Lt. Gov. Kate Marshall formally announced Thursday afternoon that she will resign and accept a position with the Biden administration.
Marshall, whose move The Nevada Independent reported earlier this week, will become the White House’s senior adviser to governors within the Office of Intergovernmental Affairs but will continue to serve as lieutenant governor until her transition sometime in the late fall.
“I will work on the same issues I have during my time in elected office: to ensure that the American Dream can be reached by all who seek it in Nevada and our country,” Marshall said in a press release.
Julie Rodriguez, director of the Office of Intergovernmental Affairs, said Marshall's experience in the lieutenant governor role would help the White House accomplish its goals.
“Her first-hand experience in leading economic development efforts and supporting small businesses will be integral to President Biden’s efforts to implement the American Rescue Plan and the full Build Back Better agenda,” Rodriguez said.
Under Nevada law, the lieutenant governor’s office could remain vacant or Gov. Steve Sisolak could appoint a replacement. In 1989, when U.S. Sen. Richard Bryan took office, then-Lt. Gov. Bob Miller ascended to the governorship and the No. 2 position remained vacant.
The lieutenant governor’s post is up for election next in 2022.
Asked about his plans at an affordable housing-related event in Las Vegas on Tuesday, Sisolak said he has “no idea at this time” about whether to replace her or leave the seat vacant.
“I talked to the lieutenant governor, I talked to President Biden about it. I'm happy for her… So we have to wait and see what happens," he said. "I've obviously gotten numerous phone calls and texts and expressions of interest. But right now today, I'm focusing on affordable housing."
He noted that there will be a special legislative session in coming months and said he planned to talk to his team about whether the seat could be held open until then. On Thursday, Sisolak’s office said in a press release that there is no specific legal deadline to make an appointment.
Marshall previously served as a two-term state treasurer, winning races in 2006 and 2010. Prior to that, she was a senior deputy attorney general from 1997 to 2000.
Marshall’s resignation comes shortly after other key members of Gov. Steve Sisolak’s leadership team announced their departures. Last month, Chief of Staff Michelle White and Senior Advisor Scott Gilles said they were stepping down. Both indicated they would be taking some time off after a hectic year and a half helping shepherd the state through the pandemic and subsequent economic fallout.
Last week, Sisolak announced that former state Sen. Yvanna Cancela, who had moved to Washington, D.C. to work within the federal Department of Health and Human Services, will return to Nevada as his new chief of staff.
Update: Aug. 17, 2021. This article was updated to add a line about Dan Schwartz announcing his candidacy. It was updated again to add a comment from Sisolak about plans for replacing Marshall. This article was updated again on Aug. 19, 2021, to include information from a formal press release Kate Marshall sent about her transition to the Biden Administrationand to add comment from the White House.
Gov. Steve Sisolak has tapped former state Sen. Yvanna Cancela to be his chief of staff, as Michelle White departs from the role.
Cancela will formally join the administration in September after leaving the state in 2020 to work within the federal Department of Health and Human Services. A Democratic senator appointed in 2016 and the first Latina in the state Senate, Cancela had been an early supporter of Joe Biden for the presidency.
"I am thrilled that Yvanna will be returning to the Silver State to serve as my chief of staff. She brings a unique understanding of state government, policy experience, and the ability to build broad coalitions,” Sisolak said in a statement on Monday. “Most importantly, I know Yvanna is as dedicated as I am to making Nevada a thriving and vibrant place to call home, and I look forward to her knowledge, expertise and guidance when she joins the team.”
White, who has led Sisolak’s staff since he began his term in 2019, leaves after nearly three years of state service. Previously, she held major leadership roles in Democratic campaigns such as Hillary Clinton’s 2016 presidential bid, and helmed electoral efforts for the PAC For Our Future.
Cancela, the former political director of the Culinary Union, began her tenure in the state Senate in 2016, when she filled a vacancy left when Ruben Kihuen was elected to Congress. Cancela’s legislative accomplishments include shepherding legislation that enhanced transparency in the pricing of diabetes drugs. She was elected in 2018 to a full term.
Cancela, 33, graduated from Northwestern University and recently attained a degree from UNLV’s Boyd School of Law.
A week after the return of a broad indoor mask mandate in the state’s most populous counties, elected officials across Nevada received an earful from constituents chafing at the rule.
Roughly two months after lifting most COVID-19 related restrictions, Gov. Steve Sisolak again ramped up the state’s mitigation efforts amid another surge of cases largely attributed to the more contagious Delta variant. Nevada’s seven-day rolling average of new cases has eclipsed more than 1,000 since the end of July, and Sisolak announced Friday that the state had crossed the milestone of 6,000 COVID-19 deaths.
Michelle White, Sisolak’s chief of staff, acknowledged Friday at the state’s weekly press briefing on COVID-19 that the restrictions during the latest setback would be unpopular.
“No one wants to have these requirements in place,” White said. “No one wants to have kids returning to school in masks. No one wants to have their gatherings with masks.”
In Clark County, members of the county commission debated but didn’t take immediate action on offering $100 incentives to unvaccinated people. But in rural county commission meetings elected officials and members of the public urged noncompliance with the new mandates.
“Now they're pretending that the pandemic is worsening and they need to reinstate mask mandates and business closures,” Elko County Commissioner Rex Steninger said during a meeting on Wednesday. “We can't let that happen again. We must refuse to comply this time, our local businesses depend on us refusing to comply.”
In spite of the chorus against face coverings, Nevada’s Occupational Safety and Health Administration (OSHA) said it had not yet issued many citations to businesses for mask-related violations.
As of Thursday, state Division of Industrial Relations Administrator Victoria Carreon said that OSHA has not been instructed to begin any random checks of businesses complying with the revised mask mandate or other COVID-19 safety precautions.
Instead, Carreon said OSHA was continuing to operate on a largely complaint-based model — a necessity given that the agency only employs about 40 inspectors statewide. She added that complaint volume had picked up “a bit” in the past week — an OSHA dashboard showed 65 complaints received by the agency since the mask-wearing requirement was reinstated last Friday. The agency received only 22 COVID-related complaints in the preceding four weeks.
OSHA additionally issued a revised COVID-19 guidance to businesses on July 30 outlining the new mask-wearing guidelines. Carreon also noted that OSHA operates statewide, independent of local jurisdictions.
Mask-wearing does not make someone immune to catching the virus, but CDC guidance shows that it can protect those around mask-wearers and even offer some protection to wearers themselves.
Here’s a look at how government bodies responded to the reintroduced mask mandate over the past week.
Clark County delays another vaccination incentive
During their Tuesday meeting, Clark County commissioners discussed the idea of putting $100 in the pockets of newly vaccinated individuals, hoping that distributing dollars directly to Clark County residents would drive up a vaccination rate that remains just over 50 percent.
“I thought it was the craziest idea in the world, but then the president said ‘Oh, it’s a great idea,’ so what the hell,” said Commissioner Tick Segerblom, who proposed the idea.
The plan comes after President Joe Biden’s call for state and local governments to encourage vaccinations with cash payments. Segerblom’s proposal would allot money for up to 100,000 Clark County residents with dollars from the American Rescue Plan, which provided states with resources for incentive programs such as the Vax Nevada Days raffle.
Colorado, New Mexico and Ohio are among a number of states that have piloted $100 incentive programs. Segerblom added that The Cosmopolitan resort implemented similar payments to employees to drive their employee vaccination rates to 80 percent.
While open to the idea, some commissioners voiced concerns on the price tag — an initial $10 million allocation — and the subsequent distribution.
“I understand the goal and I think all of us have a sense that we need to do what we can,” Commissioner James Gibson said. “I'm a little concerned about the size of the commitment.”
The idea was tabled.
Gaming woes over soaring cases
Skittish investors showed their concern over new COVID-19 mask regulations nationwide by sending stock prices of several Strip casino companies downward in value earlier this week.
Chief executives from the Strip’s largest gaming operators used their quarterly earnings conference calls to alleviate those worries and boost the prices back up by Thursday.
In Nevada, the Gaming Control Board imposed mask requirements inside casinos for both employees and customers on July 27 at properties in Clark, Washoe and 10 other counties.
During a press conference Thursday in Las Vegas, Gov. Steve Sisolak said he didn’t want to impose any additional mandates or closures, calling the current mask requirement a “bridge” in helping slow the recent COVID-19 spread.
Sisolak said he would seek advice from his medical advisory team for additional recommendations on how to make large gatherings safer. The recommendations will cover crowds inside entertainment venues associated with casinos.
Sisolak cited last weekend’s CONCACAF Gold Cup soccer championship between the U.S. and Mexico at Allegiant Stadium as an example. The nationally televised game featured images of maskless fans despite the mandate that facial coverings be worn at indoor events. Allegiant Stadium, which has a translucent roof, is considered an indoor stadium. The game attracted 61,514 fans.
“Everyone that walked through the turnstile had their masks on, and 10 minutes into the match, the masks all came off,” Sisolak said. He wants the venues to also come up with plans that are “more effective for compliance and for enforcement.”
The Las Vegas Raiders are the operators of Allegiant Stadium, but a spokesman for the team did not return an email message seeking comment.
Casino operators along the Strip said they are abiding by the mask mandate. Caesars Entertainment CEO Tom Reeg said Tuesday the mask mandate was “far less onerous” compared to the restrictions the gaming company dealt with before June 1, when all COVID-19 operating guidelines and protocols were lifted.
Reeg said the current public health situation could result in “bumps along the way in terms of masks and protocols that we need to follow.” However, he said Caesars is seeing “exceedingly strong” demand from customers that “has continued to build.”
MGM Resorts International CEO Bill Hornbuckle said Wednesday it was too early to gauge any meaningful effect the current outbreak has had on business levels.
The Elko County Commission unanimously banned door-to-door “solicitation” of COVID-19 vaccines during a meeting Wednesday afternoon and decided not to enforce the mask mandate in place for most of Nevada’s 17 counties, including Elko.
Some advocacy groups, including Mi Familia Vota, have been canvassing neighborhoods in Las Vegas to encourage residents to get vaccines.
“It should be a blanket ban,” Commissioner Rex Steninger said. “Don’t come to our county and be knocking on our doors.”
Commissioner Wilde Brough said that while he’s not against vaccines and believes people should get them of their own free will, he was against the door-to-door solicitation as it could lead to “undesirables” going into people’s private space, resulting in “mischief.” Commissioner Delmo Andreozzi said he saw it as a form of “intimidation or coercion.”
“I don’t think door-to-door solicitation of your medical records is appropriate,” said Commissioner Cliff Eklund. “Just like soliciting votes, I’m against it.”
Organizers and volunteers are prohibited from seeking medical information while providing information about the virus or vaccines.
A crowd of more than 20 people at the meeting, most of whom were maskless, erupted into cheers and applause following the commissioner’s remarks. There were no public comments against either of the motions to ban door-to-door solicitation or the mask mandate.
“I wasn’t going to speak, but what I want to tell you is I'm proud of you guys,” said Assemblyman John Ellison (R-Elko) during the public comment period. “You did the right thing. Check it in advance. But what we have to do is we got to believe in the Constitution, the Bill of Rights … God bless you.”
One public commenter asked if the Elko sheriff’s office might need help in enforcing their decisions and volunteered herself as a potential “posse” member, should they need it.
The new masking guidelines also met ample resistance at Tuesday’s meeting of the Nye County Commission, which considered an item that would strengthen the county's masking rules in accordance with Sisolak’s directive.
In a public comment period, more than 40 people spoke in opposition and said they wanted to keep mask-wearing optional, including at schools, with some saying that they were constitutionally entitled to the choice.
“My child, my choice. My body, my choice,” attendee Kristy Labelle said. “And I think that's the way we should go.”
Among them was Joey Gilbert — a Reno attorney and a Republican candidate for governor.
“Unless this virus has grown by over 500 percent in the last year — because we all know that science apparently now evolves, according to the Democrats — unless this thing has grown by 500 percent, the masks don't work,” Gilbert said.
Only three people spoke in support of masking rules.
“Give us a chance to wear the mask for two months, and see if anything happens,” attendee Tom Waters said. “If the positivity rate goes down, you know the masks work.”
