With its vast farm fields, quiet roads, and sparsely-populated communities, it's almost hard to believe that Imperial County, with only 180,000 residents, has the highest-per capita infection rate of coronavirus in all of California.
According to its public health department, the county has had about 6,200 cases among 30,700 people tested, a positive rate of about 20 percent.
That's much higher compared to neighboring Riverside County's 11.8 percent.
Carmina Ramirez knows firsthand how easily the virus can spread. She says five of her relative, who live in different parts of Imperial County, recently tested positive after a family gathering.
"Some of them had mild symptoms, and others had like a two-month period of fever and cough," Ramirez said.
But her 72-year-old cousin Jose died.
Jose's sister, Patricia, says her family is her world. Even though she considers herself lucky to have survived the virus, she says her brother's death has been devastating.
"The sadness of losing my brother to this virus is something no family should have to experience," Patricia said.
El Centro Regional Medical Center is Imperial County's largest hospital, and it began to fill up with coronavirus patients in late April, many of them taken here to tents out in the parking lot. Other patients were taken to hospitals hours away, including the Coachella Valley.
"It's exhausting, it's taxing and it's not easy," said Dr. Adolphe Edward, CEO of El Centro Regional Medical Center.
Edward says the hospital's 20-bed intensive-care unit remains overwhelmed with sick patients. In the last month alone, more than 500 patients had to be transported outside of the county and he expects that number to grow.
"I am very surprised that we are getting the high numbers that we're seeing," Edward said. "It is not a single factor and it's not a single issue. It's not just from the community it's a multitude of things."
He says that includes Imperial County's proximity to the U.S.-Mexico border. Mexicali, with nearly 4,900 cases and 840 deaths, is among the hardest-hit places in Mexico and many U.S. citizens living there have fled overcrowded hospitals to seek treatment north of the border.
"Coronavirus does not know borders. Coronavirus knows it attacks people that are not doing the right things we keep talking about," Edward said. "It's folks going back and forth at rates that are high."
Doctors say another factor may be cultural.
Imperial County has the largest household size of any county in California., which may be explained by a large number of Latinx families that by tradition often live in multi-generational households.
Imperial County is about 85-percent Latinx and doctors say it's challenging for many infected people there to quarantine.
Edward says Riversie County can learn from what's happening in Imperial County.
"Be prepared to expand your capabilities in all your hospitals, be prepared to figure out ways that you have not thought of before," Edward said. "Remain flexible because plans will change, and what you planned for is not what's going to happen, so be very flexible."
When asked why people in Riverside County should care about what's happening in Imperial County, Edward replied:
"A family of four can move tomorrow from Imperial County to Riverside County and they can all be asymptomatic, COVID positive."
As for Carmina Ramirez, she continues to quarantine at home with her husband and daughter, concerned the virus that has already brought so much pain to her family will keep doing the same for other families throughout the county.
"We should be worried and we should be taking precautions," Carmina said.
This week, Imperial County's board of supervisors came up with an action plan in response to Governor Newsom's call for the county to stop its reopening. That plan includes closing all non-essential businesses and parks and encouraging people to stay home as much as possible.