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Leadership Team information sharing, messaging with partners, within the district, with the public, and the media. FAQ sheets for call center, Environmental Health team coordination with resorts. Leadership very proactive in engaging community partners prior to first case (Feb 2020), community meetings (resorts, EM partners). Forward leaning in activating ICS.

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Staff were highly engaged in normal roles and roles outside their normal duties. Community partner coordination of testing, and ICS set up and participation. Financial, staffing, equipment, supplies actions.

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OPHP did an excellent job in preparedness and response activities, leadership in testing, vaccinations, etc.
Put PH "on the map" and raised awareness of the role of SNHD.
All divisions were involved and worked in concert (not siloed.)

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Clark County policy group and interactions with elected officials, multiple meetings per week, uniform messaging, coordinating actions of all jurisdictions, achieved and maintained consensus.

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Availability for ICS, help with overcoming challenges.

Work with Hospital Partners.

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Not adequately staffed to support community partners and to staff ICS positions in initial phases. CARES Act and other federal funds came through the county and CLV. Clark County and CLV had responsibility to pay for many of the response activities for which SNHD was responsible. Funds are nearing the end, and staff hired with those funds needs to be addressed.

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COOP Plan worked for the most part, but there were some gaps.

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Funding reimbursement was a challenge, many reporting requirements with little feedback.

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Process challenges in volume and timeliness.

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Issues with some staff being able to step up and be trained for ICS positions while also doing their normal jobs.

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Environmental Health - in early stages of pandemic, there were challenges trying to find out what the requirements were so local guidelines could be written for resorts, restaurants, etc.

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Long rotations in ICS positions, difficult to accomplish normal tasks in EH.

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Testing - private sector, UMC, etc. tracking and data sharing systems were not in place and were not effective. Difficulty with system interface and deciding roles for each lab facility.

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Very strong inspection team which kept pace with extra volume.

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Threat - Getting the public to comply with requirements for masking, social distancing, and other public health requirements was a constant challenge. Lots of criticism of SNHD and other agencies.

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Effective communication and updates from Senior Leadership to staff.

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Attention on SNHD and preparedness and response efforts.

Opportunity to capture the public's expectations and opportunity to partner and collaborate to address them.

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Significant pressure to perform from leaders at other levels forced SNHD to adapt and overcome significant challenges.

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Opportunity to use lessons learned and performance of past 2 years to maintain levels of funding for staffing and other resources in order to maintain highest level of staffing and resources for ongoing support of service levels.

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Fee adjustments implemented after Covid were well supported due to demonstrated need that emerged.
Keep in place guidelines, and be more proactive in developing guidelines for next major public health issues.
Contacts and relationships established during Covid can be built upon and maintained.

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Developed model for reaching hard to reach populations. Maintaining the model for future events.

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Implementation of 4-day work week, work/life balance improvements.
Telework policy was in place but working from home to the extent needed for Covid was not in place.

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Social distancing made access to all staff (all hands on deck) difficult. Non-essential staff were not available for activities they would normally be available to do (support for PODs, etc.)

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Hospitals, schools, resorts, etc.

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In an effort to support partners, were stretched to support extra meetings (e.g. school boards)

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Maintain new funding levels.

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Support for staffing, facility set up, etc. for Isolation and Quarantine activities - support for vulnerable populations (shelters) for homeless, Catholic Charities, Social Service, etc.
Challenge dealing with unpredictability, volume and timeframe to support those additional activities.

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Not enough time to implement, challenges securing contracts to support an activity, or outside help such as FEMA or CDC team, were not able to be implemented on time.

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In later stages and ongoing, difficult to keep people's attention to participate in public health measures.

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Resort closures - pressure and challenge to keep people safe while recognizing financial impacts.  Requirements were lifted too soon.

Misinformation - constant combatting of misinformation.

Physical threats to SNHD staff, throughout response and remaining today. Ongoing physical/security issues for staff.

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Difficulty achieving and maintaining proper security for staff. Additional security measures needed to be put in place. Challenges maintaining security and personal safety in public meetings.

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Retirements (loss of knowledge, skills and abilities of senior staff), staff retention.

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Higher pay in other fields, other facilities, resulted in loss of staff.

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Length of response, never practiced in an exercise, addressing staff burn out.

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HR policies - Covid vacation time assisted with burn out and morale.

Senior Leadership should take an active role in ensuring employee wellness.

Worked with VSRC, partnered with resort partnerships to achieve positive activities for staff.

Expand wellness support and access to services.

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Opportunity for public to recognize the positive aspects and hard work of SNHD employees.

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Ability to work with other division leaders and get to know them and their roles better.

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Having consistent leadership in both BCC Chair and SNHD Board Chair helped to support staff, ensure resources were made available, and to fend off misinformation and criticism. Also input into Governor's Task Force.

Good support from County Management for SNHD activities.

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Testing, vaccination locations.
Elected official support - food trucks
MRC recognition

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Excellent support for providing IT and Informatics - testing and vaccination scheduling
EPI testing/surveillance support, online monitoring app (used for ebola, measles and then Covid)

Testing and vaccine data collection

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System in place for covid response supported monkey pox response.

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Opportunity to focus on long term response and recovery in planning, training and exercise.