In the 10 months since COVID-19 was first diagnosed in the region, the daily statistics have numbed us to the personal toll it’s taken on patients and their loved ones. But for thousands of Northern Nevadans who headed to the front lines to care for their neighbors, the impact on individual patients is part of their daily lives. It’s why they’ve carried this community through to the turning point in the battle — caring not for statistics, but for human beings.
The region’s doctors, nurses, environmental services workers and medical staffers have long kept up the battle to keep the community healthy. To take on the novel coronavirus, they’ve been joined by members of the Nevada National Guard, who partnered with the Washoe County Health District to enhance community testing; by the electricians, HVAC technicians and tech support crews who converted a parking garage into a hospital ward; by the local manufacturers who began to produce ventilators, hand sanitizer and personal protective equipment; by the immunization experts poised to stop the spread of the virus in Nevada.
In gratitude for their ongoing effort, the Reno Gazette Journal has chosen those who are leading the fight against COVID-19 as the Citizens of the Year for 2020.
‘A lot of unknowns’
Just weeks after the first cases of COVID-19, the state called on the Nevada National Guard to lend their expertise in what would become the largest, lengthiest state activation in the Guard’s history.
“The guard trains year round for every crisis imaginable,” Gov. Steve Sisolak told reporters when he activated the Guard on April 1. “When the guard gets called in, you know you’re dealing with the best of the best.”
Reno’s Maj. Laurie MacAfee, a nurse in her civilian life, served as the deputy commander of the Nevada National Guard’s Task Force Medical Team.
“When it first started out, there were a lot of unknowns,” MacAfee told the RGJ. “None of us were sure what our role would be, or the magnitude of it.”
Friends of MacAfee’s in New York and New Jersey, also nurses, provided a harrowing preview of the virus’ toll.
“To be honest, it was the desperation in my friends’ voices — the deaths they were seeing, patients dying alone,” MacAfee said. “As nurses, we’re not used to allowing patients to die alone.”
She said she knew it wouldn’t be long before the virus had a similar impact in Nevada.
“I thought, if we don’t start mitigating and do our part, this is going to sweep right into the Western states. We’ve got to get ahead of it, we’re at an advantage and we have to start learning from them and take precautions from them.”
Guard members were tasked with transportation and logistics, as well as testing, contact tracing and other support operations. MacAfee joined the effort with local health districts, beginning with the Washoe County Health District, augmenting their efforts with the Guard’s resources. The same concept was used by the Guard at three sites in Clark County as well as dozens of mobile sites in rural Nevada and Tribal nations.
From a testing perspective, the rapid response has paid off. Out of the 2 million coronavirus tests in Nevada since the pandemic began, more than 1.2 million have been administered by the Nevada Guard.
MacAfee said she hopes our shared humanity doesn’t fall victim to COVID-19.
“We’ve got to continue to be kind to one another,” she said.
“I think that’s the No. 1 thing when you see your neighbors — it’s OK to talk to each other. Everyone wants to put their head down. Keep your heads up. We’re still humans; we need that interaction.”
For a strain of virus little known outside specialized circles, those on the front lines had a lot to learn in a very narrow window of time — the symptoms, how it spreads, how the public could best protect itself. Some initial recommendations, like covering the nose and mouth and washing hands, are still the golden rules of the COVID-19 era. Others, like scrubbing down groceries and wearing gloves to handle the mail, have fallen to the wayside.
“You do change your behavior as you learn a bit more,” said Dr. John Hess, a family medicine practitioner in Reno. “It’s just part of the scientific process. It means we’re smart; it means we’re learning.”
Medical offices put the same trial-and-error process into practice — leaning on telemedicine whenever possible to avoid intermingling patients and reducing the chance of asymptomatic spread. The COVID era means initial visits are taking place via Zoom, and waiting in the doctor’s lobby has been replaced with waiting in the car.
With the state’s contact tracers overwhelmed with new cases, Hess said doctors also have taken up the responsibility of instructing new COVID patients of how to proceed with their diagnoses, such as how long to quarantine, symptoms to watch for, and at what point to seek additional medical care. Of course, nothing has been subtracted from the previous workload.
“We’re still managing people with diabetes, heart disease, high blood pressure, cancer, all the other things,” Hess said. “COVID-19 is all on top of that.”