Opponents of the mask mandate found sympathetic ears among commissioners — Commissioner Donna Cox made spurious allegations about the governor's wife, invoking her heritage. Kathy Sisolak is Chinese-American.
A few days later, the governor issued a statement on Twitter saying he was "furious after hearing vile, blatantly racist comments made against my wife" and called on every Nevada Republican elected official and candidate "to join me in calling out this bigotry."
"Kathy and I, along with so many others, have worked hard to fight back against the anti-Asian racism brought on by misinformation regarding COVID-19, but comments like these only take us backward," he said on Monday. "Now is a time we should be coming together to get us through what has been one of the hardest times in our state, not attacking one another."
At the meeting, Commissioner Leo Blundo stated his support for the Second Amendment (the right to bear arms) and opposition to critical race theory.
“[Mask mandates are] control of the public, control over the people, control over your children,” Blundo said. “Control over what you do, what you say, what you think.”
The commission opted to not cast a vote to align county rules with the state's directive and let the item die.
And at the Lyon County Commission meeting on Thursday, Commissioner Ken Gray called the mask mandate "political showmanship," saying that only 0.03 percent of COVID-19 cases in Lyon County are breakthrough cases and expressing his opposition to a mask mandate in the county. Other commissioners agreed.
“One of the reasons that [people] got the shot, the vaccine, was to get rid of the mask,” Lyon County Commissioner Robert Jacobson said at the meeting. “So what I’m hearing is that those people that got vaccinated are now wearing the mask because of 0.03 percent? Are you kidding?”
Jeanne Freeman, public health preparedness manager at the Carson City Health and Human Services, defended masks and the staff work to boost Lyon County’s 37 percent vaccination rate.
“If vaccination rates go up, then we can see that that mitigation effect can be there and we're less likely to have the spread and therefore more likely … to be able to take those masks off,” Freeman said.
County Manager Jeff Page alluded to public backlash against staff who are trying to increase vaccination rates.
“There have been unkind things thrown at the people who provide services for us. They have nothing to do with [making] the policy,” Page said.
Reporter Riley Snyder contributed to this story.
Updated at 2:38 p.m. on Aug. 9, 2021 to add statement from Gov. Steve Sisolak.
The Southern Nevada Health District is recommending that both unvaccinated and vaccinated people wear masks in public settings, the first concrete step Clark County health officials have taken to address the rising tide of COVID-19 cases in the region beyond promoting vaccination and testing.
Health district officials on Friday recommended that all individuals, regardless of their vaccination status, wear masks in “crowded indoor public places” where they may have contact with unvaccinated individuals. While the new guidance is only a recommendation, the announcement by the health district represents a change of course in messaging from just a couple of weeks ago, when officials said they were focused only on the vaccination campaign and that there was no discussion about other reimplementing mitigation measures.
Public places where the health district is recommending that people wear masks include grocery stores, malls, large events and casinos.
“Using masks correctly has proven to be effective in helping to prevent people from getting and spreading COVID-19,” the health district said in a statement. “With the rise in cases and slowing vaccine rates in Clark County, the Health District’s recommendation to wear masks in crowded public settings ... is a step to fully utilize the tools we have available to stop the pandemic.”
The health district, however, stressed that getting the COVID-19 vaccine “is the most important and effective step people can take to protect themselves and others from COVID-19.” Southern Nevada District Health Officer Fermin Leguen said during a press call Friday afternoon that if the county is unable to stem the tide of cases, it may have to look at mitigation measures beyond the mask recommendation.
“Contingent to how we see the progress of the disease in the community in future days and weeks, there could be additional measures, if it is necessary,” Leguen said.
The health district’s announcement comes as COVID-19 cases and hospitalizations continue to quickly climb as the Delta variant spreads across the state. As of Thursday, an average of 710 new COVID-19 cases in Nevada were reported each day over the last seven days — five times the recent low point a month and a half ago. COVID-19 related hospitalizations, meanwhile, have increased threefold over the last month to 771 as of Wednesday.
Nevada has the fifth highest case rate in the nation per capita, with Clark County almost entirely responsible for the state’s rapidly worsening numbers. Some counties, however, including Washoe, have also seen small increases in case numbers in recent days.
However, Washoe County District Health Officer Kevin Dick, on a call with reporters on Friday afternoon, said he wasn’t yet ready to make the same recommendation on indoor mask wearing for Northern Nevada, as the situation just isn’t as bad as it is in the South. He did urge residents to get vaccinated, though, so the county doesn’t find itself in the same situation as Clark County at some point in the future.
“We don't want to move backwards, and we don't want to end up in a situation where we need to make a recommendation for everybody to wear masks,” Dick said.
Michelle White, chief of staff to Gov. Steve Sisolak, said on a press call on Thursday that the state would support whatever decisions local governments make when it comes to mitigating the spread of the virus.
“The governor is completely supportive, as the entire state is very supportive, of any decisions that will be made at the local level if those decisions are determined to be right for those areas,” White said. “The state will be ready to continue providing any support that we can in the most robust and aggressive way.”
Across the border in Southern California, health officials in Los Angeles County announced on Thursday a return to mandatory indoor masking, regardless of vaccination status. Los Angeles County’s case rate is currently less than half of Clark County’s.
Sólo se veían sonrisas en North Las Vegas cuando el Gobernador Steve Sisolak y otros líderes comunitarios se reunieron la semana pasada para anunciar los primeros ganadores de los premios que suman a $5 millones de dólares en el sorteo para nevadenses vacunados.
La multitud, en su mayoría sin cubrebocas, se rió entre dientes de los chistes de Sisolak — "Siento que estamos en los [premios] Óscar aquí, o algo así" — y aplaudió con entusiasmo cuando una maestra de jardín de niños de North Las Vegas recibió el premio en efectivo más grande de la noche por $250,000 dólares. El ambiente festivo hizo que fuera fácil olvidar la razón por la que todos estaban allí: para alentar a la mayor cantidad posible de nevadenses a vacunarse contra un virus que aún es mortal y que, una vez más, se propaga rápidamente.
"Si bien estamos en un lugar mucho mejor ahora que hace un año, la pandemia no ha terminado", dijo Sisolak.
El verano ha marcado el comienzo de una sensación de normalidad en la vida de muchas personas, ya que han reanudado las cenas con los amigos, se han reunido con la familia para pasar las vacaciones y se han ido de viaje. Sin embargo, las últimas semanas han traído consigo un recordatorio no deseado: el COVID-19 sigue entre nosotros y nos infecta como nunca.
"Las variantes a las que nos enfrentamos, que esencialmente dominan el campo ahora, son virus olímpicos", dijo el Doctor Mark Pandori, director del Laboratorio de Salud Pública del Estado de Nevada. "Estos son los que han competido y competido y competido y ahora son los más competentes en infectar a las personas".
A medida que la altamente transmisible variante Delta se ha afianzado en los EE.UU y en Nevada, en particular, el Condado Clark se ha convertido rápidamente en un epicentro de la última ola del virus. A partir del viernes, Nevada tuvo la cuarta tasa de casos más alta per cápita en la nación de los últimos siete días; durante varios días la semana pasada, la entidad fue número uno en el país.
El repunte en el Condado Clark, de alguna manera, no sorprende. El condado tiene una tasa de vacunación baja, una alta densidad de población y una economía basada en atraer a millones de turistas nacionales e internacionales. Si bien los expertos en salud pública dicen que los nevadenses vacunados permanecen bastante bien protegidos contra COVID-19, incluida la variante Delta, hay poca protección para que los nevadenses no vacunados eviten enfermarse.
Sin más distanciamiento social, restricciones de capacidad o mandatos para el uso de mascarillas y una variante altamente transmisible, los funcionarios estatales están enfatizando que el riesgo para los nevadenses no vacunados ahora es mayor que nunca durante la pandemia. Han regresado al modo de responder a la pandemia de tiempo completo después de relajar la respuesta a emergencia a principios de este verano, disolviendo un grupo de trabajo COVID-19 en todo el estado, despidiéndose de su director de estrategia para la pandemia y terminando las llamadas de prensa de rutina.
Como un indicador de la creciente gravedad de la situación, esas llamadas de prensa se reanudaron la semana pasada.
“Este es uno de esos momentos en los que vemos y decimos: 'nos sentíamos mucho mejor, y ahora que estamos aquí, estamos viendo este aumento, ¿qué hacemos?'” dijo Michelle White, jefa de gabinete de Sisolak, en una entrevista. “Es una estrategia renovada. Es este renovado sentido de urgencia a nivel estatal. Es un nuevo examen de cómo estamos abordando las vacunas y la pandemia en general".
El estado está comprometido con el esfuerzo de vacunación y ha solicitado la asistencia de los equipos federales para ayudar con los crecientes casos de COVID-19. Se espera que los primeros elementos de FEMA, la Agencia Federal para el Manejo de Emergencias, lleguen esta semana al sur de Nevada, y más habrán de venir. Se espera que se concentren en el alcance de las inmunizaciones dirigidas a comunidades con bajos niveles de vacunación y en aumentar las oportunidades de pruebas para el virus.
Si bien algunos expertos en salud pública han reiterado sus peticiones para que el gobierno federal y los estados individuales restablezcan los mandatos de mascarillas y otras medidas de mitigación a la luz de este último incremento de contagios, Sisolak dijo a The Nevada Independent la semana pasada que no hay un nuevo mandato para el uso del cubrebocas en el futuro inmediato.
“Estoy seguro de que podemos correr la voz. Podemos vacunar a suficientes personas”, dijo Sisolak. "No quiero dar pasos hacia atrás".
Si bien la propagación del virus en el Condado Clark, siendo el condado más grande del estado, domina los números a través del estado, algunos condados rurales también han experimentado repuntes. Hasta el viernes, en Nevada habían destacado los condados de Clark, Elko y Lander por sus altas tasas de casos de COVID-19.
“Cuando hablas de un entorno que es hostil o menos hostil para el virus, tienes uno que es menos hostil al virus en el sur de Nevada porque es más fácil encontrar un huésped y cuando encuentras un huésped, la probabilidad de que ese huésped no se haya vacunado es mayor”, dijo Pandori. "Es un entorno más tolerante para este virus".
Pero Ali Mokdad, epidemiólogo del Instituto de Métricas y Evaluación de la Salud de la Universidad de Washington, dijo que Las Vegas probablemente siempre estará en una posición particularmente vulnerable cuando se trata del virus debido a su sector turístico.
“Cuando comparas estados con otro estado, tienes que verlo básicamente como si estuvieras jugando a las cartas. Juegas con tu baraja, no puedes jugar con las cartas de otra persona”, dijo Mokdad. "Básicamente, la cultura y la gente que ingresa, eso está permitiendo que el virus llegue más rápido, está permitiendo que el virus se propague más rápido".
Two senior members of Gov. Steve Sisolak’s staff announced on Tuesday that they are stepping down after more than two and a half years in his office.
Chief of Staff Michelle White, who has been with Sisolak since November 2018, leading his transition into the Governor’s Mansion, shepherding his office through two regular and two special legislative sessions and playing a key role in the state’s COVID-19 response, will stay in her role through the summer to facilitate the selection of her successor and ensure a smooth transition.
White, in a statement, called serving as chief of staff “the honor of my lifetime” and said she looked forward to supporting the governor’s staff during the transition.
“For close to three years I've had the privilege of witnessing the Governor’s unparalleled commitment to leading Nevada through some of the most trying and unprecedented times in our State’s history – civil protests against systemic racism, the impacts of a climate crisis, and a global pandemic and subsequent economic crisis that forced tough decisions aimed at protecting the lives and livelihood of all Nevadans,” White said. “I will forever be humbled that the Governor trusted me to serve his office and our great State throughout this time.”
Senior Advisor Scott Gilles, who has been with Sisolak since January 2019, will depart the governor’s office on Friday. Before joining the Sisolak administration, Gilles managed government affairs and legislative relations for the City of Reno and served as the deputy secretary of state for elections.
“I am incredibly grateful to the Governor for his dedication to the State and his confidence in me to be his Senior Advisor through the unprecedented challenges the State has faced during my time in his office,” Gilles said in a statement. “I am humbled to have been given the opportunity to serve the Governor and Nevadans in this role, and I look forward to our State’s continued progress under his leadership.”
