Leading Las Vegas

Las Vegas, Nevada. There are no tourists on the sidewalks.

The sounds of birds echo the strip, downtown casinos are lit up, but the slots are shut off, and the tables empty. A city built on risk restaurants and revelry is suddenly very sober.

They say the night is always darkest before dawn. But what happens between the darkest hour and the sunrise? What is between the bad and the good? What gets us from disaster to recovery? We are here today to answer these questions and to find out what happens in the middle.

Today, we're going to dive into the middle of Las Vegas response to the COVID 19 pandemic, and address how leaders in Las Vegas were able to respond to the first global pandemic in over 100 years and keep people safe through creativity and innovation while laying the groundwork for a return to a new normal in a post COVID 19 world. I'm Autumn and Gilera am Jennifer in Colorado. And I'm Kevin Hickey, your host for this episode of leading Las Vegas focused on the Las Vegas response to COVID 19 pandemic. In this episode, you will hear from Mason Ben howling Chief Executive Officer at University Medical Center and Carolyn levering Emergency Management administrator for the city of Las Vegas, who provide insights into the Las Vegas response and how a key stakeholder University Medical Center participated in the response, we will explore how preparedness collaboration between stakeholders creativity and innovation helped Las Vegas overcome challenges, including reducing the spread of COVID 19. Responding to PPE and other supply shortages, implementing testing and administering vaccines.

Las Vegas, Nevada, the Entertainment Capital of the World, home to over 2.2 million residents and destination for over 42 million visitors each year, locked in participate in densely packed activities and casinos, conventions, entertainment venues, restaurants and nightclubs. COVID-19 seem to be a distant threat to the community of Las Vegas and health responders until it received its first positive case on March 5 2020. The infected individual was a man in his 30s who had traveled to Washington State. A couple of days later, a woman in her 70s tested positive in Clark County. And by the end of March, over 250 people had tested positive in the county with 10 having fallen victim to COVID-19 the numbers only increased from there. Imagine you are the emergency management administrator for the city of Las Vegas. It is January 2020. Any global pandemic is headed your way. What do you do? Carolyn levering was in that role at that time and continues to serve in that capacity? pandemic is kind of a slow burn, right? You, you see it come in, and you're trying to gauge what it's going to look like and how long it's going to last. And there's so many unknowns with biologicals. So, the good news is we've been planning and preparing for a variety of different types of pandemics. And we've had small tests over the years h one and one for example. People forget bird flu was out there, you know. So there's there's a lot of things that have cropped up over the years. That caught our attention now and again, but it wasn't really until COVID-19 came along that we started to recognize the enormity of the situation and how bad it could really get a couple of things about emergency management and crisis management standout from Miss Lovering statement. First, preparedness, disasters and crises are low probability high impact events. It's been over 100 years since the Spanish flu killed approximately 50 million people worldwide. So yeah, global pandemic is a low probability event. The bad news is that when it happens 10s of millions of people are likely to die, economies crumble and many more suffer from the fallout. During the interim period between crises, it is imperative to be prepared to train response and recovery efforts and to have the resources available to adequately carry out a plan. Second, it is important to learn from the past crises, while h one n one was a much smaller threat than COVID-19. It provided insights into what a response and recovery effort for an infectious disease actually look like. We will discuss the importance of after action reviews later. Lovering makes the following comments regarding preparedness because a lot of

