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A
I
am
ready
to
go
good
afternoon.
Everyone
here
welcome
to
our
second
week
of
the
81st
session,
so
I'm
excited
we'll
go
ahead
and
get
started.
Madam
secretary,
may
you
will
you
please
take
roll.
D
B
F
B
A
I
am
here
and
for
the
record
I
didn't
know
if
I
heard
assemblyman
or
liquor,
but
I
see
him
on
the
screen
and
I
see
him
trying
to
do
it.
So
if
we
could
present
there,
we
go
thank
you
and
I
think
I'm
just
going
to
get
started
with
our
first
presenter.
I
know
that
they
have
been
very
flexible,
given
the
fact
that
we
had
to
square
in
our
newest
member
into
our
body
today
this
afternoon.
So,
like
I
had
said
before
last
week,
we
are
going
to
do.
A
Oh,
I
can't
believe
I'm
saying
this
a
deeper
dive
into
some
of
these,
like
state
agencies
that
are
here
so
if
we
can
go
ahead
and
turn
that
over
broadcast
to
the
division
of
public
and
behavioral
health
in
the
department
of
health
and
human
services,.
D
Okay
hi
good
morning,
my
name
good
afternoon,
my
name
is
lisa
sharik,
I'm
the
administrator
for
the
division
of
public
and
behavioral
health
here
with
me
today,
is
julia
pink
slowly
coming
into
the
screen.
Deputy
administrator
for
community
health
services,
also
with
with
me
today,
is
miss
nikki,
aker
director
for
carson
city,
health
and
human
services.
Behind
me,
mr
kevin
dick
county
health
officer
for
washoe,
county
health
district
and
dr
furman
leguin,
county
health
officer
for
southern
nevada,
health
district
and
we'll
share
our.
A
And
I
think
you
need
to
put
it
in.
I
think
the
full
screen
view.
G
B
Hello,
this
is
broadcast.
We
are
only
able
to
see
it
in
the
editing
view
if
you
could
either
go
up
to
the
top
and
do
from
the
beginning
or
when
you
are
opening
the
screen
share
option
itself.
You
want
to
go
and
click
specifically
on
the
application.
When
you
open
the
zoom
screen
share
and
not
the
monitor
that
it's
on.
B
B
B
A
A
I
don't
have
well
enough
eyesight
to
be
able
to
read
those
small
little
screens,
but
if
you
would,
you
could
follow
around
committee
members
if
we're
not
able
to
do
that
and
then
again,
this
is
also
available
on
nellis.
If
you
want
to
further
review
some
of
these
slides
that
are
presented.
D
Okay,
are
you
able
to
see
that
now
I
I
truly
apologize.
We
can
see.
D
Okay,
moving
to
slide
two:
this
are
you
able
to
see
me.
I
feel
like
I'm
not
on
video
either.
A
D
Sure,
okay,
so
good
afternoon,
my
name
is
lisa
sharik,
I'm
the
administrator
for
the
division
of
public
and
behavioral
health.
Here
with
me
today
is
julia
peake,
deputy
administrator
for
community
health
services,
along
with
miss
nikki
aker,
who's
directly.
Behind
me,
director
for
carson
health
and
human
services,
mr
kevin
dick
county
health
officer
from
washoe
county
health,
district
who's
online
and
dr
furman
leguin
who's
also
online
and
who's
the
county
health
officer
for
southern
nevada
health
district
moving
to
slide
two.
This
provides
an
overview
of
our
division's
vision
and
mission
slide.
D
Slide.
4
provides
an
overview
of
our
agency's
operations.
As
you
can
see,
we
are
comprised
of
five
service
branches,
community
health,
regulatory
and
planning
clinical
behavioral
health
policy
and
administrative
services
slide.
Five
and
six
provide
an
overview
overview
of
our
public
health
programs.
D
Slide
seven
through
nine
provides
an
overview
of
our
division's
accomplishments.
Of
note,
I'm
particularly
proud
of
the
work.
The
division
of
public
and
behavioral
health
has
continued
to
do
related
to
addressing
covet
19
spread
within
nevada's
license
facilities
compared
to
the
national
average
of
the
percentage
of
deaths
and
facilities
as
it
compares
to
total
deaths.
Nevada
has
consistently
been
under
25
percent,
whereas
the
approximate
national
average
is
40
with
some
states
as
high
as
80
percent.
D
Additionally,
nevada
has
been
under
20
percent
since
august
and
as
of
today,
we
are
at
15.8
percent
and
for
anyone
who
had
an
opportunity
to
watch
our
pre-session
hearing,
that's
1.5
lower
than
that
presentation.
A
couple
weeks
ago
slide
10
provides
information
of
our
division's
public
health
priorities,
and
with
that
I
will
turn
it
over
to
julia
peake,
who
will
provide
an
overview
of
the
rest
of
our
presentation
for
the
division
of
public
and
behavioral
health.
C
Perfect,
this
is
julia
peek,
with
the
nevada
division
of
public
and
behavioral
health.
Thank
you
chair
for
allowing
us
to
talk
on
public
health.
Today,
I'm
going
to
do
an
overview
of
public
health,
so
I'll
be
taking
the
next
many
slides
to
talk
about
public
health,
and
I
would
start
off
by
saying
one
of
the
easiest
ways
to
understand.