Neither White nor Gilles has announced their professional next steps, though Gilles said in an interview Tuesday that he has been looking at some potential opportunities but plans to take some time off before making a decision about what to do next. He said he looks forward to spending more time with friends and family and having more work-life balance moving forward.
“The last two and a half years have been an amazing opportunity in the face of some really difficult challenges,” Gilles said. “This job is very all consuming in the best of times, and it was even more consuming during the heavy stretch of the pandemic.”
The departure of White and Gilles represents a significant upheaval for the governor’s office amid a difficult period of economic recovery and climbing COVID-19 cases and ahead of what is likely to be a difficult re-election campaign for Sisolak.
Sisolak, in a statement, said he would be “forever appreciative” of White’s and Gilles’s service and guidance to him as governor.
“They have been with me from the start, and they have held the public’s interest at the forefront of what they do every day. I will miss them tremendously,” Sisolak said. “No one could have predicted all that we would have faced together since I took office, and their leadership and expertise during historically challenging times have undoubtedly made Nevada a better State. I look forward to watching their next steps as they continue their incredible careers.”
It was all smiles in North Las Vegas on Thursday as Gov. Steve Sisolak and other community leaders gathered to hand out the first of $5 million in prizes to vaccinated Nevadans.
The mostly maskless crowd chuckled at Sisolak’s jokes — “I feel like we’re at the Oscars here, or something” — and applauded enthusiastically when a North Las Vegas kindergarten teacher was awarded the biggest cash prize of the night, $250,000. The festive atmosphere made it almost easy to forget the reason they were there: To encourage as many Nevadans as possible to get vaccinated against a still-deadly and once again rapidly spreading virus.
“While we're in a much better place now than we were a year ago, the pandemic is not over,” Sisolak cautioned in his opening remarks.
Summer has ushered in a sense of normalcy to many people’s lives as they have resumed going to dinners with friends, gathering with family for holidays and taking long-delayed vacations. The last couple of weeks, however, have brought with them an unwelcome reminder that not only is COVID-19 still among us, but it is also better at infecting us than ever before.
“The variants that we're facing, which essentially dominate the field now, are your Olympian viruses,” Dr. Mark Pandori, head of the Nevada State Public Health Lab, said in an interview this week. “These are the ones that have competed and competed and competed and are now the most proficient at infecting people.”
As the highly transmissible Delta variant has taken hold across the United States, Nevada, and, in particular, Clark County, has quickly emerged as an epicenter of the latest surge of the virus. As of Friday, Nevada had the fourth highest case rate in the nation per capita over the last seven days; for many days last week, it was first.
The uptick in Clark County, in some ways, comes as no surprise. The county has a low vaccination rate, high population density and an economy built on bringing millions of domestic and international tourists together. While public health experts say vaccinated Nevadans remain fairly well protected against COVID-19, including the Delta variant, there is little protecting unvaccinated Nevadans from falling ill.
With no more social distancing, capacity restrictions or mask mandates and a highly transmissible variant, state officials are stressing that the risk to unvaccinated Nevadans now is greater than it has ever been during the pandemic. They have returned to full time pandemic response mode after starting to transition away from it earlier this summer, including dissolving a statewide COVID-19 task force, saying goodbye to its pandemic response director and ending routine press calls.
In a marker of the increasing seriousness of the situation, those press calls started back up again this week on Thursday.
“This is one of those moments where we’re looking and saying, ‘It did feel so much better, and now we’re here, we’re seeing this increase, what do we do?’” said Michelle White, Sisolak’s chief of staff. “It is a renewed strategy. It's this renewed sense of urgency at the state level. It is a reexamination of how we're approaching vaccinations and the pandemic in general.”
The state is all-in on the vaccination effort and has requested assistance from federal surge teams to help with the rising COVID-19 cases. The first boots on the ground from FEMA, the Federal Emergency Management Agency, are expected to arrive this week in Southern Nevada, with more to follow. They’re expected to focus on targeted vaccine outreach to undervaccinated communities and boosting testing opportunities.
While some public health experts have renewed calls for the federal government and individual states to reinstate mask mandates and other mitigation measures in light of the latest surge, Sisolak told The Nevada Independent on Thursday that no new mask mandate is on the horizon.
“I'm confident that we can get the word out. We can get enough people vaccinated,” Sisolak said. “I don't want to take steps backwards.”
The rise of the Delta variant
Public health experts believed it was only a matter of time before the Delta variant became the dominant strain of COVID-19 in Nevada and the rest of the U.S. The Alpha variant, formerly known as the U.K. variant, is 50 percent more transmissible than the original strain of the virus, and the Delta variant is thought to be 40 to 60 percent more transmissible than that.
What has been interesting to those in the public health field, though, is how quickly the Delta variant has taken hold. Three weeks ago, the Delta variant was responsible for 16 percent of sequenced COVID-19 cases in Nevada in the previous 14 days. Two weeks ago, it was 46 percent. This week, it was 60 percent.
“The speed with which it did [increase] has been a surprise,” Pandori said.
Those who have been keeping an eye on statewide metrics expected that COVID-19 cases, test positivity and hospitalizations might once again increase after the state fully reopened on June 1, but they have been similarly surprised at how rapidly those metrics have climbed. The number of new cases being reported each day on average has doubled over the last three weeks, and test positivity and hospitalizations have doubled in just two weeks.
As of Friday, the state was seeing about 473 new cases reported on average each day over the last seven days, a number it hasn’t seen since mid-April. Hospitalizations, meanwhile, sit at 640, putting the state back to where it was in late February.
“We knew that hospitalizations were going to go up when we reopened,” said Chris Lake, executive director of community resilience for the Nevada Hospital Association. “But what we didn't necessarily anticipate was the new Delta variant, which is very highly contagious. That increased transmission, along with the plateau in vaccinations, is really what is driving this rapid increase in hospitalizations.”
While the surge in Clark, as the state’s largest county, dominates the statewide numbers, some rural counties have seen upticks as well. As of Friday, the state had flagged Clark, Elko and Lander counties for high COVID-19 case rates.
The Delta variant, however, has been identified in at least seven counties statewide. Among the state’s most populous counties, the Delta variant was responsible for 54 percent of sequenced cases in June in Clark County, 46 percent in Washoe County and 56 percent in Carson City.
While Washoe and Carson have less population density than Clark County and slightly cooler weather that allows for more outdoor activities, public health experts point to one key difference as to why the virus has rapidly spread in Clark County while numbers have remained low in its two northern counterparts: vaccination rates.
Nearly 50 percent of Carson City residents and 47 percent of Washoe County residents are fully vaccinated against COVID-19, compared to only 38 percent in Clark County. That, coupled with Southern Nevada’s face-to-face service economy, have made the county ripe for a surge, public health experts say.
“When you talk about an environment that’s hostile or less hostile for the virus, you’ve got one that’s less hostile to the virus in Southern Nevada because it’s easier to find a host and when you find a host, the probability of that host being unvaccinated is higher,” Pandori said. “It’s a more forgiving environment for this virus.”
Southern Nevada Health District officials said they haven’t identified specific locations responsible for the uptick in COVID-19 cases so much as unvaccinated people generally being out and about in the community.
“One factor that is driving the positivity rate is the amount of individuals in our community and statewide who are not vaccinated,” said Victoria Hughes, contact tracer supervisor for the Southern Nevada Health District.
Complicating things, the ones who are most likely to be out and about — younger adults — are also the ones who are least likely to be vaccinated. More than three-quarters of Nevadans aged 60 and up have received at least one dose of the vaccine, while only half of those 20 to 59 have received their first shot.
While younger adults may believe their generally stronger immune systems will protect them against COVID-19 and that they don’t need the shot, the numbers say otherwise.
Data provided to the Independent by the Nevada Hospital Association show that adults aged 20 to 59 were responsible for 57 percent of new hospitalizations between June 27 and July 7, compared to only 36 percent between Nov. 27 and Dec. 7 during the prior surge. By comparison, those 70 and up only made up 22 percent of new hospitalizations, compared to 41 percent during the previous surge.
“You can see it’s really a younger population going to the hospital,” Lake said. “It really is a flip flop.”
Brian Labus, an assistant professor of public health at UNLV, said there’s a degree of variability in a disease outbreak. Over the course of this pandemic, for instance, the U.S. has seen hotspots crop up in New York, Michigan and California at different times.
“We've seen this over the course of the entire pandemic. There have been cities that have always been hotspots for a couple of weeks, and then some new city takes over as things flare up,” Labus said. “Kind of like when a fire is raging, like a forest fire, you're going to find places that have hotspots and places where it slows down.”
But Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington, said Las Vegas will likely always be in a particularly vulnerable position when it comes to the virus because of its tourism industry.
“When you compare states to another state, you have to look at it basically like playing cards. You play your deck of cards, you can’t play somebody else’s cards,” Mokdad said. “Basically, the culture and people coming in, that's allowing the virus to arrive faster, allowing the virus to spread faster.”
What public health experts aren’t yet sure about is where the current surge is heading. Research on the Delta variant is ongoing, but data out of Israel have shown that the Pfizer vaccine is 64 percent effective at preventing symptomatic and asymptomatic infections and 93 percent effective at preventing hospitalizations and deaths, which public health experts consider good news for vaccinated individuals.
The picture is less rosy for the unvaccinated, though. Early research out of Scotland suggests the risk of hospital admission related to the Delta variant is twice what it was for the Alpha variant, and about 95 percent of hospital admissions in Clark County over the last three months have been among unvaccinated individuals, Dr. Fermin Leguen, chief health officer for the Southern Nevada Health District said last week.
Some public health experts are holding out hope that the recent surge in hospitalizations won’t translate to as many deaths as the state has seen during previous waves, owing to the comparatively younger ages of the current hospitalized population, the experience doctors now have in treating COVID-19 and the effectiveness of the vaccines in preventing serious hospitalizations and deaths. For the unvaccinated, though, they stress that the situation is even worse than it was last year.
“As we see people getting infected, we see more hospitalizations, and we naturally see more deaths from that,” Labus said. “Our vaccination rates are preventing some people from being hospitalized and dying, but we still have a major proportion of our population completely unprotected. So if they get infected, their risk of death is going to be the same as before.”
The vaccination campaign
When Craig Barnes tested positive for COVID-19 before a trip to Hawaii, he was in shock. He received his second shot of the Pfizer vaccine in late March and had started easing back to normal life, including going out to eat and playing video poker at casinos. Even in big crowds, he didn’t even think to put his mask on, he said.
Barnes, 51, started to feel sick in late June, but a trip to the doctor’s office left him with a diagnosis of sinusitis. It wasn’t until a couple of days later when he went to get tested before his trip that he found out he had the virus.
At first, he was angry at having to cancel a family vacation. But that anger quickly turned to relief, particularly when he thought about the fact that his brother had been hospitalized with COVID-19 back in October for three months. His worst symptoms, by contrast, included fever, fatigue and a loss of taste and smell.
“Now that I’m looking back, if I didn’t have the vaccine, how sick would I have been? I really believe if I had not had the vaccine I would have been in the hospital or either sick for four or five days,” Barnes, who lives in Las Vegas, said. “I truly believe that.”
There has been some understandable angst and frustration among vaccinated individuals who have contracted the virus, though. Vaccination gave them a sense of freedom, invincibility even. While reports of breakthrough cases — those among fully vaccinated individuals — are concerning, public health officials statewide have continued to underscore that breakthrough infections represent just a fraction of the overall cases and hospitalizations they are seeing.
According to Department of Health and Human Services data requested by the Independent, there have been 136 breakthrough cases identified statewide that have resulted in hospitalization or death out of more than 1.2 million fully vaccinated Nevadans. (Less serious breakthrough cases are not tracked by the state.)
Those aged 60 and older make up 78 percent of those breakthrough cases, while men, who have generally been hit harder by the virus throughout the pandemic, were responsible for 61 percent.
As the COVID-19 situation continues to worsen in Nevada, state officials have been doubling down on the vaccination effort. A vaccination may not protect someone from catching COVID-19, but it may turn a serious hospital stay into something resembling no more than sinusitis, as it was for Barnes.
