Leading Las Vegas

5,146,112 That's the amount of deaths caused by COVID 19. At the time of this recording, there have been 348,819 confirmed COVID 19 cases in Clark County and 6121 deaths. When the pandemic first started, the world wouldn't have been able to predict the scale it would climb to. This is one of the top 10 deadliest pandemics in history. How could we have known how to respond to it? How could we have known how to prevent it? What measures could have been taken to mitigate the casualties? Welcome to this episode of leading Las Vegas, focused on the response of public health agencies in Southern Nevada. I'm Kelsey Terry,

and I'm Christina donathan.

And we will be your narrator's as we focus on the southern Nevada health districts response to the COVID 19 crisis.

The Southern Nevada Health District is a local public health authority in Clark County that serves and protects the health of 2.2 million residents 72% of Nevada's population, and 42 million visitors each year. Clark County consists of residents in Boulder City, Henderson, Las Vegas, North Las Vegas, and mesquite. In this episode, we had the opportunity to interview two professionals from the Southern Nevada Health District Office of Public Health Preparedness whose key functions are emergency preparedness. Our first guest is public health supervisor Misty Robinson.

I am currently the supervisor for the Office of Public Health Preparedness at the Southern Nevada Health District. I have a master's degree in political science, and I'm currently working on my PhD in public health at UNLV. My master's degree is from the University of North Texas. I'm from Texas, originally Dallas area. I've been working at the Health District for 15 years. Well, more than 15 years now and in the same department public health preparedness for the COVID response. I am serving as the Emergency Support Function aid, which is public health and medical and emergency medical services. That also includes the coroner and behavioral health. So I have been the coordinator for that at the multi agency coordination center for the county. And then also here I've been kind of a department operations center manager.

Our second guest on this episode is Southern Nevada health districts Office of Public preparedness management. Jeff Quinn. Yeah.

So Jeff Quinn, I'm the Manager of Public Health Preparedness here at Southern Nevada Health District. I've been in preparedness for about 20 years. My educational background is I have a bachelor's in microbiology from the University of New Mexico. Primarily my work associated with that after my my post grad was working in infectious disease research, laboratory type type setting. I've also worked in forensic toxicology, then went back to grad school and got a master's in public health in 2002. So with that, I transitioned and did a lot of environmental, environmental health type work, doing health validation, surveys with vulnerable populations down and Louisiana and really kind of transit transitioned after September 11 into public health preparedness. A lot of the federal funding at the federal level from NIH was transferred over to Homeland Security and other agencies so really necessitated the created public health preparedness Well, public health preparedness is not new, I mean, it has its origins back in the CCC back in, in the 50s Preparing for like the Cuban Missile Crisis and preparing families at home. That's a big part of our outreach with with natural disasters now is to prepare at the lowest possible level then work with the higher level agencies and then to be able to respond to threat so you know, my background is pretty diverse but it's it's it's led me pretty well. Into this I worked for the state of Nevada is their preparedness manager before coming down to Las Vegas here and I've been here in Las Vegas for about 13 years.

March 5 2020 was the day the Southern Nevada Health District reported the first positive Coronavirus case in Clark County, Nevada. From that day forward. The day to day operations in Las Vegas began to change drastically. The World Health Organization officially declared the Coronavirus as a pandemic on March 11 And the net Next day, Governor Steve sisolak declared Nevada in a state of emergency. The first COVID death occurred in mid March, causing a domino effect with schools, casinos and all non essential businesses closing, hospitals began using pop up tents and their emergency room parking lots to care for patients with COVID 19 symptoms. Governor sisolak announced hospitals in Nevada would not have enough ventilators necessary to fight the outbreak. By the end of March, Governor sisolak formed a COVID task force issued statewide moratoriums on evictions, limited indoor gatherings, and issued travel advisories for out of state visitors, requiring them to self quarantine for 14 days.

efforts have been made throughout the state in responding to the COVID 19 pandemic vaccine response with a targeted focus on Clark County. Clark County is considered 70% more vulnerable than other US counties. At the time of this recording 62% of Clark County residents have received at least one dose of the vaccine and 50% are fully vaccinated. The state has worked with the Southern Nevada health district to initiate mobile vaccine units and determine appropriate locations especially rural and urban areas, enabling and enrolling new providers in stalking and administering vaccines to their patients. continued use of the vaccine call center and text message program that promotes getting vaccinated and also reminds patients to receive the second dose of the vaccine, continuing developing partnerships with businesses to promote the campaign get out the vaccine. This allows for community organizations to recommend the vaccine to unvaccinated residents in Southern Nevada, the Nevada vaccine equity collaborative ensures Communication and Community Outreach is occurring throughout all regions, especially in southern Nevada to reach vaccine goal recommendations.