Public
health
is
to
understand
the
historical
accomplishments
in
the
field.
C
C
C
C
C
This
next
slide
is
a
model
that
we
used,
often
in
in
public
health
and-
and
we
really
can
speak
about
the
issue
as
it
relates
to
this.
It's
called
the
social
ecological
model,
and
it
helps
us
understand
the
many
levels
of
an
issue,
especially
as
it
relates
to
population
or
public
health,
so
this
model
starts
locally,
for
example,
with
the
individual
and
then
their
peers
and
family,
and
then
evolves
to
the
highest
level,
which
is
the
influence
of
policy.
C
This
model
helps
us
understand,
which
level
or
level
impacts
the
health
issue,
so
we
can
develop
specific
interventions
at
each
of
those
levels.
The
next
slide
shows
an
example.
There's
many
examples.
I
thought
this
one
was
particularly
easy
to
look
at
it's
related
to
childhood
obesity,
and
it's
just
a
good
illustration.
So,
for
example,
with
childhood
obesity,
we
look
at
the
child
themselves.
Their
personal
demographics
are
a
primary
factor
in
their
weight,
but
also
their
parents
weight
food
preferences
in
the
home
at
the
policy
level.
C
In
this
same
scenario,
this
is
where
the
larger
population
efforts
occur
around
childhood
obesity,
so,
for
example,
related
to
obesity,
seeing
nutritional
details
on
food
items
or
on
restaurant
menus.
Those
are
all
things
that
affect
healthy
eating
and
obesity.
Also,
the
taxing
of
certain
items
can
change
behavior
and
those
are
all
policy
opportunities,
as
we
look
at
obesity
and
healthy
living
going
on,
I'd
be
remiss
if
I
didn't
speak
about
the
amazing
universities
in
our
state,
specifically
but
nationwide
as
well.
C
So
there's
great
diversity
in
the
field
of
public
health
and
what
you're
seeing
in
front
of
you
is
a
list
of
the
specialties
or
core
competencies
that
our
public
health
professionals
can
focus
on
and
truly
this
is
a
holistic
approach
to
addressing
public
health
and
and
again,
I
just
want
to
acknowledge
our
universities
in
the
state
who
have
been
such
a
pivotal
part
of
our
response
to
covet
in
this
state
going
on.
I
know
this
is
a
lot
of
words,
but
I'm
just
going
to
provide
a
highlight,
and
I
also
provided
a
link.
C
Public
health,
like
all
topics,
evolves
over
time.
We
are
in
a
period
of
time
that
is
coined
public
health
3.0,
where
public
health
professionals
a
century
ago
may
have
focused
on
very
granular
outbreaks
or
a
crisis.
Now
we
function
more
as
strategists
to
pull
partners
together
to
look
at
inequities
and
opportunities
for
intervention
again,
a
really
good
illustration
provided
by
the
cdc-
and
we
often
get
asked
in
public
health,
about
our
relationship
with
healthcare.
C
It
truly
is
a
partnership
where
healthcare
focuses
on
the
health
of
the
patient
in
front
of
them,
and
we
focus
on
how
all
the
patients
together
become
population
health
and
the
health
status
of
the
collective
group
and
how
to
intervene
more
on
public
health
3.0.
As
I
mentioned,
public
health
is
in
constant
evolution
with
public
health
3.0.
We
focus
much
more
on
collective
impact
and
reaching
our
residents
where
they
are.
We
also
understand
more
and
focus
on
social
determinants
of
health
that
lead
to
a
particular
health
outcome.
C
You'll
hear
a
person's
zip
code
is
often
more
a
reflection
of
their
health
than
their
genetic
code
and
that's
some
of
the
things
we
look
at
as
we
delve
into
public
health
data,
and
so,
for
example,
you
may
have
health
insurance
due
to
affordable
health
care,
but
you
might
not
be
getting
preventative
screening,
even
though
it's
an
allowable
service,
so
in
public
health
we
try
to
understand
why
that's
occurring.
What
is
the
barrier
if
it's
no
longer
health
insurance,
and
how
can
we
help
address
address
that?
C
C
The
bulk
of
our
population,
as
you
know,
is
served
by
a
district
health
department,
but
the
state
still
provides
direct,
provides
direct
service
in
many
counties
and
we've
also
delegated
some
authority
for,
for
example,
carson
city,
health
and
human
services
going
to
the
next
slide.
The
structure
and
function
of
public
health
are
in
several
statutes,
but
I
will
highlight
just
two
and
those
are
found
in
nrs,
439
and
nrs441a.
C
These
have
been
of
particular
interest
over
the
covid
response,
but
again,
there's
many
you'll
hear
later
from
our
two
district
health
departments
who
function
largely
as
independent
health
agencies,
as
well
as
carson
city,
health
and
human
services,
who
operates
as
a
regional
health
department
under
delegation
of
authority.
That's
allowed
in
that
law.
C
C
It's
representative
of
the
county,
commissioners,
the
sheriff
and
a
health
officer,
and
we
work
a
great
deal
with
the
health
officer.
That's
designated
one
of
the
challenges
that
we
we
had
as
it
relates
to
covet.
Is
there
were
every
rural
county
looked
different
in
some
rural
counties?