“When you have a variant like the Delta variant that spreads more easily, it's going to be possible that some people who are vaccinated will get sick. But typically, when they do get sick, the disease is more mild, so they won't don't wind up being hospitalized. They don’t wind up dying from it,” Labus said. “It's kind of like wearing a seatbelt. It's not going to stop all people from dying in car accidents, but it really reduces the numbers and just because some people still die in car accidents doesn't mean everybody should stop wearing their seatbelts.”
The problem, public health experts say, is that many unvaccinated individuals are behaving as if they are vaccinated, going out frequently in crowded places, not social distancing and not wearing masks.
“Ninety percent of our new cases in the past three months are from the unvaccinated population, so vaccines do provide considerable protection,” said Dr. Nancy Diao, division director of epidemiology and public health preparedness for the Washoe County Health District. “I think when the mask mandate was removed by CDC, it was to provide a reward for those who are vaccinated and an incentive for those who aren't. But a portion of the population who are unvaccinated, they saw this as a sign that, ‘We’re good,’ and nothing more needs to be done.”
Even for those unvaccinated individuals who are still trying to be careful, there is a risk. Yvonne Culliver-Holland, a 55-year-old from Pahrump, said she fell ill with COVID-19 after her sister and her sister’s friend recently came to visit. Culliver and her husband had been vigilant since the beginning of the pandemic, staying home as much as possible, hand sanitizing frequently and continuing to wear masks out in public. Her sister and the friend were the first two guests they had invited to their home.
As it turns out, the friend had a sore throat but didn’t tell anyone before they came, Culliver said. They chalked it up to the dry air.
Culliver, who is vegan and considers herself very healthy, fell very sick with the virus, as did her husband. Her symptoms included fever, headache, body aches, cough, fatigue, dizziness and lack of appetite.
“I finally felt like we were kind of breathing, if you may, just like, ‘We made it, we're okay,’ and then this happens,” Culliver said. “Literally, COVID. Like, I can't believe it. We really are sitting here with COVID. Today makes two weeks that we're sick. We’re not well.”
Culliver still isn’t interested in getting vaccinated and says she hasn’t received a vaccine since she was an adult and was able to make her own decisions. But she says she plans on being even more cautious now.
“You hear everyone, you see the news and everything and everyone saying, ‘Oh, finally the restrictions are being let up.’ Although I've always heard that, I’ve said, ‘Yeah, well I'm going to continue my same routine. I'm not going to change,’” Culliver said. “Now, it's just confirmation for me, like, ‘Oh my goodness, it is still out there. I knew it was out there, but this is just confirmation like, good Lord, nobody’s safe.”
State officials know they won’t be able to convince everyone to get vaccinated, but they are hopeful that through targeted outreach and their vaccination awards campaign, known as Vax Nevada Days, they will at least be able to keep the pace of vaccinations up.
As of Friday, Nevada ranked 33rd in the nation for percentage of total residents fully vaccinated, with about 5,800 shots being put into arms on average each day over the prior seven days.
“Even when we don't see a huge jump, just the fact that we are able to level off and maintain the number of vaccinations that we've been seeing and maintain that rate, it's actually a really good sign,” Dr. Ellie Graeden, founder and CEO of Talus Analytics and an adjunct faculty member at Georgetown University’s Center for Global Health Science and Security who has been consulting with the state on its COVID-19 response, said of the state’s vaccination awards program during a press call this week. “We may not need to see a big spike for it to still be really indicative of a successful program.”
Messaging around the vaccine has often focused on individuals: how the vaccine will protect them, how it will protect their families and how it will let them get back to the activities they enjoy. That may not be much of an incentive, though, for unvaccinated individuals who don’t see the virus as a threat.
Public health experts say there’s another, more global reason to get vaccinated, though. Each time the virus spreads, it has a chance to mutate. Those mutations, over time, add up to become new variants that can evade vaccines, better infect people and possibly make them sicker. Without a critical mass of vaccinated individuals to halt the spread of the virus for good, the virus will only continue to evolve.
“It's a very difficult situation because as long as you're not vaccinated and you're getting infected, or even if you are vaccinated and you just somehow get infected, it's just going to perpetuate this virus and perpetuating it leads to its further evolution,” Pandori said. “So, while these current lineages may not be much of an issue for us if you're vaccinated, we could be creating a variant eventually that would be a more serious issue for us.”
Pandori described it as “genetic warfare.”
“[The vaccine] is another weapon in an arms race, literally, with this virus,” Pandori said. “I think that's a much more kind of wonkier message to sell, but now that people are so mad and crazy about variants, it has opened the door to teach that about the vaccine.”
Even as they continue to push the vaccination message, local health departments are once again making preparations for a surge of cases. The Washoe County Health District is in the process of upping its contact tracing capabilities in preparation for a possible fall surge, while the Southern Nevada Health District has the capacity to pull health district members off of other assignments to help contact trace, though it hasn’t yet had to do so.
Hospitals, meanwhile, are keeping an eye on the rising numbers but aren’t yet thinking about surge capacity or crisis standards of care, Lake said.
“The hospitals are watching it very closely. I don't think we're at a level of concern that we were with the previous waves of this virus, but we're definitely watching it,” Lake said.
State officials have been hesitant in recent days to even answer questions about whether reimposing mitigation measures is on the table, instead emphasizing the importance of the vaccination effort.
“We're constantly looking at a whole number of things we can do but, again ... the top of that list is vaccinations,” White said. “But it's also our responsibility and our obligation to remind folks that if you are not vaccinated, the same risks that were there a year ago, over a year ago, are still here today. In fact, it’s increased.”
But nationally, some public health experts, including the University of Washington’s Mokdad, have been pushing either for the federal government or states to reimpose mask mandates. Mokdad said states should also consider setting benchmarks and reimposing restrictions if their residents don’t meet them.
It would be a hard political pill to swallow, Mokdad acknowledges, but he also worries about the danger of not doing so.
“There are so many ongoing experiments — and I hate to use that word — all over the world. I mean, we don't live by ourselves on this planet,” Mokdad said. “We see what's happening around us. In many countries that didn't rush to do the right things, they paid dearly for it.”
Gov. Steve Sisolak said on Tuesday that he is “damn proud of what this Legislature did” and thinks it was “a very productive session,” highlighting priority policies that he will likely run on during the 2022 midterm election.
The first-term Democrat rattled off a list of accomplishments during the 120-day session that ended Monday, including distributing $100 million in grants to small businesses, earmarking federal funds to modernize the unemployment system, passing a bill that guarantees many hospitality workers the “right to return” to their old jobs and passing measures that expand voting opportunities.
He also says he’s “110 percent” sure he will run for re-election in 2022, saying he thinks the state is on the upswing after a turbulent year responding to the pandemic.
“I think we have an opportunity to build a new Nevada in the future, and I want to be part of that,” he said.
Below are highlights from a wide-ranging interview Sisolak conducted with reporters from his Carson City office.
State public option
Sisolak confirmed Tuesday that he will sign Senate Majority Leader Nicole Cannizzaro’s SB420, legislation that will make Nevada one of the first states in the nation to adopt a state-managed public health insurance option.
The governor’s commitment to sign the bill dashes the hopes of opponents urging a veto after a contentious legislative journey for the bill, which requires insurers that bid to provide coverage to the state’s Medicaid population to also offer a public option plan resembling existing qualified health plans on the state health insurance exchange system. The bill also calls for an actuarial study and for the public options to become available starting in 2026.
“It's not something that you flip a switch and happens overnight,” Sisolak said. “But anytime there's an opportunity to get health care coverage available for more Nevadans is certainly something that I'm interested in.”
Sisolak said he has not scheduled a legislative special session focused on how the state should spend the coming $2.7 billion in federal American Rescue Plan dollars and hundreds of other federal COVID relief funding streams coming into the state.
Nevada lawmakers ended the regular session without a clear plan on the coming federal windfall — though lawmakers approved legislation, SB461, earmarking $335 million of the federal dollars to the unemployment trust fund aimed at avoiding any automatic hikes in unemployment taxes paid by businesses.
The legislation also includes millions more in direct spending on specific public health, food insecurity and other programs, while also creating a “waterfall” of funding priorities for future use of the federal dollars.
Will that be enough to avoid a special session? Sisolak demurred, saying his office was still working through the U.S. Treasury guidance on how the federal dollars can be spent and for now was taking a “wait and see” approach. The governor added that a fall special session will be necessary to complete the state’s redistricting process, after delays in compiling and reporting U.S. Census data caused by the pandemic.
“When there's a session necessary, we'll call it,” he said.
Tax initiative petitions
Part of the deal to pass a bill imposing a new tax on the mining industry involved the Clark County Education Association teacher’s union withdrawing two proposed ballot measures that would raise sales and gaming taxes. Lawmakers amended a bill in the waning hours of the session to explicitly authorize such petitions to be withdrawn within 90 days of an election, even after they have qualified for the ballot.
“I'm gonna trust that any commitment that they made to me or to my staff, they're gonna follow through on,” Sisolak said.
CCEA Executive Director John Vellardita said after the bill’s first hearing but before a vote that “if we get a deal, we will keep our word.”
But Sisolak said he wasn’t sure exactly when that would happen or if it would be right at the allowable deadline for withdrawal.
“I would hope we don't have to wait ‘til 90 days right before,” Sisolak said. “Hopefully it will be sooner than that. I don't know how much sooner.”
Asked if he was worried that the strategy of filing an initiative petition to try to force certain actions from policymakers would become commonplace, the governor said he hoped not.
“I don't believe in legislating by initiative petition,” he said. “The public's input is certainly required, it's necessary and sought out. But that's why we elect people. I don't think that the initiative petition process is the most effective way to get results. And I hope that that's not what this causes.”
After what was arguably the highest profile bill to die in the legislative process — a measure advanced by the Assembly on party lines to abolish the death penalty — Sisolak said nobody has yet approached him asking for him to impose a moratorium on capital punishment.
He also said he doesn’t believe he has the individual power to grant clemency for people on death row who fall outside of a category he thinks the death penalty should exist for — the most egregious cases, such as mass shootings and terrorism.
Sisolak’s chief of staff, Michelle White, said the governor had wanted to meet with people on both sides of the issue, including families of victims and of people on death row, but those talks did not happen before the session.
“There were no conversations with our office leading up to this legislative session on the death penalty,” she said. “There was no outreach saying, 'we're going to do this and so we want to get some input on this.'”
Sisolak said he was uncomfortable making such a momentous decision in an environment where many legislative meetings were remote and public comment was taken in short increments over the phone.
“It's different when you're sitting face to face with someone you see them, the family member,” he said. “And I'm not talking necessarily about the large groups, I'm talking about the family members who lost a loved one as a result of a mass shooting.”
He said there was “zero” consideration about being seen as soft on crime when Republican Joe Lombardo, the sheriff in Clark County, is planning to run for governor.
“When I make legislative decisions, they have nothing to do with my political opponents,” he said.
The compromise by which the mining tax was approved involved funding authorization for a program many Democrats dislike — the tax credit-funded Opportunity Scholarship program that supports low-income children attending private schools. The bill brings funding back up to 2019 levels, reversing an arrangement that lets no new children enroll and effectively begins a phase-out of the program.
Asked if he thinks the program should be a permanent fixture in Nevada, Sisolak noted that one Legislature can’t bind a future Legislature.
“There were a lot of discussions leading up to that. It wasn't easy,” he said. “Good governance is all about compromise. I mean, it's not just getting your way all the time.”
Asked if he would include it in the recommended budget he will put forward if he is re-elected ahead of the 2023 session, he said he hasn’t thought about the budget for next session but will “definitely” be talking to his top staffers about what the budget will look like.
“This was an agreement that was made,” he said. “I'm going to follow through with my side of the agreement, all the terms that were made.”
Sisolak acknowledged that the bill was a “heavy lift” but said he was still a supporter of the concept mentioned during his January State of the State address, saying that it put no state money at risk and could help with economic development. He said building support for the bill was difficult with the Legislature largely closed to the public and in-person meetings.
“I think the concept was misunderstood because the detractors put it out there like it's a company town, and you're given control of the government. That's not at all what it was,” he said. “But in the midst of a 120-day session, when I was in the initial discussions on Innovation Zones, I wasn't contemplating having a pandemic.”
