‘The next one’: How Nevada is preparing for future pandemics

The coronavirus pandemic isn’t over, but we’re closer than ever to returning to a sense of normalcy.

The state’s 14-day positive test rate has dipped to 5.3%, just above the World Health Organization’s goal of 5.0% for economic reopening. The number of known and suspected COVID-19 cases in Nevada hospitals has dropped to its lowest levels since statewide record-keeping began in early April 2020. More than one in five Nevadans have received at least one dose of a coronavirus vaccine so far.

Now, some state officials are planning for the next pandemic to hit the Silver State.

Watching for the ‘next one’

With the global population nearing 8 billion, humans and nature have never been in closer contact, creating more opportunities for animal-borne diseases to make the jump to humans.

“The possibilities are endless,” according to Dr. Trudy Larson, dean of the School of Health Sciences at the University of Nevada, Reno, and member of the state’s Medical Advisory Team.

Any place where chickens, pigs and humans live in close proximity can create a melting pot of avian, swine and human influenza — and there’s a strong possibility that an influenza mutation could be the “next one.” Changing climates have created breeding grounds for more insects, opening the door for a mosquito-borne virus like Zika, or an aggressive, drug-resistant form of malaria.

“It’s not a matter of if; it’s a matter of when,” Larson told the Reno Gazette Journal. “That’s why our responses to pandemics have to rely on things we know we can implement rapidly.”

Trudy Larson

Nevada had a pandemic playbook in place, along with all other states. The Centers for Disease Control and Prevention had a national playbook as well. The plans were created following the 2009 swine flu pandemic, which killed an estimated 284,000 worldwide, including an estimated 12,500 in the United States. The playbooks featured elements now familiar — surveillance, closing borders, shutting down interstate travel, a robust case-finding effort, and quarantine of patients.

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“It’s all there, beautifully laid out,” Larson said. “However, the farther we got away from that particular episode, the fewer resources went into maintaining the infrastructure needed to respond in that fashion.

“We knew exactly what to do, but there was not a will nationally to do this. The underfunding and the politics (surrounding) the CDC did not allow them to take the role that they should have — because that’s where the experts are.”

Surveillance is key, Larson said. A global network of scientists continues to monitor and model disease threats, serving as an early warning system for countries to pull the trigger on their pandemic plans.

“In our global economy, where almost everything is one plane ride away, infectious diseases that are readily transmittable must be managed as a global crisis,” Larson said.

Best-laid plans

Plans, in and of themselves, are no guarantee of success — just a starting point. Caleb Cage, the state’s COVID-19 response director, worked through simulated pandemics in his previous role as head of the State Division of Emergency Management and Homeland Security.

“It was one of the seven major threats and hazards that we prepared for, so it was something that was always being planned for,” Cage told the RGJ. “The thing that has been a lesson for me is how much more intense and protracted an actual pandemic is than what you can necessarily prepare for. We haven’t had a pandemic of this magnitude for 100 years.”

Caleb Cage, the COVID-19 Response Director for the State of Nevada, poses for a portrait in the Nevada State Capital Building in Carson City on Jan. 15, 2021.

Cage said that although Nevada is still under the COVID-19 emergency declaration, the state is working on its in-progress review of the response. One area that needs work is Nevada’s health infrastructure. Nevada ranked 39th in per-capita spending on health and hospitals as of 2017, according to an analysis by the Tax Policy Center.

“We have not historically made major investments in things like public health … and we’re really experiencing the outcomes of the lack of investment,” Cage said.

The state was able to set up a field hospital early on in the pandemic — a tent structure in Las Vegas which handled overflow patients among the city’s homeless population. But there was far more demand for additional hospital space throughout the state.

Carson City requested a field hospital to treat prisoners at the Warm Springs Correctional Center, which saw a severe outbreak last fall. Many rural facilities were operating at capacities far exceeding 100%, and hospitals in the state had to turn away those seeking elective procedures. In Washoe County, Renown Regional Medical Center converted its parking garage into a 1,400-bed facility in April, eventually utilizing the space for a surge in cases in late 2020.

Cage said the state would work with the Federal Emergency Management Agency and the Army Corps of Engineers on plans for alternate care facilities for future crises.

But physical infrastructure is just one piece of the health care challenge.

“You only have so many licensed professionals,” Cage said. “There are tried and true ways for increasing (the number of medical professionals), and a lot of it goes to the funding formula which goes to fund higher education in the state of Nevada.”

An effort has been underway since 2004 to double the number of nursing slots available at state colleges and universities, and to work with K-12 programs in the state to connect with higher-education medical programs.

