Las Vegas Sun

March 28, 2024

Reopening Las Vegas too soon risks more than a new wave of infection

Social Distancing at the Welcome to Las Vegas Sign

Steve Marcus

A sign at the Welcome to Las Vegas sign recommends social distancing to limit the spread of the coronavirus (COVID-19) on the Las Vegas Strip Friday, March 27, 2020.

Gov. Steve Sisolak has praised Nevadans for adhering to COVID-19 shutdown directives, but if control measures are reduced too soon, the disease will likely spread beyond control, said Brian Labus, an epidemiology expert at the UNLV School of Public Health.

“We could see an increased amount of cases or deaths; we could potentially overwhelm the hospitals,” he said.

Nevada has had fewer reported coronavirus cases and deaths than initial projections that forecast the virus would overrun a medical system lacking adequate intensive care unit beds and ventilators.

Health experts say there is no way of knowing if the declining rate of infections Nevada is experiencing will bounce back up if social distancing and other precautionary measures now in force don’t continue.

That’s why Sisolak still hasn’t announced a concrete date as to when so-called nonessential businesses would be allowed to reopen. He continues to maintain that the risk of lifting the shutdown isn’t worth the potential setbacks in containing the virus. The last thing anyone wants to have, Sisolak said this week, is to reopen the state only to have to shut it down again, which could bring even more harm to Nevada’s economy and health care infrastructure.

“Arguing that the curve is flattening and that we can immediately lift restrictions in one fell swoop is like arguing that the parachute has slowed our rate of descent so we can take it off now,” Sisolak said. “We cannot take off the parachute. Experience gleaned from other countries teaches us that we cannot flip a light switch and turn our lives and our economy back on too quickly. We still have a responsibility to protect people and to protect our economy.”

The only way to know for sure if the spread of the virus is truly slowing down is through expanded testing, which should happen as early as this weekend in Clark County, Labus said. Testing not only indicates the direction cases are heading, he said, but where Nevada is on the curve.

“Even though we’re potentially decreasing, if we’re still at the peak of that outbreak, it’s still too early to reopen,” he said. “When you hear the fire is contained, that’s not when you stop fighting the fire.”

Labus, who is part of the five-member statewide task force to help advise the governor on the scientific aspects of the COVID-19 pandemic, said current figures didn’t tell the whole story of where Nevada was on the curve. He also said there was delay between “when we do things” and “when we see the effects of our actions.”

“It takes up to two weeks for people to get sick, and then it takes time for them to get care and actually get tested,” he said. “The stuff we’re looking at now is based on the things we did three-plus weeks ago. Things have changed since then, and you have to make sure we’re on that path and it’s not just a few good days.”

The University of Washington’s Institute for Health Metrics and Evaluation study projected COVID-19 would kill around 240 Nevadans by August, which is down significantly from last month when it indicated that around 800 Nevadans would die. A Los Alamos National Laboratory model indicates that there is an 80% chance Nevada has reached its infectious peak. But these models assume current social distancing and mitigation measures will maintain past May 1, said Kyra Morgan, state biostatistician for the Department of Health and Human Services.

The Institute for Health Metrics and Evaluation estimates that after May 20 Nevada may be able to begin relaxing social distancing, with proper containment strategies in place, including testing, contact tracing, isolation and limiting gathering size.

Social distancing measures have severely cut the chances of widespread infection in Nevada, said State Epidemiologist Melissa Peek-Bullock. In a presentation Tuesday, she indicated that a positive coronavirus patient would potentially cause 406 people to be infected within a 30-day period. By limiting exposure by just 50%, that same person would cause 15 people to be infected within that same 30-day period.

Sisolak said the criteria for reopening businesses includes a downward trajectory of COVID-19 cases and hospitalizations over a 14-day period, maintained hospital capacity without crisis standards of care, a sustained ability to protect vulnerable populations in places like health facilities and nursing homes, and confirmed protective measures in places of business.

Most important, Nevada’s shift to test patients who display COVID-19 symptoms — not just those who are severely ill or hospitalized — will be key in understanding the situation in Nevada, Peek-Bullock said.