Raises for state workers
Some lawmakers spoke out against a plan to give raises up to 3 percent for state workers covered by collective bargaining agreements, and 1 percent to those without. It’s the first budget approved since state workers were authorized to unionize.
“I guess what I find disturbing is because this becomes a reward and an incentive to put everyone under a collective bargaining unit, because we don't pay them if they don't,” Sen. Keith Pickard (R-Henderson) said before voting against a bill implementing state employee pay. “And to me that seems to be a little inappropriate.”
Asked whether the arrangement is fair, Sisolak said it’s not collective bargaining if everybody gets the same thing.
“I've been involved with different parts of collective bargaining for a long time. That's what collective bargaining is,” he said. “Different units came forward with different proposals and different requests and made cases and they came to agreements. And I'm no one to stop that.”
SNWA turf removal
While cautioning that he wanted to read the bill for any last-minute amendments, Sisolak indicated that he also will sign a proposal backed by the Southern Nevada Water Authority that would generally prohibit non-functional grass outside of single-family residences in Clark County starting in 2027. The bill would remove about 5,000 acres of unused grasses, which uses about 10 percent of Nevada’s 300,000 acre-foot water allocation from the Colorado River.
Sisolak called the idea behind AB356 a “great policy,” saying that anyone who flies into Las Vegas can see the infamous “bathtub ring” on the shores of Lake Mead and see the need for water conservation in Southern Nevada.
“I think that it's incumbent upon us, for the next generation, to be more conscious of our conservation and natural resources, water being particularly important,” he said.
The checkered flag is poised to start waving as state lawmakers enter the final month of the legislative session with a host of major policy and budget issues still unresolved, from repeal of the death penalty to raising taxes on the mining industry, wholesale changes to the K-12 funding formula and many other big-ticket items.
Tuesday’s meeting of the Economic Forum — the panel of five economists who forecast expected state tax revenue — is generally viewed as the green light for a host of budgetary issues and major bills to move to the finish line before the clock strikes midnight on sine die, May 31.
Most indicators are that the improving economy, coupled with rising COVID vaccination rates, will boost state tax revenues above what the Forum forecasted in December — about $8.5 billion over the next two fiscal years, or about $500 million less than the last two-year budget cycle.
Legislators have nonetheless proceeded based on the less-rosy budgetary picture, making tough cuts to education and health care programs that at times drew heated debate. While a recovering economy is expected to help alleviate some of those previously identified cuts, lawmakers say they’re still waiting on the bigger piece of the puzzle — U.S. Treasury guidance on how the state can spend the roughly $2.9 billion allocated through the recently passed federal American Recovery Act.
But without guidance soon, legislators say it's almost a guarantee that a summer special session will be needed to make a decision on how to dole out the one-time federal windfall.
“Every day from this day forward, we're running out of time,” Senate Finance Committee Chair Chris Brooks said. “(If) that happens at a certain point ... the only way we can do it is to close the budget, and then fill it back in at a later date, just because we'll run out of time.”
Gov. Steve Sisolak’s Chief of Staff Michelle White echoed those comments, saying that the governor’s office didn’t want to recommend allocating general fund dollars to needs that may later be met by an influx of federal funds — even on topics that might attract bipartisan support, such as funding a replacement unemployment insurance system, a broad expansion of preschool and more. Beyond the flexible $2.9 billion, other pots of federal funding with more specific earmarks are also expected.
“The governor wants to make sure that that's a process that can go through the appropriate budgetary process, and with the Legislature having full input,” she said. “We hope that's the case.”
Outside of the budget, legislators are beginning their typical ritual of rolling out ambitious bills in the waning days of the session, including a state-based public health insurance option, fixes to the oft-criticized unemployment insurance system, and a major transmission and electric vehicle omnibus bill. They’re also making progress on behind-the-scenes negotiations, including on a much-publicized effort to raise mining taxes and implementing a wholesale change to the decades-old K-12 funding formula.
But hopes in early May can often turn to tears by June, with many landmines and potential pitfalls awaiting lawmakers and major pending legislation. Here’s a look at the state of play for some of the biggest proposals on tap for the last month of the session.
The question of a potential mining tax hike has simmered in the background through the first three months of session. There’s been little public movement from lawmakers, but three proposed constitutional amendments raising the industry’s constitutional rate cap are playing the role of Chekov’s gun.
Though progressive advocates are clamoring for lawmakers to move forward on AJR1 — striking what they call the mining industry’s sweetheart deal in the Constitution and imposing a 7.75 percent tax on the gross proceeds of mining companies — discussions are ongoing about a potential deal that would lead to lawmakers dropping the proposed amendments in favor of a more immediate tax change.
Democratic legislators appear wary of sending a mining tax resolution to the 2022 midterm ballot and stirring up rural angst at a time when Gov. Steve Sisolak and other high-profile Democrats are up for re-election. The mining industry may also be wary of a ballot measure — voters in 2014 narrowly defeated a ballot question removing the language in the Constitution capping mining taxation, but that victory for the industry came during a midterm election that favored Republicans and had particularly low turnout (though many expect the 2022 midterms to be difficult for Democrats as well, given that the party controlling the White House historically does poorly in midterm elections).
“I said even last special session that if we can find common ground and some compromise that would avoid us having an expensive … exercise on the ballot, that we will certainly be open to that, and we still are,” Assembly Speaker Jason Frierson (D-Las Vegas) said on Monday.
Negotiations are still fluid — meaning things could easily collapse between now and the end of session. But lawmakers, including Senate Finance Chair Chris Brooks (D-Las Vegas), say that some sort of immediate mining tax increase may be the “best and only option” to raise revenue this session.
“I would prefer to see a collaborative approach between the industry and the Legislature to come up with a change in the current [taxation] structure that they have,” he said. “That would be a sustainable way to put money into our budgets in the short term, and not many years from now. I'm supportive of that approach.”
But any struck deal will lead to a math problem — lawmakers need at least a handful of Republican votes in the Assembly and Senate to clear the needed two-thirds threshold for a tax increase.
One of Republicans’ most prominent concerns when the proposed constitutional amendments emerged over the summer was that the mining industry was surprised by them; this time around, the industry is at the table for discussions. Republican leaders in both chambers have not completely closed the door on a tax increase, but said they want more input in the process and would want any revenue hike be narrowly tailored and go to specific programs or functions amenable to both parties.
“I think that all tax bills should have been discussed from the get-go,” Senate Minority Leader James Settelmeyer (R-Minden) said in an interview. “I don't think it's proper to bring anything with 30 days left and say, ‘Oh, here you go. We made the deal, and now we want you to vote for it.’ Why not have a discussion with us?”
State-based public option
One of the most heavily lobbied issues over the last month of the session will be the effort to implement a state public health insurance option — requiring insurers that bid to provide coverage to the state’s Medicaid population to also apply to offer a state-backed public option plan.
SB420 was introduced in the Senate on Wednesday and sponsored by Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) and has already been scheduled for a hearing Tuesday.
The legislation — dubbed “CannizzaroCare” — comes from public option efforts in past sessions, including a 2017 effort to allow Nevadans to buy into the state’s Medicaid program, (which the Legislature approved but that was vetoed by Gov. Brian Sandoval), and a 2019 study lawmakers approved to look into the possibility of allowing Nevadans to buy into the state’s Public Employee Benefits Program (PEBP) health plan.
The legislation is backed by a cadre of public health groups (including health districts in Washoe and Clark counties) and progressive organizations, but has attracted an organized opposition effort from doctors, hospitals and health insurance panning the legislation as an “unaffordable new government-controlled health insurance system.”
Death with dignity
The latest in a long line of efforts to legalize a process allowing terminally ill patients to self-administer life-ending medication prescribed by a physician hasn’t made much movement since it was referred without recommendation out of committee by the first committee deadline in early April.
The bill, AB351, was referred to the Assembly Ways and Means Committee shortly after, where it’s sat ever since. But bill sponsor Edgar Flores (D-Las Vegas) said he was confident about the bill’s chances — adding that he expected it to come up for a hearing and likely vote at some point once the budget committee finishes processing more straightforward agency bills.
“Eventually we'll have an opportunity to have a hearing there, and then hopefully get it to the floor,” he said. “And I'm confident that that's where it's at now. Obviously, things may change, but I think that's where we're at now.”
Flores said he had also spoken with the state’s Department of Health and Human Services, and believed the agency would take its fiscal note (estimated cost to implement) off the bill.
The concept has divided lawmakers, and not always along strict party lines. Assembly Minority Leader Robin Titus (R-Wellington) said she had struggled with the bill; her libertarian side supported giving patients those rights, but thought that many of the concepts including limiting a coroner’s investigation and timelines in the bill were improper.
“I have real issues with those things, apart from my struggle with does a person have a right to decide how they end their life,” she said.
Members of the Assembly recently voted along party lines to abolish the death penalty, pushing the proposal as far as it’s ever been in Nevada after fits and starts in recent sessions. But the bill hasn’t been touched in the Senate, where both the committee chair responsible for processing it and the Senate majority leader are prosecutors whose boss — Clark County District Attorney Steve Wolfson — has been vocal in favor of keeping capital punishment.
Gov. Steve Sisolak has at times expressed unqualified opposition to the death penalty, and on other occasions said he would support it for extreme cases, such as the Oct. 1 mass shooting.
Senate Judiciary Committee Chairwoman Melanie Scheible has said that the bill could move forward if the sponsor can come with an amendment that is acceptable to the governor, but bill presenter Assemblyman Steve Yeager — while acknowledging he wants to make progress — says he’s not sure whether he and abolition supporters would accept a watered down version of the bill.
Others, including leaders of the Nevada State Democratic Party, say the onus is on senators to at least give the bill the courtesy of a hearing. In a video not widely circulated before this week, Scheible affirmed unequivocally at the Battle Born Progress Progressive Summit in January that she supported the quest to end the death penalty.
Republicans have latched on to one of the most prominent failings of the executive branch — massive backlogs in an inundated unemployment claims system — as one of their top priorities this session. Lawmakers of both parties often mention the emails they have received from claimants desperate for stalled benefits.
Senate Republicans have met with claimants in the glitchy Pandemic Unemployment Assistance (PUA) and hinted for weeks that they would introduce legislation to address issues identified in a lawsuit brought by PUA claimants, such as the lack of communication between a regular unemployment and PUA computer system. They also have been publicly critical that the Department of Employment, Training and Rehabilitation loan policy bill, SB75, makes technical changes to the regular unemployment program but does not speak to some of claimants’ marquee complaints.
Though Republicans’ bill, SB419, dropped last week, Senate Finance Committee Chairman Chris Brooks described it as a “stunt” and likely dead on arrival because it proposes spending $40 million from the strained general fund on a multi-year modernization project.
Brooks said the ambitious project should wait until the latest round of federal funding comes through. Democrats have listed a modernization project as a top priority in a framework on how to spend the money, and say they expect the federal guidance will allow such a use.
White said Democrats are in agreement with recommendations made by a governor-appointed unemployment strike force led by former Assembly Speaker Barbara Buckley.
“We have to make sure that anything that we've identified last year that could be better, that we're making all efforts to change now that funding … will be available, pending eligibility,” White said.
DETR officials have said it could take up to a year to design a request for proposals laying out exactly what the state wants out of the IT overhaul. In the meantime, the governor’s budget proposes a modest $1 million over the biennium for contractors to help resolve close to 2,000 technical issues of various sizes within the benefits system.
Release of the long-awaited report from the statutorily-created Commission on School Funding last week laid bare what many lawmakers and public education advocates have long suspected — moving Nevada to the national average in per-pupil school funding will cost more than $2 billion over a decade and hundreds of million of dollars in additional revenue every year.
The report recommended that lawmakers implement major changes to the current sales and property tax systems, but those general proposals have largely fallen flat. On property tax changes, Brooks said he “absolutely” agrees changes are needed but “I don't think now's the time to do it” as the state continues to recover from the COVID-19 pandemic.
Frierson in a previous statement panned the sales tax as regressive but signaled support for restructuring the mining tax and bringing in revenue from short-term rental companies such as Airbnb.