They
had
a
very
functional
board
of
health
that
was
meeting
on
a
regular
basis
and
tackling
population
health
issues
locally.
C
C
That
said,
the
counties
have
moved
mountains
in
this
regard,
and
so
now
I
think
that
functional
necessity
of
a
public
health
system
at
the
county
level
is
is
incredible,
so
I
do
just
want
to
acknowledge
all
the
efforts
there
they've
really
stepped
up.
The
next
slide
is
a
very
short
list
of
what
we've
learned.
I
could
certainly
talk
much
more
on
this,
but
so
too
can
our
public
health
partners
that
will
be
coming
up
later.
What
we
found
is
in
public
health,
as
I
mentioned
with
that
easter
egg
diagram.
C
We
have
such
a
variety
of
partners
that
we
work
with
when
we
address
a
specific
issue,
but
one
of
the
challenges
here
is
we
we
had
to
become
the
convener
in
many
cases
and
not
the
doer,
and
we
had
to
work
with
our
again.
Our
counties
and
county
leadership,
but
specifically
emergency
management
and
that
group
of
people
locally,
including
our
national
guard
and
department
of
emergency
management
at
the
statewide
level,
has
really
helped
with
the
logistics
and
to
operationalize
these
incredible
public
health
interventions.
C
We
also
clearly
identified
a
need
for
flexible
funding
to
support
a
public
health
crisis
in
real
time
and
support
basic
infrastructure.
As
you
know,
our
federal
partners
did
come
come
through
with
funding
for
epidemiology
and
labor
capacity,
immunization,
public
health,
preparedness
and
other
items,
but
we
did
function
with
what
we
had
for
several
months
in
the
beginning.
C
We
also
don't
have
the
ability,
really,
with
the
exception
of
covet
funding,
to
address
the
need
locally.
We
have
many
public
health
crises
and
often
you'll
see
nevada
at
the
low
end
of
a
good
list,
because
we
don't
have
basic
infrastructure
funding.
I
also
talked
about
decentralization
of
public
health.
I
again
can't
speak
highly
enough
of
how
our
specifically
rural
and
frontier
counties
stepped
up
when
they
had
no
infrastructure
prior
and
accepted
delegation
of
authority
from
our
chief
medical
officer.
C
C
C
We
skimp
ourselves
at
the
division
on
things
such
as
human
resources,
support,
I.t
infrastructure,
support,
fiscal
support,
because
the
need
for
direct
service
and
and
our
county
need
is
so
great.
But
that
creates
a
huge
challenge
for
us
and
that
even
with
covid,
we
received
430
million
dollars
for
the
response,
but
us
at
the
division.
C
C
I
believe
our
lab
reporting
went
up
8
000
times
what
we
were
used
to
and
and
it
really
crippled
our
system.
We
were
functioning
largely
in
some
cases
on
faxed
reports
and
that
quickly
became
unmanageable.
So
we've
had
to
develop
use
some
of
this
funding.
Luckily
to
develop
things
within
our
public
health
infrastructure.
That
will
will
impact
us
for
all
diseases
going
forward.
C
The
other
major
challenge
that
we
had
is
the
expectation
that
we
could
release
data
in
a
day
and
related
to
public
health.
It's
typically
not
real
time
surveillance,
and
so
we
were.
We
were
really
challenged
with
hiv
data,
for
example,
we
take
a
year
and
a
half
to
clean
it
before
we
release
it
and
make
sure
it's
absolutely
the
most
accurate
record
on
file.
So
those
are
things
that
that
were
reasonable
expectations
of
of
our
community
and
and
of
people
who
needed
that
information.
C
C
I
had
to
get
a
slide
in
there
just
to
speak
about
this.
A
little
each
biennium
will
re-report
on
where
we
are
nationally
with
public
health
spending,
and
so,
according
to
the
american
health
care
rankings,
they
say
we're
the
least
healthy
state.
As
far
as
public
health
funding
alaska
was
the
best
at
289
per
capita
and
we're
at
50
per
capita.
That
said,
we
have
had
investments
in
the
past
several
years,
related
to
family
planning,
women's
health
connection
and
other
services.
So
we
have.
C
We
have
done
things
in
the
past
biennials,
but
we
are
still
much
further
behind
than
many
other
states.
One
report
shows
that
an
investment
of
ten
dollars
per
person
in
evidence-based
programs
can
save
the
country,
as
you
see
here,
16
billion
annually
within
five
years,
and
one
of
the
important
points
is
who
benefits
most
from
public
health.
It
is
those
children
and
infants,
under-resourced
communities.
C
A
huge
ask
of
us
is
to
identify
inequity
and
disparities
and
offer
suggestions
as
to
how
we
can
intervene
and
ensure
that
that
is
removed.
That
concludes
our
presentation
at
division
of
public
and
behavioral
health.
I'm
happy
to
take
questions
with
lisa
or
I
can
turn
it
over
to
nikki
aker,
who
serves
as
the
director
of
carson
city,
health
and
human
services.
A
I
think
they
have
a
couple
of
questions
and,
if
that's
okay,
you
know
some
of
those
numbers
were
really
quite
impressive,
especially
in
light
of
the
fact
that
you
said
that
you
were
talking
about
how
your
I.t
started
off
with
faxed
reports,
and
I
was
half
expecting
carbon
paper
and
typewriters,
although
I'm
sure
they
also
exist
within
the
division
as
well.