We ask public health leader Jeff Quinn, if the level of severity associated with COVID caught him by surprise. And if COVID would have been less impactful if the disease could have been mitigated early on.

I don't think that COVID necessarily caught us by surprise. When I talked about the biological threat. We work with other partner agencies to do a threat hazard identification and risk assessment for Southern Nevada or community to identify the top threats. We train and exercise and prepare to respond to these things through hyper hypothetical scenarios, or full scale exercises. This is all done prior to the the actual disease or threat impacting us. So really textbook, we were able to mount the response pretty quickly, I do believe it is kind of surprising how easily a COVID is transmitted. Even early on we had you know, we really didn't have a defense we had no vaccine yet developed, you know, the mask mandates and respirators, you know, do provide some level of protection. And that's what we kind of the mitigation measures we had to put in early on but in that you always have a percentage of the population that that will not be accepting of the measures that you're implementing. So with that, I thought that that and even to this day, it two years into this, you know, I'm surprised by by those that that don't want to be vaccinated that don't believe in getting tested. And really the challenges that we in communities across the country face right now are because of those personal choices.

Mask mandates early on provided a level of protection, but it may not have been enough to stop the hard hit it would have on the world, specifically Clark County.

Let's see what else Jeff has to say about mitigating the spread and impact of COVID earlier in the pandemic.

Do I think that we could have mitigated earlier? I don't think so. And really the reason I say that is really you look at the resources you have in the tools you have to combat the threat. I think with the amount of money that rolled out, I think the federal government at the federal level was very quick to recognize the potential threat and to back it with funding to get that money distributed out to states and local jurisdictions to be able to respond to this emergency. But the barriers are is our biggest limiting factor. You know, the timing of how long it takes to get COVID tests into a jurisdiction so that you can start implementing us it is never quick enough. We're always behind time is the biggest limiting factor that for anything. So on a national scale, even development of the COVID vaccine was it's miraculous really, you know when you compare it to see So flu and other vaccines, I don't think they rushed the vaccine per se, they, their urgency was to prepare the vaccine, but to do it in a safe as possible manner they did the clinical trials, there's always a gamble that you're that you're rushing vaccine. But I think with the amount of people that we vaccinated so far, it is a safe and effective vaccine for preventing COVID-19. So it doesn't prevent you from getting COVID. But it prevents the more severe outcomes and complications related to COVID, which is hospitalizations and deaths. So, in that sense, you know what, we're always behind the thing, we're waiting for the vaccine. And then when we got vaccine that was in the in the quantities we needed sufficient to provide it to even the priority groups that we had identified. But I think we did a very good job of working with the state and federal partners to identify priority groups who are most susceptible are most vulnerable to that and targeting those populations. First looking at our diverse populations that we have that have a greater proportionality of infection and serious complications and deaths related and then targeting those communities. And then the greater community as well. And, you know, it's just it's a huge challenge, but a lot of successes across the board.

Since Clark County is currently in an area deemed to be of substantial transmission levels, a masked mandate is still in effect, and individuals two years of age and older, vaccinated or unvaccinated must continue to wear masks and indoor settings. Substantial transmission means that there are 50 to 99 new cases per 100,000 people, or test positivity rates are between 8% and 9.99%. In the past seven days. According to the Centers for Disease Control. This is the metric that is used to determine mask requirements.

socio economic factors limited access to health care and health resources. Varied immune responses in public health funding, amongst others are all contributing factors leading to the higher rates of COVID 19 infections and deaths in Clark County. Many of the communities impacted the most have large minority populations and our medically underserved areas throughout the valley. The communities that had the highest rates of COVID-19 are North Las Vegas, central Las Vegas and Easton West Las Vegas. Testing for COVID-19 was not manageable for some low income residents. Many were drive through sites and needing a vehicle was a barrier. Access to testing did leader improve using targeted community testing in areas with high COVID-19 rates, with stores having limited quantities of essential items no cure or treatment for COVID-19 Insight, misinformation on social media hospitals at maximum capacity with limited health resources treat the sick, elective surgeries being canceled. Routine doctor's appointments being missed and holding off on other health concerns. Unemployment and overall the not knowing fueling the fears into Nevadans many services and health care appointments or virtual disc created barriers for those without access to internet services.

We asked public health leader Jeff Quinn, what he feels was the best action the Southern Nevada Health District took and the COVID-19 response in Clark County,

I think, you know, the best action that we've done is to get you know, once once resources become available to get them out to the public as quick as we could to allow access to diverse populations, thinking about the mobility issues, and then challenges I think, you know, we've gotten very good at being very creative in our planning and dealing with the barriers as as they present themselves. And you know, I think if you reflect back on our operations to this to this point, when you think about the convention center that we staffed to provide high throughput of the public, working with our community partners to work with, like RTC and busing systems to get to segments of our population to put them on the bus, bring them down to get them vaccinated and return has all been very, very effective, but very Novolin and creative as well. In house at the Health District, our informatics and and contact tracers and our Information Technology team really worked on the fly to create infrastructure systems to allow us to report results to the public so that they could go online and they could get those those results much quicker than requiring a physical person to actually call them and provide those results. All those things gave us time in the long run. But as a more effective way of information sharing that's gone on. But, you know, without COVID, we really and really pushing our staff to think outside the box could not have developed some of these resources and tools.