"With regards to other revenue structures, many take time and robust stakeholder outreach and that has not been something we have had during this session," Frierson said.
Still, lawmakers are moving forward with plans to accelerate a shift to the new “Pupil-Centered Funding Formula,” an update to the dated past funding formula initially approved by legislators in 2019. Many of those budget details, including promises to implement various hold harmless protections to avoid massive overnight funding losses for rural school districts, are still in the works.
Some Republicans have expressed openness to increase funding for education if it has direct ties to student outcomes and is allocated in a transparent manner; they fear that it could otherwise be swept up into collective bargaining agreements. They also have bristled at the shift toward the new funding formula, which has reshuffled the deck on some of their party’s most significant legislative accomplishments — a series of “categorical” programs targeted toward specific student groups with special needs that flourished under unified Republican control of the governor’s office and Legislature in 2015.
Settelmeyer cautioned that Republicans would only be likely to support tax increases directly tied to targeted education spending (the so-called “categoricals,” which include programs such as Read by Grade 3, and Zoom and Victory schools). He said the odds of starting a discussion on a “bipartisan way of how to get there” didn’t bode well at this late stage in the session.
“That's nothing new. Education has always wanted more money,” he said. “Republicans have shown consistently, if it goes to a purpose, we'll have a discussion. You want it to just go to the same system? I think we tend to be a little bit less likely to agree.”
A bill to authorize cannabis consumption lounges seeks to resolve a longstanding conundrum in the state — that using cannabis is legal, but consuming it anywhere outside a private home is illegal. It stands at odds with an assumption that drove much investment in the Nevada marijuana industry — that tourist consumption would make the Silver State’s cannabis industry punch above its weight.
The measure, AB341, is described — even by the director of the Cannabis Compliance Board — as the most promising vehicle for diversifying an industry with upper ranks that skew white and male. “Social equity” elements of the bill would give a competitive advantage to lounge operators who have been adversely affected by the War on Drugs, bringing new players into an industry characterized by extremely high barriers to entry and fierce competition for a limited number of licenses.
A similar consumption lounge concept failed late in the 2019 session, but that was before the Cannabis Compliance Board had formally assumed regulatory oversight of the industry. Proponents are optimistic that with a focused regulatory body in place, the state is now ready to take a step toward lounges.
The bill has been parked in the Ways and Means Committee because of the estimated $3 million the Cannabis Compliance Board would have to spend to support the projected 30 new positions needed to regulate scores of consumption lounges. Marijuana regulation is generally self-supported by licensing fees, although the board has not yet estimated how much revenue the lounges would bring in to balance out the ledger.
“I'm hopeful it's gonna move,” said Assemblyman Steve Yeager (D-Las Vegas), the bill’s sponsor, adding that it would likely be one of the last things finished in the session. “I just think it's gonna sit there for a while, because we have to close sort of everything else … before we can really have a discussion about what might be available to satisfy that fiscal note.”
Another potential wrench in the wheels is that the bill requires a two-thirds majority vote, which means it’s possible Republican-raised concerns about people driving after consuming marijuana could sideline the bill.
Asked about the possible reemergence of a policy allowing coveted dispensary licenses for applicants who did not win them in a contentious 2018 licensing round, Gilles said the governor’s office is not committing to any policies on that front, citing many moving parts, including ongoing litigation.
“I will be happy to engage in any conversations with folks if there's a proposal that's worth ... being worked through the Legislature that's going to resolve everybody's issues and everybody's concerns,” he said. “I don't know that that's possible.”
One of the biggest remaining policy-focused bills yet to drop is Sen. Chris Brooks’ forthcoming major energy policy bill, which is expected to be introduced sometime this week.
Brooks has described the provisions of the bill in past interviews — it will require a $100 million investment by NV Energy to facilitate greatly expanded electric vehicle charging infrastructure, while doubling down on transmission infrastructure — aimed at finishing NV Energy’s proposed Greenlink transmission project, which utility regulators partially approved in March.
On Friday, Brooks said that those portions and others previously described — including adoption of “tenant solar,” allowing utility-scale battery storage projects to access renewable energy tax abatement programs, and moving the state to a larger wholesale electric market would all be included in the legislation.
Brooks reiterated that there were no surprises in the forthcoming bill, and he said the goal was to start the state on major transmission projects as soon as possible — saying that while the Public Utilities Commission made the right choice in the most recent transmission case, lawmakers needed to sign off on any major policy push toward greater transmission infrastructure.
“It’s not the PUC’s job to encourage economic development in the state of Nevada, it's the PUC’s job to keep the lights on,” he said. “And so the argument that we need transmission, so that we can become a regional hub for transmission in the West, and so that we can attract economic activity to our state, is not necessarily the regulator's job... it's the policymakers and legislator’s jobs and the governor's job to give that message.”
Housing and rental assistance
Gov. Steve Sisolak has said that the state extension of the eviction moratorium, which runs through May at the state level but is backed up by a federal moratorium that lasts through June, will be the final one. But lawmakers are working on a bill that creates a “glide path” from the eviction ban into normalcy, and ushers out the hundreds of millions of dollars the state has received in rental assistance but has struggled to get out to people quickly.
“As we're coming up to the end of the moratorium, we need to figure out a way to even further ... perfect the way in which we get those dollars into the hands of landlords,” said Scott Gilles of the governor’s office.
Gilles said the governor’s office doesn’t think they can get around a federal government restriction that prevents payments directly to a landlord — with no tenant involvement — but the legislation aims “to ensure that a tenant who wants to engage and take advantage of the rental assistance dollars will ultimately have that opportunity.”
Assemblyman Steve Yeager (D-Las Vegas) said discussions include how “we can slow the eviction process enough so that the monies that are there get used” and whether there are other pots of less-restricted money that could help tenants who don’t qualify under newer, stricter federal rules setting income limits or landlords who are having trouble securing the required tenant cooperation.
It’s still unclear whether the bill would have provisions that prevent landlords from immediately evicting a tenant after receiving overdue back rent through the assistance program.
“We're looking at … whatever options are there to keep people in their homes and if there's some enticement for a landlord to be paid these dollars or ... have some sort of agreement going forward through the mediation program,” Gilles said. “Obviously that's the intended result.”
State worker collective bargaining
Another potential hurdle in the rush to finish the session will come in the novel process of approving collective bargaining agreements for state workers — the first-ever undertaking since lawmakers expanded bargaining rights to state employees in 2019.
In theory, the bargaining units (representing a swath of state workers) are supposed to come to a tentative agreement with the state’s Department of Administration, go for approval to the state’s Board of Examiners (composed of the governor and other statewide elected officials), and is then transmitted to the Legislature as a budget amendment, prior to the end of session.
However, a spokeswoman for the Department of Administration said Friday that only one agreement (with the Nevada State Law Enforcement Officers Association) out of the seven recognized bargaining units is ready to go before the Board of Examiners.
The agency said it does not “currently have a timeline” for bringing forward agreements with bargaining units represented by AFSCME (which represents four) and is still negotiating tentative agreements with two other units — the Battle Born Fire Fighters Association and Nevada Police Union.
The 2019 legislation authorizing state workers to collectively bargain also contains provisions giving the governor the final say on wages or other monetary compensation despite any approved collective bargaining agreement.
White said that the main focus right now was timing, and getting budget amendments over to lawmakers with enough time to spare before the end of session.
“Anyone could look at it right now with 30 days left and say that's a tight timeline, and it is a tight timeline but, we feel confident in our partnership throughout this process to negotiate in good faith and get everything done that we can possibly get done in these negotiations and agreements,” she said.
Right to Return
A bill presented by Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) that guarantees hospitality workers the right to return to the job they lost during the pandemic has not advanced since it had a public hearing in early April. But the measure, SB386, has a waiver that exempts it from legislative deadlines, and parties have been negotiating to address stark disagreements between union and business interests.
“Our whole goal is making sure people can get back on the job and so it's something we're monitoring. I think there are some real, real challenges that people are trying to work through. And that's kind of the last update I've had on it,” White said on Saturday. “So I think we'll see. I think it's something that folks want to find a resolution on.”
It comes as hugs with family, dinners with friends, work days that feel just a little safer and errands run without a second thought.
It comes as first doses, second doses and paper vaccination cards multiply. It comes as cases, hospitalizations and deaths fall.
It comes as the virus begins to slip into the background, as the numbers seem less important, as the deliberateness and thoughtfulness with which many have approached the last year fades away.
It comes as a gradual exhale, a slow sigh of relief.
Hospital workers, who for a year have had a front-row seat to the pandemic, were the first to start to feel it.
Jody Domineck, a pediatric nurse in Las Vegas, was so excited for her vaccine appointment that she accidentally arrived early. As she sat waiting in the parking lot, she was at the point of tears. The awfulness of the last year, the fears of bringing the virus home to her family and the relentless drumbeat of the pandemic seemed like they were finally coming to an end.
“We took pictures. Everybody was cheering,” Domineck said. “The history was almost palpable, that this is literally making history, this is saving lives, this is how we beat this. All the work we’ve done, all the stress, all of the fear: This is how we get out of it.”
Dr. Shadaba Asad, the medical director of infectious disease at University Medical Center, described receiving the vaccine as a blessing and a relief. Her husband, who is also a doctor, fell very ill with COVID during the pandemic.
“If you work in a hospital, you’re exposed to these patients day in and day out,” Asad said. “I think when the dust settles and this thing ends, we will realize that this was the turning point in the pandemic for us.”
Dr. Scott Scherr, an emergency medicine physician in Las Vegas, described a feeling of “pure happiness.”
“When the vaccines rolled out, that was the first time in nine months that we had a sigh of relief,” Scherr said. “Having that extra layer of security really takes a huge weight off all of our shoulders.”
It has now been 118 days since the first health care workers in Nevada received their jabs, a small price to pay for protection from COVID-19. Since then, more than a million Nevadans have been either partially or fully vaccinated, a number that officials hope will quickly climb in the coming weeks now that eligibility has opened up widely to the general population.
For many, the hope is palpable.
The denouement, though, is tentative.
Roughly two-thirds of the state’s population remain unvaccinated, with 49 percent of Nevadans eligible but unvaccinated and another 19 percent ineligible because they’re under the age of 16. Typically, somewhere between 50 and 90 percent of the population needs immunity against a virus to slow its spread for good, though scientists still don’t know what the magic number will be for COVID-19.
If the current pace of vaccination from the last week holds steady, it will take 35 more days for 50 percent of Nevadans to be at least partially vaccinated against the virus. Ninety percent will take 116 days.
And, in the near future, the pace of vaccination may shift from a sprint to a crawl when the state runs out of Nevadans eager to be vaccinated. At that point, the work of informing and persuading those who are open but less eager to get the shot will become even more key for public health officials, immunization advocates and community organizations.
Those involved in the vaccination effort in Nevada acknowledge that once the state reaches that phase, it could take significant effort to boost the total percentage of vaccinated Nevadans even slightly.
The denouement drags its heels.
One day, the World Health Organization will officially declare the pandemic over, the U.S. will end its state of emergency and, so, too, will Nevada. But there is no sense of when we can expect to hit those milestones in what continues to be an ever-evolving situation.
This past week, COVID-19 cases in Nevada ticked upward for the first time in three months. It’s a trend other states are seeing too as they lift pandemic health and safety restrictions and as more transmissible variants of the virus become more prevalent. Michigan, where the situation is worse than anywhere in the U.S. right now, has almost climbed back to its December peak.
Some public health experts have warned of a fourth wave of COVID-19 cases nationwide. Rochelle Walensky, director of the Centers for Disease Control and Prevention, recently described a sense of “impending doom.” Others, including Dr. Anthony Fauci, the Biden administration's chief medical advisor, believe a fourth wave is unlikely in light of the increasing number of vaccinations.
Where there is more consensus, though, is that we have once again reached a critical juncture in the pandemic as the vaccination effort races against the spread of the variants and our overwhelming desire for life to return to normal as quickly as possible.
We long for a catharsis that will purge the virus and its many varied consequences — financial, emotional or otherwise — from our lives.
That catharsis has been delayed.