People don't realize that preparing for pandemic is the same thing as preparing for any kind of an emergency. Right? You you make a kit, you make a plan, and you stay informed. Those are always the keys. And when we talk about making a kit, we're talking about understanding what your family needs are. Every family is different and unique. And so if you've got elderly people in your household or young infants in your household, or pets in your house, all of those things are going to make changes to what your preparedness plan is going to look like. So being prepared for an emergency means being prepared to communicate, letting people know you're safe, and being able to find out about the safety of your loved ones, checking on your neighbors. levering began preparedness efforts with the Health Department years before the pandemic. I know locally, I started working with our health department in the early 2000s. They had never heard of ICS Incident Command System, this wasn't a new thing. But they were open to it receptive to it. And they trained a lot of people in the organization and continued to build their plans around this concept of incident command system. So I was really pleased to see that the Southern Nevada Health District initiated an incident command system within their ranks to ensure that they had an organizational plan to determine how to approach the situation. The Incident Command System, or ICS, is a standardized approach to the command control and coordination of emergency response. Providing a common hierarchy within which responders from multiple agencies can be effective. This allows various stakeholders in the community to easily fold into response and recovery efforts. Mason van howling CEO at University Medical Center states that collaboration with other community partners was key to Las Vegas, his response to the pandemic, I think, I think we did a great job collaborating, I know, not everybody sees the work and the time and the energy and the hours spent working together. But I think, you know, from from the state, the county, the city, the local, you the collaboration has worked really well. And you know, and a lot of us were were were colleagues friends before, but you know, working around the clock, so many hours, really has brought us together and with the community's interests, really at heart. So I think that's been the best thing is the collaboration that has happened with all the agencies, and everybody that steps up, and really is our true problem solvers. It's just amazing to see the the energy and just the teamwork that has happened. And again, not everybody sees that. But I'll tell you, everybody's been working extremely hard seven days a week spending more waking hours working on this issue than their own family. So it's been just been nice to see our city step up. You know, I got to see it after October 1, the community come together and be supportive. And again, Las Vegas has come through again. So it's, you know, we're in this together and just we just need to remember that we're managing well, and the city's coming back. So you know that I think that's the biggest takeaway for me is, it's always been collaborative. It's never been finger pointing. It's just how to solve the problem. And let's get it done. A hallmark of any crisis is the unknown. How is this pandemic spread? What is the mortality rate? How sick are people going to get? Are we prepared to handle this? levering sums up the challenge of the unknown as follows? The challenge in a pandemic is what are we telling them? Because there's so many unknowns. And so a lot of people would accuse of flipping and flopping and changing our mind. The fact of the matter is, it's it's not a hard science. It's a soft science. It's squishy. And as we learn more, we're able to do more, but it takes time. And with a 24/7 news cycle. Taking time is something some people don't want to do. They want to know the answers yesterday and and they want those answers to be sure and solid and set. And that's just not going to happen. I CEO of the largest medical facility in the Las Vegas area. Mr. Van Hollen provides the following on uncertainty in the early days of the pandemic, and how pre pandemic preparedness efforts became the foundation for the initial phases of the Las Vegas response effort. Certainly, there's been several chapters through this pandemic, the pre patient zero that we had in Las Vegas. I think that is what have we done in regards to Incident Response Incident Command disaster

response is with all the agencies within the county, where that's the House District, the fire department Metro, our health, our hospital systems, first responders EMS. So there's always a lot of work and training that goes along with that. Obviously, we've we've drilled on things like Ebola and other outbreaks. But typically we're doing mass casualty type of things so much like after October 1 and pre October 1 response, but what led up to our readiness for the Southern Nevada. The other part is, you know, in the middle of the pandemic, when we had our first patient back in March of 20, how the hospital started to handle those patients absence of really good clear picture of therapeutics and treatments and long ahead of a vaccine. We didn't know a whole lot about the virus and how it was transmitted. You know, it's early on, we thought it was on surfaces and hands and other things. Notice the importance of collaboration with community partners in incident and disaster response and preparedness efforts. Then howling even notes that knowledge gained from other types of critical incidents like the October one mass shooting, and how to handle mass casualty events contributed to the response efforts.

