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Monica:
The School district (CCSD) leadership is what made a difference for them and there were a lot of comments, directions, and opinions and the work done by the leaders led them to where they are today.

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Monica:
They are still meeting as a cohesive group (Monthly) and they will continue to meet as they see an increase in cases. They have been more collaborate than in the past. It was essential that their workers continued to come because it provided a sense of calmness and it made it okay for people to come to work. They were able to provide food to the students throughout.
The proactive way the handled Behavioral and mental health.
Ryan:
The virtual environment and EOC was a best practice and will continue to be used.
Stacey:
The technological upgrades, from zoom to remote desktop connections. At the beginning it was difficult, but it has been much improved. The importance of having the 800 number call center, and we should have some sort of call center established that can be turned on whenever there is an emergency that the public can call when they have questions.

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Gregg:
They realized quickly that contact tracing and disease surveillance was difficult. The health district tried to supplement this effort. They want this to sustain in the future. The health district and the school of public health should continue partnering. Southern Nevada Health District is working on a grant which will find teams to deliver this kind of function.
Stacey:
The fire dept. did a fantastic job overseeing operations and so did the MACC. Sometimes they were not notified of operational changed until late because they were dealing with so many inquires and information requests. There could have been improvement in communication in that aspect. They did hold regular conference calls within the agencies, and they still share communication regularly.
Carolyn:
She strongly recommended a joint information center initially, but the Health district struggled, and they underestimated the complexity of the situation. If they had established this, then it would have made a difference in the beginning. The united message to the public is where there were challenges.

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Carolyn:
Level of coordination with state and emergency management. It rolled downhill to local agencies when the others were not working well early on. Agencies were struggling to procure PPE early on. When the state launched to a large database, the state did not coordinate the distribution with them. Her inbox was jammed with requests for PPE and it took resources on their part that they were not planning to allocate. This happened twice.
Monica:
The school district has its own regulation and there was a perception that it was easy to just hire a lot of people. There still is a huge shortage of nursing staff and understanding that while contract tracing may be easy at the health district, but in the school district, it is not a reality. They need people with a higher skillset and knowledge. It is so intricate that it is hard to get things working operationally as needed. When people began to listening to their needs, then they were able to move forward.

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Gregg:
As a state entity, they were impacted by the changing regulations coming from the Governors office and required them to transition from regular operations to a remote operations or hybrid operations which was significant on higher education.
Carolyn:
enormous pressure was placed on their communities because of what was happening in other parts of the country. Many people underestimated how important the school system is to the community at large, and the quantity of students that receive services on a daily basis. The fact that they did not have the ability to keep going placed pressure on their systems.

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Stacey:
Things were changing constantly and it was difficult to keep up with the changing situations. Messaging was changing constantly due to this being an evolving emergency and political challenges at the national level also complicated messaging.
There should have been an 800 number that the public could call, but it took a while to establish one and even longer one to accommodate other languages.
Ryan:
Every state and community declared a state of emergency. PPE needed to be distributed and there was not enough. They had to come up with creative ways to come up with PPE. Companies provides PPE even when they did not normally make them. They could not rely on the national or regional assets.
Will:
Staffing was a challenge early on. Trying to staff an EOC with their small community was difficult. It felt as though they were not where they should have been, but they had to make due with who they had. Rules were changing by the Governor daily which made it challenging. It did not seem as though there was enough time to implement the changes.

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Michael:
Boulder city EOC team included a diverse group of staff from different department. That diversity was a strength because it helped to have different perspectives and problem solving.
Carolyn:
City of Las Vegas strengths was the preplanning and the established relationships with the local public health provider that they could contribute to the longstanding established plans. Even as they were struggling to plan for the virus.
Gregg:
UNLV has the only school of public health in Nevada. It helped provide additional expertise where they were lacking in the beginning. When it came to the vaccination stage, the school of nursing played a huge role in operating the points of dispensing.
Monica:
Health services were able to leverage resources in terms of testing in the beginning, which evolved into the vaccinations. Clark County worked cohesively with other agencies with developing support. There were many agencies that supports the school district which allowed them to reopen as safely as possible.
Stacey:
The county is a great job steering its way through the pandemic. It was a challenging situation and they were able to set up testing and vaccination centers and community programs with both public and private sector partners. They did a great job working and collaborating with the health district.

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Dr. Leguen:
There is a lot of sharing through the pandemic. There are frequent meetings in their cross country organization about what works and what does not.
Strengthening their communication within the community. They have been working with representatives across many different communities (African American, Asian, Hispanic, etc). They spoke with people across all parts of the community, rather than just elected officials.
The MACC was beneficial for what they wanted to achieve because they wanted people that are recognized in the community, and they were able to freely respond to needs.
Virginia:
Communication was great throughout the process. Heads up about new regulations was beneficial in being able to get better response from the community.