It may, however, offer an opportunity:
An opportunity for state officials, public health experts and others involved in Nevada’s pandemic response to not put the events of the last year behind them but instead sit with them and think through what could have been done differently. An opportunity to assess where the state is today and prepare for a recovery that is only beginning. An opportunity to think about the future and how to better brace for the next pandemic, the next natural disaster and the next emergency.
We want life to go back to normal. We want to move on. We want to forget.
The denouement, though, comes slowly.
It asks us to sit here among the still-smoldering ashes of a once-raging wildfire.
It asks us to nurse the wounds of the devastation the pandemic has brought down on our public health system, on our economy, on our schools, on our government entities and on us.
It asks us not to forget.
For the last year, hospital workers in Nevada and across the nation have found themselves on the frontlines of a war with what has often felt like little to no armor.
Even when they did have the appropriate personal protective equipment, they still worried about getting sick or, often worse, bringing the virus home to their families. Anxiety, for many, became a constant companion.
That all changed when the vaccines arrived.
“The bullets were flying by you for a year, and finally somebody handed you a bulletproof vest. That’s what it felt like to me. I’m like, ‘Wow, can I get a helmet with that?’ And they’re like, ‘Yeah, that’s the second shot. Here’s your helmet,’” said Dr. Bret Frey, an emergency medicine physician in Reno. “I’m like, ‘Wow, I got gear. I feel good.’”
UMC, the county-run hospital in Las Vegas, was the first to start administering vaccines in the state nearly four months ago. The hospital had set up its vaccination clinics — complete with computers, signs and social distancing markers — days before the first shipment of vaccines were expected to arrive and had been drilling its vaccine distribution process.
So, when the doses arrived early, on Dec. 14, the hospital saw no reason to wait.
“Our gut was telling us that we were going to get it on Monday. So the team got in early, we prepared, and then we got the call from the health district that said the shipment had arrived,” said Mason VanHouweling, UMC’s CEO. “Within an hour and a half we were putting a vaccine in our longstanding ICU nurse, who had been working day and night at the hospital and she volunteered to be our first vaccinated health care worker in the state of Nevada.”
It was an auspicious beginning to a vaccination effort that would prove, at times, rocky over the next several weeks as the state struggled early on to secure needed information from the federal government, battled infrastructure and technology issues and grappled with growing inequality in the vaccine distribution process. At one point in January, the state ranked third to last in the nation for doses administered per capita.
Candice McDaniel, who until recently helmed the state’s COVID-19 vaccination effort as a health bureau chief within the Division of Public and Behavioral Health, framed those difficulties as the growing pains of an unprecedented public health operation.
“It’s the scale,” said McDaniel, the new deputy administrator of the Division of Welfare and Supportive Services. “It’s the amount of individuals you’re really trying to reach.”
One of the biggest challenges the state faced early on was the lack of advance notice from the federal government about the state’s vaccine allocation. Because the federal government only told the state how much vaccine it could expect to receive a week in advance, it was difficult for state health officials to scale the vaccine operation up or down to match the number of doses being sent.
That communication, though, has significantly improved in recent weeks, state health officials say — and not just in the form of more advance warning from the federal government on vaccine allocation. McDaniel pointed to the rollout of the health center vaccination program and the expansion of the retail pharmacy vaccination program as two instances where the federal government has ensured the state has been in the loop even though those programs are administered at the federal level.
“I would never venture to say that there aren't challenges,” McDaniel said of the state’s relationship with the federal government on the vaccination effort. “But I feel like when we reach out for guidance or response, we are able to get that.”
It wasn’t just the federal government, though, that stymied the state’s early rollout of the COVID-19 vaccine. The state also faced significant internal challenges.
Despite months of preparations, the state’s vaccine infrastructure found itself quickly overwhelmed as the immunization effort opened up to seniors in January. Vaccination registration portals sometimes crashed because of the number of people trying to access them at the same time; seniors struggling to sign up for appointments overwhelmed vaccine help lines; and records of thousands of shots administered needing manual input into the state’s vaccine database piled up.
Immunize Nevada, the only statewide immunization-focused nonprofit, saw its call volume increase 550 percent in January, the organization’s executive director, Heidi Parker, said. To handle the increased workload, the organization brought on 19 interns for the spring semester instead of its usual four or five.
The state also pivoted, standing up a standardized statewide vaccine registration portal, which the Southern Nevada and Washoe County health districts now use, and a statewide call center. Federal Emergency Management Administration (FEMA) staff came in to help clear the data entry backlog, most of which was in Clark County, and FEMA and the National Guard continue to play a key role in operation of the county’s mass vaccination sites.
Dr. Fermin Leguen, health officer for the Southern Nevada Health District, said that Clark County, which is home to nearly three-quarters of the state’s population, was bound to experience some of the most significant challenges in the vaccine’s rollout owing to its size.
“The complexity of the dynamics of this metropolitan area are quite different from these other jurisdictions,” Leguen said. “The resources needed and everything is quite different and exponentially larger than what you could experience in any of those other jurisdictions.”
The state’s rural counties, by contrast, saw a comparatively smooth early rollout of the vaccine. While some rural counties have grappled with geographic challenges, particularly if they have multiple population centers, others saw a relatively easy rollout, which they attribute to their small population numbers and the close-knit nature of their communities.
“When it came time to do the frontline medical personnel, they had all the medical personnel done within a week or two,” said Ely Mayor Nathan Robertson. “It took larger areas in the state a month or more to even get to where we were.”
White Pine County, where Ely is located, continues to have one of the highest rates of vaccination in the state, with 5,500 doses administered for every 10,000 residents, compared to 4,800 in Clark County. White Pine also has a population of a little less than 10,000, compared to Clark, at about 2.3 million.
As the vaccination effort continued, frustrations arose as a result of changes to and confusion over the state’s vaccination playbook. In October, state officials released the first iteration of the playbook, which divided the population into four vaccination tiers. That initial vaccine plan prioritized almost all of the state’s essential workers before people with pre-existing conditions, who were in turn prioritized ahead of elderly Nevadans.
In January, the state announced a new version of the playbook that shifted the state to a new vaccination structure that would instead create two parallel vaccination “lanes” that would allow the state to work through vaccinating its essential workforce at the same time it began to vaccinate members of the general population.
While the change may have made sense on a practical level, it frustrated some county officials, who had been making preparations based on the earlier tiered structure, and confused some residents, who were unclear where they fell among the dozens of categories across the two lanes and which categories were even currently eligible for vaccination, particularly as counties proceeded through the lanes at different paces.
Counties also sometimes found themselves hamstrung by the state, wanting to proceed through the lanes more quickly as they struggled to fill open appointments. McDaniel said the state’s focus was on making sure counties had the data they needed to make decisions about whether it was the appropriate time to progress to the next group.
“Obviously with any very large data set, there’s going to be a possible delay in getting that information to them in the timeframe they need to make decisions,” McDaniel said. “That was definitely, obviously a challenge.”
Karissa Loper, McDaniel’s deputy, added that it wasn’t that the state was “stopping” counties from progressing through the lanes. Rather, she said, the state “wanted to use the data to do so thoughtfully.”
Four months from when the vaccine distribution effort began, those working on the immunization front in Nevada feel hopeful. Despite the fact that Nevada has continued to receive significantly fewer doses per capita than other states — as a result of the federal government using older population estimates to allocate doses — it continues to rank among the among the top half of states for vaccines administered as a percentage of vaccines delivered.
“Despite, I think, a lot of hiccups and some of the challenges that maybe were at the top of mind early on, we worked through those and everybody continued to innovate and adapt and do all these things to continue to get us moving forward,” Parker said.
The state’s vaccination effort, though, will face new tests in the weeks and months to come. With demand for the vaccine far outweighing supply over the last several months, public health officials have focused on getting shots into the arms of people who want them as quickly as possible.
It’s not that they haven’t already started to focus on the issue of vaccine hesitancy. But the conditions over the last few weeks — which have required people to scour state and pharmacy websites for appointments and wait in long lines at often busy mass vaccination sites — have made it a tough sell.
Moving forward, as supply starts to exceed demand, the core focus for public health officials and others involved in the vaccination effort at the state and local levels will be on education. They hope to answer questions from vaccine-hesitant people and remove barriers by making shots more widely available at pharmacies and doctor’s offices.
The state, in partnership with Immunize Nevada and the ad agency Estipona Group, is also launching a new campaign called “3 Million Reasons,” encouraging people to get vaccinated to protect their 3 million fellow Nevadans.
Michelle White, chief of staff to Gov. Steve Sisolak, whose background is in elections, compared it to a get-out-the-vote (GOTV) effort. In every election, there are voters who are going to cast their ballots no matter what. Others need to be persuaded about a candidate or may only vote if it’s convenient for them.
“They’re not going to be opposed to a vaccine, they’re not anti-vax, they’re likely to be on board, but we have to make the effort to make sure they actually show up,” White said. “That takes a ton of effort, that GOTV effort. There’s a reason why it’s the biggest push on a campaign, and it’s the same thing here. It is making sure we provide every opportunity to get those folks out.”
There is a concern, though, that the numbers of new people vaccinated each day may soon start to plateau. In the 2019-2020 flu season, only 44 percent of Nevadans got vaccinated, and the state had one of the lowest vaccination rates among both children and adults in the nation. As of today, 40 percent of those eligible have been vaccinated against COVID-19, or 33 percent of the overall population.
Vaccine hesitancy comes in many forms. For some, it might be questions about how safe the vaccine is or whether they need to be insured to receive it. It might be that they need those questions answered in their preferred language. It might be that they need to have a conversation with a trusted community leader, like a pastor, rather than a doctor or public health expert.
“We firmly believe that people who refuse it, it’s because many of them are scared,” Asad, the medical director for infectious disease at UMC, said. “They have questions and sometimes they’re just afraid to even ask that question.”
For others, it may be that they would rather get the vaccine at their local pharmacy or doctor’s office, somewhere that is more comfortable and convenient than a mass vaccination site. State officials said there is no specific timeline to stand down the state’s mass vaccination sites in Clark and Washoe counties, though they expect to see a gradual transition of the vaccination effort from those sites to pharmacies and health care providers over the course of the year.
Addressing vaccine hesitancy, those involved with the vaccination effort say, is also key to making progress on the vaccine equity issues the state continues to grapple with. In February, Sisolak announced a new initiative to address what he described as alarming disparities in the rate at which working-class families, lower-income households and communities of color were receiving the vaccine in Clark County.
Since then, a Nevada Vaccine Equity Collaborative has formed to address disparities in the vaccination effort, but its work is just beginning. While individuals who identify as Hispanic make up 30 percent of Nevada’s population, they represent only about 18 percent of vaccinated individuals today. People who identify as Black make up 9 percent of the population but less than 6 percent of vaccinated individuals.
And while rural counties led the state’s vaccination effort early on, the urban counties are catching up while some rural counties are falling behind. Elko, the state’s largest rural county, for instance, has only administered 3,100 doses per 10,000 residents.
Even so, state officials are hopeful vaccination numbers will soon rise with the recent launch of two mobile vaccination units that will travel across rural and tribal areas to boost access to the vaccine. The vehicles can hold 8,000 doses of the COVID-19 vaccine and are expected to be able to vaccinate at least 250 people per day, per location with the one-shot Johnson and Johnson, also known as Janssen, vaccine.
“In a state like Nevada, there are so many communities that just need to feel comfortable going to a location, whether that’s having folks who are speaking in their first language or, if they’re undocumented, having folks who they would feel comfortable with there,” White said. “The easier we can make that, the more equity we’re going to experience.”
Despite the road bumps in the vaccination process, the COVID-19 situation in Nevada is significantly better than it was several months ago.
In December, at the worst point of the pandemic, the state was seeing more than 2,700 new cases reported on average each day, and more than 2,000 people hospitalized with the virus statewide. Today, that seven-day average is a little less than 400, with hospitalizations just a little more than 300.
“We've learned a lot. We're better prepared,” said Christopher Lake, executive director of community resilience for the Nevada Hospital Association. “If everyone can work together and keep doing what we all know is right, that’s the social distancing, the getting the vaccine ... wearing the mask and controlling the droplets and the aerosols, if we can do that we can definitely manage this, and I feel optimistic about that.”
The trends, though, have started to move in the wrong direction. Though the numbers are still significantly better than they were in December, they’re not as good as they were in March.