Lovering invent howling discuss Las Vegas his response to multiple challenges posed directly or indirectly by COVID-19. The number one priority in emergency crisis response is to save lives and prevent further injury or harm to people. From there, the goal becomes recovery or returning to a normal pre crisis state.

treating those with COVID-19 and stopping the spread of the disease were at the top of the list for response efforts. quarantines available hospital beds, PPE supply shortages, and whether or not to implement shelter in place orders were some of the challenges to saving lives and preventing the spread of the pandemic, development and deployment of COVID-19 tests and ultimately, vaccines were challenges which needed to be addressed to begin the recovery process and return to normalcy. levering addresses some of these challenges. And of course, early on before we had vaccines, the question was testing how are we getting testing out to people? And how are we going to make it more accessible to people who don't have the ability to do transportation, for example, of course, we were looking at concerns as businesses were starting to shut down. How are we going to help people who still have to make those rent payments, pay those utility bills, the people that are living paycheck to paycheck, suddenly don't have those options anymore. For us, we were concerned about the spread of COVID, and how to prevent the spread. But And early on, we discussed whether schools should close down or should not close down. And if they close down for how long, early on, we all, all love the idea of a two week flatten the curve concept. That that was obviously a quick fix that, that we tried to wrap our heads around and and were hopeful for but it wasn't to be those impacts the impacts to our school system, ripple throughout our community in ways that I think a lot of people don't understand. With schools closed, parents are home with their kids. And teachers can't teach and trying to gin up a whole ability to educate our students and keep our teachers employed and our parents employed as well. It was madness for a lot of families, and continues to be a struggle for a lot of families even today. What we were going to do with the schools, what we're going to do with our workplaces with the families that were already struggling today, today, then the next component, our homeless population, without really understanding how easily this virus was spread. Our concern was when you put 250 homeless people into a shelter overnight, and they are right next to each other side by side by side.

Are we doing our best to prevent the spread of this disease amongst a host population. And that is where the city of Las Vegas partnered with Clark County to open up a homeless facility where homeless people could isolate and quarantine because early on it was like if you're sick, you need to isolate if you've been exposed you need to quarantine or to homeless people do those things. Clearly providing shelter to the homeless population created unique challenges involved in stopping the spread of COVID 19. There were also concerns about how rapid spread in this population would impact local hospitals. levering describes how Las Vegas responded with a creative solution for the homeless population. So we built an isolation and quarantine center we nicknamed it the ISO cue. This facility was a has been listed as a best practice

across the country now, as a really amazing way to keep people isolated from each other and quarantine from each other in three different categories. We had the people we knew tested positive and were sick that we were monitoring. And then we had people had been exposed, and we were waiting on positive test results in remember early on those test results might take three or four or five days. And then we had people that really just needed to get off the street and be in a safe place where they may maybe weren't exposed or tested yet, but we were keeping an eye on them. Yeah, homeless people have a whole host of other medical concerns. So it's not just parking you somewhere and waiting for you to get sick and hoping you don't get so sick that you clog up the hospitals, but it's taking care of your diabetes, or asthma, your bronchitis, your all your other conditions that you have, while we keep you out of the hospitals and the homeless shelters. So that is probably the project I'm most proud of, in the early onset of COVID is the ISO key facility. It was capable of housing up to 500 people, we never had to have that many people there. I think at the peak, we were probably around 130 people at any one time. But the fact that it was in case we needed it, I believe, relieved a huge burden for our health care system. The hospitals in the area were very grateful to us for being able to have that kind of facility in place, so that they could take care of truly emergent patients. It really is great how all of the different agencies were able to come together to find the best possible methods of making sure that the community stayed healthy to some capacity or another. Then howling describes innovations University Medical Center to address the challenges of handling patient surges. Well, typically our ICUs are negative, we're able to convert those over, we had so many ICU patients at the time, we had to adjust and reconfigure some of our other intermediate care beds or some of our medical beds. So we were able to do that actually ventilate some of it out the window versus, you know, back through the air handling system. So you know, when you're we got seven storey tower, so we're able to create negative flow rooms do a lot more ventilation outside versus having a go through the hospital, then how lean highlights creativity by University Medical Center staff, just creativity with our staff, and I made it I saw patient beds in areas that I thought we would never use in the hospital just because we were in a surge capacity with with a number of patients that needed our help. We use our OB unit in a different way. We use our children's hospital in a different way. We put males up in our OB unit, I never thought that I would see that in healthcare. But we got creative and we needed the beds and deliveries were down actually, during COVID. Believe it or not our volumes on OB went down. So we were very creative, putting adults in the pediatric unit. Fortunately, through all of this, the COVID has not impacted the pediatric population as much as we thought it would. Leading up to our first patient. There were a lot of internal meetings on ensuring that we were all partnered with with the leadership of the Southern Nevada health district and in their infection control teams. UMC, we have our own employed infection control specialists, Dr. Assad and Dr. Medina. And so we were all coordinating on a couple of fronts making sure we have PPE, how do you treat those patients and obviously, we have negative pressure rooms that kind of keeps the air typically air blows outside and goes back out in the main corridor. We wanted to make sure that because this is a respiratory disease and spread by the air that we all had enough negative pressure room so we added another 30 negative pressure rooms here at UMC to be able to take care of those patients. Every now and then Howleen discuss challenges related to PPE. Everything at the beginning was PPE, masks, gloves, goggles, a brand's everything you can think of that you need to protect yourself from the virus if you are in the healthcare industry. So from the city's perspective, for the services we provide to the public, one of our biggest thing was making sure that our emergency medical personnel in our fire department who go into people's homes right and and perform CPR and perform all sorts of things out in the field. Our first goal is to make sure that they were safe to continue to do their job.