So
I
I
did
want
to
point
out
that
make
a
point
of
you
know
highlighting
when
our
state
is
a
leader.
A
Nationally,
specifically,
you
had
talked
about
how
our
numbers
were
about
half
in
those
long-term
care
facilities.
I
think
you
said
nationally.
It
was
about
20
and
our
40
and
we
were
at
about
20,
and
that
was
even
lower
more
recently.
But
can
you
maybe
highlight
what
it
is
that
we
are
doing
right
and
are
we
sharing
those
best
practice
manage
management
practices
with
other
state
agencies
and
other
regulatory
responders.
D
Right,
lisa
sherick
for
the
record.
Yes,
so
what
we
did
early
on
was
create
essentially
strike
teams,
and
you
know
we
have
always
had
our
office
of
public
health
and
invest
investigation,
epidemiology.
We
call
ophi,
we
also
have
our
health
acquired
infection
team
and
then
our
healthcare
quality
and
compliance
team,
and
so
early
on.
D
We
made
a
concerted
effort
to
make
sure
that
those
three
teams
were
working
very
closely
together,
along
with
the
facilities
to
identify
infection,
control
issues,
provide
a
lot
of
technical
assistance
really
coming
from
the
angle
of
improving
rather
than
punitive,
and
so
we
have
done
work
with
also
the
department
of
corrections.
D
D
I
don't
particularly
have
any
information
as
far
as
what
we've
done
to
share
with
other
states,
but
I
can
check
and
follow
up
and
provide
that
information
later
sure.
C
If
I
might,
I
just
lisa,
mentioned
the
health
facility,
epidemiology
team.
That
is
something
that's
unique
to
nevada
and
I'll
just
say.
We
we
learn
from
our
crises
in
public
health
and
we
developed
that
team
as
a
result
of
a
hepatitis
c
outbreak
in
clark,
county
and
and
we
knew
that
we
had
to
have
a
basically
a
strike
team
that
could
intervene
immediately,
and
so
we
had
those
relationships
and
structure
built
prior
to
covet,
and
so
we
were
able
to
come
in
and
just
make
minor
modifications
to
that.
C
Other
states
who
had
not
worked
so
directly
with
epidemiology
and
healthcare-associated
infections
had
to
build
that
from
scratch,
and
so
that's
something
we
are
really
proud
of.
The
other
thing
again,
we
learned
from
crisis
is
that,
as
a
result
of
povid,
we
were
on
separate
reporting
systems
at
the
districts
and
the
state
and
we're
all
going
to
move
to
the
same
infectious
disease
reporting
system
so
that
we
have
a
standardized
way
to
collect
data.
C
So
so
we're
learning
a
lot
and
again
making
really
foundational
public
health
improvements
and
where
we
do
have
the
opportunity
to
share
with
what
we're
doing
in
other
states,
I'll
just
I'll
just
note
for
pivot,
19
vaccination,
we
have
the
highest
administration
rates
in
our
region
and
we're
often
on
calls
with
our
regional
partners
where
we
talk
through
what
we're
doing
offer
suggestions
of
what's
working
and
what's
not
so
in
that
in
that
ways,
with
this
crisis
we
are,
we
are
a
leader
in
the
region.
A
B
Armstrong
you
very
much
chair
nguyen
and
thank
you
so
much
miss
eric
and
this
people
for
your
presentation,
the
one
I
have
just
a
couple
quick
questions:
are
you
collecting
demographic
information
on
the
covet
rates
and
how
do
how
is
nevada,
looking
comparatively
to
the
national
rates
of
cobit
infection
and
deaths
in
the
black
and
brown
communities
in
our
state?
B
I
hope
that
we
are
collecting
that
data
and
that
you
can
report
that
information.
Thank
you
very
much.
C
Sorry,
julia
peek
for
the
record.
Thank
you
for
the
question.
We
are
collecting
information
on
race,
ethnicity.
We
also
are
one
of
the
only
states
that
added
questions
related
to
lgbtqi
issues.
Again,
we
don't
know
a
disparity
until
we
look
at
the
data
and
see
if
there's
truly
a
disparity
in
a
number
of
areas,
I
think
we're
pretty
standard,
I'm
happy
to
pull
that
data
for
you
directly
not
to
air
some
dirty
laundry,
but
I'll
explain
some
of
the
challenges
with
public
health
data.
C
In
this
capacity
we
get
that
data
from
lab
reports.
So
the
cases
you
see
on
the
nb
health
response
dashboard
is
often
because
you
needed
it
in
such
real
time
to
to
see
what's
happening
with
the
disease
burden.
Lab
reports,
though,
required
by
our
federal
partners.
Now
often
don't
have
race,
ethnicity,
and
so
we
were
going
off
a
lot
of
data,
that's
unknown
and
trying
to
do
the
investigation
of
those
cases,
so
we
could
get
that
added.
So
it
is
a
huge
effort
and
lift.