“Testing expansion is absolutely essential in early identification, the corresponding contact tracing and continued containment efforts,” she said.

Labus said there were likely to be variations in day-to-day numbers of confirmed cases, especially when testing is expanded, so a small movement up or down in case numbers doesn’t necessarily indicate where Nevada is on the curve.

Nevada’s infection rate is among the lowest in the country at just under 4,400 as of Friday, which is partly why some like Las Vegas Mayor Carolyn Goodman are calling on the governor to reopen the state, even suggesting that casinos reopen now. But Labus said the reason why Nevada and Las Vegas have so far been spared from much of the fatalities seen in other parts of the country was because they had more time to prepare than hot spots like Seattle and New York City.

“We had the benefit of looking at what those cities did and learning from them,” he said. “Seattle was seeing cases before anyone else was. New York was seeing spikes before anyone else. So we could take steps before those things happened here. The reason we’ve been treating ourselves the same way like New York or Seattle or any of those other places is we could very easily become those cities and we don’t want that to happen.”

While Nevadans should celebrate the lower number of cases and deaths, these results did not happen by chance, said Dr. Shadaba Asad, medical director of infectious disease at University Medical Center.

“This virus is not behaving any differently in Nevada as it is in any other state in the country,” she said. “We haven’t discovered any treatments that are effective against the virus and we don’t have a vaccine, so the reason we are seeing a lower number of deaths and cases is because of the (social distancing) measures in place. These measures, that seem so simple, so innocuous, are actually the ones resulting in these changes.”

State leaders also need to consider how the rest of the country is containing the virus when formulating a plan to reopen, particularly with Las Vegas relying so heavily on tourism, which before the pandemic, would increase the population by 20-25% daily with people from out of state, Labus said.

“We can’t think of Nevada as an isolated state,” he said. “People are going to cross back and forth one place to another, and our industry is dependent on other people coming from those other states. So even if we can do an amazing job of stopping every case of disease here, if people are coming to Nevada from a place that hasn’t done that, that presents a risk to us.”

When the state does reopen, it’s not going to be all at once, Asad said, adding that social distancing and hygiene measures and even wearing cloth masks will likely continue until there is a vaccine.

Resorts will be putting their reputation on the line once they do eventually reopen, said Stephen Miller, an economics professor at UNLV.

“It’s not in their interest to reopen and then close down again,” he said. “That will destroy confidence of tourists even coming here. “

Resort officials say they plan to adhere to any safety guidelines necessary. Those could include masks for casino dealers and the use of thermal cameras to detect patrons’ temperatures.

“I have been on calls almost daily with one of the country’s leading public health and pandemic preparedness experts, as well as various leaders in our medical community representing our hospitals,” Wynn Resorts CEO Matthew Maddox said in a memo published last week, “and they agree that an incremental reopening makes sense, and that science and data must lead us out of this in a safe fashion.”

Even with incremental reopenings, a full economic recovery by this year is increasingly unlikely, some economists say. It is more likely the country will see a “W-shaped” recovery, where the economy starts to look better, only to have a second downturn later in the year. This potential second downturn could be triggered if the economy is reopened too soon, causing another spike in deaths from the virus.

“Pretending the world will return to normal in three months or six months is just wrong,” Diane Swonk, chief economist at Grant Thornton, told the Washington Post on Wednesday. “The economy went into an ice age overnight. We’re in a deep freeze. As the economy thaws, we’ll see the damage done as well. Flooding will occur.”

Clark County Chairwoman Marilyn Kirkpatrick, whose board has jurisdiction over the Strip and the rest of unincorporated Clark County said that while the increase in testing would put the community in good standing to contain the virus, she was in no hurry to allow nonessential businesses to reopen too soon.

“We want to do this methodically and we want to ensure that we only have to do it once,” she said. “We are working with the state and have supported our governor 100%. It is our responsibility as the Clark County Commission to reopen the Las Vegas Strip and to ensure that we do that right.”