arms. And you're going back to that issue about supply chain and logistics. Learning that our country gets almost everything from China, when it comes to those kinds of supplies for health care,

again shows the vulnerabilities our country has let itself get to, by not being able to manufacture those things so readily. Luckily, we had some pretty innovative businesses that make other products that were able to retool their processes to continue to supply things like the the goggles and the face shields and the masks. We were lucky to find some vendors that were reliable a lot of vendors were tying up our purchase orders by making promises they had no intention of keeping, oh, sure you want 100,095 masks in three days, yeah, we'll get that to you. And then you'd get the get the PIO out to them, and it'd be backordered for three weeks,

or three months in some cases. So there were a lot of games being played by vendors. And so we had to really dig down to the root of what resources were reliable. And, and of course, everybody's calling up making the best offer ever. And when they come to you through a council Persons Office, or you know, somebody like that, you have to vet every single one of them. So that was one of the the biggest things our emergency operation center was doing was going through and vetting every vendor that came to our door to see if what they were bringing to us was legitimate, and, and then find the monetary resources to commit and make it happen. So early on, those were some of the biggest issues was the supplies to protect our medical health care providers. I think early on, as you recall, you know, a simple mask, we kind of take for granted, especially in healthcare, where it's just always on the shelf, and they're plentiful, and we can get them in two days.

You know, we've we had to get really ahead of that and as the word was demanding more PPE and sanitizers and other infection control measures. So I think our supply chain team here at UMC has really done yeoman's work on staying ahead of that, before it was just the PPE component. Now, it's everything else, whether it's catheters and tubing, things such as our food supply, some of the things that typically are plentiful are challenges. Now, I mentioned aluminum, obviously, UMC, we have a trauma center, we have a lot of crutches and those type of things. So you know, all those things that, that the world is struggling with, definitely impacts healthcare as well. And the time to get things where things were one to two days now it's two to three weeks to get those supplies so, but we've got a world class team here, especially in our supply chain does a great job at handling ads, the following about the University Medical Center supply chain team, and the Las Vegas responds to challenges posed by an over reliance on foreign source PPE and other essential goods, we spend a lot of time supporting them getting information, sourcing, whether a product is on backorder, or unlimited allocation. So we try to work those relationships and prioritizing here to Southern Nevada, if there are some longer lead times, we're stocking up, we at UMC have to offsite warehouses that we did not have before the pandemic, where we've been storing supplies and making sure that the providers at the bedside have the tools that they need. But you know, something as simple as a bedside procedural kid that may have five or six things that are already in a package. Some of those packages are not coming in now. So what we're trying to do is, if we can get certain components there will also source and allocate. So we're kind of piecing things together, where before, it was far more turnkey. So lead times are important. But we are also changing the way that we do business to,

you know, as far as some of the supplies that we're doing and finding alternatives. And it's it's across the board, whether it's pharmaceutical, bedside, equipment, resources, but also managing in the lead time. So it's it's literally every day, every hour that we're having to ensure that we have the tools to do our job. A lot of a lot of industries have relied on foreign producers for their supplies and equipment. And I think even early on just seeing some of the creative things that our own Nevadans were able to do, whether it's providing mask and shield protectors and other things that helped slow the spread of COVID COVID-19 here. It was just nice to see the industries change and shift their businesses

