Sen. Lindsey Graham (R-SC) said Wednesday he hopes to attend former Attorney General Adam Laxalt’s Basque Fry in August as Senate Republicans hope to win back the majority in the midterm elections by focusing on conservative issues that they argue resonate with Latinos in Nevada and other swing states.
“I’m looking at that,” Graham said. “I don’t know if I can make it. Adam’s a good guy and would be a good candidate for us out there.”
Sen. Rick Scott (R-FL), chairman of the National Republican Senatorial Committee (NRSC), Senate Republicans’ campaign arm, would not rule out attending.
So far, Sen. Tom Cotton (R-AR) is the only confirmed Republican senator set to attend. Sen Ted Cruz (R-TX) said he was invited but can’t make it due to his schedule. Sen. Rand Paul (R-KY) said he has no plans to attend. Both have attended in the past.
Laxalt, who ran unsuccessfully for governor in 2018, is considering running against Sen. Catherine Cortez Masto (D-NV), who is seeking re-election after her first term in office.
Scott confirmed that he had spoken with Laxalt, former Sen. Dean Heller and other potential candidates that he would not name. Heller now appears to be laying the groundwork to run for governor.
“I've talked to quite a few people in Nevada,” Scott said. “Ultimately, it's a personal decision whether people want to run or not.”
President Joe Biden won Nevada by just two percentage points and the NRSC is eyeing Cortez Masto’s seat as it looks to pick up the one seat Republicans need to break the Senate’s 50-50 party split. For the moment, Democrats control the chamber through Vice President Kamala Harris, who can break tie votes.
On Thursday, the NRSC released a poll conducted in Spanish of 1,200 Latino voters in eight swing states, including Nevada, that it believes shows that Latinos are allied with the GOP on issues such as immigration and capitalism.
While the poll only included 300 Latinos from Nevada, Scott argued that the survey shows that the GOP can connect with Latinos and win them over. That's something Scott prides himself in doing after winning a close Senate race in 2018. Scott beat his Democratic opponent by 10,033 votes.
“If you look at this poll, they're like a typical Republican,” Scott said Wednesday. “They're aspirational. They have a faith in God. They care about freedom. They care about opportunity. They're not into big government. They want the rule of law, and they want good schools. That's a Republican.”
Jazmin Vargas, spokeswoman for the Democratic Senatorial Campaign Committee, the Senate Democrats’ campaign arm, said that the poll didn’t reflect the unpopularity of Republicans’ policies with Latinos. She cited Republican opposition to the American Rescue Plan, which was enacted in March and provided $4 billion for Nevada and direct payments of $1,400 for most individuals.
“A fake poll from the NRSC won’t change Senate Republicans’ record of attacking Latinos’ access to affordable care, their refusal to support DREAMers, and their unanimous vote against a coronavirus relief package that has provided direct economic relief to millions of Latino families and small businesses,” Vargas said, adding that a poll in April showed that 76 percent of Latinos approve of the law.
“Latinos will hold every Senate Republican accountable for their toxic agenda in November next year,” Vargas continued.
Conducted by OnMessage Inc., a Virginia-based Republican political polling and consulting firm, the NRSC poll also had respondents from Arizona, Florida, Georgia, North Carolina, Ohio, Pennsylvania and Wisconsin.
The survey found that 63 percent of those polled agreed that “capitalism is the best form of government because it gives people the freedom to work and achieve their potential.”
The question reflects Republicans’ strategy to paint Democrats as too liberal. It also comes after the leadership of the Nevada Democratic Party was taken over by a slate of Democratic Socialist candidates in March.
On immigration, 72 percent agreed that the government “should do what is necessary to control our southern border and stop the surge of illegal immigration happening right now.”
Another 69 percent opposed “allowing illegal immigrants to receive the same welfare and unemployment benefits as citizens.”
Fifty-eight percent also said they agreed that too many people were living off of government assistance.
Scott, who also served as Florida governor, said he planned to use the poll to show his fellow Republicans what is possible when it comes to talking to Latino voters.
“I did it in my races, so there's no reason we can't do it across the country,” Scott said.
Scott said he did not know if there would be a contentious primary for the GOP nomination in Nevada, but he said that tough primaries can help fortify a candidate for the general election.
Asked whether he believes former President Donald Trump would play a role, Scott said he hopes he does, adding that Trump remains popular with GOP voters.
“If you look around the country, his agenda is very popular,” Scott said. “So I think he can be helpful.”
Trump’s endorsement could give any contender an edge in the primary, and Laxalt, who won Trump’s backing for his 2018 gubernatorial bid, helped lead an effort in Nevada to spread false claims that improprieties in the state's election led to Trump’s defeat. Senate Minority Leader Mitch McConnell (R-KY) has also eyed Laxalt for the Senate race.
But with a recent rise in nonpartisan voter registration, a candidate that embraces the idea that the election was stolen could run the risk of turning off independent voters in a general election.
Graham said that Trump and other Republican candidates would be wise to move on from the 2020 election.
“I think there comes a point where you need to pivot forward,” Graham said. “Generally speaking, 2022 is about ‘what are you going to do for me and my family.’”
Graham said Trump is not the first politician to have a hard time letting go of a campaign.
“He's got some legitimate concerns, but he will be well-served, I think, by looking forward,” Graham said. “Time will tell.”
Progressives and public health advocates backing legislation to establish a state-managed public health insurance option in Nevada say it will boost health care affordability and accessibility.
Opponents, including the health care industry’s biggest names and local chambers of commerce, argue that a public option would lead to higher health care costs and threaten the state’s already fragile health care system.
Much of the public debate over the bill, SB420, so far has been simplified into sweeping statements like these, which are now being amplified by national organizations throughadcampaigns targeted at everyday Nevadans. Supporters and opponents of the legislation have also released polls showing how politically popular or unpopular they believe the bill to be in an effort to persuade lawmakers to vote for or against the bill.
Less attention, however, has been paid to the bill’s fine print in an effort to understand what kind of effect it actually might have on the state’s health insurance landscape, provider network, uninsured population and the overall cost of health care.
At its core, the legislation would require insurers that bid to provide coverage to the state’s Medicaid population to also offer a public option plan. While the plans would resemble existing qualified health plans certified by the state’s health insurance exchange, the legislation would require them to be offered at a 5 percent markdown, with the goal of reducing the plans’ average premium costs by 15 percent over four years. The first year the public option plans would be offered is 2026.
The full impact of the bill likely won’t be known until the state conducts an actuarial study of the proposal. But, in the absence of such a study, The Nevada Independent took some time to talk last week with Sabrina Corlette, a research professor, founder and co-director of the Center on Health Insurance Reforms at Georgetown University, about the potential benefits and drawbacks of the legislation.
While her colleague, Katie Keith, gave a presentation on Nevada’s health care landscape during the bill’s hearing before the Senate Health and Human Services Committee last week, Corlette said she has not been involved with the bill and reviewed the legislation at the Independent’s request.
Corlette said that while she’s skeptical of the industry’s argument that creating a lower-cost public option will lead to cost-shifting elsewhere in the health care system, it’s difficult to know how negotiations between insurers and providers will play out. She also argued that if Nevada’s goal is reducing its uninsured rate, there may be other ways for it to “get a bigger bang for [its] buck.”
“The devil is very much in the details,” she said.
The bill passed out of the Senate Health and Human Services Committee on Tuesday on a party line vote. It will head next to the Senate Finance Committee to review the bill’s fiscal impact.
The below conversation has been lightly edited for length and clarity.
What were your first impressions reading the bill?
It is certainly within the public option rubric that I'm seeing being debated in other states. There's lots of different flavors of the public option, but, in terms of what I saw in the bill, this is consistent with what I'm seeing.
It's important to understand what the goals are, and I would say that times have changed because of the change here at the federal level and with the passage of the American Rescue Plan and these enhanced [federal] subsidies that help people who are up and down the income scale for marketplace plans. The state should certainly take that into account, and lawmakers and policymakers in the state should be — whatever they want to achieve — thinking about it in the context of the federal changes.
I do think that even with the federal subsidies, there is certainly merit in taking a look at premiums, the cost of care, what's driving the increases in premiums every year, and trying to address those cost drivers and bring down overall health care costs, not just for people in the [Affordable Care Act] marketplaces, but for small employers and large employers. I think everybody's struggling from high and rising health care costs.
What I'm trying to say is, if your goal is to reduce the number of uninsured in the state of Nevada, I am not sure that this bill is going to have a really dramatic impact. If your goal is to send a clear signal to health care providers who are — and I can't speak specifically to Nevada — but, when we look at what's driving increases in costs nationwide, it's hospital prices, it’s drug prices and it’s physician costs. So, if the goal is to reduce overall system costs, then I think this bill is taking a noble approach in terms of going where the costs in the system are, which is really on the provider side.
My threshold question is: What's your goal? What are you trying to achieve? Again, if the goal is covering the uninsured, there may be more efficient ways and you can get a bigger bang for your buck with some other approaches.
Opponents of the bill have argued that Nevada should wait and see what impact the American Rescue Plan has on the health care landscape, while proponents argue that those changes are only temporary and the time for Nevada to take action is now. What merit do you see in those arguments?
It is absolutely correct that under the current federal law the federal enhanced subsidies expire at the end of 2022, but President Biden has proposed extending them, and I think there's fairly broad support, at least among Democrats in Congress, for extending them. Certainly nobody should be counting on them being extended, but I think there's a decent chance they will be. If you're a state policymaker, I think you have to think about a future in which these enhanced subsidies are available. Unfortunately, it requires you to have a plan A and plan B, because of the uncertainty, but it would be a mistake not to think about a future in which these subsidies will exist.
Up until this point, you had this weird dichotomy in the market where you have a group of people who are subsidized and insulated from any premium increases, and then a group of folks over 400 percent of the federal poverty line who feel every single dollar of those premium increases. They're totally exposed. The American Rescue Plan puts everybody into the subsidized camp, unless you're undocumented.
I do think it changes the risk-benefit analysis for state policymakers who are trying to think about what to do. I'm not making an argument not to try to address costs in the system. But part of this goes to the counterintuitive way in which the premium tax credits under the ACA work. What happens is the lower your premiums are in a given state, the less dollars you draw down from the federal government in premium tax credits. It's this kind of perverse consequence. You want people to try to reduce costs in the system but, with the premium tax credit, the more you reduce costs, the more you're reducing federal tax dollars coming into your state. From a fiscal perspective, that’s something to think about.
I want to be clear I'm not arguing against doing a public option. I'm not arguing against trying to rein in provider prices. I think those are all very noble things to do. A good chunk of the uninsured in Nevada are eligible for subsidies and are eligible for Medicaid. That’s maybe where you could get the biggest bang for your buck, if the goal is expanding coverage.
That's an argument opponents have been using against the legislation: Because more than half of the uninsured in Nevada are either eligible for Medicaid or subsidies, why is the state not instead focusing on those populations? Is it a both/and or an either/or?
It doesn’t have to be either/or. There’s a lot you can do to try to bring people who are eligible but uninsured into the system by increasing awareness and making it easier to get through systems. That does not preclude also doing a public option to try to lower overall health system costs. I don't know that it's necessarily either/or, you just have to define what your goals are.
Beyond the two groups eligible either for Medicaid or subsidies, there are two other buckets of people who are uninsured: Those for whom affordability or immigration status is a challenge. Thinking about that first bucket: Is reducing premiums costs enough to encourage those folks to purchase coverage?
It's hard to talk about this without thinking about the American Rescue Plan, too. We're seeing with the American Rescue Plan that when you reduce people's premiums — in this case through subsidies — people will sign up. So, if we're talking about a world where there's not these enhanced subsidies and you have a bunch of people who are unsubsidized, would lowering their premium by 15 percent bring some of them in the door? Yeah, I think so. I couldn't tell you how many — that would need to be studied by an actuarial analysis — but yeah, I think it should bring in some. The premium is the first number people look at and why so many of them say, “I just can't afford it.”
Will this bill help Nevada’s undocumented population?
If you’re low income, and you're not eligible for subsidies or for Medicaid, I'm not sure that a 15 percent reduction in the total premium is going to be something that you see as affordable. But I don't want to lump all undocumented immigrants into one category. If you have health issues, where you regularly need to see a doctor or you know you're going to need a surgical procedure — there's lots of reasons why you might purchase insurance, even if you feel like it's too expensive for your household budget — reducing the premiums for unsubsidized insurance could certainly help some of those folks. But if you’re at 100 percent of the poverty line, it's going to be a stretch no matter how much you reduce the premium,
Thinking a little bit about the cost side of things, this bill does have a 15 percent premium reduction goal and sets Medicare rates as the floor for negotiations with providers. The argument that opponents of the bill have been using is that this artificial pressure being created is going to lead to cost-shifting elsewhere in the system. Is there any merit to that argument?
I hear this one a lot. I’m a little bit of a skeptic on the cost-shifting argument. The empirical economic literature out there suggests it's way overblown. But, in general, what the economic analyses have shown is that even where provider prices are newly capped in one context, we're not seeing big jumps in prices in the commercial market. In general, the economic literature does not support that there's going to be widespread or serious cost-shifting. That said, I think it could have an effect. I think that's where you'd want some analysis to be done.
My sense in talking to insurance companies is that for their commercial products, they are typically negotiating with providers and hospital systems across all of their products. If you're talking about a United or Anthem, they're typically going to a major hospital system and they are negotiating prices for all of their commercial products. It's possible that if the state is saying prices have to come down for the public option that Anthem could use that as leverage in its negotiation to bring prices down across the board.
It's really hard to predict how some of those negotiations will play out. I could imagine Anthem saying to a major hospital system, “Look, if you don't want a massive shift of employers dropping their plans and shifting people to the individual market to these lower price plans, then you better work with me.” I can see dynamics where a price cap for the public option plan actually works to keep group commercial prices down. I can also see it going in the other direction. I just don’t know.
Providers haven’t been happy about that provision, which requires them to participate in a public option plan if they also participate in Medicaid, the Public Employees' Benefits Program or workers’ compensation. They argue that the bill will create more instability within an already fragile provider network in Nevada. Are there real considerations to think about there?
I think it's something that could play out very differently in different parts of the state. You may have providers in Reno that really want to participate in the state employee plan because there are a lot of state employees in Reno, but there may be other parts of the state where the hospital sees one state employee every other week and may just tell the public option to pound sand. It's really hard to predict the effects, and I think it is a good idea for the state to be paying attention to those issues now and thinking about what combination of carrots and sticks will get the maximum provider participation and recognizing that there could be big differences across the state.
I wanted to also talk a little bit about the federal waivers the bill leans on. I know 1332 waivers have been used for reinsurance programs, but they haven't been used for a public option before. How do you see that playing out at the federal level?
If the state can show through actuarial studies that it is bringing down the cost of the premiums by 15 percent — as I mentioned, that will lower the amount of premium tax credits coming into the state — and if they get a waiver, the feds will essentially give them what they call the pass-through money. Whatever amount they should have gotten if they hadn't reduced premiums, they will get in this pass-through money.
What's nice about that is it could enable helping create a fund, for example, to help people with deductibles or other things where people have challenges with insurance. It's never been done before, but we have a new federal administration and I think there's a lot of openness to states pursuing these kinds of experiments now, so it's certainly worth a shot.
When Nevada first considered a public option, it was 2017, right after President Trump was inaugurated. There's a new political climate now, and President Biden has even talked about a national public option. How do you see Nevada’s public option fitting in with what’s happening at the federal level?
I doubt there will be a federal public option plan in the short term and, frankly, I think a lot of times the federal government looks to state for not just good health policy ideas but also evidence of what could work on a national level.
I would say that if Nevada wants to pursue a public option, it should move forward and if it works and it works well, it might become a model for a national program. But I think that is a long term thing. Certainly there's a lot of interest here at the federal level in the public option, and I think they would want to encourage states to move forward if they wanted to do so.
Steve Waclo and his wife, Zita, have long loved the Hawaiian islands.
Last February, over the course of four days, they took a train ride around a farm on Kauai, sipped margaritas on Oahu, snorkeled with tropical fish off the coast of Maui and visited lava flows on the Big Island. The island cruise was a much-needed respite from the snowy Carson City winter for the retired couple.
As their ship clipped across the Pacific Ocean to Ensenada, Mexico, the final port of call on their cruise, the captain came in over the intercom: They had received word from the mainland that multiple passengers on the previous leg of the ship’s voyage had fallen ill with COVID-19, which was at the time still in the early stages of spreading across the globe. The ship, the Grand Princess, would be changing course and returning to San Francisco, its port of departure, immediately.
At first, the couple didn’t see any reason for alarm. No cases of the new virus had been identified onboard, and the early return seemed precautionary. The most substantial change was that they had to be served at the buffet. But when they reached the Bay Area, they watched with interest as the Coast Guard airlifted test kits onto one of the top decks of their ship.
Shortly after, all passengers were ordered confined to their cabins, their meals delivered to them on trays at their doors and the news of their fate delivered to them largely by the national media. Information on the boat itself was scarce.
“We didn’t know where we were going to go. We were out in the ocean going around, which was kind of disturbing,” Zita Waclo said. “Nobody told us even when we were going to get off the ship.”
The Waclos found themselves entirely at the mercy of the federal, state and local government officials back on land who were struggling to figure out what should be done with them and their fellow passengers.
As the Grand Princess held 50 miles off the coast of Northern California with 3,533 passengers and crew members, President Donald Trump made his preference known: that the boat stay where it was. At the time, 238 people in the United States had tested positive for the virus; results from the airlifted test kits showed the ship would add 21 more to that total.
“I like the numbers being where they are,” Trump said during a visit to the Centers for Disease Control and Prevention in Atlanta. “I don’t need to have the numbers double because of one ship that wasn’t our fault.”
Two days later, on March 8, state health officials in Nevada finally received the full list of the names and contact information for the 49 Nevadans on the ship. (A 50th, the spouse of another passenger, was later identified.) As the Grand Princess docked at the Port of Oakland the next day, state officials scrambled to prepare to bring the Nevadans home so they wouldn’t be sent to an out-of-state military base to quarantine. The final decision, though, was up to Gov. Steve Sisolak.
“You have a situation where there’s this new virus. People are really fearful and scared. You have a group of Nevadans who are on this cruise ship. You want to protect the residents back home, so you don't want to bring in potentially infected folks back into your state, but you also are worried about these Nevadans who are now stuck on this ship and then being told they're going to go to an army base and then, potentially, an army base in a state very far away,” Michelle White, the governor’s chief of staff, said.
The next day, Sisolak emailed the passengers directly to let them know his decision: They would be coming home. In the email, he acknowledged their frustrations and anxiety over the lack of information they had received and said he felt the same.
“I can assure you that my frustration will be loudly and clearly expressed to leaders in Washington D.C.,” he wrote.
Back on the ship, the Waclos watched from their stateroom balcony as ambulances, buses and trucks lined up at the docks in Oakland. Below them, National Guardsmen readied supplies and rearranged tents. People needing medical attention were carried off the ship. It brought the gravity of the situation into focus.
“Watching the ambulances back up and the stretchers being taken off, we realized this is serious business, people are dying,” Steve Waclo said. “We could potentially die if we do something wrong, if someone slips up.”
When the Waclos were finally told one morning it was their turn to disembark, they had no idea where they were going. It wasn’t until they were on a bus to the Oakland International Airport they were told they wouldn’t be heading straight home to Nevada but rather flown to the Marine Corps Air Station Miramar, in Southern California. Federal officials wanted to test all the passengers for COVID-19 before sending them elsewhere.
At home, state officials felt equally in the dark as the federal government provided them with an ever-changing timetable for when the Nevadans could return.
Local health districts made preparations to receive the passengers once they landed on Nevada soil, including securing the personal protective equipment and vehicles needed to transport them home. A representative of McCarran International Airport voiced concerns about even being able to receive the Southern Nevadans when the time came because of flight restrictions associated with a planned visit by Trump that week. State officials sent out flurries of emails each day informing local officials and airport representatives that the Nevadans were coming, not coming, then coming, and then not coming again.
This went on for four days.
“I completely understand the frustration with the lack of timely detailed information from the feds as I too share in this sentiment,” Malinda Southard, manager of the state’s Public Health Preparedness Program, wrote in an email to Clark County’s fire chief on March 11, a Wednesday. “Best I can do is keep pushing us forward to get our residents home soon and safely.”
In Washoe County, local health officials were eager for their residents to be home. They had gone to the airport three times in anticipation of the passengers’ arrival, only to be called off. Officials just hoped that when the operation was finally a go it wouldn’t be in the middle of the snowstorm expected to roll in that weekend.
Of course, it was.
