be without power for two days, what's your plan?’” McCarthy said.

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Dr. Bela Patel, the chief of critical care medicine at UTHealth’s McGovern Medical School, said that during the power outages some recovering Covid-19 patients showed up at emergency rooms, filling up already crowded hospitals. Others told her they couldn’t get to a hospital and instead spent days struggling at home.

“It was really devastating for them,” said Patel, who runs a clinic for those recovering from long-term symptoms of Covid-19. “They were panicking because they weren't getting enough oxygen, their oxygen levels were dropping and they were trying to figure out what they could do.”

Patel said she was aware of about 40 calls to her clinic throughout the outages from recovering Covid-19 patients in need of oxygen, but in most cases her team couldn’t get it to them and instead directed them to go to an emergency room. While she said she is hopeful that many of those patients will recover from the damage caused by hours or days spent in frigid homes without access to supplemental oxygen, others may not be able to bounce back.

When patients with serious respiratory conditions spend several hours or days without access to supplemental oxygen, doctors say, it puts a significant strain on their heart and lungs, limiting the flow of oxygen-rich blood to vital organs and leading to potentially life-threatening complications. Frigid temperatures like those seen during the outages — the inside of many Texas homes dropped below 40 degrees — can further complicate breathing conditions, leading to lung spasms.

“We certainly hope that most of them will get to their baseline, and some of them already have,” Patel said. “But we do know of examples where patients didn’t recover and continue to deteriorate.”

Across the state, at least 40 deaths have been directly attributed to the storm and power failure, according to The Associated Press. Experts say the figure is likely much higher, but it may be weeks or months before the total death toll is known, as officials comb through records and certify deaths across the state. It’s unclear if any of the 40 reported cases involved people who were recovering from Covid-19.

Beyond the harm that can result from a lack of oxygen and a lack of heat, the emotional stress resulting from a dayslong power outage can also affect a patient’s heart and lung function and require additional medical care, Patel said. That’s an extra challenge in a state like Texas, with the largest number of uninsured residents in the country.

Image: Aftermath of power outages caused by winter weather in Fort Worth, Texas
Christina Beverly checks the oxygen levels of her grandmother, Marie Smith, on Feb. 20. Their Fort Worth, Texas, home had been without power since Feb. 14.Cooper Neill / Reuters

It could have all been prevented, she said.

“When you look at the long-term effects of what this had on our patient population,” Patel said, “it’s really a medical disaster.”

'It happened again'

Marin, a filmmaker who moved to the United States from Colombia two decades ago after meeting Daysi at a California film festival, thought he had a bad cold when he started feeling sick in early December. But then he awoke in a panic a few days later, unable to draw in a full breath.

His wife called 911 and an ambulance rushed him to Houston Methodist Sugar Land Hospital, where doctors diagnosed him with Covid-19 and admitted him to the ICU. That night, as doctors contemplated whether to connect him to a ventilator, Marin said he silently begged God to spare his life.

Image: Mauricio Marin while he was being treated for Covid-19 at a hospital in Houston.
Mauricio Marin while he was being treated for Covid-19 at a hospital in Sugar Land, Texas.Courtesy of Marin family

He called his wife from his hospital bed, barely able to speak, and told her to tell their two children, ages 18 and 20, that he loved them, and that he was proud of them.

“I truly believed I was going to die, but somehow I was given another chance,” said Marin, who slowly recovered over the next three weeks before being sent home with supplemental oxygen. “And not even two months later, it happened again.”

On the morning of Feb. 17, Daysi Marin said, after her husband had been without power for more than two days, she feared he was dying. He told her he was having severe chest pains after so many hours straining for air.

“I have never been in a situation like that, where you see somebody dying in front of your face, and you cannot do anything,” she said. “It was terrifying.”

She felt like God was answering a prayer when a neighbor, responding to a plea she’d posted on Facebook, showed up that evening with a six-hour supply of oxygen — “like a miracle from out of nowhere,” she said.

Image: Mauricio Marin shows the message he had tattooed on his arm after being discharged from a Covid-19 ICU.
Mauricio Marin shows the message he had tattooed on his arm after being discharged from a Covid-19 ICU.Brandon Thibodeaux / for NBC News

Following the ordeal, Marin said, he feels worse than when he was initially discharged from the hospital. He can’t walk around the house without becoming winded and can’t go even a moment without being connected to supplemental oxygen. After the back-to-back traumas, he said, he feels like he’s always on edge, worried about what would happen if any of his breathing equipment fails him.

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Marin said his doctors prescribed additional medication to help his body recover in the wake of the outages and have asked him to return for additional tests to determine whether his heart or lungs were further damaged.

Daysi Marin isn’t sure if her husband will ever fully recover from the ordeal — or if she will.

“Last night, Mauricio was choking again and water was coming out his nose and his mouth,” she said, two weeks after the outages. “At night, I sleep a few hours and then I’m always up, checking if he’s breathing.”

She’s had to resort to anxiety medication to manage her panic attacks, she said. “I’m worried all the time.”