I was to meet some of the health and the demands that we were seeing in healthcare. You know, obviously, we like to do business local that that is one of our top of the list, if we can get it here locally, we want to support our friends and our neighbors here in Las Vegas. So I think you're gonna see a lot more shifting back to the US and hopefully that's packed in Nevada as well. You know, it's constantly trying to find alternatives and, and you've got to respond very quickly to so if we get a lead on a certain product, we try to move very quickly and not hold up anything that would slow down that product coming to UMC, but also getting enough of that supply to be able to make sure that we have it for the long haul. One final word from Van hauling on Las Vegas is evolution in treating patients with COVID 19. But we've evolved. And we tried a lot of different treatments, you know, everything from hydroxychloroquine, and remdesivir, and Regeneron. And now treating patients with monoclonal antibodies and

a monoclonal antibody, if you don't mind. Sure. So it's kind of a, it's a treatment that goes on kind of in the middle of early diagnosis of COVID. So it helps kind of infuse antibodies to give it an additional impact on protecting the immune system, the respiratory system, so it doesn't get overwhelmed. We quickly learned that patients that did get on ventilators was not the best course of treatment. So I think we learned a lot about high flow cannulas and proning a patient. So we've evolved over the last year and a half on how to treat patients and try to reduce the amount of deaths. Choosing a course of action based on the best information you have at the time. And then adapting and evolving as new information comes in is key to effective emergency and crisis response. Las Vegas, his initial response was to address the unknown aspects of the virus, treat those infected and prevent the spread of COVID 19. This required having a foundation of preparedness and having a high level of collaboration between stakeholders to develop creative and innovative solutions to overcome challenges posed by the pandemic. Next year, we'll hear how testing, rapid testing and administering vaccines became the road to recovery. Testing was a big thing early on, nobody really had the technology to test for COVID 19 in the state at the time, it was all being run out of the CDC. And we had to when we did test, those those swabs went to the CDC on the East Coast, unfortunately, because the world and the country was sending all their swabs to the CDC took a couple of weeks, they acknowledge that they got it and then a couple of weeks turn around for to see a patient was positive. And that certainly wasn't good enough at the time. So working with the state health labs, Southern Nevada health district and UMC that we set up a realize that we needed to have faster turnaround times that, you know, we needed to have 24 to 48 hour turnaround times on what we were what we were dealing with. So we can isolate patients, make sure that they weren't spreading to our staff, their families, but also other patients within the hospital and you know, just our testing, we converted an outpatient rehab, physical speech and occupational rehab area, because we were closed, and we did not want to bring patients in to the hospital that did not have COVID. So we reconverted this, this space into a UMC already has an amazing lab, one of the best in the country. And we converted a outpatient rehab space into a dedicated COVID lab. And our team got that up in less than 40 days of construction and ventilation and adding equipment to be able to provide 24 hour turnaround on COVID test. So we were doing a lot of the states lab to help district labs, our own patients, but other hospitals that were able to give diagnosis to so they can treat the patients a little quicker. So that was an amazing feat. Developing safe and effective vaccines in record time was a major challenge for the country. In this highly politicized environment we find ourselves in it is no surprise that COVID-19 vaccines have become a political football for many, with some calling for vaccine mandates and others seemingly refusing to get the vaccine on principle alone. This podcast doesn't take a position on either side of the issue. But it is presenting politics and the politicization of emergency and crisis management as a challenge for the Las Vegas response to COVID-19. When it became politicized in such a way that now it's not just a matter of public health, it's a matter of whether you're you're blue or red or green, or whatever your politics are. That's where it became very concerning to those of us in this field. The virus isn't