“I have confirmation we have a dedicated plane out of Miramar tomorrow just for Nevada residents. US HHS confirms there are no more maybe’s probably’s hopefully’s — our people are coming home tomorrow!!” Southard wrote in an email to state health officials on Saturday.
That night, nearly two feet of snow piled up in Incline Village, half a foot in Northwest Reno and an inch elsewhere in town. Ski resorts shuttered as an avalanche warning was issued. Washoe County Health District staffers scouted their neighborhoods the next morning to figure out if the roads were passable; they even had to go buy snow chains first thing that morning for one of the vehicles.
After days of anticipation, the plane touched down in Reno at 12:27 p.m. on March 15. The Northern Nevadans, at least, were home and the Southern Nevadans, who were on the same plane, soon would be, too.
Many of the Washoe County residents needed help getting down the stairs and out of the plane before they were loaded into two vans. One of them, staffed by health district employees Jim English and Wes Rubio, would make stops in Reno before heading over Mt. Rose Summit to Incline Village. English read the directions and checked in on the passengers while Rubio drove.
Both were suited up in white, full-body hazmat suits, full face respirators and gloves as they plowed through the snow with a van full of weary, N95-wearing, COVID-exposed passengers. An unmarked sheriff’s car trailed them to make sure there was no trouble.
At each stop, they battled snow flurries and their respirators iced over in the freezing temperatures. At one point, they swapped their transit van for a four-wheel-drive Jeep Cherokee in a passenger’s Galena cul-de-sac to make it over the summit to Incline through four inches of snow. They had to keep driving. There was nowhere else for the passengers to go.
“We were trying to do as best we could to protect the public and those people that were on that on that bus just to at least get them home,” Rubio said. “It was a massive effort.”
The repatriation of the Grand Princess passengers was not only a massive effort but also the first major challenge in the pandemic where local, state and federal officials were asked to work together to solve a pressing public health problem. They would be asked to overcome many more together in the months to come, from ramping up testing and contact tracing efforts to deploying a mass vaccination campaign.
“That was a big test,” White said. “Then, it only got harder.”
For state and local officials in Nevada, the repatriation effort was largely a success story, a proof of concept that they could work together and communicate effectively to achieve a common goal. Despite their frustrations with the lack of information onboard the Grand Princess and at Miramar, the Waclos praised the state’s response. Once they were home, Carson City Health and Human Services called them every morning during the 14-day quarantine period to check in on them and offered to bring any food and medicine they needed; the governor even called once to see how they were doing.
“I was very impressed by the Washoe County people and the Carson City people,” Zita Waclo said. “They were ready for us, and they really followed up very well.”
The coming months, however, would strain relationships between state and local governments as they struggled to address a daunting public health crisis with few resources and what much of the time felt like little to no support from the federal government.
Sometimes the adversity brought them together as they allied to face a grim future in the face of no centralized national response strategy. The Grand Princess incident, they say, should have been a harbinger of what was to come in the way of federal communication and support during the course of the pandemic. It also showed that state and local governments could work cooperatively to meet the needs of everyday Nevadans.
But the adversity also sometimes wrenched them apart, widening a growing political divide in the state and turning existing cracks in differences in beliefs over the role of state and local governments into deep chasms. Sisolak’s COVID-19 response plan, formed in the absence of a national response framework, caused rural governments long known for rebelling against the federal government to direct their ire instead toward the state. And even when the state and local governments agreed about how to best address the pandemic, underresourced and overworked officials often struggled to effectively communicate with each other, leaving wounds and eroding trust.
There’s a term doctors use to describe what happens to COVID-19 patients when their immune systems go into overdrive: It’s called a cytokine storm. When it happens, the body’s immune system turns against itself and starts to attack healthy tissue and organs.
It’s not unlike the position Nevada has often found itself in over the last year.
There’s an oft-repeated phrase in the emergency response world about how disasters should be managed: They’re supposed to be locally executed, state managed and federally supported.
But, from the get-go, state officials in Nevada say federal support was lacking in the pandemic response. The tone was set at the top, they say, with Trump’s comments downplaying the seriousness of the virus and supporting unproven treatments. This seeped down to the federal Department of Health and Human Services, which clashed with the state over more mundane, bureaucratic public health policies, including whether asymptomatic individuals should be tested and which COVID-19 tests were reliable enough to use in nursing homes.
“There was never a time when our decisions, the governor’s decisions, at the state level and our partnership with the local governments was not undermined by the mixed messages or new messages coming out of the federal government,” Caleb Cage, Nevada’s COVID-19 response director, said.
Cage, the former head of the state’s Division of Emergency Management under Gov. Brian Sandoval, said the first step in any emergency response is to move past collective denial by getting everyone’s buy-in on the seriousness of the situation. That’s much more easily done with something like the response to a wildfire, where the threat is readily apparent, than it is for a pandemic, where the threat is an invisible pathogen.
That collective buy-in, however, never happened. Instead, Trump painted Democrats’ response to the virus as part two of the January 2020 impeachment trial in an attempt to cost him his re-election; Democrats, meanwhile, were eager to point out all the ways in which they believed Trump was failing to lead on the pandemic.
“Now the Democrats are politicizing the coronavirus — you know that, right? — coronavirus, they’re politicizing it,” Trump said at a rally in South Carolina on Feb. 28. “... And this is their new hoax.”
The politicization of the virus, Cage said, created an incentive for people to stay in the denial phase, hindering the federal government’s ability to move to the collective response phase.
From the state’s perspective, it was trying to communicate one thing to the general public and having it constantly contradicted by federal leadership. A week after Nevada made the decision to shut down nonessential businesses on March 17, 2020, the president was still drawing parallels between COVID-19 and the flu. (Scientists believe COVID-19 may be 10 times more deadly than the flu, though the exact mortality rate is still unknown.)
“We lose thousands of people a year to the flu. We never turn the country off,” Trump said at a Fox Newsvirtual town hall on March 24. “We lose much more than that to automobile accidents. We didn’t call up the automobile companies and say, ‘Stop making cars. We don’t want any cars anymore.’”
The politicization of the virus made it more difficult for the state to get widespread buy-in from everyday Nevadans on the importance of key parts of the state’s pandemic response, too. On one hand, there was Sisolak, the state’s Democratic governor, advocating the importance of mask-wearing; on the other, there was Trump, the Republican president, waffling on the benefits of masks. Even though the scientific evidence only supports one of those two positions, the issue felt — and continues to feel — political to many because of the differences in the way that Republicans and Democrats spoke about masks.
The divide in messaging over public safety measures became, perhaps, the clearest when Trump rallied thousands of supporters in Minden and Henderson in September in defiance of Nevada’s COVID-19 health and safety rules. Dave Fogerson, who at the time managed Douglas County’s pandemic response as deputy fire chief at the East Fork Fire Protection District, said the event put him in a difficult position.
Officials at the county — which is home to more than twice as many Republicans as Democrats — made clear that the event would go on. The local paper, the Record-Courier, summarized the county’s position as this: “Spokeswoman Melissa Blosser said that after careful consideration and weighing the authority of state directives versus First Amendment rights, the county ultimately decided to welcome the sitting President of the United States to our community.”
Privately, though, Fogerson said that people who supported the event were calling to apologize.
“‘Hey, sorry we’re doing this. We want to do this because how often does the president come to town? But we understand what we need to do to keep this going,’” Fogerson recalled them saying. “In the end, the county gave me an award when I left Douglas County for all those efforts — even though we were, it seemed like, on opposite ends of the spectrum — because of trying to do that balance of, ‘Here's where we need to go and here's what you need to do to get there.’”
For state health officials, the pandemic brought a significant shift in the kind of communication they were used to having with their federal counterparts. For one, inconsistent communication from the federal government about what was expected made it difficult for state health officials to do their jobs, Richard Whitley, director of the Department of Health and Human Services, said.
“They weren’t responding to us as a state in the same way that we were familiar with,” Whitley said. “All of those seemed to be in flux and seemed to be being changed while we were needing, perhaps, that relationship to be at its strongest.”
One example state health officials point to from the beginning of the pandemic was the conflicting guidance they received from the Centers for Disease Control and Prevention about which individuals coming in by plane needed to be quarantined.
In one instance, state health officials struggled to get contact information from the CDC’s Division of Global Migration and Quarantine (DGMQ) for three passengers on a Las Vegas-bound Korean Air flight who had recently been in China. The state only discovered the situation after news outlets reported the flight had been diverted to Los Angeles, one of three airports that was screening for COVID-19 at the time.
State officials said that CDC representatives they spoke with seemed not to be aware of their own agency’s latest travel guidance. Melissa Peek-Bullock, the state’s epidemiologist, said one federal official even hung up on her.
“It wasn’t clear that everybody within the organization understood that guidance,” Peek-Bullock said. “The inconsistent messages that were coming from CDC to the states made it very difficult and frustrating for us early on.”
The situation prompted Whitley to pen a letter to the CDC expressing his concern.
“I understand this is a rapidly evolving situation; however, I am concerned about the breakdown between the communication the states have received from the CDC, and information provided to the CDC DGMQ,” Whitley wrote in a Feb. 11 letter. “Our state relies on DGMQ to assist in the response to travelers, and the lack of communication in this circumstance created frustration and confusion for all those involved.”
State health officials also saw politics seep into their everyday work. For instance, they were shocked when Dr. Robert Redfield, director of the CDC, directly telephoned Nevada’s chief medical officer, Dr. Ihsan Azzam, in early March to request his help in getting Adam Laxalt, the former attorney general of Nevada and a prominent Trump supporter, tested for COVID-19 after he was possibly exposed at the Conservative Political Action Conference but showing no symptoms. At the time, the CDC’s own guidance restricted testing to symptomatic individuals.
“We do everything possible to treat all people the same, focusing on their risk and not on who they are in terms of importance,” Whitley said. “That’s not a population approach. That’s a privileged approach, and so they set a tone for that.”
State health officials were also wary when the federal government quietly changed the rules to require hospitals to directly report COVID-19 data to the U.S. Department of Health and Human Services instead of to both HHS and the CDC, and asked nursing homes to directly report their data to the federal government instead of to the state. Those moves made it challenging for the state to get its hands on valuable COVID-19 data, Whitley said.
“We had to figure out our own ways of collecting the data and identifying where the opportunities for intervention were and where the problems were, with not direct assistance from the federal government,” Whitley said.
The state also directly clashed with the federal government in its policymaking as well. The CDC, for instance, released new guidelines in August that said asymptomatic people should not “necessarily” be tested for COVID-19. The move prompted an immediate backlash from Nevada health officials, who made it clear the state would continue asymptomatic testing.
“When you really have large widespread outbreaks of pandemic, this is the time to test more, not the time to test less,” Azzam said.
Nevada also made the decision in late June to follow in the footsteps of more than a dozen other states and enact a mask requirement in the absence of any federal rule. It wasn’t until late January, a little more than a week after President Joe Biden took office, that the CDC finally issued its first mask order, for travelers only.
“We kept on asking the CDC, ‘Should we start implementing masking for everybody?’ and we were told, ‘No, we don’t really need that,’” Azzam said. “If we don’t know who is spreading the virus, it’s better to mask everyone. You can’t prevent 100 percent transmission, but you can prevent a reasonable amount and reduce infection.”
State health officials’ biggest dust-up with federal health officials, though, came in October. The federal government had directly distributed antigen tests — a type of COVID-19 test helpful in identifying people with COVID-19 but generally less accurate for those who don’t have the virus than the gold-standard PCR tests — to nursing homes, with what state officials described as very little guidance on how to use them appropriately. Nursing homes were also given no guidance on how to report the results of those antigen tests to the state to be counted in its COVID-19 data, state officials said.
As state health officials scrambled to develop that reporting mechanism, they noticed that the antigen tests were coming back with a high percentage of false positives. Among 39 positive antigen tests sent for confirmatory PCR testing, 60 percent came back negative for the virus.
State officials’ immediate concern was that some nursing home residents were incorrectly being identified as positive for COVID-19 and sequestered with true COVID-positive patients, thereby exposing them to a virus they didn’t actually have. So state health officials issued a directive to nursing homes to stop the use of the antigen tests as they looked into the issue further.
In a scathing letter in response to that decision, Adm. Brett Giroir, the Trump administration’s COVID-19 testing czar, accused state health officials of “a lack of knowledge or bias” and said their decision would “endanger the lives of our most vulnerable.” He added the federal government would “take appropriate steps” if state health officials did not “cease the improper unilateral prohibition” on use of the antigen tests.
“Your Department’s across-the-board ban on POC antigen tests in such settings is based on speculation,” Giroir wrote. “It may cost lives.”
In response to those threats, state health officials rescinded their directive while reiterating their concerns over use of the tests and asked the federal government to reconsider its stance. (One federal official did, however, note in an email to state health officials the CDC does not recommend that nursing homes group asymptomatic patients into a COVID ward based on a single antigen test; rather, those individuals should be considered presumptive positive and isolated with precautions until a confirmatory PCR test is performed.)
What could have been a civil back and forth over a policy difference turned into a heated clash. Peek-Bullock described the federal government’s response to the state’s decision on the antigen tests as “very unusual.”
State officials say that even when they believe the federal government was genuinely trying to help, it often did so in a way that subverted the state’s role in the pandemic response. For instance, when hospitals struggled to secure PPE early on, the federal government provided it directly to hospitals and other health care providers, instead of sending it to the state to then be sent to the counties to then be distributed to hospitals — the usual chain of custody.
“I believe in their minds they were doing it to fight bureaucracy,” Cage said. “But there's a reason this framework is in place, and that's because these private hospitals, public hospitals, aspects of the health care system in the state are asking us for resources, and we don't know how to prioritize the resources if the federal government is going around us.”
But the federal government was critically helpful to the state in one primary area: funding. As of early March, it has provided nearly $25 billion in federal aid to Nevada with $4.1 billion more on the way from the American Rescue Plan. State and local officials say that federal funding — approved by both Republican and Democratic-controlled congressional chambers and signed into law by both Republican and Democratic presidents — was key to their pandemic response efforts.
And, a year since the pandemic began, the federal-state relationship is healing. State officials say they have seen a night and day difference in their relationships with their federal counterparts since Biden took office earlier this year. They report that communication has significantly improved with federal officials — U.S. Health and Human Services Secretary Xavier Becerra met with Sisolak at the Capitol in Carson City this week — and when they have a request, such as federal support to catch up on a vaccination data-entry backlog earlier this year, it’s usually granted.
They say it isn’t because Biden is a Democrat, either.
“The difference in mutual respect, collaboration, willingness to have hard conversations, willingness to work together, willingness to not worry about who gets blamed for what and all of this — that’s just the starting point,” said Cage, who worked previously under two Republican governors and is a lifelong Republican voter. “The previous administration had what I believe will be long remembered as the poorest disaster response in the nation’s history.”
The state’s frustrations with the federal government, however, have a parallel: Local governments’ frustrations with the state.
The root causes of each are strikingly similar. Local governments, charged with executing the finer points of the state’s overall pandemic response, say they often found themselves struggling to play catch-up when the state publicly announced its latest COVID-19 health and safety policy because they had been given little advance warning. They also grappled to keep up with ever-shifting state policies about which establishments could be open, to what extent they could be open and the timetable for those rules. Some think the state struggled to be collaborative in its response as the pandemic drew on, unwilling to cede its decision-making authority even when circumstances may have necessitated different solutions for different parts of the state.
The frustrations date back to the state’s initial decision to close schools and shutter nonessential businesses in mid-March of last year. To some extent, counties understood the hurried nature of the decision: The state was in an emergency situation and was reacting to a constantly developing situation. But they still found themselves in the uncomfortable position of trying to provide guidance on a local level — to residents and businesses alike — to policies they themselves had just learned about.
“I still remember when we closed everything down and schools were closed, we met in Douglas at 7 o’clock the next morning to, ‘Oh my God, did you hear that yesterday? What are we going to do? How are we going to take care of this?’” said Fogerson, the former deputy fire chief from Douglas County. “Kind of having a panic moment because we were being reactionary.”
Local officials say they often scrambled before each state press conference to figure out what was going to be announced before it was released publicly. In the early days of the pandemic, local officials say they often received no advance information about what policies were going to be announced; they were happy when they started getting even an hour or two’s notice.
“When I was in Douglas, it was ‘What do you mean there is going to be a press conference at 3 o’clock today? Aren’t they going to tell us what it is? Why do we have to watch it on TV?’” Fogerson said. “Whereas now the governor’s office is leaning forward a bit more and getting some information out ahead of time.”
Because local officials had little warning about new state policies, particularly early on in the pandemic, they felt there wasn’t an opportunity for them to voice their concerns and have a consensus-building conversation with the state, which meant some local governments were charged with carrying out policies they didn’t agree with, believe in or understand. The state may not have needed counties’ permission to enact emergency policies under the law, but the state did need local buy-in for those policies to be most effective.
State officials acknowledge the frustrations of their local counterparts. But when they reflect on why they didn’t bring local governments into the fold earlier, they see themselves moving quickly to make choices deep in a crisis response mode that didn’t allow hours for multiple roundtables and scores of phone calls about each policy decision. White, the governor’s chief of staff, said there were dozens of consequential policy decisions the state was making each day.
“It is hard to loop in everyone who feels that they need to be looped in. I'm not saying that they shouldn't be. I'm not saying that their voices don't matter, that they wouldn't have great input,” she said. “But the reality is you have to make those decisions quickly. We have an incredibly small staff that can only make so many phone calls.”
On the flip side, the state’s attempts to centralize certain aspects of the public health response were complicated by the fact that public health in Nevada is historically decentralized. Public health services are provided at the local level in Clark and Washoe counties, as well as Carson City, which together make up more than 90 percent of the state’s population, while the state is responsible for managing public health for the remaining tenth of the population living across 14 rural Nevada counties.
While the localized public health delivery model can be quite effective, in the time of the pandemic it meant the state was often in the position of offering assistance to local health districts for contact tracing or testing, though the decision of whether to accept that help was left to local jurisdictions. That made it difficult, if not impossible, to have a standardized public health response across the state.
“There needs to be a level of statewide response consistency, yes, but there was great latitude and need for them to be completely different locally because they have different resources,” said Julia Peek, a deputy administrator in the Division of Public and Behavioral Health.
As the pandemic drew on, the state made several overtures to local governments to try to create that latitude on the emergency response side as well.
The first came in the form of a so-called Local Empowerment Advisory Panel, or LEAP, which was tasked last spring with assisting counties as they started to reopen businesses after the shutdown. Sisolak, during a late April press conference announcing the new body, said it would be a “disservice” to the state’s residents to pretend its urban and rural counties have the same needs.
When Eureka County Chairman J.J. Goicoechea was asked to join the panel as a representative of the state’s rural counties, he was optimistic. His urban counterpart on the panel was Clark County Commission Chair Marilyn Kirkpatrick, whom he had a longstanding collaborative relationship with and who had recommended him for the job.
But LEAP’s responsibilities ended up being much narrower than Goicoechea initially anticipated, centering primarily around drafting reopening guidelines for approval by the state.
“We thought we were going to have maybe a little more authority and we were going to approve this or approve that or do some things,” Goicoechea said. “It never really materialized.”
Once all businesses — save strip clubs, night clubs, day clubs and brothels — were allowed to reopen, LEAP essentially fell by the wayside. It was frustrating not only for Goicoechea but other local officials who believed the state was finally starting to get things right by delegating more authority to the rurals and bringing more people into the decision-making process.
“LEAP just dissolved, because we were no longer effective. We weren't being talked to,” Goicoechea said. “That’s the unfortunate thing.”
The governor’s office, however, said it was more that LEAP evolved.
“The input and interaction and coordination with a lot of those leaders who were a part of that group, I don’t think, has stopped at all,” White said. “I think things just take on a different form as we’re going through that response.”
In August, Sisolak announced a new pandemic response framework. This one, he said, would also take into consideration counties’ innate differences: Counties would be evaluated based on three criteria to determine whether they are at elevated risk for the spread of COVID-19 and, if so, they would be required to present a mitigation plan to a new statewide COVID-19 Mitigation and Management Task Force.
The task force, though, ended up doing more management than mitigation. The body spent its first several weeks determining whether bars in seven counties could reopen following a summer surge in cases. As cases began to climb in the fall, counties flagged at elevated risk of transmission spent significant time telling the task force about their plans for community-wide education about the virus and almost no time about any new mitigation measures, such as business closures or limits on gatherings, they planned to put in place.
In fact, in the more than seven months it has existed, the task force has only approved one concrete mitigation measure stricter than the statewide standards. In September, Washoe County proposed keeping its gathering sizes small as the state moved to allow larger events to take place.