It’s an uncomfortable reminder that better does not equal good.
“That’s the problem. People say, ‘Oh it’s better now,’” said Brian Labus, an assistant professor of public health at UNLV. “Well, yeah. ‘A little bit better’ doesn’t mean this thing is over at all.”
Top of mind, for public health experts in Nevada and around the world, are the COVID-19 variants, including the UK, South African and Brazilian strains. As of Friday, Nevada had identified 155 cases of the UK variant, one case of the South African variant and one case of the Brazilian variant. Additionally, two strains identified first in California, which are also considered variants of concern, are now responsible for about 46 percent of infections in Nevada. (The Silver State has the second highest prevalence of the two strains in the country, after California.)
Nevada has also identified 10 cases of the New York strain and one case of a second Brazilian strain. Both of those strains are, at this point, considered only variants of interest, not concern.
For now, most vaccines seem to be at least somewhat effective against the variants, though the strains identified in South Africa and Brazil do appear to blunt the vaccine’s power.
The concern, though, is that as the virus continues to spread, more variants could emerge.
“Each variant consists of numerous mutations. In other words, we're not talking about one mutation for each new variant, we're talking about a whole collection with different effects. Some of those mutations actually decrease the danger of the virus,” said Dr. Kevin Murphy, an infectious disease specialist in Reno. “But obviously if you get the wrong combination of countervailing mutations, then the net effect may be something worse.”
That’s why health officials have encouraged people to be cautious — by continuing to wear masks and practice social distancing — as the vaccination effort proceeds. It’s a race, they say, between the vaccines, which could significantly limit or stop the virus’s spread, and the variants, which could evolve to evade the vaccines entirely.
That race also comes as the state prepares to hand over control of most COVID-19 health and safety rules to local jurisdictions. Counties are in various stages of drafting plans for the transition to local control, which will undergo review by the state’s COVID-19 Mitigation and Management Task Force starting next week.
Unlike some other states that have started to reopen more broadly, Nevada will maintain a statewide mask mandate even once the transition to local control happens on May 1, and Sisolak has said that he has no plans to lift that mandate in the foreseeable future.
But other key decisions, such as whether businesses should be allowed to open to 100 percent capacity, will soon be up to the discretion of each jurisdiction. Counties have generally been looking forward to the transition, which will give them the decision-making authority they have wanted for months.
Even though this transition is happening at a pivotal moment in the fight against COVID-19, state officials still believe it’s the right time for the power shift to occur.
“They certainly want responsibility to make decisions within their own communities. They know their communities very well. We want to empower them to do that,” White, the governor’s chief of staff, said. “Of course there are always going to be concerns about the virus in general, and you do see these increases in other states, you see the variants, et cetera. The most important thing, I think, the state can do is maintain things like a mask mandate.”
Other mainstays of the state’s public health response to the pandemic, including testing and contact tracing, will remain for the time being, though they have already seen somewhat of a shift in focus.
For instance, Mark Pandori, head of the state’s public health lab, noted that COVID-19 testing is no longer just focused on identifying cases of COVID-19 but also in describing those cases — in other words, looking at the genetic sequence of the virus to understand how it is changing. Local health districts, too, continue to contact trace in the usual way, but they’re paying particular attention to figuring out where people who test positive for variants may have contracted the virus and where it may have spread.
“Over the next six months to a year, every public health lab will screen for cases in asymptomatic people. We will do the surveillance we wanted to do a year ago, and it’ll be a routine part of our work,” Pandori said. “When we find cases, they will get sequenced so that we can look at how the virus is changing in the population, because the last battle, the last stand against this virus will come down that avenue, which, if it doesn’t change very much, or if the changes aren’t effective for the virus, really, then we win, and if we find that it’s changing a lot, then it’s guerrilla warfare like we’ve been in with a lot of other diseases, like influenza.”
It’s a reality many are preparing for: Our public health response to COVID-19 may not be as all encompassing as it is right now, but the virus, still, may linger.
“I don’t want to say forever, because I’d like to think that we will eventually be able to go after this with a vengeance — we’re not going to let this thing get away with what it’s done — I mean going after it not just with vaccines and not just with testing, but to go after it pharmacologically,” Pandori said. “This will be chased into the hills and hunted like no virus ever seen. So I’d like to think that we will eradicate it eventually. But in the meantime, we’re going to be faced with controlling it as we do with everything else.”
The good news, public health experts and health care providers say, is that Nevada is far better equipped to do that today than it was a year ago. It’s why, despite the variants and yet-unachieved herd immunity, they still feel optimistic about the future. In fact Asad, the medical director of infectious disease at UMC, believes there’s no room for pessimism in the pandemic response.
“If I have learned anything from this pandemic, it is that in order to survive, you need to be quick thinking and flexible,” she said. “You don’t give up until it’s completely over, so there’s absolutely no room for pessimism, as far as I’m concerned.”
After the last year, many are eager for the pandemic to be over.
The question is: What does that even mean?
Will the pandemic be over when the World Health Organization says it is? When the national state of emergency ends? When Nevada lifts its state of emergency?
It’s unclear when any of those three things might happen. But Caleb Cage, Nevada’s COVID-19 response director, said, from a technical perspective, the latter may be a ways off.
That’s because being under a state of emergency opens up additional doors for the state, including federal aid. Cage said that everything the state and its political subdivisions do in response to the virus right now is considered an “emergency protective measure;” state and local jurisdictions are reimbursed 75 percent for general pandemic-related emergency expenses and 100 percent for vaccine-related costs by the federal government.
Without a state of emergency, it would be more difficult for Nevada to make the case to the federal government that it should be reimbursed, meaning that funding could go away. Cage said that while the decision to end the state of emergency is up to the governor, he doesn’t foresee a timeline right now where staff would recommend he do so.
“I don’t see us closing the door on the declaration process, and the resources that it makes available to us, anytime in the near future,” Cage said.
Even as the state of emergency persists, state officials, public health experts and health care providers are already looking toward the future, including not only how to rebuild and recover but how to prepare for the next emergency, public health or otherwise.
Nevada’s public health system, for instance, has been chronically underfunded. Nevada ranks 49th in the nation in public health spending per capita, with $8 spent on public health per Nevadan, according to a report from the Commonwealth Fund. Even the best funded public health departments in the country struggled to provide necessary services in the time of the pandemic.
It’s unclear, though, whether the pandemic will lead to lasting changes in the way public health is viewed and, consequently, funded.
Richard Whitley, director of the Department of Health and Human Services, is hopeful.
“Public health is that system of infrastructure that the public often doesn’t see. They don’t see that they’re being protected until they’re not, whether it’s water or air or environment. Until it’s a problem, it’s easy to overlook it,” Whitley said. “But I think that the public and I think that elected officials have been able to witness it in action.”
However, Pandori, the head of the state public health lab, is a little less optimistic.
“Right now, money flies into COVID. But in two years, if COVID looks like the flu, are public health labs going to keep being funded? Are we going to build more public health labs? Are we going to build a national network of infectious disease labs? No way,” Pandori said. “Do you think that the government wants to pay for something that’s going to sit and do what apparently looks like nothing for how many years? You’re going to spend a trillion dollars to build a national lab infrastructure and wait for the pandemic that comes, what, 20 years from now? Thirty years from now?”
It all comes down, Pandori said, to the fact that if public health is doing its job, no one ever notices.
“We succeed because you don’t notice something. We succeed because all your friends don’t have chlamydia,” Pandori said. “Our victories, they’re not under the radar, they don’t have the ability to appear on radar because it’s the absence of something.”
Emergency managers, meanwhile, are starting to think about how the lessons learned from this emergency can better prepare them for the next one. The pandemic has underscored the importance of widespread disaster training, thinking big and not underestimating how quickly a situation can develop into something more serious, not relying on mutual aid to come to the rescue and ensuring that personal protective equipment is always in stock and at the ready.
“Hopefully it’s not another pandemic in the next few years, but for wildfires, for earthquakes, for anything else, I think the muscle memory of having to work together, having to ask for help, not being prideful, will be there,” said David Fogerson, head of the Division of Emergency Management. “I think more people have been exposed to how to make bigger decisions with not a lot of information behind it. That decision-making skill is, I think, going to help everyone.”
For Sisolak, the pandemic has underscored the need to bolster the state’s fragile health care infrastructure, an effort that a $25 million allocation in his budget toward the construction of UNLV’s medical school complex aims to support, and also fix the state’s broken unemployment system, an overhaul that could cost nearly $50 million over the next two to three years.
Nevada has to “learn from this tragedy as much as we can,” Sisolak said in an interview last month.
For the rest of Nevadans, the lessons learned may be small but important: Washing our hands a little more regularly, staying home when we feel sick and, maybe, donning a mask during flu season just to be extra safe.
“You think back of all the things we used to do: We just blew on the candles on the cake and now everybody is going to eat that, or you went bowling — while eating your pizza or your chicken wings or your french fries — you just go and put your fingers into that ball, and after, you don’t go wash your hands, you just go back and start grabbing your food,” said Yarleny Roa-Dugan, a nurse in Las Vegas. “I think people are going to be more aware of how clean they are. Hopefully this will last. But as we know in history, people tend to forget, and then history repeats.”
It’s hard to know how to feel right now.
Should we feel optimistic about how many Nevadans have been vaccinated and that case numbers and hospitalizations are still relatively low here? Or should we be concerned that the vaccination effort isn’t going quickly enough, that the variants are spreading too rapidly and that cases and hospitalizations, though low, may once again be on the rise?
In interviews over the last two months, dozens of state officials, public health experts and health care providers have, by and large, expressed optimism about the future. It comes in shades — from “cautiously” to “categorically” optimistic — but they are glass-half-full nevertheless.
“The fact is none of us know what this is going to look like six months from now. But we all know that all we can do is continue to add tools to address the pandemic going forward,” Cage said. “Nobody knows that’s going to happen with the variants.”
Amid that optimism, they are realistic. Cage, in an interview in early April, said state officials expected to see the numbers start climbing in the future. A few days later, they did.
So, what happens from here?
“What we’re watching for is what are the consequences of that climb going to be. Are people starting to catch the virus again but fewer people are going to the hospital therefore fewer people are going to the ICU therefore fewer people are dying?” Cage said.
If so, "that’s a really positive outcome for this and gives us more methods for dealing with this," Cage said.
It can feel impossible to think about recovery when the emergency is still ongoing. It can feel impossible to think about recovery when so much of the damage is unseen.
But Nevada has a lot of healing to do.
White, the governor’s chief of staff, pointed to the throngs of people on the Las Vegas Strip in recent weekends. Those crowds, she said, belie the tens of thousands of hospitality workers and service employees whose jobs aren’t coming back.
“When you walk around the streets of Las Vegas, you see people coming back, you see this excitement in the air, which is great,” White said. “But there are a lot of people who every day are waking up very worried about walking to the mailbox and opening an envelope and seeing another bill.”
Nevada has been presented with the opportunity to rebuild before, including in the wake of 9/11, the Great Recession and 1 October. White, however, said the current moment presents a “once in a lifetime opportunity” to do so.
“It’s a huge opportunity in this state ... to say, ‘We will rebuild,’ and ‘The vision that we believe needs to be achieved,’ so the next time there is a pandemic or a recession or a disaster or whatever else we can’t predict now, we’re not all sitting around the table saying, ‘Nevada is hit the hardest once again,’” White said.
But, the more COVID fades from mind, the harder it may be to do that.
“When things start to get better, that urgency can go to the wayside sometimes,” White said. “When things get better, jobs are coming back and people are feeling more optimistic, it won’t be front of mind that our public health system has some systemic challenges that need to be fixed within it, and we can’t lose sight of that.”
The list of policy areas the pandemic has spotlighted is long: Health care, the economy, mental health, homelessness and education, among them.
But the pandemic, to many, has revealed an even deeper need for healing, the kind of healing that happens not at a policy level but a personal one.
It’s the healing of deep political divisions. It’s the healing of trust between institutions and individuals. It’s the healing of the wounds we have inflicted on each other.
It’s a deep, hard kind of healing.
Nevada, though, is no stranger to adversity.
What is the pandemic, to the resilient people of the West, but yet another hard time.