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Dr. Leguen:
The issue with funding, the state of Nevada is at the bottom of local funding for health departments. There needs to be a sustainable increase of funding.
The location of federal funds to large population areas, they need to see a fair share.
They need to increase their lab diagnostic capacity and find the staffing to support that. and enhance their surveillance capability.
Virginia:
The evolution of the responce was amazing to watch, and as soon as things came up, the response team was there to deal with it.

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Dr. Leguen:
Staffing was a big issue from the very beginning for surveillance, contact tracing, lab workers, etc. Limitations for staff in regards to testing and vaccination sites.
Public Health programs have been paralyzed because of the pandemic because they had to reassign employees for pandemic effort and it has had huge implications across the org.
Being in a large metropolitan area, federal funds are assigned to the state rather than them. The issue of community response have been heavily influenced by politics. This limited their ability to reach the outcomes they desired.
Misty:
A lot of their programs, especially surveillance, have been hit by the pandemic and they have not been able to monitor other important diseases as well as they should be.
Fortunately, grantors have been involved in the response which helped them to meet their deliverables.
Up until now, they have staff completely focused on COVID, and there were many things places on the back burner that are only now being addressed.
Virginia:
It seemed like there was a lot of vaccines that were unused, and it seems as though hospitality workers should have been vaccinated earlier. IT was painful to watch and hear about vaccines not being able to be used by people.
Dr. Leguen:
Especially at the beginning, there a missed opportunity to vaccinate more people throughout Clark County. However that was not the way the plan was designed, they were not allowed to move into different parts of the community.

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Dr. Leguen:
The federal government has a strong influence on how they responded to the pandemic in the beginning because guidance was coming from CDC, FDA, etc. The State was also a huge influence because they took control of the response across Nevada.
There was originally an issue with hatred towards Asian Americans which required a lot of effort through community outreach to educate the community.

Misty:
Guidance was changing so quickly that everyone was unsure of what to do. Everyone was looking towards the health district for answers and they were unable to provide answers to the many questions. Since there was so much misinformation, that these external factors hindered the response and continues to hinder response. People at the MACC were looking towards them for answers and they did not fully have answers and they had to learn as they go and give their best guess.
Dr. Leguen:
Having a representative from official places was a different experience and they have benefitted from that experience. They helped them learn early about possible trends in the community.

Virginia:
The biggest external factor was the politicization as many people made up their minds quickly about how they were going to respond whether they would comply or not.

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Dr. Leguen:
Their initial challenge was with the changing definition of the virus. It made it more difficult for their Surveillance unit. Also, their lack of laboratory support at the beginning of the pandemic. Funding for these laboratories was not enough at the beginning of the pandemic. Lab personnel were experiencing burnout faster than other employees.
The limitations in regard of human resources and funding as their org. was not prepared for that. There was not enough staff to monitor how many people were admitted at the beginning of the pandemic. Also the lack of PPE, there was not enough for the hospitals in the area.
There was too much politicization of the pandemic leading to misconceptions within the community and people not following guidelines.
Employees had to be reeducated about the pandemic, and many more people had to work from home which they had to learn how to do as well.

Misty:
Dealing with people stuck on cruise ships and trying to get them home. They had to get people fed, as they had no food or toilet paper and could not leave their house. There was confusion about where requests for PPE needed to go at the beginning of the pandemic.(MACC Coordination)
All staff were going at full force at the beginning of the pandemic which caused burnout in many employees, and they were not able to get more staff in until the end of the year (December). Going through the processes and contracts was also an issue.
Virginia:
Communication was so important because guidelines were changing quickly, and there was a lack of resources which made it difficult to fulfil the changing requirements.

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Dr. Leguen
Health District: Org. has a long history of providing for the state. They keep close collaboration with local authorities.

They have strength in terms of surveillance, and there is a group of highly skilled individuals working in the unit. The Unit has been enhanced more recently. They work with the federal govt. and the CDC.

Misty:
Their biggest strength is their partnerships, within the community and the state.  Relationship with the counterterrorism center, and when the virus reached the US, they were prepared in advance to deal with the outbreak.

Virginia:
Resorts had 3 large international operators, and they had already seen what was occurring, which allowed them to make appropriate decisions regarding how to respond.
They did well at communicating with employees and guests regarding the pandemic. They were able to donate lots of food, and provide employee support and some properties continued to pay employees throughout the closure.
They hired experts to provide them with guidance on how to respond to the pandemic.