“[The task force] made it fairly clear that with the increase in cases that we were seeing in Washoe County that the county needed to do something or the task force was going to do something to them,” Washoe County District Health Officer Kevin Dick said. “That perspective and understanding on the part of local leadership provided some leverage to get them to that commitment.”
Even under the task force model, some counties still felt like they were under the thumb of the state. Scott Lewis, director of emergency management for Nye County, said it sometimes felt like counties were children trying to appease their parents.
“What its intended goal was, as a state, what can we do to best remedy this as a collective team?” Lewis said. “And it was never that. It was always like a parental type of approach, and we had to come up with the magical words to make our parents happy with us.”
Cage, who chairs the task force, acknowledged the body did not work out in practice the way in which he had initially anticipated. Counties, for instance, largely did not bring forward to the task force individual mitigation measures during the fall surge, and the task force didn’t put them forward either; rather, Sisolak enacted a new “statewide pause” that limited occupancy at businesses and again limited gathering sizes homogeneously across all 17 counties.
“The governor always had reserved the right to do so, and that’s where we got in November,” Cage said. “So in a sense it worked as it should. My personal opinion is that the pressure locally was so much that there really wasn’t an appetite locally to put additional measures in place.”
While it may not have been a robust decision-making body, the task force has helped repair some relationships between the state and local governments by providing a regular forum for communication. Some local officials say the task force opened a line of communication to the state.
“From my perspective, and I can only speak for Lyon County, once they developed the task force and put Caleb Cage in charge of it, the majority of my communication complaints went away,” said Jeff Page, Lyon’s county manager. “We were getting good, direct positive feedback from Caleb and the task force as to what they were expecting, what the issues were and what the challenges the state was facing were.”
Dick echoed those sentiments, calling the task force “worthwhile overall.”
“I think that relationship between the health district and Caleb Cage and the members of the task force has really strengthened over time,” Dick said.
Nowhere was the state-local relationship, perhaps, more strained over the course of the pandemic than in rural Nevada, where individual liberty is prized and love of government is scarce.
Initially, as Clark and Washoe counties were hit hard by the virus, rural counties were optimistic that they might be able to avoid the virus altogether. While urban America grappled with SARS scares in the early 2000s, rural America was largely untouched by the virus. Rural counties hoped their isolation and low population density would come in handy this time, too.
It quickly became clear that would not be the case as tiny Humboldt County, with a population of a little less than 17,000, became Nevada’s hardest-hit county, the result of a large family gathering that had exposed many individuals to the virus. As the virus began to spread across rural Nevada, public health experts and rural officials became increasingly concerned about the effect COVID-19 could have on those communities, owing to the fact that rural counties generally have older populations than urban ones and the dearth of medical care in rural counties.
For some rural health officials, the importance of community buy-in about mitigation measures quickly became evident. Rural Nevadans might not take kindly to rules being handed down to them from the federal or state governments, but they could be appealed to on an individual level to take steps to protect themselves and their community.
The rest of the country was grappling with how to balance individual liberty with the need for collective action too, but that tension was acute in the rural West.
“One of the things that makes our country special is all the choices that we have. To me, that is a very sacred thing. It is, I think, to all of us,” Dr. Charles Stringham, Humboldt County’s health officer, said. “But, as a result, when you fight the virus in the United States, your best weapon is information and also trying to encourage people by being compelling, because at no point did we ever have interest in encouraging people by regulating or legislating. We’ve just never really wanted to do that here in Humboldt County.”
Stringham’s approach was particularly introspective: If the residents of Humboldt County weren’t listening to him, he figured his message needed to be more compelling. He started a series of “Ask Me Anything About COVID-19” Zoom sessions to answer community members’ questions about vaccination, viral transmission and the efficacy of mask wearing, among others, in a commonsense, plainspoken way.
“My hope was that if people really did think that masks were ridiculous and that they didn’t work, and if people really did think that six feet seemed arbitrary, and that if people really did think that mutations in the virus would negate the effect of vaccinations, that they could call in and ask those questions and get real answers,” Stringham said.
During one of those Zoom calls in December, Stringham was asked why he and other members of the medical community were so focused on social distancing and mask wearing instead of advocating the benefits of, among other things, the malaria drug hydroxychloroquine. Stringham was calm and deliberate in his answer, saying he wished the drug would have worked to treat COVID-19 but that scientific studies didn’t bear that out.
“There's always an assumption that if allopathic physicians don't do something, that it's because we're holstering that or we're sequestering it, we're not bringing that to bear,” Stringham told the man. “But the bottom line is that in allopathic medicine, we have to be able to prove that something has an effect.”
Another asked why the media makes such a big deal about COVID-19 deaths and not flu deaths. Stringham explained that 34,000 people in the U.S. died of the flu during the last flu season; at the time, 300,000 had died of COVID-19. He also noted that people who contract COVID-19 can go on to develop long-term health conditions that impair their quality of life.
“I can't even really talk about this without getting a little bit choked up,” Stringham said. “This is not the flu. It is not the flu. I wish it were, but it isn't.”
Other rural communities took a similar approach. In Ely, Mayor Nathan Robertson went on the local radio station every day to answer people’s questions about the virus, from technical inquiries about which businesses were allowed to be open and what assistance was available to broader questions about whether martial law had been declared and whether the National Guard would prevent people from getting to their doctor’s appointments in Salt Lake City.
“There was a real vacuum of just credible answers,” Robertson said.
As the state created new COVID-19 health and safety rules, the focus for some rural leaders was how to help their businesses comply. Robertson said Ely’s focus was on assisting businesses at the local level to avoid the state sending out compliance officers.
“Everybody was just kind of in an attitude of cooperation: ‘Hey, how can we help? Our goal is to make sure your business stays open,’” Robertson said. “We can’t afford to lose a single restaurant in our community. We can’t afford to lose any of our businesses. We’re so isolated.”
In Lyon County, Dr. Robin Titus, the county’s health officer and the Republican Assembly leader, advised local ranchers about how to group guest workers into pods so that if someone tested positive for COVID-19, they would know exactly who was exposed.
“They were paying attention. They were calling me,” Titus said. “They wanted to make sure things were safe.”
And though rural Nevada has earned a reputation for opposing the state’s COVID-19 health and safety rules, several rural officials say they believe their residents took the virus seriously when it counted. Titus said she has a 95-year-old patient who was very cautious about the virus and stayed home. Goicoechea, who is also Eureka County’s health officer, said his residents were “really good” at isolating and quarantining when they tested positive or someone in their household came down with the virus.
“They may be chipping their teeth on Main Street saying, ‘This is all fake. This is a hoax. I don’t believe in it,’” Goicoechea said. “But when we called them up and said, ‘You’re positive, I need you to shut ‘er down. You gotta stay home. Let us know what we can do,’ they went home and they stayed home and they cooperated.”
Of course, compliance wasn’t universal. Robertson acknowledged there were some instances in Ely where people called the sheriff alleging a business was discriminating against them because they weren’t wearing a mask. Law enforcement would inform them that businesses could put in place whatever rules they wanted and could kick them out for not following them.
“They were like, ‘Well, what do you mean? They didn’t let me in.’ And they’d say, ‘Well, this is a private business. They don’t have to,’” Robertson said.
Multiple rural officials also noted that there was always going to be some degree of pushback from their residents about the state’s rules simply because of the high price they place on individual freedoms. But they also believe that philosophy shouldn’t stop people from doing the right thing for their neighbors.
“You don’t have to choose either safety or freedom,” Stringham said. “You can absolutely have both, and that was the message that I was trying to deliver.”
But, because of the communication role they took on, some rural officials found themselves in the difficult position of trying to be the bridge between the state and their residents. They didn’t have great answers when their residents asked why the state had allowed casinos to open to 50 percent but churches were required to be limited to 50 people. They didn’t have great answers when residents asked why their kids couldn’t go to school but daycare centers were open. They didn’t have great answers for why casino restaurants remained closed while eateries across the street could open.
“That would be frustrating, because you would be getting calls from these businesses going, ‘Hey, my neighbor across the street, who’s got a restaurant, their restaurant is open. Why can’t mine be open?’” Robertson said. “There would be a lot of calls like that.”
They also didn’t have good answers for their residents about why certain statewide policies should be applied to them when they were experiencing a low level of case growth in their communities or could pinpoint where the case growth was coming from. In White Pine, most cases were traced back to specific gatherings, including a Halloween party and a softball game, Robertson said.
“When the sheriff’s office gets something from the county health officer and that says, ‘Hey, so-and-so tested positive,’ he knows exactly where that person is most of the time. He knows who they hang out with,” Robertson said. “He can say, ‘Well this is how you get ahold of so-and-so and here’s how we do this,’ and bing-bada-boom, it’s done.”
Rural officials who have tried to actively aid the pandemic response by getting their communities to follow the state’s health and safety protocols have often found themselves in the community’s crosshairs as a result.
“There’s some lifelong friends of mine who are very, very upset. I mean, they’re to the point where they don’t want to talk to me because they think I quote-unquote ‘drank the Kool Aid,’ if you will,” Goicoechea said. “But everything I’ve done is to protect people and to protect the economy. I’m not taking unnecessary risks but, at the same time, I’m willing to take some calculated risks because I know where the disease is spreading in my community.”
It didn’t help that the pandemic became a political issue, either. If conservative rural Nevada was already wary of government officials telling them what to do, they were particularly wary of a Democratic governor from Clark County telling them what to do — particularly when that message contradicted the one coming from their local officials and a Republican president most of them supported.
Lewis, Nye’s director of emergency management, said that though local officials have become more supportive of pandemic response efforts “because they see the light at the end of the tunnel,” it used to be “horrific” to come before the county commission at each of its meetings to give a COVID-19 update when many didn’t believe in the severity of the virus.
“The political side of it was probably one of the worst things to deal with when we’re trying to make sure we meet the state’s requirements, we meet the state mandates and yet our local governments were telling us just the opposite,” he said. “They wanted nothing to do with it. They didn’t want to hear the reports. They didn't believe in the masks. They didn’t believe in the numbers and what the numbers meant. The deaths were made up, and it was a huge conspiracy, and that was extremely disheartening.”
In fact, the political discord was so severe that several rural county commissions, starting with White Pine County, passed a series of similar resolutions opposing Sisolak’s emergency directives. Robertson, who leads the only incorporated city in White Pine, framed those measures as chest-thumping by a small contingent of politically motivated individuals.
“I mean, honestly, I think I got more support for just being level-headed and cool and attending to the issues than I would have by screaming and thumping my chest and sending nastygrams to Carson City,” Robertson said.
Goicoechea, who said that he was responsible for drafting 99 percent of the version of the resolution Eureka County passed in January, acknowledged the measure was a statement. But he said it’s also one that his constituents needed to hear.
“People needed to see it in writing,” Goicoechea. “I’m not going to make a demand, knowing that he has the authority granted in the Constitution of the state of Nevada and he was exhibiting that under his emergency powers. But I did want him to hear we want things to be done differently. We expect them to be done differently.”
Looking back, rural officials wish there had been more communication with the state early on.
“We’re the ones down on the frontlines trying to implement what you’re drawing down from the top,” Robertson said. “If you want to know how it’s going, if you want some help on ‘hey, how could this go better?’ talk to your mayors, talk to these people, talk to these county commissioners, and there could’ve been more of that.”
Now, the relationship between the state and rural Nevada may, in some ways, be worse than it has ever been. Rural officials believe there is a healing process that needs to happen.
“It’s too far into it. We’re 12 months in. If it had been six months: ‘Okay guys, let’s get back to work,’” Goicoechea said. “But now we’re 12 months in and I feel that maybe some folks are really starting to entrench: ‘Hey, you guys aren’t working for us and when you do come back, you think you’re just going to come out here and start dictating how we’re going to do this stuff?’ I’m very fearful that the relationship we’re having with the state agencies, there’s going to be a long time trying to build that back.”
Beyond the rural context, the relationships between the state and local governments have continued to have their hiccups.
In response to the state’s decision to expand gathering sizes in September, health district officials in Clark and Washoe counties sent a strongly worded letter to the state, saying that it was “inappropriate” for local health authorities to not be consulted in the state’s public health decision-making process.
More than six months after the state’s first emergency directive, local health districts found out about the decision at the same time as the public.
“Our phones would just light up here. All of those businesses were calling us to find out what was going on, how they were affected, what they needed to do. We didn’t have any more information than they did,” Dick, Washoe County's health officer, said. “That was quite frustrating.”
While they were given slightly more notice before the state put in place its statewide pause this fall, concerns over communication remain. The state’s overtures to local governments — in the form of LEAP, or the task force — while positive have often felt like just that: overtures.
“I think there could be better communications, and more regular communications,” Dick said. “There have been opportunities for those dialogues and discussions but they haven’t been continued. There’s been some activity and initiative to make sure those communications happen and then they sort of go away.”
Counties say they still sometimes have to play catch up when it comes to the state’s policies. Lewis, Nye’s director of emergency management, said everyone had just gotten on board with the state’s tiered vaccination structure — though some believed it didn’t make the most sense for Nye — when the state announced that it was moving to a new, lane-based approach.
“You’ve got to be kidding me,” Lewis recalled thinking at the time. “Here we are toeing the line and the line came back and snapped us right in the butt.”
Even now, a year after the pandemic began, Lewis isn’t sure what exactly his role is supposed to be. With the ongoing rollout of the COVID-19 vaccine, which is supposed to be managed at the local level, he still feels like he doesn’t have the flexibility he needs to make decisions at the county level.
“Every time we made a decision it was, ‘You can’t do that, you have to do what we tell you or what we’re giving you,’” Lewis said. “I’m like, ‘Well, no, no, you can’t have it both ways. You can’t say I’m responsible for the decision and then take the ability away from me.’”
In Clark County, Sisolak and Kirkpatrick, the commission chair, have butted heads at points over the course of the pandemic, including after Kirkpatrick publicly pushed for the state to reopen businesses more quickly after the winter surge and Sisolak targeted Clark County for inequalities in the vaccine distribution process. For her part, though, Kirkpatrick says communication with the state has improved.
“Some days are harder than others, because we try to understand what’s behind the reasoning,” Kirkpatrick said. “But I will tell you there are a lot more meetings, a lot more conversations.”
And then there’s Las Vegas Mayor Carolyn Goodman, who during a CNN interview last year suggested the city serve as a “control group” to determine the benefits of social-distancing measures and recently said the governor’s prolonged emergency power “smacks of tyranny,” indicating that Sisolak had been unwilling to hear her input.
Sisolak, in an interview earlier this month, acknowledged his communication with local governments could have been better. But he also noted that there are hundreds of local government officials around the state and said it’s just not possible to communicate with all of them.
“Some of them were saying, ‘Wait a minute, why don’t you do this?’ or ‘Why don’t you do that?’ There’s 17 counties I’ve got to deal with, not just one,” Sisolak said. “They all want some attention, they all deserve some attention, and we can always do better.”
And, alluding to Goodman’s earlier comments, Sisolak said that he refused “to let the citizens, the residents of Nevada be used as test subjects or guinea pigs.” Whatever criticism he has received for his decisions during the pandemic — whether for being too strict or too lenient in the state’s rules — he bears.
“The buck has to stop with somebody and it stopped with me,” Sisolak said.
Still, multiple local officials said they give the state credit for the way it supported their pandemic response at the county level. Jeanne Freeman, public health preparedness program manager for Carson City Health and Human Services, said that trust between her agency and the state is deeper than it was before.
“They have their perspective and what they see, but then they have inquired, they have listened to us when we’ve said, ‘We see what you’re saying about that, but we’re not sure that’s really going to be how it’s going to work when we get it down to the local level,’” Freeman said. “We’ve met them in the middle. They have given a lot.”
Lewis said there were some state officials with "really spectacular personalities" that "shined" during the pandemic who understood the difficult situation local officials were in.
"I understand there's both sides of that because they're obviously overworked," Lewis said. "There was that lack of compassion and empathy both ways."
And some local officials, despite their complaints, give Sisolak and the state credit for the difficult position they were in.
“Part of my respect for the governor is those tough decisions that he's made to protect the state of Nevada,” Dick said. “I really commend the governor and his courage for the decisions that he's made. But I haven't seen that type of leadership, for the most part, coming at the local level.”
If anything, the pandemic has underscored the importance of relationships — and highlighted how difficult it is to build them in the middle of a crisis situation if they weren’t already there.
“Theoretically we could’ve done listening tours and town halls and developed those relationships as much as we could,” Cage said. “But the resources and the time constraints were so extreme and really remain so extreme right now as we transition to the vaccination effort that there really just was not the mechanism, the capacity to do that.”
Fogerson, who was appointed the head of the state’s Division of Emergency Management this fall, says the value of relationships is something he tries to keep in mind as a local-turned-state official.
“At the state, your job is not to do. Your job is to support and enable the local providers,” Fogerson said. “I used to get very mad at state employees that would come down and tell me how to do something or, ‘Here, we’re going to do that for you.’ … It’s going back to that civics lesson of who really needs to be the sharp end of the stick and how do we help them to sharpen that stick better?”
For some in local government, it finally feels like things are looking up.
In February, Sisolak announced the state would be transitioning the responsibility for COVID-19 health and safety mitigation measures to the counties by May 1. Mask and social distance requirements will remain in place statewide, but it will soon be up to counties to figure out how many people can be inside a business and how large gatherings are allowed to be.
Several counties, at multiple meetings of the COVID-19 Mitigation and Management Task Force last week, voiced their intent to open businesses 100 percent as soon as they can. Most businesses across the state are allowed to operate at 50 percent capacity.
“We can do it safely. We have the plan. We’re ready. We’re looking forward to it,” Goicoechea, the Eureka County Commission chair, said. “We will be ready to go and open up safely in a big way as soon as he lets us.”
For the next couple of weeks, county staff will be working on their plans for the transition to local control and getting them approved by their county commissions. Those plans will then be presented to the task force sometime in mid-April.
“That’s one of the smart things about what the governor is doing is put that decision-making process back in the hands of the people in the state of Nevada to use the sense that they have to take care of themselves and their families, and businesses to take care of their business and their customers,” Page, Lyon’s county manager, said.
Local governments now find themselves grappling with the kinds of questions the state has been facing all along, including how to enforce any mitigation measures.
Once the transition to local control happens, the state’s Occupational Safety and Health Administration will continue to enforce statewide policies but doesn’t have the authority to enforce local policies. That will be left to local code enforcement officers, who may not have the bandwidth to routinely surveil stores, and sheriffs, who, as elected officials worried about their reelection bids, may not be interested in enforcing the measures.
Counties are also pondering what happens if cases once again start to rise: Will the state step back in, or will it be up to them to put in place mitigation measures on their own?
“Go ahead and kick it out to local government control, see a spike in the summer, and then issue some kind of an emergency directive that we’re going to pull back some of these openings, you will have a complete uprising,” Goicoechea said. “That is my biggest fear.”
While Sisolak said the state would remain “flexible” and continue to monitor trends on a county level during the transition to local control, the goal of the new plan is for counties to take the reins and the state to step back. Still, Sisolak will retain the legal authority to issue new statewide emergency directives unless the Legislature takes action to limit the governor’s power.
Republican lawmakers have put forward legislation this session that would do just that, though those proposals have not yet been given hearings by Democrats, who control both chambers of the Legislature.
“There’s three branches of government for a reason and this extended emergency stuff really needs to be defined on what the governor’s role should be, and that’s the thing: There’s really no definition of it and that’s the problem,” said Titus, the Republican Assembly leader. “We're trying to put some bills forward to define it, but so far we haven’t gotten any traction with that.”
Counties, however, are finding that taking the reins from the state is easier said than done.
“I want people to open their businesses up to 100 percent capacity, but my fear is if that happens and then we get wave three of COVID and it’s more severe than wave one or two, do we go back to what we’ve been doing? That’s a concern,” Page said. “I’ve said this publicly: I thank God I’m not the governor. I can’t imagine making those types of decisions and impacting people’s lives.”
A year into the pandemic, Titus, who is also a family practice doctor in Lyon County, is of the mind that people are well-informed enough to be able to make choices about what behavior is safe or unsafe. She says it’s the kind of conversation she often has with her patients when discussing treatment options.
“Once a person has all the information, and I give them the information that I have, they have the right to refuse treatment. They have a right to self-determination, even if I didn’t agree with their decision, even if I thought they made a bad choice,” Titus said. “Once we’ve educated everybody as the government, once we give them good informed consent, they have the right to choose not to do that.”
There are, however, limits to that idea.
“You have the right to self-determination as long as it doesn’t impact those around you,” Titus said. “You have the right to get COVID if you want to. You have a right to make a bad choice and get sick, but if your choice then impacts the entire roomful of people that you’ve now exposed, I’m sorry, we have the right to remove you from that room.”