Many saw how much of a financial burden COVID-19 caused Nevadans were out of work. When all non essential businesses were shut down. For 10 weeks, the historic Las Vegas Strip was completely empty. And for a town that relies on the casinos, it was very concerning to see the effects of the shutdown. COVID also posed financial challenges to public agencies. For example, the Southern Nevada Health District took on added responsibilities to manage the pandemic, and promote as many resources to the community as possible. We asked Jeff and misty about the challenges their organization faced during COVID. And how grants for disaster relief funds were beneficial.

Yes, I, you know, I think to maintain continuity of operations early on in this pandemic, we had to look at what services have to be continued, as far as public health services that we provide, and then what others that we could put on the backburner to leverage those financial resources to be able to mount an effective response in the community, you know, it does come to down to dollars, especially, you know, with declining balances in the public health workforce in general, over the years through attrition, retirement, loss of train, public health workforce, you know, when this pandemic started, we were kind of behind, we didn't have enough resources and manpower to do what we needed to do to respond to. So I think with the, you know, the federal government, and states kicking down a lot of federal money, it allowed us to hire on more staff to train that staff, and to use them for the response. But as always, when the when the emergency goes away, the dollars go away. And then it really becomes a challenge for the district to either repurpose individuals that were hired under under federal grants, or to let those folks go, and then it gets into the balances the checks and balances of Do you have, you know, a workforce capable ready to respond to the next threat. And so, really, I, you know, the health district is, is has done a very good and we are very fortunate and beneficial to be the recipients of federal funds, that helps us, you know, cover some of those costs of mounting this response, just like I get back. From my perspective, when I look at an event COVID vaccination or testing event, I look at it in dollars and cents as well. And really, it's a challenge where it's like preparing for a party that that no one that ends up coming. So when when there's not very high demand or low participation by the public that we're providing those services for. It really kind of is is heartbreaking on your soul. So anyway, but yes, in the short term, you know, I think we're good in the long term, it's going to be some challenges.

Misty Robinson also talked about the role of grants and the challenges of relying on them.

We work off of a lot of grants. So we do have several grants now that are strictly COVID related, it's going to take some time to to know if those are going to continue for a while because we do expect Coronavirus to not go away completely, it's probably going to end up being like flew to where we're going to have to get like a an annual booster or something like that. In fact, I just got my booster today. So, you know, I think that this is going to be around for a while. And so we probably will continue to get funding for COVID for hopefully, a while, however, and long term, a lot of a lot of these grants, don't pay for everything. So it's gonna be a struggle to get back our emergency funds and things like that to you know, our because we do get paid through tax dollars too. But it is a very small amount. And so we did have a an emergency fund, we still do and it's for times like this where we need to pay vendors and things for to respond to the emergency. So it's going to take a long time to to get back that fund, as we are still responding to to the event. So I'm not sure what that budget is right now. This is just kind of speculation, but I know that the grants aren't gonna pay for some of these Things in some grants aren't you have a match, like the Stafford Act, you have a seven, the five, they'll pay for 75%. And you have to match 25%. So, and we've been spending, you know, millions and millions of dollars on on different things. So it's gonna come back to bite us in the, in the end here. So that's just my expectation.

It took courage for individuals to lead during the pandemic, when the insurgency and the unknown cause fear and disruptions throughout the world and more specifically in Southern Nevada. However, the product of this courage in some cases, were effective responses by leaders. We asked Missy, if there was one program she supervised that she felt was the most impactful during COVID-19.

So that is a complicated question, actually, because I, I wear many hats right now. So as a supervisor of my team of my program, I would say that my program, they probably are the most impactful because we're the ones who've been training for years and years training all of our employees to respond to something like this. So that's how our team what our, our entire health district was ready to respond to this event because they remembered such and such exercise where they did this. And so they they remembered those things that we taught them. But I also as ESF eight, I wasn't technically a supervisor, I was a coordinator, you know, so I kind of worked between county and between the health district. And to be honest, the health district as a whole, everybody has come, it's come together and worked hard, they've worked their butts off to kind of help, I can say that, to really do this service for the community. There are so many great people here, that there isn't really one group that can be identified that has done anything more impactful or less impactful than the other. And then also as ESF eight, all of the jurisdictions doing all of the work. It's just it's been an amazing year. It's probably not good to say this. But honestly, this, this isn't in public health emergency has brought us all together as a community. It's just been an amazing journey. I wish it didn't have to happen this way. And I wish it were done now. I'm ready for it to be over. But it's been it has been an amazing, amazing experience amazing learning experience for for all of us, I think. But yeah, it's it's hard. It is very complicated question to talk about, you know, one single program because it's just everybody has done their, their job so well. And we've worked so well together.