C
C
Some
of
the
challenges
that
we
do
experience
with
that
equity
is
that
that's
self-reported
by
the
individual,
and
sometimes
they
may
feel
uncomfortable
sharing
that
so
we
have
to
communicate
really
effectively
about
why
we
collect
that
data,
how
we're
going
to
use
that
data
so
we're
doing
a
lot
of
effort
in
that
regard
right
now,
but
across
the
board
nevada's
trying
to
be
as
progressive
as
possible
in
asking
as
many
questions
across
all
diseases,
in
the
hopes
that
we
can
find
inequity
and
then
address
them,
race,
ethnicity
and
otherwise.
B
I
was
just
going
to
ask
miss
peak
if
you
can
tell
me
as
a
representative
for
my
community.
B
What
can
those
of
us
who
are
elected
officials
do
to
help
improve
the
confidence
in
our
communities
for
them
to
report
this
data
to
you
so
that
you
can
have
better
data
to
to
to
report
and
to
collect?
What
can
we
do
to
help.
C
Yeah,
thank
you
so
much
and
thank
you
chair
for
letting
me
respond
to
that
question.
You
truly
are
the
champions
in
the
community,
and
so
what
you
say
will
be
heard.
I
think
the
effort
needs
to
be
on
our
part
in
public
health
to
get
you
the
talking
points
and
information.
You
need
to
then
go
champion
that
back
to
your
community,
so
I'll.
C
Take
that
away
as
well
and
send
information
out
to
you
all
as
to
specifically
around
vaccination,
but
the
importance
of
in
any
disease
and
investigation,
providing
that
to
the
public
health
partners
and
understanding
that
that's
confidential.
But
it's
used
by
us
to
bring
resources
that
to
the
community
and
identify
if
there
is
disparity.
So
I'm
I'm
happy
to
take
that
out
and
get
you
all.
E
E
It's
challenging
without
a
pandemic,
let
alone
what
you've
had
to
put
up
with
this
last
year,
and
we
have
communicated
many
times,
and
I
appreciate
that
recently
in
the
news
there's
been
some
pretty
big
information
about
the
disparity
and
actual
the
vaccine
and
who
have
received
the
vaccine,
and
I
know
that
you
have
heard
me
ask
this
question
before
in
the
money
committees,
when
we
talk
about
receiving
covert
funds
and
where
they're
going
and
making
sure
we
have
that
outreach.
E
As
our
my
colleague
assemblywoman
summers
on
armstrong
asked
about,
you
know:
how
do
you
get
it
out
to
the
folks
get
them
gaining
trust?
I
know
that
our
attorney
general
made
a
big
point
when
he
got
his
vaccine
because
he
wanted
the
communities
to
be
reassured
that
it's
okay
to
get
that
vaccine,
as
we
know,
there's
a
huge
amount
of
distrust
in
the
process
and,
frankly,
rightfully
so.
E
My
concern
is
that,
with
these
numbers
that
have
come
out,
it
was
that
again
there's
a
significant
disparity
about
who
has
gotten
this
vaccine
and
I'm
wondering
if
it
wasn't,
because
you
were
following
the
governor's
office
when
they
talked
about
the
different
lanes
and
the
different
tiers
that
can
you
describe.
Maybe
perhaps
that
that's
where
the
tears
fell,
that
there
was
the
first
responders
and
then
the
and
then
the
people
over
70
and
the
second
tier
and
some
of
those
criteria.
So
I
just
kind
of
wondered:
wonder
it
may
it.
E
I
know
it's
a
touchy
subject,
but
it
needs
to
be
asked
that
how
was
was
it
decided
to
give
those
those
vaccinations?
Because
I
think
you
just
need
some
clarity
that
again,
you
were
just
following
the
tears
that
were
put
out
there
as
a
direction
and
and
has
that
changed
it
all.
Now
that
we
know
that
that
maybe
wasn't
good
enough.
C
Yeah,
this
is
thank
you
for
the
opportunity
to
answer
the
question:
julia
peake,
so
I'll
start
off
by
saying
the
funding
question
a
little
bit,
because
I
think
that's
an
important
one.
The
cdc
the
disparities
and
inequities
have
been
something
our
federal
partners
have
been
emphasizing
since
the
start
of
the
pandemic
and
again
is
reflected
in
the
data
we
have
as
well
so
related
to
the
vaccination
grant.
C
At
least
10
percent
of
that
award
has
to
go
directly
to
addressing
disparity
in
the
community
and
equitable
distribution
that
includes
racial,
ethnic
disparity,
but
also
specifically
called
out
rural
residents.
So
those
are
things
that
each
of
our
local
health
departments
will
build
into
their
budgets
as
they
spend
that
award
there's
also
an
equity
task
force.
C
I
think
that's
such
an
important
discussion
and
point,
and
so
if
we
looked
at
straight
population
distribution,
then
we
would
look
at
our
folks
within
a
certain
zip
code
getting
the
level
that's
appropriate,
based
on
their
overall
piece
of
the
population,
and,
as
you
mentioned,
that's
not
how
this
works.
It
is
related
to
lanes
or
tiers,
and
it's
been
called
different
things,
but
we
based
our
our
playbook
and
our
recommendations
on
the
acip
recommendations
and
what
our
cdc
partners
said.
C
So
it
might
look
like
there's
an
in
certain
again
zip
codes
or
age
groups,
but
it's
a
result
of
following
the
playbook.
Are
we
perfect?