From top state officials down to everyday Nevadans, many are of the belief that the biggest challenge of the pandemic wasn’t the virus itself, but the lack of communication — and, by extension, the relationships, community and trust that come along with that — to respond to it.
Without communication, state and federal governments can’t cooperate, state and local governments can’t work together and governments at any level can’t effectively convey important, potentially life-saving, information to their citizens.
“Communication, it’s always going to be something we have to strive for in government to do a better job of,” Page said. “It’s always going to be our biggest failing.”
The bill is the fulfilment of a promise that Frierson made earlier in the session to make the state’s pandemic-induced change to mail balloting in the 2020 election permanent, but is also likely to draw staunch opposition from Republican lawmakers who have denounced the expansion of mail voting and have introduced many of their own election-related proposals.
But the bill does more than just make expanded mail voting permanent. It also would shorten the deadline for fixing issues with signatures on mail ballots and for how late a mail ballot could be counted after election day.
It also would explicitly authorize election clerks to use electronic devices in signature verification, require more training on signature verification and adopt a handful of other provisions aimed at beefing up election security measures.
To be clear, many details in the bill could change (the measure hasn’t even been scheduled for a hearing as of Friday). But it’s already attracted some tentative support from an important ally — Gov. Steve Sisolak.
“The Governor has been supportive of efforts to expand voting access and opportunities for eligible Nevadans, and based on how Nevadans embraced voting by mail in record numbers this past fall, he believes it makes sense to consider making this a permanent option while also ensuring continued opportunities to vote in person,” Sisolak spokeswoman Meghin Delaney said in an email, while noting that the governor will continue to “review and evaluate any legislation that may come before him.”
Here’s how AB321 would change future elections in Nevada:
Enshrining expanded mail-in voting while changing deadlines
In a technical sense, AB321 fulfills the Republican legislative goal of repealing AB4 from the 2020 special session — the bill that expanded mail-in voting during the pandemic or other declared state of emergencies.
The bill repeals large sections of election law related to mail and absentee ballots (including AB4) — but re-enacts many of the same provisions in a more streamlined way.
As with AB4, the bill would require all county and city clerks to send every active registered voter a mail ballot before a primary or general election. Inactive voters, who are legally registered to vote but don’t have a current address on file with election officials, would not be sent a mail ballot (inactive voters were sent a mail ballot in the 2020 primary election, but a failure to update Clark County voter lists in time before the general election led to many of them being sent general election ballots).
The bill would allow voters to opt-out of being mailed a ballot, by providing written notice to their local or county election clerk.
But AB321 also changes some of the deadlines that were in place for the 2020 election.
AB4 allowed election officials to accept mail ballots that were postmarked by Election Day and received within seven days after election day. If passed, AB321 would shorten that deadline from seven days after the election to four days.
It also would reduce the amount of time in which voters can fix issues with their signature on a mail ballot — a process called “signature cure.” The provisions of AB4 gave voters a 7-day window after Election Day to “cure” a signature issue or error; AB321 would shorten that to six days after the election.
Another shortened deadline is how long election officials would have to process mail ballots. As in AB4, election officials could still start processing received mail ballots up to 15 days before an election (totals would still be kept secret), but they would have to process all mail ballots by the 7th day after an election. AB4 allowed election boards to take up to nine days after an election to finish processing mail ballots.
The measure also would allow Indian reservations or colonies more time to request the establishment of a polling place within the boundaries of the reservation or colony. For primary elections, the deadline to request a polling place would be moved up from the first Friday in January to April 1, and from the first Friday in July to Sept. 1 for general elections.
The legislation maintains other contentious items in AB4, including legalized ballot collection (derided as “ballot harvesting” by opponents). Under those provisions, a voter can authorize another person to deliver their mail ballot to either a drop box or an election clerk’s office on their behalf, with substantial (felony) penalties if a person does not turn the ballot in before the election or otherwise fails to return the ballot.
Signature verification and other security measures
Beyond those changes, the bill also would implement explicit directions on machine signature verification and other security related provisions that were contested in court filings prior to the 2020 election.
For one, it grants explicit permission for election clerks to check signatures electronically — a point that the Trump campaign challenged in an ultimately unsuccessful federal lawsuit filed shortly after AB4 was approved, and shortly after election day in 2020.
If a county election clerk opts to use an electronic device for signature verification, AB321 requires a test of the accuracy of the machine before the election, and also requires it to be set to the same “standard for determining the validity of a signature” as a manual review by an elections worker.
Clerks also would be required to conduct daily audits of each signature-checking device during the processing of mail ballots, which would include a review and sample of at least 1 percent of verified signatures each day. County clerks would also be required to prepare a report on each daily audit, and would require the review of signatures to be overseen by an election board whose members “must not all be of the same political party.”
Regardless of whether a county uses an electronic machine or staff to check signatures, AB321 would require that each county election clerk and any members of their staff who help administer elections complete a training class on forensic signature verification. The class has to be approved by the secretary of state’s office.
In a previous interview, Frierson discounted any notion that widespread fraud occurred in the 2020 election, but said he wanted to still take into consideration that a considerable number of voters had some doubts about the election administration process in 2020.
“Regardless of whether or not I believe that the basis for those concerns is legitimate or reliable, I do believe that we need to hear them out and make sure that we have an inclusive vetting process, and that we care about safe and secure elections,” he said in a February interview.
The bill retains the standard for signature verification present in AB4 — at least two election employees must have a “reasonable question of fact” as to whether the signature on the mail ballot matches the one on file, with “multiple, significant and obvious” differences between the signatures.
Another change is that the bill would require the secretary of state’s office to enter into an agreement with the State Registrar of Vital Statistics to cross check the list of registered voters in the state with a list of deceased individuals. The bill would require a comparison of records to be conducted at least monthly.
Though primarily focused on mail voting, the proposed legislation would also make a change for those who continue to vote in person. Under current law, if a registered voter shows up to a polling place and has a signature that doesn’t match the one on file, the election worker is allowed to ask for personal data or other forms of identification that verify their identity. The bill would exclude a person’s date of birth from that “personal data” that an election worker can ask about.
And while not directly related to election security, the bill also would add county or city clerks, or any of their deputies, to the list of occupations and positions which are allowed to request their personal records be kept confidential.
The vast majority of election complaint case files submitted to top Nevada election officials in the last six months regarding the 2020 election were closed without any findings that election laws were violated, even as many Republicans continue to assert that the election was rife with fraud and stolen from former President Donald Trump.
A log obtained by The Nevada Independent through a public records request shows there were 298 election integrity case files submitted to the secretary of state’s office from the beginning of September through Tuesday. It does not characterize the complexity of any individual case — such as whether a complainant suggested a single improper vote or submitted a spreadsheet alleging thousands of suspicious votes — or offer names of complainants or the accused.
Of those case files, 255 — or 86 percent — have been closed either because no violation was found, the underlying issue was resolved, or the case was referred to investigatory authority in the secretary of state’s office.
Only 41 of the roughly 300 files submitted for the 2020 election have not been resolved, which includes 15 submitted by the Nevada Republican Party earlier this month (many entries in the log list out several thousand alleged examples of voter fraud). The GOP and the state had widely varied public descriptions of the scope of their submission, with the party saying it submitted 122,918 records, and the state categorizing it as fewer than 4,000 distinct reports.
The log shows basic information about Election Integrity Violation Reports received by the office, which is the public-facing complaint form that individuals can submit to the secretary of state’s office identifying alleged instances of fraud or violations of election law.
A single report can contain multiple examples of alleged “fraud” or issues, which likely explains the variance between the number of reports that the state and Republican Party say were submitted.
The document gives a fuller view of the work that Republican Secretary of State Barbara Cegavske’s office has done to investigate largely unsupported allegations of voter fraud and irregularities in the 2020 election — a line that Trump and prominent state and national Republican Party officials have repeated since the election was called for President Joe Biden.
The secretary of state’s office has maintained for months that it has not seen any evidence of widespread voter fraud that could meaningfully affect Trump’s 33,596-vote loss to Biden in the state, but says it is still investigating several “isolated” cases of potential fraud.
Among the findings in the log:
Seven of the submitted complaints were listed as “Referred to Securities” or “Currently with Securities” — meaning they had been referred out for potential action by law enforcement. Four of the complaints dealt with “campaign practices,” two dealt with “voter fraud” and one dealt with “misconduct.”
About 75 of the complaints are labeled as “data base concerns (voter history)” and all but one originated in the month of November. At that time, the secretary of state’s office was trying to clarify to the public why an online system might not have reflected that a person’s vote had been counted; the system was not updated until the election was certified, even if the ballot was already counted.
Two complaints of “ballot sent to deceased person” are shown as closed with no violation.
35 complaints, filed at various points throughout the campaign season, deal with “campaign practices;” 27 of those are listed as resolved with no violation.
52 of the resolved complaints are categorized as “voter fraud” with no further information listed.
About a dozen complaints listed polling place concerns or irregularities, including two about poll worker attire.
In a press release issued Tuesday, the secretary of state’s office said it had inventoried, labeled and evaluated all election-related complaints submitted by the state Republican Party after a rally-style event two weeks ago. The office said the assessment revealed far fewer Election Integrity Violation Reports than the party advertised in a press release, all of which were filed by the chairman of the Nevada Republican Party, Michael McDonald, with several “already under investigation by law enforcement.”
A letter the secretary of state’s office sent to the Nevada GOP as a “receipt” on Tuesday, and that was obtained through a public records request, indicates the GOP had delivered in four boxes, a USB drive with 23 documents and spreadsheets, three business cards and 3,963 elections integrity violation reports.
“We take every complaint seriously and will conduct a thorough and detailed examination of the information provided,” the letter said.
It also indicated that eight of the documents on the USB drive were sworn affidavits that had been redacted, and the secretary of state’s office requested unredacted versions as soon as possible.
Details in the election violation report log and the response letter indicate that several of the affidavits appear to be copies of material or reports that the Trump campaign submitted to a state court as part of an election challenge seeking to have presidential results in the state overturned. All of the cases failed in court, though the party has released some of the affidavits or evidence originally filed under seal on its website.
In a response to Cegavske that was published Tuesday, the Nevada Republican Party said the secretary of state’s Tuesday statement is “validating our assertion that there is voter fraud in the 2020 election” and planned to follow up with emailed copies of “each and every complaint.”
“We need better transparency from our elected officials investigating these matters, especially with so many Nevadans questioning the integrity of our voting process,” the party said in an emailed statement Wednesday. “We hope that Secretary Cegavske finally demonstrates a commitment to the concept that no amount of voter fraud is acceptable in the great State of Nevada.”
The virus came to Nevada slowly, and then all at once.
At the beginning, it was a specter, a theoretical possibility but — public health officials optimistically thought at the time — an improbability. Nevada’s state epidemiologist, on Jan. 13, 2020, penned a report on the developing situation: Health officials in China had identified a novel coronavirus. There were 41 confirmed cases, all residents of Wuhan besides one recent visitor to the city, and one death.
“At this time there has been no evidence of person-to-person transmission, although there is still much to learn in regard to this novel virus,” state epidemiologist Melissa Peek-Bullock wrote in the report.
The primary focus from the Centers for Disease Control and Prevention, she said, was on standing up facilities at the three primary airports travelers to the U.S. from Wuhan pass through in New York, San Francisco and Los Angeles. All passengers from the city were to be screened upon arrival and, if unwell, referred to a hospital for further evaluation.
At that point, all state health officials here could do was communicate that information to local health authorities statewide and continue to monitor the situation. She wrote that the CDC believed the overall risk to the public was low.
The Silver State’s first brush with COVID-19 came nearly two weeks later. A Northern Nevada resident was transferred to a Bay Area hospital for isolation and monitoring after arriving in San Francisco from Shanghai with a cough, shortness of breath, fever and other flu-like symptoms. Her travel companion, who had not been stopped in California and made it back to Washoe County, fell ill too. Though neither of them had been to Wuhan, the first woman’s case was concerning enough to place them formally under investigation for the virus.
Fortunately, they were soon cleared after the first woman tested negative for COVID-19.
A few days later, a Southern Nevada man who had recently traveled to Wuhan was admitted to a local hospital after coming down with a sore throat, fever, cough, chills and body aches. He also tested negative.
The most dramatic early investigation centered around a Southern Nevada flight attendant who had been exposed to a confirmed COVID-19 case while on the job. Health officials had instructed the man to isolate; instead, he traveled with his family to Los Angeles, where he came down with a cough. Health district officials told him not to fly back to Las Vegas. He refused. They suggested he drive back. He refused. They asked for his itinerary. He refused.
For two hours one February evening, state officials, CDC officials and health officials in Las Vegas and Los Angeles scrambled to secure a public health “do not board” order that would prevent the man from flying. Complicating things, because the man was a flight attendant, he could fly standby on any one of the many airlines that flies between the two cities — and his name wouldn’t appear on a flight manifest until he had boarded.
The “do not board” order came too late: State officials received a call from the CDC at about 8 p.m. The man had flown standby and had just landed in Las Vegas. The “do not board” order was issued just after he boarded the plane. But, once again, it ended up being just a close brush with the virus. Health district officials that night made contact with the man, who agreed to cooperate with their investigation and isolate in his home; four days later, he tested negative for COVID-19.
This game of whack-a-mole continued for several weeks as it became clear that finding COVID-19 in Nevada was not a matter of if but when.
State and local health officials from across the nation, during a call on Jan. 26, shared their concerns about asymptomatic spread of the virus; China had reported that such spread was occurring, but the CDC had been unable to confirm. The possibility of asymptomatic spread was important because it meant that a traveler or multiple travelers could have unknowingly already brought the virus to the U.S. With little to no testing available at the time and extreme restrictions in place on how tests could be used, health officials would have no way of knowing to what extent the virus was already here.
Health officials on the call discussed the possibility of school closures and requiring employers to allow remote work, measures to help halt viral spread. But there was still so much they did not know about the virus.
“It was emphasized that decisions are required to be made with a lot of uncertainty and limited knowledge of the infectious period, overall infectiousness and sustainability of transmission and severity of this novel virus, so decisions need to be cautious and re-evaluated as we learn more about the virus,” Peek-Bullock wrote in one of her daily reports about the call.
A month later, a virus that had once been a point of interest was now a cause for concern. Fourteen cases had been identified in the United States, including two cases of person-to-person spread, while an additional 39 people with the virus from the Diamond Princess cruise ship and Wuhan had been repatriated to the country. Nevada health officials held a call with representatives of local health districts, the state public health lab and the state hospital association to discuss federal guidance, testing capacity, hospital preparedness, isolation and quarantine and public messaging.
Peek-Bullock, in her Feb. 24 daily report, underscored the seriousness of the situation, bolding and underlining the following:
“During the weekly national call today, CDC emphasized their goals, stating we cannot stop every traveler now that sustained transmission is occurring outside of China, but it is important to continue to slow and continue to contain the spread in the U.S. CDC stated that we are to expect spread to occur in the U.S. and now is the time for states to assess their readiness and ensure they are prepared. They emphasized this is not expected to go away, and in fact is expected to escalate.”
In short: The virus was here in the U.S., even if we hadn’t found it yet in every state. The only option now: Slow it down.
Four days later, Gov. Steve Sisolak gathered together more than two dozen of the state’s top government and health care leaders — state health officials, hospital representatives, local health district leaders, congressional staffers and education officials among them — in a crowded, standing-room only conference room at the Grant Sawyer State Office Building in Las Vegas. More joined from Northern Nevada by phone.
It was a meeting of the minds, so to speak, except that many had never actually met, according to some who attended. But in the coming weeks and months, their names would be familiar throughout the state: There was Dr. Mark Pandori, head of the state public health lab; Dr. Fermin Leguen, head of the Southern Nevada Health District; and Christopher Lake, the public face of the hospital association on all things COVID-19.
Despite the growing seriousness of the situation, those in the room didn’t have any idea just how quickly things were about to change, how bad it would get or how long it would last.
Afterward, the group descended to the building’s lobby, where they huddled behind Sisolak for his first press conference on COVID-19. He stressed to the public three things: That there were no confirmed COVID-19 cases in Nevada, that the immediate health risk from COVID-19 was low and that there had been no COVID-19-related deaths in the United States.
He did, however, note that more COVID-19 cases were likely to be identified.
“We’re going to prepare, not panic,” he said. “We’re going to choose collaboration over chaos.”
Six days later, on March 5, Ronald Pipkins became the first Nevadan to test positive for the novel coronavirus.
It was the beginning of, perhaps, the most difficult year in Nevada’s history, one that would lay bare the chronic underfunding of public health systems, a lack of investment in aging state infrastructure, including its unemployment system and continued economic overreliance on the tourism industry.
It was a year that would see 1 in 10 Nevadans test positive for the virus and more than 5,000 lose their lives to it, more than all U.S. military casualties in the nearly nine-year Iraq War.
It was a year that would see a quarter of Nevadans unemployed, as the state’s economy came to a sputtering halt last spring in an attempt to stop the spread of the virus. It was a year that would see a sharp rise in depression, anxiety and substance abuse in a state that already struggles to provide mental health services to its residents even in good times.
It was a year that would pit the state’s public health needs against its economic ones, every day a Sophie's choice.
It was a year that would see Sisolak come under heavy criticism for not communicating with the public well enough, for not bringing local governments into the fold early enough and for making policy decisions that seemed, to some, arbitrary and capricious, infringing on their individual liberties.
It was a year that would sow deeper divisions in a state with a long history of bipartisanship that’s increasingly been tested in the last few years. It’s a year that would see rural communities refocus their longstanding mistrust of government from the federal level to the state.
It was a year that would see Nevada’s health care providers pushed to their limits, overwhelmed, scared and at a loss for how to best care for their patients. It’s a year that would see Nevada’s fragile health care system pushed to its limit, too, and, surprisingly, not break.
It was also a year that would see resilience in the face of despair.
It’s a year that would see rank-and-file public health officials work harder than ever under the most scrutiny they had faced in their lives.
It was a year that would allow Nevada to take advantage of its relative nimbleness and lack of bureaucracy and move quickly to devise innovative solutions to meet the state’s needs, even when those solutions didn’t always work out as expected.
It was a year that would make clear to many that Nevada, as divided as it is, is still, at its heart, a scrappy Western state whose residents are accustomed to fighting for survival against the odds.
This is the story of that year.
Early in January 2020, public health experts didn’t see much reason to worry.
There are outbreaks of disease all the time, and a novel coronavirus in of itself wasn’t necessarily concerning.
SARS and MERS, two novel coronaviruses that surfaced in 2003 and 2012, respectively, claimed relatively few lives despite their high levels of mortality, in part because their spread was typically associated with symptomatic individuals. That meant that isolating people who were ill was very effective in containing spread. Plus, there are a bunch of everyday coronaviruses that circulate through the general population that only cause the common cold.
“There are weird things always popping up all over the world, and most of them don't turn into anything,” said Brian Labus, an assistant professor of public health at UNLV and former senior epidemiologist for the Southern Nevada Health District. “That's why it's hard to get really excited early on when you hear about some new virus like this because most of the time they do not spread that easily from person to person, which means we're not going to have a big outbreak.”
Public health officials started to take the virus more seriously, though, as more information came to light about it, including the fact that it could be transmitted person-to-person and spread by people showing no symptoms.
On Feb. 11, Nevada State Public Health Lab officials validated the CDC’s assay, meaning that they now had the capability to test for the virus at their lab in Reno. It was the same day the virus received its official name from the World Health Organization. It would be labeled SARS-CoV-2, and the disease caused by it would be called COVID-19.
Lab officials, though, didn’t want to sit around and wait for the virus to come to them. They were already having conversations with the Washoe County Health District about whether they might be able to start looking for COVID-19 in samples already at the lab that had been collected to be tested for other respiratory illnesses. So much of the focus to that point had centered around testing symptomatic people who had relevant travel history or were close contacts of confirmed cases. Northern Nevada health officials wanted to know if the virus was already here.
But, at the time, the CDC had strict rules about how the test could be used, namely, to test those with travel history or contact. That would’ve made sense, public health experts say, if the virus had behaved more like SARS. But even by that point in February, there were indications the virus was spreading asymptomatically, even if the role of asymptomatic transmission was still unclear.
That meant that Nevadans sick with respiratory illnesses might have COVID even without a relevant travel history or confirmed close contact.
“It's not that I'm trying to point fingers or make fun of anyone, but we already knew how ridiculous that was then,” said Pandori, the lab’s executive director. “The chief [epidemiologist] of Washoe County and myself already wanted to start looking, but we had to wait.”
Heather Kerwin, Washoe’s chief epidemiologist, believes Nevada might have been able to identify cases a few weeks, if not an entire month, earlier had officials been allowed to start screening respiratory specimens for COVID-19. Pandori said it is “very easy to hypothesize” that earlier surveillance testing could’ve had an impact on the trajectory of the virus.