We also asked Jeff Quinn if there was a program that he supervised that he felt was the most impactful in the fight against COVID 19.

Well, I'm gonna armchair quarterback and say it's pretty much my staff within public health preparedness here. You know, we're kind of the Emergency Management arm of public health. And from day one, with monitoring emerging threats in the world. Las Vegas is, is a travel destination that's world recognized. And pretty much for a long term, we identified that biological threats are one of our top hazards for our area. And that the potential that anything circulating in the world, anywhere that's going on, has the ability to make it to Las Vegas. So we're always monitoring prior to the pandemic on emerging threats. And really looking at at Do we have the mitigation steps implemented necessary to either detect that case when it comes into Las Vegas. A person gets admitted to a hospital that, you know, is showing signs and symptoms of that particular particular disease agents that were notified and can be able to try to curb the spread of it before it really becomes a problem. But with that, you know, my staff is is pretty much integrated across the board. We've activated our incident command system. We're in, you know, I think our 92nd operational period for our response, and, you know, the fortitude and the strength of the staff that I have, is there still engaged like they were in the first week so it becomes a challenge with exhaustion and overload and overwork that Uh, I think the the challenge is, is for us to keep people motivated enough to continue to work so that we don't lose them through attrition, retirement, and other things. But I think my team is pretty, pretty well prepared in their training and expertise. And in the bigger picture of thing, see, the ultimate goal is to protect the population. So it's a big motivator to keep us going, and they've done an exceptional job.

We asked Misty to share a few key characteristics she thinks someone in her position would require,

I would say, diplomacy is one and knowing how to say no, without it being a negative. Yeah, I guess that goes along with diplomacy. But yeah, just understand trading, trying to understand where the other person is coming from, and what they're trying to get at what their actual need is, versus what they're telling you. Like, I've had one jurisdiction, who was not happy with me, when I told him that he was not going to be able to get vaccine right away, you know, just trying to explain to him why and, and in a way that would not offend him in a way that would continue to foster that relationship. So it's, you know, again, diplomacy, pretty much it.

In our interview with Jeff, we asked him what characteristics he feels makes for a great leader,

I think, you know, we have, everybody has the potential to be a strong leader, I think you, you really have to be a people person. And really, when I say people person, that's kind of a more general broad thing. But really, you have to have a be a people person that understands people, even outside of your comfort zone, outside of your class, you know, you have to be able to relate to people on multiple levels. And also, I think you have to have some, some, some empathy, as well. Listening is always is always a good quality, you know, and when I talked about having empathy, and some of the other things, those have really been tested during COVID. At some point, you know, when you're you're in the field for long hours, you're creatively thinking and how we can get more people tested, how we can provide services to the public, when, you know, we set up these large testing and vaccination sites and nobody comes kind of the soul crushing, you know, a part of that is, is to not just get discouraged in it and throw in the towel. I think, you know, a good leader who always has to come back to what the mission and objectives are. A strong leader needs to motivate staff to achieve that mission and those objectives. And give them the tools to do it, you know, words of encouragement to help people when they're feeling down. But also, you know, to look for individuals that really do need a break, and they need to step out and get out of the mind fraid of other response, and take time for themselves to be with their friends and family to recharge, re motivate. And that's a challenge that we really haven't had this this threat has been in our community for two years. And while we have ebbs and flows, we know that the potential for for us to get it back into high positivity. And to have people a medical surge event in our hospitals to have beds occupied. Our ICUs full is always the challenge but really a good leader can identify the strengths of themselves, their team members, and be able to organize them in the best possible way to still meet agency and mission objectives without really losing them.

In the midst of panic and fear, it took strong leaders to communicate effectively and navigate through the financial hardships and other obstacles that the pandemic has brought on since 2020.

It is important after a crisis that we learn from the leaders that paved the way for us throughout this pandemic to be better prepared in the future. Southern Nevada public health agencies have been responding to COVID 19 to reduce the impact of the virus and work to safeguard the health of the local community and facilitate tourists safely.

This podcast was produced by Christina donathan II and Imperial Jonathan King Kaplan and Kelsey Terry as a part of the emergency and crisis management master's program at the University of Nevada, Las Vegas. sound engineering was provided by Kevin Kroll we'd like to give a special thank you to our professor of leadership, innovation and adaptability class and executive producer, Dr. Joel Lieberman.

Please check out the other episodes of leading Las Vegas focused on the response to COVID and other important issues facing leaders today.