No
anything
we
present
on
can
be
improved
and
is
not
perfect,
and
so
it's
a
matter
of
drawing
more
attention
to
it.
Ensuring
that
we
have
data
collected-
and
this
goes
back
to
the
the
former
discussion
as
well
as
how
important
it
is
to
share
information
with
the
person.
C
So
one
of
the
things
that
we're
going
to
be
looking
at
is
mobile.
Outreach
you've
seen
it
before,
with
like
the
mama
van,
for
example,
where
we
can
go
out
into
a
community
and
over
vaccinate
or
test
that
community
with
that
resource.
It's
going
to
be
particularly
helpful
when
we
get
a
a
one
dose
like
the
johnson
and
johnson,
eventually
to
really
target
specific
zip
codes.
Again,
that's
most
important
when
it
becomes
a
general
population
vaccination.
C
We
are
working
really
hard
again
with
the
equity
across
the
70
plus
year
olds.
The
the
biggest
challenge-
and
you
guys
have
heard
this
is
just
the
supply
issue.
At
this
point,
we
have
a
limited
number
of
vaccinations,
and
so
it
is
challenging
for
folks
to
get
the
resource.
One
of
the
things
that
we've
done
to
implement
equity
and
address
barriers
presented
is
develop.
The
call
line,
though
not
perfect,
it's
getting
huge
number
of
calls
and
we're
walking
people
through
how
to
do
that.
C
So,
if
you
don't
have
a
smart
device
or
you're
having
a
hard
time
navigating
the
website
or
the
various
pharmacy
websites
for
enrollment,
you
can
call
our
helpline
and
we'll
walk
you
through
that.
So
again,
not
perfection
by
any
means,
but
we're
certainly
trying
to
get
better
eyes
on
it
and
better
data
that
we
ensure
equity
at
at
every
level.
We
have
control
over.
E
Thank
you
for
that
response.
If
I
might
follow
up
madam
chair,
that's
fine,
yeah
great,
thank
you,
and
so
just
to
follow
up
on
that.
I
think
it
would
be
helpful
to
have
an
over
if
you
could
get
us
some
numbers,
not
just
on
the
cobot
vaccine.
Because
again,
as
you
said,
this
is
a
unique
position.
We
developed
the
best
plan
that
we
could
and,
as
you
said,
maybe
not
perfect.
E
I
think
there's
been
from
real
disparities
in
getting
vaccines
in
general
and
and
we'll
get
control
this
pandemic,
but
we
may
not
get
necessary
control
of
the
need
to
reach
out
and
get
more
people
vaccinated,
not
just
with
covid
vaccine,
but
with
the
flu
vaccine.
We
know
that
we
are
so
we're
in
the
bottom
of
the
number
of
folks
who
actually
get
vaccinated
for
the
flu.
I
think
only
44
of
our
population
gets
the
flu
vaccine
and
I'm
so
so.
E
This
goes
far
beyond
the
cobit,
but
what
the
covet
has
done
is
really
been
able
to
show
us
our
real
holes
in
our
system
and
bring
them
to
the
forefront,
and
I
think
if
we
could
see
some
data,
maybe
what
the
traditional
vaccination
rates
are
across
the
board
for
all
the
vaccines
available
and
how
you
know
we
need
to
do
better
for
all
members
of
our
of
our
nevada
communities.
I
think
that
would
be
helpful
too,
not
just
this.
This
cobid.
That
obviously,
is
in
the
news
more.
E
But
when
we
talk
about
you
know
the
we've
done
better
with
the
flu
vaccine
this
year,
we're
still
lacking
on
some
of
the
stuff
and
these
vaccines
that
need
to
be
given
or
people
should
consider
getting,
and
so
that's
more
of
a
comment.
So
hopefully,
if
you,
when
you
say
when
we
get
some
of
this
data,
that
you
say
you
are
now
gathering
we
can
have.
Actually
you
know,
what's
the
disparity
rates
in
overall
vaccines
and
who
is
getting
them
and
then
a
final
comment.
I
love
your
clear
masks.
E
I'd
like
to
see
the
facial
expressions
and
thank
you
for
supporting
those
today
and
hopefully
they
become
more
available,
because
I
think
the
facial
expressions
are
critical
to
communication.
So
thank
you
for
that
and
again,
thank
you
for
all
you're
doing.
A
And
thank
you
for
your
presentation
this
morning
or
this
afternoon.
I
know
we
have
quite
a
few
other
presentations
to
get
to
so,
and
I
don't
see
any
questions
right
now,
but
if
you
do
have
any
other
further
questions
I
do.
I
would
ask
the
members
to
reach
out
directly
to
our
presenters.
A
I
think
we
can
get
you
their
contact
information
as
well,
and
I
think
the
next
presentation
we're
moving
on
to
is
the
carson
city,
health
and
human
services,
and
if
I
can
remind
everyone
to
please
state
your
name
prior
to
speaking
just
so,
we
can
make
sure
we
have
a
clear
record
for
committee.
Secretaries.
G
Okay,
okay,
good
afternoon
for
the
record,
nikki
aker
director
of
carson
city,
health
and
human
services,
and
thank
you
very
much
for
inviting
us
and
letting
us
present
today.
So
for
carson
city,
health
and
human
services,
we
are
a
county.