“When you don't react quickly to something or as quickly as you can, from a surveillance perspective, it's essentially a fact that you allow it to make headway or to spread in a manner that you might have had an opportunity to intervene,” Pandori said.
But, at that point, the federal government, at the highest echelons, wasn’t taking the virus seriously. President Donald Trump, at the White House on Feb. 10, said the country was in “great shape” and suggested the virus would disappear “in April with the heat, as the heat comes in.” Two weeks later, he said the virus was “very much under control in the USA” and that the country had had “very good luck.”
We still don’t actually know how early COVID was circulating in Nevada. When the antibody test for the virus came out last spring, the state lab tested old blood samples they had stored from December 2019 and January 2020 but didn’t find any antibodies for COVID-19. Some studies have tried to extrapolate how early the virus was spreading in Nevada and elsewhere across the country. One projects the virus was already spreading in Nevada by mid-February and puts the state among the first 10 to have community transmission.
Doctors here, based on what they now know about COVID, believe they were seeing cases as early as January. At the time, they chalked it up as a particularly severe flu season.
“In January, we were seeing tons of people with flu-like illness, and we were calling it the flu,” said Dr. Scott Scherr, the regional medical director for TeamHealth, which manages five emergency departments in Las Vegas and one in Elko. “When you look back at it, it wasn’t flu at all. It was COVID.”
In those early days, it wasn’t yet clear what kind of an impact the virus would have on Nevada, but government officials and the health care industry were starting to prepare. Clark County started updating its emergency plan. Hospitals started to think through the difficulties they might face in securing personal protective equipment, much of which is manufactured in China. They also dusted off their mutual aid agreements, which let them lean on each other for support in a crisis situation.
What was clear though, by the end of February, was that COVID was coming. For Las Vegas, a city that hosts nearly 50 million visitors a year, the virus was always just a short drive or plane flight away.
“We understood that it had all the makings to be a large scale, global pandemic at the time,” Peek-Bullock said. “But early in January and February, I don't know if any of us would have predicted where we would be sitting here a year from now.”
The situation escalated quickly: Concern became alarm.
On March 5, Nevada went from zero COVID-19 cases to two: Pipkins and a Washoe County man in his 50s who contracted the virus after sailing aboard the Grand Princess cruise ship. Though government officials, public health entities and health care workers had been preparing for the last few weeks, the first two cases brought the seriousness of the situation into sharp focus.
“Once we had the ability to really start identifying cases, those case counts grew very quickly,” Peek-Bullock said. “We know now the virus is transmitted very efficiently person to person, so I think that from our perspective, it really ramped up quickly for us too.”
Within a week, two cases had become 11, and health officials here knew that as they continued to test they would only find more cases.
Publicly, state and local officials put on a brave face: Yes, more cases might be identified. But if Nevadans did their part — avoiding contact with sick people, cleaning surfaces and washing their hands — we would get through this together. After all, Nevadans had leaned on each other in the aftermath of the mass shooting on the Las Vegas Strip two and a half years earlier. Why would this be any different?
“I encourage all Nevadans to prepare, not panic, and to continue to choose to collaborate over chaos,” Sisolak urged at a press conference two days after the first cases were announced.
But panicking happened anyway. Grocery store shelves were stripped bare as Nevadans, and those across the country, stocked up on toilet paper and canned goods, unsure of what was to come.
Behind the scenes, the governor’s office was assessing whether it had enough body bags and having conversations about air quality control standards should the furnaces in the crematoriums start burning overtime. In the governor’s office, a chart on the office wall showed the cases increasing day by day, doubling and then tripling. What they needed was more information, more guidance. Enter the governor’s Medical Advisory Team.
Dr. Paul Sierzenski, chief medical officer of the acute care services at Renown, was in the parking lot of Raley’s one day in early March when he got a call from the governor’s office asking him to join a new five-member advisory team Sisolak had established to help guide his decision-making.
The group’s first meeting was March 14, and the governor’s objectives, according to the meeting’s minutes, were straightforward yet seemingly impossible: He wanted to, one, figure out how to help identify individuals with COVID-19 and, two, define goals for the state to contain and mitigate the spread of the virus.
The governor’s office, the minutes note, wanted guidance only on one initial objective: “How do we inform the governor to make decisions on social distancing, mass gatherings, school closures, based on logic and facts for containing, mitigating, preventing?”
The members of that team, in interviews, praised the science-based approach and the decision to bring them — some of the state’s top minds in public health and infectious disease — into the fold so early on. The group still provides advice to this day, though it doesn’t meet nearly as frequently as it did in March and April last year, when it convened almost daily.
But there was one big problem: The Medical Advisory Team knew about as much about this novel virus as the rest of the public did. Sure, its members were familiar with SARS and MERS. They grasped influenza pandemic planning. They knew the playbooks on what they were supposed to do. But knowing what to do and figuring out how to do it are two entirely different things, they quickly learned.
“We had the plan but not the infrastructure,” said Trudy Larson, dean of the School of Community Health Sciences at UNR and one the members of the governor’s Medical Advisory Team. “This is so new for us as a country. No matter how much we wanted to, we really didn’t know all the pieces to put in place and, really, because of some of the social disruption that the country had gone through, we also didn’t have a common way of looking at these things.”
Caleb Cage, former head of the Division of Emergency Management under Gov. Brian Sandoval, who was pulled in to assist the Sisolak administration’s response to the pandemic, felt similarly. Though the state had previously participated in exercises to drill the state’s pandemic response such as Operation Rabbit’s Foot in 2015, Cage said that nothing could’ve prepared them for what it would be like to live through the last year.
“I’m not saying it is bad training and a bad exercise, but it certainly doesn’t stand up to the experience that we’ve had over the last nearly a year,” Cage, the state’s COVID-19 response director, said. “The stakes are real. In an exercise the stakes are, ‘Oh, you learn a lesson and you don’t do it again next time.’”
Part of the problem was, as the governor was asking his Medical Advisory Team big, important questions about how to respond to the virus, the members were themselves still trying to answer basic questions: How easily does the virus spread? What’s the death rate? What will actually stop the spread?
Those in the governor’s office said they were sure the answer — whatever it was — would be found in science: They believed in science. They trusted the scientists. They wanted to do what the scientists said.
“I think there's always this mindset that we will figure this out, that we will figure out a way as a country to control this and get a handle on it,” said Michelle White, the governor’s chief of staff. “I think that was the expectation of all Americans, that that's what we do, that we will get a grip on this and figure out a way to keep it controlled.”
The virus, however, had other plans.
When Nevadans awoke the morning of March 18, the roar of everyday life had dulled to a quiet murmur. School playgrounds were empty. The state’s four-mile-long adult playground was empty too as casinos famed for never closing chained their doors and boarded up their windows.
Slot machine screens blinked blue. They were out of service, and Nevada was too.
The writing had been on the wall. Two days earlier, schools in Nevada and 25 other states closed their doors, the rest to follow suit in the days to come. By the time Sisolak announced all gambling in the state would cease as the clock struck midnight on St. Patrick’s Day, several major resorts were already in the process of shutting down their operations, facing a wave of canceled bookings. Other nonessential businesses were given until noon to close up shop.
A bevy of people — public health experts, doctors, epidemiologists, business owners and representatives of various sectors of the economy — had provided their input to Sisolak and his staff in the days and hours leading up to the shutdown. But the decision was Sisolak’s alone to make. White said it was an “excruciating” process.
“At some point, when you’re the leader and everyone’s looking at you, you have to make that choice and you know it’s going to be massively consequential and you know that it is going to be applauded or it is going to be booed by all sorts of people and that that doesn’t matter at some point, that you just have to do what you think is best with the information you have in front of you,” she said.
Sisolak, in an interview, recalled walking out onto the balcony of his office at the Grant Sawyer Building in Las Vegas one evening in early March and looking out at the lights of the Strip.
“I’m saying to myself, if I shut this down, those lights are all going to go dark and 100,000 people are going to be out of work and kids aren’t going to be able to go to school, and I thought about the potential ramifications of what those decisions would be,” Sisolak said, choking up. “I came in and I said, ‘I’ve got no choice, we’ve got to shut it down,’ because too many lives were at risk.”
His primary focus, as he made clear at the time, was the public health crisis at hand. Back then, public health officials didn’t even know how deadly COVID was. Because of limited testing early on, data out of New York City, which was hit early and hard by the virus, showed that nearly 1 in 10 New Yorkers who had tested positive for the virus died from it. Some health experts were recommending people clean their groceries and packages because of concerns about surface-to-surface transmission. Little had been confirmed about the role of asymptomatic transmission.
At a press conference announcing the business closures, many questions focused on cause and effect: Would businesses face penalties if they remained open? How would the government police it? Sisolak, however, seemed irritated.
“I don't know if I can make this any clearer ... This is affecting the lives of our citizens. People are dying. Every day that is delayed here, I'm losing a dozen people on the back end, they're going to die as a result of this,” Sisolak said, bristling. “It's incumbent upon the citizens of this state to take this seriously. Next question.”
It’s not that the governor’s office wasn’t aware of the economic consequences of shutting down and how many Nevadans’ lives would be affected. But the public health crisis seemed so daunting and the shutdown so necessary to get the virus under control.
Furthermore, the shutdown was billed as a short-term situation. The school closures were initially supposed to last only three weeks. Businesses were to be closed only for 30 days. But the virus stubbornly lingered as hospitals scrambled to secure resources and learn how to treat this new disease.
At the beginning of April, Sisolak put in place a “stay at home” order, formalizing what had existed in spirit for several weeks and extended the closures of nonessential businesses and schools. By the middle of the month, the shutdown had been extended to an undetermined date and schools closed for the rest of the academic year.
“It’s a symbol of truly no one really knew how long this was going to last for,” White said of the early emergency directives. “It was this immediate decision making needed to protect the health of the public in that moment.”
Everyone wanted certainty in that time, from everyday Nevadans to the governor himself. Everyone wanted to know that if only we did X, then all of this would be better. But we didn’t know what X was. In those months, the entire world was still solving for X.
“We want to be able to say, ‘This one is 100 percent foolproof,’ and oftentimes in this situation, the options that we had to lay out on the table — not only is it not always a no-win situation, it is, how do we lose the least?” White said. “How do we do the most good for the most people, understanding that each one of these choices is going to have a negative impact on someone or something somewhere?”
At the worst point in April, statewide unemployment hit 28.2 percent, climbing to 33.5 percent in Las Vegas. Today, 1 in 4 Nevadans is enrolled in Medicaid, the state’s insurance program for low-income individuals and families, up from 1 in 5 before the pandemic.
State officials and public health experts say it can be easy to criticize these early decisions with the benefit of hindsight. We now know the virus is not as deadly as we initially thought, though still more deadly than the flu. We also know that COVID got much worse in Nevada this fall than it ever did in the spring. When Sisolak closed nonessential businesses in March, there were only 55 confirmed COVID-19 cases statewide. At the worst point in the pandemic this fall, the state was identifying more than 2,700 new cases a day. But they say that lessons learned during the spring shutdown and the time it bought the state were precisely what allowed many businesses to remain open, at least to some extent, this fall.
Had we known back in March what we know about COVID today, those who helped advise the governor said, they might have made different recommendations about closing businesses and schools. But thinking back to what they knew at the time, they — and the governor himself — believe that shutting down was the only option.
“It was really just a lot of unknowns that led us to all we could do to stop the transmission,” Labus, one of the members of the governor’s Medical Advisory Team, said. “Nobody knew what was going on with this particular virus. We were still trying to understand it.”
In late March, as the refrigerated trucks began to pull up to New York City hospitals, Nevada — a state where people sometimes grimly joke that the best health care you can get is at McCarran, the airport, leaving town for a city with world class medical care — braced for an onslaught.
Health officials worried that if New York City, which has some of the most hospital beds per capita of anywhere in the country, couldn’t handle COVID, how would little Nevada fare, particularly its rural residents, some of whom live more than 100 miles from the nearest hospital?
“If they couldn’t handle it there, we definitely couldn’t handle it in Nevada,” Labus said.
Sisolak temporarily placed the state’s Department of Health and Human Services and Division of Emergency Management under the direction of Major General Ondra Berry, adjutant general for the Nevada National Guard.
It was an operation completely unfamiliar to the Guard. In some ways, it was easier: Guard members weren’t deployed overseas and could return home to their families every night. They didn’t have to face the day-to-day horrors of war. In other ways it was more difficult: They faced the danger of bringing the virus home to their families, as the death toll mounted quickly.
Berry likened the daily COVID death reports on the nightly news to the daily casualty reports they’d get during the Gulf War. Since March 26, at least one Nevadan has died from COVID-19 each day with the exception of one day. At the peak this winter, Nevada lost 47 in a single day.
“It may not be the same atrocity that you may see in war, but you are in a battle for people’s lives,” Berry said. “If the best solutions are not in place, then those who we care [about] and love and matter may not get to see tomorrow. It’s a different kind of similarity, but it’s a fight.”
And it was coming. Nevada, the state born in the heat of battle, readied itself.
When Pipkins tested positive for COVID-19 at the North Las Vegas VA Medical Center in early March, his doctors were in disbelief. It was the first novel case in the VA system nationwide. Higher-ups from Washington, D.C. called every day for an update on his case.
The initial treatments Pipkins’ doctors tried didn’t seem to work, so they did the only thing they could think to do — put him in a medically induced coma and hook him up to a ventilator to keep him breathing while his body continued fighting.
“That’s all that we had at the time. That feeling as a physician — especially when people would come to us and say, ‘Hey, listen, you’re the expert. What can you do to make me better?’ — I had no good answer at the time. All I could say is, ‘Listen, I can keep you alive until something happens, but that’s the best that I can do,’” said Dr. Myron Kung, a pulmonary critical care physician at the VA hospital and one of Pipkins’ doctors. “That’s a frightening position to be in as a provider.”
Kung said he was learning more and more about the virus watching CNN, just like everyone else was.
Scherr, the emergency medicine physician, recalled patients flooding into the ER in March and April struggling to get enough oxygen; doctors’ first instincts were to intubate them and place them on ventilators to keep them breathing. Just as state officials were working with the best information they had at the time, so, too, were doctors struggling to fight a virus with what they knew. Though patients’ chances of surviving significantly dropped once they were ventilated, it still gave those like Pipkins a fighting chance.
The problem was, what would they do when they ran out of ventilators?
“In the beginning of it, our ICUs were full,” Scherr said. “Our ventilator capacity was near 80 percent.”
Once the state effectively shut down, the numbers started to drop. A peak of 711 COVID hospitalizations in early April plummeted to 421 just a month later. In the same timeframe, the state went from having 240 COVID patients on ventilators to only 115.
Doctors, nurses and hospital officials across Nevada say that initial shutdown — painful as they know it was for so many of their friends, family and fellow Nevadans — bought them critical time to prepare. They secured additional resources, including personal protective equipment and ventilators, set up additional bed space and learned more about the virus and how to treat it. That decision, they say, saved an untold number of lives.
It’s impossible to know exactly how many lives Nevada might have lost had it acted differently. If Nevada were New Jersey, which like New York was also hit early and hard by COVID, it would’ve lost more than 8,000 of its residents to the virus. If it were Mississippi, which has taken a relatively lax approach to COVID restrictions, it would’ve lost 7,000.
To date, Nevada has lost more than 5,000 lives to the virus.
“When we first started seeing that surge of COVID, there was not a single hospital in the [Las Vegas] valley that was ready to deal with that,” said Dr. Shadaba Asad, UMC’s medical director of infectious disease and another member of the governor’s Medical Advisory Team. “If the city had not been shut down and that spread of infection had not been halted, or at least reduced, I think it would have resulted in a catastrophe where our hospitals would not have been able to take care of the patients who became ill.”
Early on, hospitals were focused on making sure they had the bed space and staff to handle a sudden influx of COVID patients, who typically require lengthy hospital stays. There were two ways to accomplish that: Facilities could either increase bed space, as Renown did when it made the decision at the end of February to set up an alternate care site in its parking garage, and bring on additional staff, difficult when states were competing for a limited pool of traveling nurses, or they could decrease the number of patients in the hospital, thereby reducing the number of beds and staff needed.
While some hospitals focused on the former, Nevada hospitals statewide did the latter, suspending all non-urgent surgeries. That means people who needed hips replaced could not get them replaced and people who needed tumors removed at some point in the near future could not get them removed.
“It’s really with a heavy heart that you make that decision that we’re going to stop that,” said Lake, executive director of community resilience at the Nevada Hospital Association, which announced the suspensions back in March. “It’s not a financial decision, it’s really a triage decision.”
Nevada hospitals, like those everywhere else in the world, also struggled to secure personal protective equipment (PPE) for their workers as global supply chains collapsed and the cost of basic, necessary medical equipment like masks, gloves and surgical gowns skyrocketed. Because testing was so limited early on, hospitals had to treat every patient as if they might have COVID. So did first responders. That meant expending significant amounts of PPE on every patient — PPE that had quickly become the scarcest resource.
“It was sort of like a shark feeding frenzy with blood in the water,” Lake said.
The situation got so bad that the first mission of a private-sector task force established by the governor to assist with the state’s COVID response raised $10 million dollars to purchase personal protective equipment, including 2 million N95 masks, 2.6 million surgical masks, 1.5 million gloves and hundreds of thousands of face shields and goggles.
Meanwhile, in hospitals some workers say their facilities were keeping PPE under lock and key. Others tried to buy their own supplies and bring it from home. But the heart of the issue was that there just wasn’t enough available in Nevada, across the country or around the globe.
“I can’t even begin to explain this fear and dread even amongst health care providers when we started getting these first patients because it’s a highly contagious disease and knowing very little about it, being exposed to it day and night and not sure if we were actually protecting ourselves, if we were taking the disease back to our loved ones,” Asad said.
And time has borne out how important personal protective equipment is in protecting hospital workers. When Yarleny Roa-Dugan, a labor and delivery nurse in Las Vegas, fell ill to COVID in January 2021, it wasn’t because she had been exposed to a patient but rather to her carpenter husband, who they believe contracted the virus at work from someone who wasn’t wearing a mask and later tested positive.
On one level, the concerns over PPE were about protecting health care providers. But they were also making sure that hospitals had enough staff to treat all of their patients. If health care workers were already a scarce resource in Nevada before the pandemic, what would hospitals do if a significant portion of their workforce had to quarantine because of exposure to COVID or because they fell ill to the virus themselves?
When Pipkins came into the VA hospital in March, 47 employees who came into contact with him had to quarantine at home for 14 days because they weren’t wearing PPE.
“If you started quarantining health care providers exposed to people with COVID, before you knew it, you would have nobody to take care of these patients,” Asad said. “We started learning slowly, and this had primarily to do with availability of health care providers, if a health care provider was exposed to somebody with COVID, as long as they had absolutely no symptoms concerning for COVID, they were allowed to work with precautions, daily symptom monitoring and daily screening.”
The state shutdown also bought doctors critical time to learn how best to treat the illness. They discovered it was better to place patients on their stomachs and give them high flow oxygen for as long as they could bear, only putting them on a ventilator as the last resort. They started giving their patients steroids. They started using remdesivir, an antiviral drug, and convalescent plasma.
Spring, as it turns out, was just the beginning for Nevada’s hospitals. The state would see nearly twice as many COVID-19 patients hospitalized during the summer surge and three times as many during the fall surge compared to the worst point during the spring.
But doctors believe if not for the initial shutdown, they never would have been prepared for what was to come.
“It would have broken down the health care system completely and it would have resulted in innumerable, avoidable deaths,” Asad said.
If the goal had been solely to stop all spread of COVID-19, the best way to accomplish that would have been to lock every single person on the planet inside their home until everyone infected with the virus had either recovered or died from it.
This was, of course, never a realistic option.
Nevada’s lockdown, by comparison, was relatively porous. People were still allowed to go to the grocery store and pick up takeout. Workers in some essential industries, such as manufacturing and construction, were allowed to continue to go to work. Friends and family could still gather privately in small groups in their homes.
Still, some Nevadans may have been hopeful the lockdown would eliminate the virus and they would be able to emerge sometime in late spring or early summer and return to life as they knew it. State officials, however, knew that was not going to be the case. Their focus was mitigation.
They knew a lockdown couldn’t reasonably last forever, and they knew that cases would rise once it ended. That’s why, once the initial tide of COVID-19 cases started to ebb, their focus turned to figuring out how to reasonably stop as much spread of the virus as possible while also allowing Nevadans to do the things they reasonably needed to do to sustain themselves.