Still, Nevada had the second-worst ratio of hospital employees per capita in the U.S. in 2019, with one for every 73 residents, according to data from the Bureau of Labor Statistics. And in 2020, Nevada had the second-worst ratio of primary care doctors per capita in the U.S. in 2020, with one for every 1,768 residents, according to a study by the University of Wisconsin Population Health Institute.

Aside from health care infrastructure, the state also needs to improve broadband access, especially to rural parts of the state — not only for education and telehealth access, but for economic development.

“We have tried really hard to balance the public health and economic health of the state,” Cage said.

But the state’s reliance on the tourism and hospitality industry — which has proven to be especially vulnerable to a contagious health crisis — hit Nevada’s economy harder than nearly any other state. According to the Bureau of Labor Statistics, Nevada’s nonfarm payroll employment decreased by 10.8% from January 2020 to January 2021, tying New York and trailing only Hawaii as worst in the nation.

‘The state we deserve to live in’

The pandemic and subsequent business shutdowns caused Nevada’s unemployment rate to skyrocket to near 30% in April — the highest level ever recorded for a U.S. state, and worse than the depths of the Great Depression. Jobless Nevadans flooded the phone lines for the Department of Employment, Training and Rehabilitation to collect unemployment, and quickly discovered that the system wasn’t up to the task.

Nevada Treasurer Zach Conine pictured in an undated courtesy photo.

“Our systems did not scale to meet the needs of the pandemic,” State Treasurer Zach Conine told the RGJ.

Other state offices encountered work-from-home headaches as well. Phone systems didn’t have enough trunks to forward calls to cellphones. The state’s VPN system didn’t have enough licenses to allow staffers to work online remotely, 

The downturn also reduced the state’s fiscal plans to tatters, forcing state officials to pull $401 million from the rainy-day fund last May. Conine considers it the right move for the state.

“Staying in the plane when it’s going into the side of the mountain is not fiscally prudent,” he said. “If you have a parachute, use it.”

For future downturns, Conine is backing Senate Bill 47, which would allow the state to borrow money as an emergency measure to pay expenses already approved by the Legislature like state payroll and National Guard expenditures.

Conine said the conversation now needs to turn to economic diversification in order to weather the next pandemic. That means spurring Nevadans to invest in their own small businesses, which Conine said will be the backbone of the recovery; and attracting companies to move to the Silver State, which is an entirely different matter. The state can provide financial incentives, which it has done with corporations including Tesla, Apple and Amazon; or it can improve education, workforce development and infrastructure, Conine said.

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Gov. Steve Sisolak and legislators in Carson City have made moves to fund the infrastructure bank, a program that combines state funding and private capital to help counties, cities and other local entities finance improvements to transportation, water, sewer, hospital and school construction projects. It’s been in existence since 2017, but it may receive funds for the first time this year — $75 million, according to the governor’s draft budget.

Conine said there are many shovel-ready — and “shovel-worthy” — projects in the pipeline that can provide needed infrastructure improvements and high-paying jobs in the state during its recovery.

Another untapped source from outside the state is the collection of federal funds, in which Nevada ranks near the bottom. Conine said Nevada is more than $1 billion per year below the country’s per-capita average for securing federal dollars for Medicaid funding, early childhood education, transportation projects, health care for seniors, after-school programs and assistance with utility bills. Legislators are proposing a cabinet-level position to help secure Nevada’s fair share of federal cash.

“We need to take steps to build the state we deserve to live in,” Conine said, “rather than the state we have to live in.”

What worked, what didn’t

Reviewing our COVID-19 reaction and results is necessary for the state’s future plans. But taking a hard look at our missteps can be excruciating.

“In whatever sector we look at — the economy, education, everything — we’ve been experimenting in real time,” Larson said. “And that’s hugely uncomfortable.”

In fighting an invisible enemy, many Nevadans took diligent measures to prevent infection. Some have proven effective — frequent hand-washing, wearing masks in public and disinfecting shared surfaces like shopping carts. Others, in retrospect, were excessive, like washing grocery packaging, spraying mail with disinfectant and wiping down credit cards.

It’s been no different at the state level. Conine said state officials couldn’t wait to make long decisions, instead opting to make good decisions quickly when information was lacking — describing the process as “let’s try something, and then make any necessary shifts.”

Larson said that, in retrospect, schools probably should have been kept open, while bars and restaurants probably should have been closed immediately.

But hindsight is 20/20. And it’s not easy, even after the fact, to determine the difference between effective action and overkill.

“We need to be in a state of perpetual forgiveness,” Larson said. “We’re trying to do the best with the information we have and to torture ourselves with excellence will get us nowhere.”

Brett McGinness is the engagement editor for the Reno Gazette Journal. He’s also the writer of The Reno Memo — a free newsletter about news in the Biggest Little City. Subscribe to the newsletter right here. Consider supporting the Reno Gazette Journal, too.