We
have
a
county
board
of
health,
carson
city's
municipal
code,
I'm
talking
about
our
county
board
of
health
requires
a
nevada
licensed
doctor,
whereas
nrs
439
does
not
carson
city
elected
to
create
a
county
board
of
health
in
2003
and
as
julia
presented.
G
The
board
of
health
composition
includes
the
county,
health
officer,
carson
city
board
of
supervisors
sheriff
and
county
clerk,
so
an
overview
of
our
health
department.
We
are
a
local
health
authority,
not
a
district.
Since
carson
city
is
a
consolidated
municipality
to
be
a
district,
two
or
more
counties
or
cities
need
to
join
together
and
that's
through
nrs
439.370.
G
Carson
city
is
a
city
department
of
carson
city.
Our
department
received
public
health
accreditation
in
may
2016.
After
many
years
of
working
on
this
endeavor.
The
core
documents
of
accreditation
are
the
county.
Health
needs
assessment.
The
community
excuse
me,
the
community
health
needs
assessment,
the
community
health
improvement
plan
and
the
strategic
plan.
G
Some
other
important
plans
include
the
quality
improvement
plan,
the
workforce
development
plan,
the
risk
communications
plan
and
the
public
health
emergency
operations
plan,
and
we
right
now
are
in
the
midst
of
going
for
re-accreditation,
so
stopping
at
the
health
department
before
covid
was
38
ftes
and
currently
we
are
at
65.5
ftes
on
this.
This
slide
here
I
do
have
our
organizational
chart.
G
I
realize
it's
probably
too
small
for
you
all
to
see
what
the
disease,
control
and
prevention
division
and
php
organizational
charts
will
be
on
other
slides
and
php
is
the
public
health
preparedness,
so
the
budget
for
carson
city
is
it's
a
9.4
million
dollar
budget
29
percent
is
general
funded,
63
percent
is
grant
funded.
This
percentage
is
higher
currently
due
to
the
cova
grants
that
we've
received
and
an
8
revenue,
and
this
revenue
also
includes
an
interlocal
agreement
and
I'll
explain
what
that
is
on
another
slide.
G
We
also
facilitate
referrals
from
providers
that
serve
the
youth
to
my
life.
My
quip
program
and
this
program
is
also
researching
different
ways
to
reach
their
audience
due
to
the
covet
restrictions.
We
one
thing
that
I
did
not
include
on
this
slide
is:
we
do
have
a
small
grant
for
diabetes
outreach.
G
The
staffing
for
this
division
is
4.5
ftes,
and
this
division
is
100
grant
funded.
Then
we
have
our
clinical
services
and
I
listed
out
the
services
that
we
provide.
We
do
receive
title
10
funding
directly
from
the
federal
government
and
we
sub-grant
some
of
that
funding
to
douglas
county.
We
receive
other
funding
from
the
state,
either
as
passport
grants
or
from
state
funding.
G
Currently,
the
clinic
is
seeing
patients
and
we're
taking
measures
to
protect
themselves
as
the
staff
and
also
the
clients
from
covid.
The
staffing
in
that
division
is
10
ftes.
That
division
is
nine
percent,
general
funded,
61
grant
funded
and
30
percent
revenue.
We
do
bill
different
insurances
and
we
also
collect
cash
payments
on
a
sliding
scale
for
services
provide
provided
from
those
that
are
uninsured
or
do
not
wish
to
use
their
insurance.
G
G
G
So
our
epidemiology
is
program
is
very
involved
in
coveted
contact,
tracing
and
reporting.
You
know,
along
with
covid,
there
continues
to
be
other
reportable
disease
that
need
to
be
investigated,
and
currently
we
have
1.5
ftes
working
on
those
other
diseases.
Staffing
for
this
entire
division.
G
Right
now
is
16.5
ftes
and
prior
to
covid
it
was
two
ftes.
We
also
have
some
individuals
that
are
helping
us
that
are
not
included
in
our
staffing.
That's
we
have
two
from
the
national
guard.
We
have
two
behavioral
health
ambassadors
and
we
have
two
cdc
foundation,
employees
until
march
31st,
and
we
will
be
putting
those
into
our
staffing,
the
cdc
foundation,
employees.
G
So
this
division,
the
it's
two
percent
general
funded
and
98,
grant
funded
for
the
epidemiology,
and
I
included
the
organizational
chart.
What
you
see
in
green
is
the
environmental
health
and
the
rest
is
epidemiology.
G
So
carson
city,
health
and
human
service
is
different
from
other
nevada
health
authorities
by
having
human
services
within
the
health
department.
This
division
provides
health,
welfare
and
community
assistance,
as
required
by
nrs,
along
with
some
of
the
other
activities
that
I
listed
above
fast.
I
just
want
to
take
a
minute
and
talk
a
little
bit
about
fast,
which
is
the
forensics
assessment
safety
triage
team.
This
is
a
collaboration
with
other
service
agencies
that
go
into
the
county
jail
attempting
to
connect
inmates
with
services
while
in
jail,
and
so
that
they
will
have
that
upon
release.
G
This
division
has
eight
ftes
and
is
45
percent
general
funded
and
55
grant
funded
and
our
public
health
preparedness
or
you'll
help
me
say
php.