The answer was, on its face, simple: One, they needed Nevadans to continue to interact as little as possible to limit the spread of the virus; two, they needed all Nevadans who wanted to get a test to be able to get a test in the event they fell ill; and three, they needed to be able to contact trace all Nevadans exposed to the virus to prevent them from spreading it to more people.
But changing human behavior is a tricky, if not impossible, proposition. Plus, Nevada was already lacking in public health infrastructure prior to the pandemic, which meant it was nowhere near prepared to undertake a testing and contact tracing effort of this magnitude, despite best intentions.
Early projections suggested that states would need 30 contact tracers per 100,000 residents. That would mean Nevada would need nearly 1,000 contact tracers. State officials estimate they had 10, maybe 15, contact tracers at the time.
Other gaps quickly became apparent as well. State officials discovered early on that several counties, which are required by state law to have county boards of health, did not.
“I remember calling one sheriff in a rural county and saying, ‘Who's your county health officer? Tell me about your last board of health meeting,’ and he was like, ‘I have no idea what you're talking about,’” said Julia Peek, deputy administrator in the state’s Division of Public and Behavioral Health. “He scrambled to get it set up, to a ton of his credit.”
The state's two public health labs — the Nevada State Public Health Lab in the north and the Southern Nevada Public Health Lab in the south — were also ill prepared for something of this scope. Both labs were well-accustomed to testing for infectious diseases, foodborne illnesses and sexually transmitted infections on a small scale, but widespread testing for COVID-19 for every Nevadan who wanted it?
“I think people still don’t appreciate or understand that there was not and there still is not and there likely will never be an infrastructure whereby every person can get a test when they want it,” Pandori, head of the state public health lab, said. “Even with disaster and bioterror preparedness, which started to be financed pretty heavily after 9/11, in particular, that money does not come within a trillion miles of making labs and public health labs possible to test anyone who needs a test at any given moment.”
That didn’t stop Nevada from trying. Health officials knew that as soon as Nevadans were allowed back out in public again, the virus would start spreading and they would need a way to find it. The answer, for Southern Nevada, came from an unusual source: UMC, the county-run, safety-net hospital. UMC’s mission, as a public hospital, is to serve the community. In the time of the pandemic, that meant effectively joining the state’s public health response.
“Did I ever think we would be doing COVID testing and running a massive vaccination enterprise? Absolutely not,” Mason VanHouweling, UMC’s CEO, said.
Toward the end of March UMC realized it needed a better solution for COVID testing. It was still the tail end of the flu season, and the hospital couldn’t tell whether its patients were sick with the flu, COVID or both. From there, UMC started talking about how the hospital could not only expand testing for its own patients but also help with the demand for public testing, which was incredibly slow and scarce at the time.
So, the hospital shuffled its funds around, including capital it had originally intended for other projects, and made the decision to set up a second, complete lab that would be able to turn around test results within 24 hours and run up to 10,000 COVID tests a day. To date, UMC has run nearly a million COVID-19 tests across Nevada, about a third of the 2.7 million tests that have been run across the state. The lab ended up costing the hospital about $1.3 million to develop and $57.5 million to operate in labor and supplies.
While there were initially talks with the governor’s private sector task force about bringing in a Chinese company, BGI, to help to establish the lab — which the U.S. government warned against — VanHouweling said the hospital decided on its own to go a different direction.
Jim Murren, former MGM Resorts CEO and head of the state’s private sector task force, helped the hospital secure a contract with Thermo Fisher, a Massachusetts-based company, to provide open source, high-throughput test machines that would allow the hospital to use a wider range of supplies for the machines and meet the demand the hospital anticipated. He did so by selling them on the idea that the company would be able to pitch to its shareholders that their test supplies helped Las Vegas — and by promising them that they wouldn’t face a ton of red tape with the contract and that government officials would move quickly on the decision.
What’s still not entirely clear is why so much of the focus from government officials and the private sector task force was on helping UMC with their entirely new lab instead of assisting the Southern Nevada Health District in expanding its existing public health lab. The Southern Nevada Health District said the answer lies in the governor’s office. The governor’s office said it was just a matter of UMC being ready and willing to quickly step in to fulfill that role. Murren said it was because UMC’s lab was considered one of the best in the nation and that he was betting on VanHouweling, the Air Force veteran who turned the once-struggling hospital around.
“I bet on people,” Murren said. “I’ve done it my whole life.”
Renown, in Northern Nevada, ended up filling a similar public health role in its community by investing $3 million on expanding its testing infrastructure. At the height of demand, Renown was running 7,000 tests a week in a county with a population of a little less than 500,000.
The Nevada National Guard also played a critical role in establishing testing infrastructure statewide, both in urban Clark and Washoe counties but also in rural Nevada and on reservations where they facilitated mobile testing efforts.
“There's nothing in the National Guard playbook that talks about setting up a testing center,” Berry, the Guard’s adjutant general, said. “But these are people who bring a variety of skill sets to the fight every day and they just knew how to do logistics, they just knew how to do planning, they knew how to do communication ... Whatever they were tapped on the shoulder to do, they just figured it out.”
Testing alone wouldn’t halt the spread of the virus, though: Nevada would need to be able to trace the virus by making contact both with the people who tested positive for the virus and with the people they had potentially exposed. Early on, the state was inundated with pitches from vendors promising their platform would be the one to solve all contact tracing ills; it settled on contracts with Salesforce and Deloitte to ramp up a digital contact tracing system and workforce. Though state officials had received early indications that their local counterparts weren’t interested in a new system, the state was hopeful that if they built it, the health districts would come.
While those preparations in the spring set the stage for the state to start reopening, the coming months would push the newly expanded testing and contact tracing infrastructure to its limit. Public health experts say the expectation that the state would be able to test every Nevadan who wanted to be tested and trace every Nevadan who needed to be traced was too rosy, particularly in light of the tremendous case volume the state would see in the summer and fall.
“The way I describe contact tracing is that you're tracing down those embers of a fire, you're trying to put out the last part of it,” Labus said. “When the forest fire is raging, it doesn't make a lot of sense to find all those little embers.”
Still, as April turned to May, the state collectively breathed a sigh of relief. Cases were no longer exponentially increasing. Hospitalizations were on the decline. Testing had ramped up. Health care workers felt more equipped to treat the virus.
But it was still just the beginning. The wildfire was yet to come.
Reopening Nevada was easier said than done.
Shutting down was immensely challenging for businesses, but it was a relatively straightforward policy once it became clear what entities were allowed to stay open and what were not. Reopening, however, would not just be the reverse of closing. It would need to happen slowly and methodically, with an eye toward figuring out which businesses were the safest to open and how to mitigate risk in those deemed less safe.
Sisolak, at the end of April, announced the state would begin an “active transition” toward reopening. He emphasized that it would be done in a data-driven way and that the state would be required to see a “consistent and sustainable” downward trajectory in COVID-19 cases and hospitalizations, sufficient hospital capacity and health care workforce and the ability to test all symptomatic patients.
The governor laid out his reopening plan in a winding, 28-page document titled the “Nevada United Roadmap to Recovery” that strove to offer certainty to an uncertain public. It outlined a four-phase reopening plan complete with Nevada-themed nicknames for each phase: "Battle Born Beginning," "Silver State Stabilization," "On the Road to Home Means Nevada" and "Home Means Nevada — Our New Normal." Each phase would allow time for the state to reassess the data and make sure that it was on track before proceeding to the next phase of reopening.
The roadmap broadly laid out the contours of which businesses would be allowed to open in each phase. Outdoor spaces, small businesses and “select retail” would be allowed to open under the first phase with strict social distancing, hygiene measures and occupancy limits. But the finer points of which businesses, exactly, would be allowed to open and how were still yet to be determined.
That responsibility largely fell to a new Local Empowerment Advisory Panel, or LEAP, established by Sisolak to help counties assist businesses with safely reopening. The name made it sound, perhaps, more formal than it ended up being in reality.
How it actually worked was that three of the panel’s members — Clark County Commission Chairwoman Marilyn Kirkpatrick, Eureka County Commission Chairman J.J. Goicoechea, and Dagny Stapleton, executive director for the Nevada Association of Counties — would spend hours on the phone on the weekend brainstorming what guidelines they thought made the most sense, which Clark County staff would then spend hours typing up. They’d then send those over to the state Department of Business and Industry for a first review and then onto the governor’s office for final review.
“I'll tell you, it's super easy to close things down, it's very hard to open things up,” Kirkpatrick said. “You're trying to think of every single business and trying to put some common sense and public health in the same conversation so that people could navigate and be open and be open safely.”
The biggest challenge, though, was figuring out how to safely reopen casinos.
“If you look from purely a public health angle, the fact that our casinos are open seems like a really bad idea,” Labus said. “But, at the same time, that's what the economic basis of our state is, and there is going to be all sorts of public health fallout if we close them. People will lose their jobs, they'll lose health insurance, they won't be able to feed their families, all those kinds of things, and those cause health problems as well.”
Because keeping the casinos closed forever was not an option, the state focused on what could be done to open them safely. Conventions, at the beginning, were out. Table games, while not ideal, could be done with strict spacing requirements and other precautions. Other establishments inside casinos, like restaurants, would adhere to the statewide guidance for those kinds of businesses.
Even public health experts from outside Nevada emphasize there isn’t necessarily anything riskier about a casino than any other establishment that brings large numbers of people together, so long as the appropriate mitigation measures are in place.
When it comes to data on points of exposure — an imperfect science for many reasons — hotels and casinos are not at the very top. Recent data show they’re behind restaurants and grocery stores in Southern Nevada.
“You can open a casino and, yes, you can put measures in place to make sure that you reduce it to a very low level of spreading,” said Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington. “To blame the casino and say, hey you guys have to do your part, and yes they have to, but also the community and everybody has to do their part.”
Both the state and the resorts had a vested interest in making casinos as safe as humanly possible. Resorts didn’t want to earn a reputation for being superspreaders, and the state worried about being put on other states’ travel blacklists, both of which would defeat the point of reopening casinos in the first place.
“We knew that it would be this tricky, delicate balance of wanting to make sure people could come here in the safest way possible at each time throughout this pandemic and protecting the reputation of the state, and particularly of Las Vegas, to make it a place where people felt safe coming and where other leaders across the country felt safe sending their own residents,” White, the governor’s chief of staff, said. “When people come here, it means Nevadans have jobs, it means Nevadans feed their kids, it means they can pay their electric bills.”
But, as safe as state officials and resorts could try to make the Las Vegas experience, bringing people together from all over the world is inherently a risky proposition. Just look at the polio scare centered around Mecca in 2005 or the superspreader conference in Boston that led to more than 300,000 cases of COVID-19.
“I would be concerned if I am a health official in Nevada, especially in Las Vegas, about who’s coming to us and what kind of variants and how much this will impact circulation of the virus in my community,” Mokdad said. “We’re not attacking the casinos, but we have proof that such events when people meet for a conference or for a wrestling game or a football game, it spreads the virus.”
For the many Nevadans who were unable to work from home this spring, the governor’s reopening plan was greeted with a sigh of relief. They would be able to go back to work. Their family members would be able to go back to work. Life would start returning to some semblance of normalcy. The four-step plan laid a clear path forward for the state.
On May 9, Nevada entered “Phase 1” of business reopenings, which allowed dine-in restaurants, hair salons and nail salons to open with capacity restrictions. Churches, gyms and bars were allowed to open as Nevada moved into “Phase 2” later that month. Finally, on June 4, tourists started to trickle back to Las Vegas as casinos once again opened their doors.
The “new normal,” it seemed, was within reach.
It was clear that cases were going to increase.
But what state officials perhaps didn’t fully comprehend as Nevada started down the path of reopening is how quickly they would do so as many Nevadans, who had for the most part been shut inside their homes for months, rushed back to their daily lives.
“It looked like, for a large proportion of people in our community, there was this sense of a kind of victory over the virus,” said Leguen, district health officer for the Southern Nevada Health District. “As you look back at the months of May, June and July and compare it with today, you will see there wasn’t that high level of compliance of people with mitigation measures, the use or masks, social distancing or the avoidance of public places. They felt at the time that the pandemic was over, everything is great, let’s go relax and party.”
At the low point in May, fewer than 100 people were testing positive for COVID-19 each day. By mid-July, that number had skyrocketed to more than 1,000.
Local health districts were quickly overwhelmed by the number of cases they needed to investigate and contacts they needed to trace. Before the pandemic, Nevada’s contact tracers were responsible for tracing relatively small outbreaks of illnesses. Even syphilis, which poses a significant public health challenge for Nevada, was nothing compared to COVID. There were only 2,000 cases of syphilis reported in 2018; over the summer, Nevada was seeing that many COVID-19 cases in two days.
While the state was able to step in and offer up its contact tracing platform and workforce, local health districts were still overwhelmed by the number of disease investigations — that’s the initial interview with a person who has tested positive for COVID-19 — they had to complete.
With the help of the Nevada System of Higher Education, the state was eventually able to scale up the number of trained public health professionals who could do disease investigation and contact tracing work. But it took time and, in the meantime, people got frustrated. Some Nevadans reported it was taking days to weeks to get their test results back and even longer to receive a call from a disease investigator — if they received one at all. At some point, health districts had to triage, focusing on the most recent positive cases first before working through their backlog.
As summer drew on and the number of new cases being identified each day began to drop, the state finally started to settle into a good rhythm. Leguen said he was even starting to feel optimistic because the health district’s workforce had expanded to such an extent that it seemed to be almost too much for the number of new cases being reported each day. At the low point in September, the state was seeing fewer than 300 new cases a day on average.
But when the fall surge hit, they were once again overwhelmed. The health district again went into triage mode. At the worst point in early December, more than 2,500 cases of COVID-19 were being identified each day, still far too many for the more than 500 people currently dedicated to contact tracing in Clark County.
State and local health officials are the first to acknowledge where their efforts fell short.
“Is any of it perfect? By no means and no stretch of the imagination,” said Peek, who helped coordinate contact tracing efforts at the state level. “Honestly, we’ve probably had more tears over building up contact tracing in the end.”
In Northern Nevada, Washoe County District Health Officer Kevin Dick said, they were essentially racing against rising case numbers to get computers, phones and space set up for contact tracing staff. Complicating matters was that even when the health district was able to contact cases in a timely fashion, there was no guarantee that people would follow the guidance given to them to quarantine and monitor for symptoms.
“In a perfect, theoretical world, maybe we could succeed with that approach,” Dick said, addressing whether it would have been possible for the state to prevent case growth with contact tracing. “In the world that we live in, I think it's fraught with difficulties.”
But the system, imperfect as it was, represented a massive improvement from the state’s capabilities a year before. To date, 1 in 2 Nevadans has been tested for COVID-19 and 58,667 cases have been identified as a result of contact tracing efforts statewide, or about 20 percent of cases reported.
The state also launched a privately funded contact tracing app, called COVID Trace Nevada, in late August to help the contact tracing effort. Though the rollout of the app was initially slow, 687,244 Nevadans have downloaded the app or opted into exposure notifications on their smartphones to date and 265 Nevadans have entered a verification code into the app confirming their positive result which has resulted in 973 exposure notifications being sent.
Looking back, public health experts say perhaps the only way Nevada could’ve ramped up testing and contact tracing to the levels we eventually ended up needing in the fall would likely have been to have a cohesive national plan and federal financial investment back in February or March.
“At the time, there were few enough cases that it was actually practical to perform contact tracing around every case. But of course, that was also the period when the [Trump] administration felt that because there were so few cases we have very little to worry about,” said Dr. Kevin Murphy, an infectious disease specialist in Reno. “That was a golden missed opportunity.”
The hospitals, meanwhile, were not all right.
By fall, Nevadans and others across the U.S. had grown weary of mitigation measures and had started to engage in riskier behaviors. Increasing numbers of COVID-19 cases soon followed here and nationwide. By then, the doctors inside the hospitals responsible for treating COVID-19 patients were growing tired too.
“I think it went from a sense of, ‘Okay, let's get this done. We're on the frontlines. This is a pandemic. We're going to see the light at the end of this tunnel,’ to, six months after that, ‘This is fatiguing. I'm tired of it,’” Scherr, the emergency room physician, said. “We had tons of endorphins at the beginning, our adrenaline was up, ‘This is what we do,’ to, ‘Damn, I’ve got to see this every day, all day.’”
Things got so bad that Renown finally started putting patients in the alternate care site — a parking garage-turned-medical unit. At Sunrise, the hospital was squeezing in patients in its old emergency departments and surgical post-op spaces. Some hospitals had patients in hallways waiting for rooms to open up. At one point, Scherr’s emergency medicine group offered its services to cover the night shift at one smaller hospital where two ICU physicians were responsible for covering 60 to 70 patients, just so the doctors could get some sleep.
“Ten days after Thanksgiving, that was the longest, probably hardest hit time during COVID,” Scherr said. “Especially in Vegas, we were over 100 percent hospital capacity. Our ventilator capacity was not close to being threatened because of our new treatment strategies, but our ICU capacity was.”
As bad as things were, hospital association officials said Nevada never reached ICU collapse at any time over the last year. That’s the point where hospitals no longer have the equipment, supplies and people to provide the needed level of care to their patients. Though hospitals individually were stretched to 100 percent or more of their capacity, the system held.
But Lake, the hospital association’s executive director of community resilience, said Nevada “got pretty close,” particularly during the summer surge. At one point, ventilators loaned to the state from both California and the Strategic National Stockpile were being FedExed around the state to the hospitals that needed them.
“If you envision it as a rubber band that you’ve pulled so tight that if you add one more patient — the straw that broke the camel's back — that rubber band will snap,” Lake said.
It’s not exactly clear why the hospital situation in Nevada never was as severe this fall as it was in Southern California, which hit zero percent ICU capacity in December. There are, however, a number of theories.
One is that maybe Southern California hospitals are much more siloed and don’t lean on each other the way that Nevada hospitals do through their master mutual aid agreement. During each surge, Nevada hospital CEOs were on calls with each other every other day discussing capacity and who could take more patients.
Another is that maybe because Nevada experienced a significant surge in cases over the summer in a way that California didn’t, doctors had significant clinical competency by the fall. Doctors say that although this fall surge was stressful, there are now clearer protocols for treating COVID-19.
Maybe it’s just that Southern California is much more densely populated than Nevada so that when things got bad, they got really bad. Or maybe, for whatever reason, Southern California’s surge picked up speed faster than Nevada’s did and the mitigation measures that the governor put in place in late November successfully halted the spread.
Or it could be that it still helps to be a small state where everyone knows everyone. They have to, in some ways, to survive in a health care landscape that at times still feels like the Wild West.
“One of the upsides to being a small state and a state that doesn’t invest a lot of general fund [dollars] into public health is that we have to know our system and we know our partners,” said Richard Whitley, director of the Department of Health and Human Services. “One thing you have to do when you don’t have a lot of resources, you have to know what you do have and what you can rely on.”
The last year has been a rollercoaster.
As cases went up, down, up, down, up again, down again and now have plateaued, state officials tried to balance public health needs against economic needs. Businesses closed, businesses opened, there was a mask mandate, bars closed again, bars opened again, restrictions on large gatherings loosened, businesses and gatherings faced new restrictions and, now, finally, those restrictions are once again loosening.
Those ever-changing guidelines were part of an effort to respond to the current milieu and to ensure that the restrictions in place matched the current severity of the public health crisis. But oftentimes, they left residents confused and frustrated that things were changing once again.
As it turns out, the governor’s “Nevada United Roadmap to Recovery” plan from the spring would be just the first iteration of many documents outlining how the state would manage through the pandemic.
It would be followed by “Road to Recovery: Moving to a New Normal” in August, a plan that shifted much of the responsibility for implementing mitigation measures to a new statewide task force. Then, there was the “statewide pause” in November, which saw new limits be placed on businesses and gatherings. Now, we’re operating under “Nevada’s Roadmap to Recovery,” which plans to transition almost all responsibility for COVID-19 mitigation to local authorities.
It’s hard to say which mitigation measures have been the most effective.
Public health experts believe the case trends are probably, in part, psychological. Cases go up when people hear that cases are going down and feel safe to go out and do things; cases go down when people hear that cases are going up and they should be careful and limit their exposure. But they also believe the mitigation measures themselves have blunted the impact: When there are fewer people visiting a business or a smaller number of people at a gathering, there’s less of a chance that someone there has COVID and, if they do, hopefully more space to minimize transmission.
The one mitigation measure, though, that top public health officials say has been key to limiting case growth: the state’s mask mandate, which was announced on June 24 and went into effect two days later.
While Nevada was among the first 20 states to enact a mask mandate, multiple public health experts said they would’ve liked to see the state enact one sooner. At least seven states enacted mask mandates in April, six did in May and Nevada was one of five states to do so in June.