up political viruses, the virus and its job is to survive. And it will adapt and change just Darwin's theory, adapt or die. And this virus wants to live very much. It's distressing to me when people put politics into play, where the the greater good of public health can be addressed fairly easily if if people were willing to participate. And the larger the number of people unwilling to participate, the longer this is going to drag out, according to levering trust and receiving information from trusted sources has been a key component of increasing the number of vaccinated people in Las Vegas. The fact of the matter is more people who were reticent towards getting a vaccine. Those people who change their minds eventually, their mind was not changed by Dr. Fauci not changed by President fide and not changed by any of the big wigs you see on TV, their minds were changed at the grocery store, in the church, at community events, talking to their cousin, their brother, their sister, their parents, it became something that was more of a one on one, who do you know, are they credible? And at the end of the day, that's what it was was Who do you personally know that you feel is credible, that can explain to you why it's better than not to have the vaccine, then Hellene comments on the initial steps in deploying the COVID-19 vaccine in Las Vegas, then you go into December 14 of 2021. We, UMC was the first hospital receive the vaccine, and we were received it on a Monday morning, and within an hour and a half, two hours, we were already vaccinating our employees here at UMC. So soon as that approval and the shipment for the EUA approval came out, we were able to vaccinate so then, you know, you get late December, you're getting the community first responder going through the tiers of priority. And if you look at the population that's in the hospital, early last year, during the summer, and some of our peak volumes in July, and around Thanksgiving period, it was typically you know, older than 70 unvaccinated and with other health issues around their care. So whether it's diabetes, heart failure, respiratory issues, whose patients were impacted the most So, but our senior population really stepped up, got the vaccination.

And were able to get those vaccines out to the most vulnerable population. Then howling has the following to say about how creative thinking and strong relationships with the Las Vegas community and the private sector aided the overall Las Vegas vaccination effort, our vaccine efforts, you know, when we mentioned that we were the first hospital to get the vaccine. Once we got our staff done and Metro and fire. The team really wanted to keep going that we had good supply. The Health District invited us to continue to help so we kind of outgrew our space here at UMC and we partnered with Wynn Resorts who have been a great partner through all of this from from day one. The Wynn Resorts have provided their ballrooms were empty and Mr. Maddox and I had said, what else can we do together and let's let's open up the best vaccine site in the world and to be able to do that at the wind ballrooms overlooking the pool and so many happy customers, but we were close, we did close to 60,000 people over in the wind ruin Wynn Resorts and vaccination. So that was another can do attitude from our team. And we're very, very fortunate to have friends, such as the wind to be able to do that.

Any emergency manager will tell you how important it is to do an after action review, or a hot wash of the response and recovery efforts to a crisis. This is essential to identify the things that worked and the things that may become standard operating procedure going forward. It is also important to learn from missteps or things that didn't go quite as planned to grow and improve and preparedness and response efforts.

Some common themes echoed by levering and Van Halloween were the importance of being prepared and having done trainings prior to the pandemic relationships established pre pandemic which led to collaboration between various stakeholders, the need to address supply chain issues and the level of foreign sourcing of PPE and other important medical care supplies and the importance of COVID-19 vaccines and boosters. Because of efforts of individuals like Miss Lovering and Mr. Van howling Las Vegas is opening up as a sense of normalcy is returning in this post COVID 19

world. Yet challenges remain as COVID cases, hospitalizations and deaths will continue to occur in the foreseeable future. Much like the virus itself, leaders managing the COVID 19 pandemic must continue to adapt and rely on creative and innovative solutions. We would like to once again thank Carolyn levering and Mason, ven howling for their time and tireless efforts, which contributed to the success of the Las Vegas response to the COVID 19 pandemic. We would also like to thank the work of our group members who contributed to this episode automag Galera, Cecily Carnegie, Jennifer and Collado Kevin Hickey, and Mark mettalic. Auto editing was provided by Kevin curl.

Additional episodes exploring the impact of COVID-19 as well as many other topics related to emergency and crisis management, or on leading Las Vegas, a podcast produced by the emergency and crisis management program at the University of Nevada, Las Vegas.