Outside of medical offices, local businesses learned to quickly adapt to the COVID-19 era. Distillers began to produce hand sanitizer. A game piece manufacturer deployed its 3D printers to produce protective medical equipment for front-line workers. A Reno-based ventilator company ramped up production to meet demand.
But the bottleneck remains at the human level. Hess said a lack of trained medical professionals is the most significant concern at the moment — for example, the Washoe County Health District has called for volunteers to assist with COVID-19 cases since before Thanksgiving. With hospitalizations and ICU bed use expected to skyrocket during and after the holiday season, the shortage will only become more acute.
“You can have all the ventilators in the world,” Hess said, “but if you don’t have people to operate them, they’re essentially useless.”
‘A time of renewed hope’
For Washoe County’s medical examiners and medicolegal death investigators, the so-called “last responders,” the coronavirus pandemic has been an extremely difficult time.
The staff’s daily meeting has grown from 15-30 minutes to more than an hour, according to Dr. Laura Knight, the chief medical examiner and coroner for the Washoe County Regional Medical Examiner’s office. Knight’s daily duties have included administration of the office, signing death certificates, performing autopsies and completing autopsy reports. In 2020, her role now includes assessing body storage capacity with funeral homes and hospitals, participating in pandemic briefings via Zoom, answering her staff’s questions about handling their own exposures and contacts, and watching for signs of staff burnout.
In addition to battling COVID, medical examiners also find themselves battling disinformation.
“I can tell you that it’s absolutely not true that only a small minority of the deaths attributed to COVID-19 are truly related to that disease,” Knight told Boston’s WBUR in November. “That’s simply not true.”
In 2019, just over 5,000 deaths were reported in the county. This year, the county expects that number to increase by nearly 1,000, Knight said. Much of that is due to coronavirus-related causes, but Knight said the county is also seeing increased drug-related deaths and homicides, something she attributes to pandemic-related stress.
“The gratitude I personally, and my staff as a whole, have received from our community during the pandemic has been very much appreciated,” Knight told the RGJ. “The little things really do count — from the family that was so grateful for the kindness of a death investigator that they sent pizza to the office, to kudos and gratitude from community leaders, and even the attention of national media to last responders’ plight in the pandemic — it all makes a difference and helps us to keep going.”
“As my staff and I receive our first doses of the vaccine,” Knight said, “it is a time of renewed hope looking forward, and gratitude. There is a long road ahead, but we can see the light at the end of the tunnel now.”
‘This is what we do’
In Nevada, a very significant hurdle remains: convincing Nevadans to receive the vaccine.
A USA TODAY/Suffolk University Poll in December found that 78% of Americans are willing to take a COVID-19 vaccine, either as soon as possible or after others have taken it. But Nevadans have proven to be more vaccine-averse. The Commonwealth Fund reported that in 2019, just 30% of adult Nevadans had all age-appropriate vaccines — the lowest rate in the United States, and well short of the 75% to 85% that experts say are needed to provide herd immunity.
Nevada’s immunization advocates say they’re up to the task.
“Looking at our team and our goal through this … I say, ‘This is what we’ve been training for. This is what we do,'” Heidi Parker, executive director of Immunize Nevada, told the RGJ. Her organization is working side by side with the state’s immunization program to provide outreach and communication about the vaccine.
The organization recently launched nvcovidfighter.org to provide information to businesses, health care providers and the general public about the latest vaccine developments.
“A lot of it will be helping Nevadans understand that if they want our economy to recover, our communities to be restored, to get back to some sense of normalcy — obviously that’s going to be a little bit of time — that’s the tool to get us there.”
While social distancing, facemasks and hygiene have helped hold the coronavirus at bay, it’s the vaccine that will push the state to long-term herd immunity in Nevada — and it’s how the state conquered smallpox, measles and other pandemics in the past.
Like others on the front lines in Nevada’s battle against COVID-19, Parker sees the arrival of vaccines in the state as a significant development, one that will make nearly a year’s worth of effort pay off.
“The last two weeks have been extremely hopeful and exciting, and it’s the good news that we all wanted to end 2020 on,” Parker said. “We’re hopeful that as long as we can get widespread vaccination happening, it should be the tool we need.”
Previous RGJ Citizen of the Year winners
Brett McGinness is the engagement editor for the Reno Gazette Journal. He’s also the writer of The Reno Memo — a free newsletter about news in the Biggest Little City. Subscribe to the newsletter right here. Consider supporting the Reno Gazette Journal, too.