“[The Medical Advisory Team had] been discussing it for a while, trying to get support for that. It was just one of those things, it’s a political decision as much as it is scientific. We recognize those issues. But at the same time we were told, just think of the science. So from a scientific perspective, it's really easy to say, this is what you should do,” Labus said. “When you actually have to put it in place, it's a little different, and that's what the governor had to decide.”
The governor, for his part, said he didn’t even have a full understanding of how effective masks were when he put the mask mandate in place.
“It's easy to look back and say, yeah, I wish I’d have done it earlier, but I didn't know then what I know now,” Sisolak said. “I think at the time we made the decision as quick as I thought there was enough evidence to warrant that decision being made and that's why we did it when we did it.”
As other states like Texas and Mississippi have now begun to lift their mask mandates, Sisolak has made clear that Nevada won’t be heading in that direction. When the state transfers control of coronavirus health and safety measures to local governments in May, the statewide mask mandate will remain in place.
“I think that’s an irresponsible thing to do now,” Sisolak said of governors who are lifting mask mandates. “There’s no science or medical advice that says that’s the appropriate thing to do.”
The last year has been difficult, to say the least, for most. But Nevada’s public health workers, stoic as they may outwardly appear, are struggling.
They will acknowledge that they weren’t prepared and that there were areas where they might have done better. They’re sure that even more of that will become clear with time. But they also believe it wasn’t for lack of trying, and many of them are near their breaking points.
“It’s like we were pushing a wagon, and it worked when we had four people holding the wheels on and now you’re expecting us to enter NASCAR. Guess what? We’re not prepared, and it’s not for creativity or lack of effort,” Peek said, tearing up. “We're doing the best we can with the resources that we have.”
The deck was stacked against Nevada’s public health system from the start. Nevada ranks last in the nation for public health spending per capita. As recently as 2019, public health officials had pleaded with lawmakers for additional public health dollars, which they said would allow them to be more proactive in responding to Nevada’s health needs as they develop, instead of reactive, to no avail.
In some ways, it’s a miracle the situation hasn’t been worse in Nevada. But it has taken a toll on those trying desperately to hold the wheels on the wagon.
Hateful emails stacked up in their inboxes, health officials say. Peek-Bullock, the state’s epidemiologist, recalled someone suggesting picketing outside her house after she appeared at a press conference.
“That was the moment for me that it really hit home because that crosses the line between your work life and your personal life, and you think about your family,” she said.
Like every other Nevadan, the pandemic has taken a toll on their personal lives in other ways as well.
Cage, the state’s COVID-19 response director, has seen his brother and sister struggle to run their family-owned bars and restaurants in Reno. Both he and Sisolak have also been public about their experiences testing positive for the virus. Peek recalls trying to essentially homeschool her kids in real time while also working 12 hours a day. In the evenings, Kirkpatrick, the Clark County Commission chair, spends her evenings helping her 6-year-old granddaughter with her homework and getting her ready for bed before doing even more work. Dr. Tony Slonim, Renown’s CEO, learned he lost his dad to COVID the day the hospital held a press conference in April announcing the opening of their parking garage alternate care site.
“You want nothing more than to do whatever you can to make their pain go away, right? In this case, it's the frustration, the uncertainty, the economic challenges, all of that, and trying to get to a place where you can do something that makes sense based on policy, based on science, and all of those things,” Cage said. “It doesn’t square with the emotional pull of doing something for a family member that you love dearly.”
They’ve felt overwhelmed and exhausted. They don’t know what to do with comments from people who suggest they have an agenda or are financially benefiting from the public health emergency. Many of them didn’t have their first day off from work until many months into the pandemic. As salaried employees, the state’s top health officials don’t get overtime and, in fact, have had their pay cut because of mandatory state worker furloughs. But, then, some of them have struggled with feelings of guilt because they feel lucky to have a job when so many others were and still are out of work.
They know they don’t always get it right. But they say their number one goal has been to wake up each day and do the best they can possibly do for the state of Nevada.
“The story is that the government is horrible and the government's doing something wrong, not that these people are working an ungodly number of hours per week and they rarely get to see their children for the good of Nevadans,” Peek said. “At some point we will have to exhale and we’ll have to shift down and go back to normal life. I don’t know how that’s going to look, honestly, we’ve been on full speed for forever. I don’t know how we’re going to go back to normal.”
The pandemic was always going to be an uphill battle, particularly for Nevada.
How is a state supposed to respond to a pandemic when it’s economy is built on the idea of bringing lots of people together from all around the world to a four mile patch of earth to have fun drinking and clubbing and gambling in close proximity to one another and then return home — exactly the things one ought not to be doing during a pandemic?
To the rest of the world, it may have appeared as if Nevada was being cavalier in its public health response when it made the decision to reopen casinos. But then, to the rest of the world, the totality of Nevada is Las Vegas and the totality of Las Vegas is the Strip, where we presumably all eat and drink all day long before going back to our high rise condos to go to sleep at night.
The rest of the world sees the waitresses, bartenders, bellmen and guest room attendants when they visit, the humans that make the casinos, and by extension, the state run, but they don’t see the homes those workers go back to and the families who rely on them to put food on the table. They don’t see the grocery store clerks, the delivery drivers and the teachers who make everyday life here possible. They don’t see how the taxes they loathe paying on their hotel rooms go to fund things like schools and Medicaid. They don’t see that — without the Strip, without the tourists, for better or for worse — life in Nevada ceases to exist.
State officials and public health experts knew on some level the casinos had to open. Perhaps only congressional approval of a universal basic income could’ve kept them closed. But the state’s decision to many felt — and still feels — contradictory, hypocritical even. Sisolak, during a press conference in mid-November, asked Nevadans to voluntarily stay home for two weeks as cases spiked statewide. But, when asked, he said the measure did not apply to tourists, who he urged to continue to travel to the state while following all health and safety protocols.
Sisolak, in an October speech, called it Nevada’s “great balancing act.”
“The public needs to understand that if we don’t step up together and follow all public health measures, hard decisions and trade offs lie ahead. This pandemic has been framed as a false choice, shut it all down or do nothing. But we know that's not the case. We know that doesn't have to be a reality. We know we can't afford it. We can continue doing our best to balance the health and safety of Nevadans with the need to protect our economy, keep people employed, provide an education to our kids, and more,” Sisolak said. “I promise that I'm doing everything I can to manage this balancing act, and that balancing act in Nevada is perhaps the toughest than any other state.”
But it was maybe less a balancing act than an attempt to make two inherently contradictory priorities live in harmony, like trying to force the negative ends of two magnets together. On one hand, there’s general agreement that bringing people together for lots of face to face interaction in casinos was probably not the best idea for stopping the spread of COVID. But if the casinos remained closed and tourists were warned against coming to the state, tens of thousands of Nevadans would be out of work, struggling to feed their families and keep a roof over their heads. They would be thrown into poverty, which brings its own set of negative public health consequences.
Nevada didn’t have the options some other states had. White, the governor’s chief of staff, recalled a conversation with an official from another Western state and wondering how leaders there had lessened the impact of the pandemic on their economy. The official told her that most of their employees were able to work from home.
“She goes, ‘Have you considered that?’ I’m like, ‘Well, we have, that would be phenomenal, but you can’t have the dealer or the valet or the cocktail waitress or the busser work remotely. We are a state that is funded primarily on face to face social interactions in large groups with a lot of people you don't know,” White said. “It's what makes us stay fun and great and amazing. In a pandemic, it puts policymakers and decision-makers in an almost impossible situation.”
In truth, maybe it wasn’t a balancing act between COVID and the economy but rather a balancing act between preventing people from dying of COVID now and preventing people from dying from poverty, mental health and substance abuse issues later.
From the perspective of those in the governor’s office, this was exactly what they thought they had been saying all along. But they realized the sentiment had, perhaps, only been peppered here and there in the governor’s speeches, in 20-page guidance documents and calls with the press. Perhaps it wasn’t clear enough to the public. That’s why they decided to have the governor drive the point home during an October press conference.
White said that the governor’s October speech was designed to speak to the frustrations of everyday Nevadans. The governor’s office understood that Nevadans were frustrated that their favorite family-owned restaurant was struggling while Strip properties were apparently bustling with tourists.
“As people view these decisions and form opinions on them, I don't blame them if they are sitting there saying, ‘This isn't fair, I'm mad.’ because they're looking at it through the lens of their world,” White said. “Putting myself in their seat, I might be mad too.”
Those close to the governor say that, as the pandemic progressed, he got more comfortable with living with, and governing through, the uncertainty. Sisolak has a reputation for being decisive — his critics would call him headstrong or a bully, even — and he’s someone who likes to make a decision and stick with it. They’re not qualities that naturally lend themselves to leading well during a pandemic.
“One of the things he had to come to grips with here — and it took a few months — is there wasn't a decision he was going to make that might still be the right decision in two weeks. He began to really live that moment and live with the need for flexibility and agility and constant adjustment — monitor, measure and adjust — knowing that when he did some of the reopenings that he might need to pull that back,” said Billy Vassiliadis, a longtime Democratic campaign consultant who is close to Sisolak. “It was more living in that moment and knowing that decisions needed to be done and revisited and done and revisited, I think he started to communicate that more confidently. He became more confident in the certainty of the uncertainty."
Sisolak, reflecting back on the last year, acknowledges that it was difficult for him as a leader to come to terms with the fact that there were no right answers and that he might choose to do something today he’d have to reverse tomorrow. And he knows that people have disagreed with him — there have been people carrying AR-15s outside the Governor’s Mansion in Carson City telling him so.
But he said that what he focused on was doing what he thought was right at the time and knowing that when he put his head on his pillow at night that he made his decisions with the right intentions.
“Can you have a disagreement on timing or on the severity of some decisions? Sure. People are always going to be there to disagree,” Sisolak said. “I'm telling you, when I looked at that Strip and those lights and saw them all going off, it's like, man, am I doing the right thing? Is this the right thing to do? And, yeah, I know it's going to be criticized. I know people aren’t going like it. I might have lost sleep over it, but I know I did the right thing.”
There are, of course, things that Nevada could have done differently.
We could have shut down earlier, harder and longer. We could have never shut down at all. Our schools could still be closed, or our schools could have opened fully months ago. We could have devoted even more time and resources to testing and contact tracing. We could have concentrated more power in the hands of the Legislature or local governments. We could have invested more in public health over the last decade. We could’ve invested in an aging unemployment system. We could have put much more effort into true economic diversification instead of, as always in good times, once again hanging our hat on the resort industry.
“When I look back at outbreaks, and I've been working outbreaks for two decades, at the end of the outbreak, it always plays out differently than you would expect it to at the beginning. The question I always have is, well, if I were in the same position, would I make those same decisions?” Labus said. “If I can say, yes, I’d make that same decision today, even knowing ultimately that it was wrong, but based on that information it was the right decision at the time, that’s how I look at our success.”
But even the death of one Nevadan to this virus was always going to be too many, let alone 5,000.
“You talk to a surviving family member of somebody that lost a family member to COVID and couldn't get into the hospital even to say goodbye to them, and it puts things in a different perspective,” Sisolak said. “That chair where that person sat at the kitchen table is always going to be empty.”
Ronald Pipkins was the last person to learn he had tested positive for COVID-19.
By the time his fellow Nevadans awoke one year ago today to the news that one of their own had tested presumptively positive for the novel coronavirus, Pipkins was in a medically induced coma fighting for his life. For a month and a half, much of it spent tangled in a jungle of blue, white and clear tubes pumping lifesaving oxygen and medications into his body, Pipkins struggled to fight a virus that he, his doctors and the rest of the world knew little to nothing about.
When Pipkins, a Marine veteran, showed up at the North Las Vegas VA Medical Center a few days earlier complaining of shortness of breath, no one mentioned COVID to him as the possible cause, and he didn’t suspect it. Pipkins had been feeling off for months. He was worried about his sarcoidosis, a lung disease. But the novel coronavirus? With only several dozen cases in the U.S. at the time, Pipkins felt like the virus was still far away in China. “It’s going to disappear,” President Donald Trump had promised just the week before. “One day — it’s like a miracle — it will disappear.”
Except it didn’t. As Pipkins fought from early March through mid-April to survive, dozens, then hundreds and then thousands of Nevadans — 3,806 to be exact — tested positive for the virus. One hundred and fifty-nine of them died.
The miracle was that Pipkins was not among them.
“God spared my life,” the 56-year-old Las Vegas resident said, reflecting back on his fight with COVID.
But the world Pipkins woke up to was very different from the one he left when he entered the hospital in early March.
As Pipkins’ doctors grasped at straws trying to figure out how to save their patient’s life, state officials, public health experts and medical professionals scrambled to figure out how to stop the virus’s rampage across the state, at that point uncertain about how it was spreading and how deadly it was. At the time, 1 in 14 people who tested positive for the virus in hard-hit Italy was dying from the virus. The outlook was grim.
Facing no clear guidance from the federal government on how to tackle the virus and no national plan to address the pandemic, Gov. Steve Sisolak, and many of his counterparts across the nation, did the unthinkable, effectively shuttering their economies. The lights on the Las Vegas Strip dimmed. The school yards emptied. The streets quieted.
Looking back, there is essentially universal agreement among top decision-makers in Nevada that shutting down, extreme and wrenching as it was, was the right choice given what they knew about the virus at the time. If they knew then what they know today, they might have made a different choice, they say, but they didn’t know then what they do today.
What none of them anticipated back in March, though, was how deep or long-lasting the devastation from the virus would be. To date, Nevada has lost 5,005 lives directly to COVID-19, as well as countless more who have died from suicide, substance abuse issues and delayed medical care as a result of the pandemic.
Others have survived but bear physical and mental scars from the last year. At the worst point last spring, 1 in 4 Nevadans was unemployed, more than half a million kids were learning by screen instead of in the classroom — if they were lucky and had the equipment and bandwidth to support it — and opioid-related overdose deaths ballooned 50 percent.
Now, more than a quarter of Nevadans are enrolled in the state’s insurance program for low-income individuals. Two in five Nevadans exhibit symptoms of anxiety, while 3 in 10 exhibit symptoms of depression. Mental health visits by kids to emergency rooms nationwide are up at least a quarter.
For most, the last year has been a never-ending pulse of sickness, struggle, loss, frustration and isolation. We’ve blamed federal, state and local governments, public health experts and other countries. We’ve blamed friends and family for taking the virus not seriously enough or too seriously. Sometimes we’ve blamed ourselves.
Now, a year since this virus first arrived in Nevada, we’ve had little time to pause and reflect. Though hindsight may be 20/20, we can't fully reap that benefit: The pandemic is not yet behind us. We’re still too close to the picture to be able to see its entirety.
That’s why, over the past few weeks, The Nevada Independent has interviewed more than 70 people, including state and local government officials, public health experts, doctors, nurses, hospital administrators, teachers, business leaders, academics and everyday Nevadans, and we plan to interview many more in the weeks to come.
Through those conversations, we have begun to piece together the events of the last year and grasp the myriad ways in which the pandemic has affected our state — what went right and what went wrong; what we didn’t know then and what we know now; and what the future might hold, for the virus, for our state and for us as humans.
As in sessions past, The Nevada Independent is publishing a series of profiles featuring all the new lawmakers in the state. This is the third installment of more than a dozen. Check back in coming days for additional stories on new legislators' backgrounds, interests and policy positions.
Freshman Republican who succeeds Democratic Sen. Joyce Woodhouse (D-Las Vegas).
Represents District 5, which includes parts of Henderson and the Las Vegas Valley east of Interstate 15.
District 5 leans slightly Democratic (36.9 percent Democratic, 31.8 percent Republican and 24.4 percent nonpartisan in the 2020 election).
Buck did not have a primary opponent in the 2020 election.
She won a narrow victory over Democrat Kristee Watson in the 2020 general election, with a 329-vote margin out of more than 67,000 votes cast.
She will sit on the Education and Legislative Operations and Elections committees.
FAMILY AND EDUCATION
Buck was born and raised in Sioux City, Iowa, and earned her undergraduate degree at Montana State University before moving to Las Vegas to begin her teaching career in the 1990s.
She also achieved a master’s degree in administration and supervision from the University of Phoenix and a doctorate in organizational leadership from NOVA Southeastern University. She is married and has four children.
Buck has a long career in education, starting out teaching English language learners at an elementary school in Las Vegas and eventually rising to become principal at C.T. Sewell Elementary School. She then transitioned to a charter school network, the Pinecrest Academy, where she rose to become lead principal and executive director of the network.
She currently serves as the president of the Pinecrest Foundation, a registered nonprofit that helps fund charter school educational initiatives including scholarships for students.
Carrie Buck’s love of teaching started with her sister.
Growing up in an isolated rural community, Buck said that after school, she would head home excited to “play school” and teach her sister everything she had learned from school that day (she takes partial credit for her sister ending up in a gifted and talented program).
After graduating from college, she moved to Las Vegas in 1996 to take a teaching job in the Clark County School District. She started as a teacher for nearly three dozen English language learner students, most of whom spoke Spanish but also others who spoke Japanese and Swahili.
“I remember driving on the I-15 South and seeing the lights for the first time,” Buck, 49, said. “And then I had a little anxiety, because it is a culture shock. Moving from these small little areas to a big city, you just don't know what to expect, but it has been nothing but amazing.”
Buck continued rising up the ranks in the education world until she became principal of C.T. Sewell Elementary in the middle of the 2005-06 school year. At the time, the school was one of the worst-performing elementary schools in the state, but Buck attracted local and national attention in her efforts to turn the school’s fortunes around and eventually earn distinction as a National Title I School.
She left the school in 2014 to become principal of the Pinecrest Academy charter school in Henderson. She left that position in 2019 to become president of the affiliated nonprofit Pinecrest Foundation, which provides scholarships and funding for other programs for the charter school network.
“It's been a great perspective being in a traditional school district, and then moving to a charter school district, and seeing all the ins and outs of school financing, and all of it comes into developing a strong instructional plan that serves kids,” she said.
Her interest in politics started back when she was still principal at Sewell, saying she initially contacted former Assembly Republican Leader Paul Anderson about possibly running for an Assembly seat. But instead, she opted for a run for a state Senate seat in the 2016 election and lost a close race to incumbent Joyce Woodhouse (D-Las Vegas) by fewer than 500 votes.
Buck also made headlines in 2017 when she was put forward as a potential candidate during a series of recall efforts targeting Democratic state senators, including Woodhouse. The recall efforts ultimately failed, and Buck later privately apologized for her role in the process.
Buck ran again for the same seat in 2020, this time narrowly defeating Democrat and political newcomer Kristee Watson by 329 votes out of more than 67,500 cast in the district (Woodhouse was prevented by term limits for running again).
Buck is one of four freshmen in the Senate, and the only Republican elected in a competitive district. She said she hoped to put her head down and focus on passing her priority bills, but wasn’t concerned if her proposals were held up or blocked for overtly political reasons.
“I learned by (watching) what happens to others,” she said. “And so when leaders treat others poorly or unprofessionally or lock it out as they have in the past, that's just what is expected,” “So there may be a little anxiety about that but I'm a big girl, I signed up for this, and I'm willing to take whatever...comes my way. I can handle it.”
ON THE ISSUES
Buck said she doesn’t plan to immediately get a COVID-19 vaccine, and disclosed that she and her husband, who works for the Henderson Police Department, both had the illness in December.
She said her symptoms were like a mild flu, but acknowledged that it “can hit anyone differently, so you just don’t know.” While she doesn’t have any reservations or concerns about the vaccine, she said that she would prefer to wait until more people in the general public begin to receive it.
“I have a lot of between 65- and 70-year-olds that are emailing me wanting the vaccine, so until constituents are vaccinated, I think I can wait,” she said.
Unsurprisingly, many of the bills that Buck plans to bring forward in the 2021 session have to do with education.
One “simple fix” she’ll be proposing has to do with making the GPA weights for dual enrollment college courses taken by high school students equal to the higher weights given to Advanced Placement classes. She’s also working on a proposal with fellow Republican Sen. Scott Hammond to provide internships for high school students and dropouts.
She also plans to introduce a bill that would ensure teachers and government employees receive training about their publicly funded retirement system and benefits.
And while it may not be a piece of legislation, she said she also wanted to ensure that no bills are passed that affect the carryover dollars or reserve accounts budgeted by individual school principals — a topic that came up but was abandoned by the Clark County School District during the 2020 policy-focused special session.
“The reason you save money as a school leader is because if the following year you're asked to make a 15 to 20 percent cut, that you can keep your staff because it brings consistency for kids,” she said. “And that's what they need. Your staff doesn't want to have to worry about transferring schools and all this upheaval. They work the best when there is trust and that there's a leader that's going to go to bat for them.”
