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With local authorities, County and Cities, collaboration with local first responders. Collaboration with private sector partners, county wide response partnership between public/private sectors.

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Strong Epi and Informatics teams. Used an application funded through ebola response dollars, repurposed for covid-19 epi surveillance. Able to use tools and develop tools in house. Disease surveillance - very experienced disease investigators.

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Employee dedication over 3 years was extraordinary. Must recognize the sacrifice to safety and mental health of all employees. Employees gave up vacation time to focus on fighting pandemic.

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Threats against personnel safety as part of a nation-wide trend to threaten public health personnel. In particular threats by anti-vax groups. Personal threats, safety measures had to be put in place to protect employees. LVMPD stepped up to provide additional security, with 2 officers and patrol cars present at all times.

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Challenge with keeping pace with PPE needs within SNHD and in the hospitals.

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Insufficient resources to combat the scale of this pandemic. Normal capabilities were not sufficient to address the pandemic at the beginning, or even today.

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Challenge keeping pace with evolving science, building trust with public officials keeping pace with public messaging. Regulations and scientific data, challenges with national coordination with ppe, masking, testing, dashboards lacking, and lack of consensus on methods for tracking/metrics. Data modernization was lacking, "information highway" was lacking. Funding should be applied to this to better prepare for next pandemic.

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Communication between state and local authorities. At start of pandemic, there was disconnect in effective communication. Was better over time, but was still not optimal throughout the response.

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Challenge with effectively using funding. Funding parameters were too specific, not flexible enough to be effective. CDC has made some positive strides in this regard, e.g. Covid-19 Disparity Grant. This also presented an opportunity in new NOFO's. Another example was ebola funding.

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Covers the largest population in Nevada, and has limited capacity to support entire community during pandemic situation.

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Opportunity to increase funding to expand capability and capacity to address infectious diseases and pandemics.

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Funding from the state would help to improve SNHD operations. Infrastructure and Workforce grant is temporary, and there is no supplement available to continue. State funding will be needed to maintain service levels absent the grant.

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Dedicated funding stream needed to meet the benchmark staffing of 1,000.

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Enhance communication between the State and local public health authorities.

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Opportunity to streamline and activate in a more timely fashion.

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Local health authorities and universities to enhance workforce development, education, training, MPH, Environmental Health, Lab Techs. Opportunity for local retention of students as work force.

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Incorporate school of public health in public health exercises.

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Working with philanthropic organizations to enhance SNHD programs. (e.g. wastewater surveillance project)
Nevada Health Equity Coalition, Nevada Immunization Coalition, HELP of SN, etc., MRC

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Volunteer programs are helpful, but it is difficult to plan for incorporating them, and to sustain volunteer participation.

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Difficult to replace retiring employees, or those who leave to join other fields of employment.

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"Infodemiology" - changes to laws, regulations, policies, procedures. Difficult to combat public health misinformation. Shift away from elected officials seen as lead in public health, not public health officials.