Buck declined to stake a position on the sales and gaming tax initiatives backed by the Clark County Education Association and currently in the Legislature, saying she wants to “see how this plays out.”
Lawmakers have a 40-day clock from the start of the legislative session to take up the measures, or else they’ll head to the 2022 ballot. Democratic leadership in the Legislature have said they don’t plan to support the measure.
As for the trio of proposed constitutional amendments raising taxation rates on mining that passed during the 2020 special session, Buck said she would support “bringing mining into the conversation” but was leaning against what Democratic lawmakers had passed last summer.
“I don't believe in isolating industries to tax them and turning people on each other,” she said. “Because then you never know who's next on the dinner plate.”
ID cards for inmates
Buck also said she’s working on a bill with Republican Sen. Ira Hansen to fix issues with identification cards for former inmates.
State lawmakers in 2017 passed a law requiring prison officials to verify an inmate’s true name and age with a birth certificate before issuing any identification cards after they’re released from state custody, but prison officials estimated that difficulties in meeting the higher standard meant nearly half of released inmates didn’t have any form of identification when they leave.
Buck said that left former inmates having to wait weeks to get other forms of identification, which makes it harder for them to return to normal society.
“Inmates that have messed up in their life but served their time and are out, we need to get them into the workforce and get them (to be) productive individuals as soon as possible,” she said.
Asked whether she believed that massive amounts of voter fraud caused former President Donald Trump to lose Nevada in the 2020 presidential election — something the president’s campaign has claimed but that has been denied by Republican Secretary of State Barbara Cegavske and in courts around the state — Buck demurred.
“I don't know, I don't know that,” she said. “I mean, I just don't know. I wasn't presented with any evidence. I didn't see for myself any nefarious happenings. So I haven't been briefed on that.”
Buck said she thought election officials should ensure that death records are closely compared to voter files, and noted that several of her Republican colleagues plan to introduce bills related to election procedures and processes, although she said she didn’t think they’d “see the light of day” in a Democrat-controlled Legislature.
She said she was uneasy about the close vote margin and issues with ballots in the Clark County Commission race between Ross Miller and Stavros Anthony, but didn’t outright say that fraud had or had not occurred in any races on the 2020 ballot.
“That's a really tough question because I don't know,” she said. “I do think that there were different things that were happening, but I don't have proof of anything, so I'm not going to be one that's going to be shouting that because I'm not an attorney with proof.”
Updated on Feb. 5, 2021 at 2:46 p.m. to correct that Buck's husband works for the Henderson Police Department, not the Las Vegas Metropolitan Police Department.
The seeds of discontent had been building for some time in the United States.
Then 2020 happened, bringing a pandemic, protests for racial equality and a presidential election, which exposed even deeper fault lines within the American populace. Brewing alongside increasingly partisan social media posts and terse political conversations among loved ones was an extremist movement.
In May, armed protesters in military fatigues gathered at the Governor’s Mansion to protest COVID-19 restrictions. In August, counter-protesters, some of them armed with military-style weapons, outnumbered protesters at a peaceful Black Lives Matter protest in Minden. Members of extremist groups appeared at pro-Trump campaign rallies and outside of the Legislature.
Then, when election results didn’t tip in President Donald Trump’s favor, extremist groups, egged on by politicians and Trump himself, embraced false claims about voting fraud.
It culminated in a violent insurrection on hallowed grounds — the U.S. Capitol, where federal lawmakers were certifying the presidential election results.
The chaos transfixed the world’s eyes on the United States, which had not seen a breach of the Capitol in more than two centuries. Now, 20,000-some National Guard troops have descended upon Washington, D.C, ahead of President-elect Joe Biden’s inauguration on Wednesday.
Extremism is not new to this moment, and it is not isolated to one region of the country. In fact, FBI officials have warned of armed protests in all 50 state capitals ahead of and on Inauguration Day. But the West, including Nevada, has long been a hot spot for anti-government extremism that, especially in recent years, has often used violent rhetoric and urged on armed militias.
The images pouring out of the Capitol had echoes of armed confrontations seen in the West — and Nevada — throughout 2020 and during the past several years. In Nevada and elsewhere, these conflicts, like the Bundy Ranch standoff in 2014, have often centered on disputes over federal public land.
"The West has the preponderance of public lands in the country and that is the anchor point of the federal government,” said Leisl Carr Childers, a historian at Colorado State University. “And Westerners experience federal oversight more closely than any other group of Americans.”
But if some roots of extremism can be traced back to the West, the expressions of extremism in Nevada over the past year echoed the nation’s politics, centering around COVID-19 restrictions, Black Lives Matter protests in the wake of police killings and false claims of election fraud.
Political leaders in Nye County and Elko County, both hot spots for public lands disputes with the federal government, have protested state COVID-19 restrictions, spread conspiracy theories about the insurrection at the Capitol and challenged the election results, perpetuating the disinformation that has provoked many far-right extremists to take action.
Mark Pitcavage, a senior research fellow at the Anti-Defamation League, said several factors contributed to right-wing extremist groups having a more visible presence across the country in 2020.
These groups, typically aligned against the federal government, embraced President Trump and often turned their ire toward local and state officials, particularly governors. He said 2020 offered a series of events that “provided a lot of opportunities for right-wing extremists to act out.” Then came the election, in which Trump and his supporters purposefully sowed doubt in the election.
“The ether was filled with claims that this upcoming election was going to be fraudulent — that there was going to be mass fraud,” Pitcavage said in an interview last week.
The series of events that primed extremists in 2020 played out in every region of the U.S. Still, Pitcavage said, it was “not a coincidence that, of the statehouses stormed in 2020, the West had two of them.”
A shifting rebellion
When pro-Trump supporters stormed the Capitol, observers who study the West were both surprised and not. Armed militiamen had confronted law enforcement here in the recent past, despite Nevada’s Constitution forbidding private militia groups.
.The insurrection at the Capitol, a public symbol on public land, looked similar to the occupation of the Malheur National Wildlife Refuge in Oregon five years earlier. The takeover of the Oregon refuge, led by Ammon Bundy and aided by militiamen, was an apex of simmering public lands feuds across the West, including the armed Bundy Ranch standoff outside Las Vegas in 2014.
But James Skillen, an associate professor at Calvin University and the author of “This Land is My Land: Rebellion in the West,” saw those incidents as the culmination of something greater.
When he watched the Bundy Ranch standoff unfold, his questions were less about the rancher, Cliven Bundy, who illegally grazed cattle on public land and was at the center of the dispute. They focused on a Fox News pundit, born in New York, who likely knew little about grazing fees.
Skillen remembers asking: “Why is Sean Hannity so supportive? Why is he tripping over himself to think that Cliven Bundy is the most stand-up person?”
In the 1970s, public land disputes began flaring up in Nevada as a movement often referred to as the Sagebrush Rebellion took hold across the rural West.
Federal public land comprises about 85 percent of the state’s land mass with roughly 67 percent of the state managed by one agency, the Bureau of Land Management, tasked with balancing economic activity and conservation on public land. As a result, the federal government plays an outsized role, especially in the rural West, over everything from grazing cattle to mining for gold.
The Sagebrush Rebellion, which came a few years after Congress passed legislation that aimed to protect more land for conservation and wildlife, sought to transfer federal public land to the states, a legally complicated and dubious task. At the request of ranchers and local politicians, state lawmakers, including in Nevada, passed legislation in support of the cause.
At the time, the Sagebrush Rebellion was a largely regional movement, Skillen said. There was no Twitter and few think tanks. Then things changed.
“What changes dramatically, already by the 1990s and then today,” he said, “is the unrest that we've seen is no longer just regional and it’s also no longer really just about land and resources. Those challenging the federal government are a coalition of people with really diverse interests.”
In 2014, the group that assembled in Bunkerville — about 80 miles northeast of Las Vegas — proved that point. The people who showed up supporting Bundy, some bearing arms, didn’t just come from Nevada or neighboring Arizona and Utah. Some traveled thousands of miles from New England, galvanized by an anti-government mission in a very different locale.
That’s what made the Bundy standoff such a groundbreaking event, said Cary Underwood, director of the Southern Nevada Counter Terrorism Center.
“For the first time that I can remember in this, you saw a surge of militia adherence or extremist followers to one common rallying event,” he said. “They demonstrated their ability to communicate across militia groups.”
Extremism in the United States exists in many forms, with certain ideologies waxing and waning — but not completely disappearing — based on current events. But anti-government and racially motivated extremism, two components that live under a broad umbrella of extremism ideologies, account for a large share of domestic terrorism threats, according to the FBI.
"Racially motivated violent extremists over recent years have been responsible for the most lethal activity in the U.S.,” FBI director Christopher Wray said during a House Homeland Security committee hearing in September. “Now this year, the domestic terrorism, lethal attacks we’ve had have, I think, all fit in the category of anti-government, anti-authority, which covers everything from anarchist violent extremists to militia types. We don’t really think in terms of left, right."
To Skillen, the Bundy standoff and the Malheur occupation signified that anti-government groups were increasingly organizing around similar causes, something he saw play out again when he watched armed Trump supporters storm the Capitol earlier this month.
“Ammon Bundy isn’t talking about land issues anymore,” Skillen said. “He's stopping high school football games over mask and social distancing requirements.”
The role of politicians
Scholars say political rhetoric, amplified during a bitter election cycle, monthslong pandemic and shaky economy, has fanned the flames of extremism.
“I blame politicians more than social media,” said Arie Perliger, author of “American Zealots: Inside Right-Wing Domestic Terrorism” and a professor at the University of Massachusetts Lowell. “When the president of the United States mentioned or embraced the Proud Boys in front of an audience of 120 million people in a presidential debate, that’s the problem.”
Even Senate Majority Leader Mitch McConnell has assigned Trump some blame for the Capitol siege. On the eve of President-elect Joe Biden’s inauguration, the Republican senator from Kentucky said, “The mob was fed lies. They were provoked by the president and other powerful people.”
Trump and his allies weren’t the only purveyors of such rhetoric.
Local elected officials and political leaders, including former Nevada Attorney General and gubernatorial candidate Adam Laxalt, have spread false claims that the election was stolen. Others have perpetuated conspiracy theories about COVID-19 rather than debunked them.
The Capitol Hill violence, which disrupted the peaceful transition of power, wasn’t enough to stem the tide of inflammatory rhetoric.
One day after the insurrection in Washington, D.C., Assemblyman John Ellison, a Republican who represents Elko County, said the rioters were not Trump supporters.
“They were Antifa — people dressed up as Trump supporters… They’ve got it on video,” he said in a Battle Born Media Networks interview. “It’s not about who wins an election but who steals the election. There will never be another free election in this country again if they don’t do something.”
Meanwhile, a letter written by the Nye County Republican Party chairman, Chris Zimmerman, made national headlines, given that it stokes more false claims about the election. “Let me be clear: Trump will be president for another four years,” the message posted online Jan. 8 said. “Biden will not be president.”
Then, last week, the Nevada GOP tweeted that Democratic Attorney General Aaron Ford was “complicit in stealing the voice of 130,000 voters in our state,” suggesting widespread election fraud.
Political leaders across the U.S., experts said, have created an atmosphere to prime supporters for extreme actions, and in some cases, failed to rebuke groups that have threatened violence.
Pitcavage said politicians bear “tremendous amount of responsibility.”
“If despite all of the facts, all of the complete lack of evidence for any significant fraud, despite dozens of court cases being lost or thrown out, after all of these accusations of fraud were repeatedly refuted and rebutted, to continue to claim that the election was stolen becomes not simply partisan positioning, it actually begins to weaken the Democratic foundations of the country because they are based on trust,” he said.
What the future looks like
From a law enforcement perspective, expect to see federal, state and local agencies be on heightened alert for more anti-government extremism threats, especially this week as a new administration takes office, said Cary Underwood, who heads the Southern Nevada Counter Terrorism Center.
“The emotions and beliefs are not going to go away,” he said. “The perception that folks feel wronged is not just going to dissipate just because the inauguration occurs.”
But Perliger said Trump’s departure from the White House may render him less helpful and, therefore, not as important to right-wing extremist groups that have aligned themselves with him.
“I think they needed him because they believe that he's in a tool that will allow them to almost dismantle the government from within,” he said. “... Yes, he will be some kind of a figurehead, some kind of a symbol maybe, but, again, he's not useful for them anymore so we’ll see.”
An open question is how the militia movement’s organization will be affected after being taken off of social media platforms, their primary arena for organizing, Pitcavage said.
“For the first time in its history, it has witnessed significant de-platforming,” he said.
Over the past year, tech companies have banned militia groups from organizing on their platforms. And after the insurrection at the Capitol, Twitter permanently suspended Trump’s account “due to the risk of further incitement of violence.” Other companies did the same.
During the Trump administration, anti-public land extremism that specifically targeted the federal government was less of a threat than it was during the Obama administration. Trump appointed officials who were sympathetic to their concerns.
This month, the Trump administration issued new grazing rights to Oregon ranchers who were convicted of arson and whose fight with the federal government helped sparked Malheur occupation. The administration took no action to stop the Bundy family from illegally grazing cattle in southern Nevada, even after a report chronicled unlawful irrigation ditches in Gold Butte National Monument.
On Friday,E&E News reported that Cliven Bundy, in a recent interview, said that he believed the conflict around the Bundy Ranch and illegal grazing would continue in the coming years.
“We’re going to have to go forward,” Bundy said. “If we have to walk forward towards guns, which we did at the Bundy Ranch, we have to do that. And we have to have faith.”
Nevada is moving to a new COVID-19 vaccination strategy that will allow the state to distribute doses to essential workers and priority segments of the population in tandem.
Under the new, highly anticipated plan, which state vaccination officials detailed at a press conference with Gov. Steve Sisolak on Monday, the state will shift from its previous system of vaccination “tiers” to a new dual “lane” strategy, which will allow workforce vaccination to occur at the same time as mass vaccination of the general population. Each of those lanes, however, will still be divided into priority groups — with public safety workers at the top of the workforce sector and elderly Nevadans at the top of the general population group.
The new, bifurcated approach will allow the state to vaccinate more people at once, for instance, allowing counties to vaccinate K-12 employees while also administering doses to elderly individuals, where the previous system had required officials to vaccinate the vast majority of one group before proceeding to the next.
“Instead of ignoring or denying the challenges we face, we will be committed to identifying them and finding solutions,” Sisolak said. “We will course-correct as necessary and remove any obstacles to get more shots in the arms of Nevadans.”
Sisolak also announced a 30-day extension of the state’s current coronavirus health and safety restrictions — initially put in place in late November and extended last month — during the Monday press conference.
The announcement of the new vaccine structure comes as the state has come under fire for having one of the worst COVID vaccine rates per capita of any state, though state leaders say publicly reported vaccine totals typically lag behind reported totals because of the logistical burden of entering each dose into a state vaccine tracking system. As of Sunday, Nevada had administered 61,644 doses, including more than 8,700 second doses, of the COVID-19 vaccine out of 170,400 doses received.
Sisolak said during the press conference that he’s “never satisfied” with how quickly vaccines are administered, but said the state needed more flexibility from the federal government and more predictability as to how much vaccine the state receives on a weekly basis.
“Nevada simply does not have the dollars and monetary resources in order to set up plans like some of the other states do, but I think if you look at the total percentage of vaccines that we've given out as relates to other states, I'm not satisfied, but I'm proud of everything that our frontline workers have done,” he said.
The lane structure will kick in after individual counties finish vaccinating those in the initial first “tier” of vaccination priority, which includes the bulk of the state’s health care workforce. The two lanes will be vaccinated concurrently, with individual counties moving through the prioritization at different rates based on vaccine availability and population size.
State immunization officials said that among the general population group, the state is prioritizing those aged 70 and older. Previously, it had said it only planned to prioritize those 75 and older. After that, the state will prioritize vaccines for:
Individuals between the ages of 65 and 69
Individuals between the ages of 16 and 64 with underlying health conditions, those with disabilities and individuals experiencing homelessness
Finally, healthy individuals between the ages of 16 and 64.
The state will allocate vaccines to the approximately 10,200 inmates in the state correctional system under that same priority list — meaning inmates over the age of 70 behind bars will receive a vaccine before an otherwise healthy individual under the age of 65 will. Under the previous version of the state’s vaccine playbook, all inmates were slated to be vaccinated at the end of what was known as “Tier 2” but before elderly Nevadans and those with pre-existing conditions, which some found controversial.
At the same time, the state will vaccinate Nevadans who are considered frontline or essential workforce, starting with public safety and security workers, including staff with the Department of Corrections, law enforcement, public safety, national security and state and local emergency operations managers and staff.
After that, the following groups will be vaccinated:
Frontline community support: Pre-K and K-12 staff, Nevada System of Higher Education frontline educators, staff and students, community support frontline staff, individuals involved in the “continuity of governance” (including legislators), essential public transportation workers, the remaining essential public health workforce and mortuary services
Frontline supply chain & logistics: Agriculture and food processing, end-to-end essential goods supply chain, utilities and communication infrastructure, Nevada Department of Transportation, frontline airport operations and other essential transportation
Frontline commerce & service industries: Food service and hospitality (including workers on the Strip), hygiene products and services and the depository credit institution workforce
Frontline infrastructure: Infrastructure, shelter and housing (including construction) and essential mining operations
Other: Community support administrative staff, college students living in campus-sponsored residential settings and remaining higher education workforce
State health officials cautioned that employment within one of those categories doesn’t automatically make a person eligible for a vaccine, saying that it would be up to individual employers and businesses to evaluate priority vaccination eligibility. Individuals who can work remotely or socially distance on the job are not recommended to receive the vaccine, even if their work group is prioritized.
Sisolak also announced at the press conference that he has convened a group, including the Division of Emergency Management, the Nevada National Guard and the state immunization team, to review logistical challenges with distributing the vaccine. He said the group is currently working with local officials to stand up vaccination centers “for our state’s most populous locations.”
Clark County health officials last week acknowledged they weren’t as far along in vaccinating their priority population as Washoe County and rural portions of the state, though they blamed the slower vaccination effort on the large population size. While the county has done well distributing doses to workers at local hospitals, it has struggled to reach all of the smaller health care settings, such as private doctor’s offices.
“This team I convened continues to look at and make breakthroughs in these challenges daily, and we will be sharing more information on these fronts as it becomes available,” Sisolak said.
But he also blamed some of the challenges of vaccine distribution on the federal government, which so far has only provided the state its total allocation amount one week ahead. Sisolak said that has put states and local jurisdictions “in an impossible position to predict exactly when prioritization groups will be able to get vaccinated.”
Sisolak said he is hopeful that President-elect Joe Biden’s administration, which takes over on Jan. 20, will move to quickly implement a unified national vaccine distribution strategy to assist states.
Shannon Bennett, the state’s immunization program manager, said during the press conference that vaccine data entry “thus far has been a challenge” — stating that each administered dose requires about two minutes of time to enter into the state data system. She said the 12,000 doses added to the state’s system over the last three days was the equivalent of about 400 hours of data entry work.
Under the 30-day extension of Nevada’s “statewide pause” announced Monday, businesses including restaurants, bars, gyms and casinos will remain limited to 25 percent occupancy, with indoor dining establishments required to take reservations and seat no more than four at a table together.
Other retail establishments, like indoor malls and grocery stores, are still allowed to operate at 50 percent capacity, though big-box stores have been required to station an employee at entrances to count customers.
Public gatherings remain limited to 50 people or 25 percent of capacity, with private gatherings limited to 10 people from a maximum of two households. Nevadans are still required to wear masks at all times when around someone from outside their household, whether indoors or outdoors and whether in public or private.
Sisolak, however, noted that “there is always the ability to adjust” the health and safety restrictions should the situation change.
He said that the Department of Health and Human Services predicts Nevada won’t see the full impact of holiday gatherings in December on COVID-19 case numbers until the end of the month. It will take even longer for any surge to show up in the numbers of COVID-19 hospitalizations and deaths, he said.
“The reality is, what the trends now show right is that the state — including Washoe and Clark — are still experiencing very high levels of disease burden, even if cases decline or plateau are starting between holiday surges,” Sisolak said. “Community spread is high, and many of our hospitals are strained.”
Sisolak also took some time at the beginning of his remarks to chastise President Donald Trump and his administration in light of the insurrection at the U.S. Capitol last week. However, he said that the “chaos and collapse did not just happen last week” but “has been developing steadily in the last four years.”
“The divisiveness and lack of leadership has resulted in the lack of a unified national strategy to combat a deadly pandemic,” Sisolak said. “It has pitted state against state on the open market trying to secure personal protective equipment.”
Read Nevada's updated vaccination playbook and a summary of it below:
Updated at 5:50 p.m. on Monday, Jan. 11, 2021 to include additional quotes from the press conference.