So
this
division
is
leading
the
covid
response.
Since
this
is
a
public
health,
emergency
testing
and
vaccination
efforts
are
being
led
by
this
division.
Along
with
working
with
other
city
county
governmental
entities.
G
G
So
as
part
of
our
covet
response,
we
have
conducted
92
testing
events
since
may,
along
with
testing
at
the
health
department
monday
through
friday,
we
have
conducted
35
vaccination
events
since
the
end
of
december
and
as
of
may
5th,
the
cat
quad
counties
accumula.
Excuse
me,
communi
cumulatives
already
can't
talk.
Today,
positive
cases
are
10
910
and
we've
had
7934
recoveries
as
of
february
6.
The
vaccinations
that
we
have
received
are
11
975..
G
G
You
know
we've
utilized
a
lot
of
those
partners
in
this
endeavor
and
then
I
included
a
couple
pics.
Some
pictures
here
in
the
lower
right
hand
corner
you
can
see
we
did
a
vaccination
clinic
at
carson
valley
inn,
and
it
was
snowing
that
day,
this
kind
of
led
our
decision
into
that.
If
we
can
help
it,
we
will
not
do
any
more
outdoor
events,
because
you
cannot
predict
nevada's
weather
and
it
was
my
staff
had
a
really
interesting
day
that
day
and
then
you'll
see
on
the
lower
picture
in
the
middle.
G
That
is
our
trailer.
That
has
everything
in
it
that
we
need,
and
we
say
that
we
take
the
show
on
the
road.
G
G
G
Our
health
department
is
very
lean
which
came
out
from
our
accreditation
site
visit
and
it
was
very
difficult
at
the
beginning
of
the
pandemic
to
get
the
work
done
and
we
were
working
long
hours
to
get
it
done
because
we
knew
we
needed
to
so.
We
opened
up
the
quad
county
emergency
operations
center.
Many
of
us
wear
different
hats,
so
keeping
up
with
all
of
our
other
duties
has
been
challenging.
G
G
Currently,
we
are
finding
sites
for
testing
and
vaccination
that,
especially
now
we
want
to
look
at
the
mass
vaccination
that
we
plan
to
do
when
we
get
a
higher
allocation,
but
sometimes
finding
these
sites
for
testing
and
vaccination
can
be
difficult.
Since
we
are
in
four
different
counties,
our
it
infrastructure,
we
really
have
pushed
our
I.t
department
to
limits.
You
know.
Looking
at
we
needed
computers
wiring.
We
set
up
a
call
center
quickly
and
information.
B
G
Our
current
scheduling
system
is
a
challenge
right
now
and
looking
at,
hopefully
something
to
improve
on
that
working
with
four
counties
and
four
separate
governmental
boards
and
four
different
health
officers
does
create
challenges.
Sometimes
because
not
everybody
thinks
the
same
way,
which
is
a
good
thing.
G
A
A
Okay,
thank
you
so
much
for
your
presentation
and,
like
I
said
all
the
other
members
can
please
you
know
all
these
presentations
are
also
on
nellis.
So
if
you
want
to
follow
up,
you
can
follow
up
with
that
information.
If
you
want
to
do
a
more
detailed
look
at
some
of
these
programs
that
are
being
performed
around
our
state,
so
without
further
ado,
I
think
the
next
person
on
our
list
is
mr
kevin,
dick
with
the
washoe
county
health
district.
Is
that
correct.
F
Yes,
good
afternoon,
sherwin
and
perfect.
A
F
You
for
all
the
members
of
committee
for
allowing
me
to
present
today.
I
believe
that
mr
felipe
is
going
to
advance
the
the
slide
deck
for
me
so
I'll
see
if
there
we
go
so
I'm
kevin
dick,
I'm
the
district
health
officer
for
the
washoe
county,
health,
district
and
next
slide.
F
Please,
the
washoe
county
health
district
is
established
under
nrs
439,
under
the
provision
for
counties
with
a
population
of
less
than
700
000,
and
that
provides
for
cities
and
the
county
to
come
together
to
establish
a
health
district,
and
that
was
done
formally
in
1972.
Through
an
interlocal
agreement
between
reno
sparks
in
washoe
county.
F
We
have
a
seven
member
district
board
of
health.
That
is
two
members
that
are
appointed
by
each
jurisdiction,
one
of
which
is
elected,
and
those
six
members
appoint
a
physician
as
the
seventh
member
of
the
board
of
health
and
per
nrs
439.
We
have
jurisdiction
overall
public
health
matters
in
washoe
county
next
slide.
F
And
so,
as
part
of
this
activity,
we
assess
the
health
status
of
our
community
and
in
that
work
we
identify
what
are
the
the
factors
that
are
driving
mortality
and
morbidity
in
our
community,
and
we
find
that
inequities
and
subpopulations
that
are
shaped
by
demographics
and
social
and
economic
disparities
are
driving
a
lot
of
the
poor
health
outcomes
that
we
see.
F
F
It's
pretty
difficult
to
hide
a
pandemic,
and
so
we
have
been
very
visible
in
the
news
as
we've
gone
through
the
the
past
year
or
so
with
coven
19.,
but
usually
the
community
is
not
so
aware
of
our
activities
but
we're
conducting
surveillance.
F
We
also
have
some
near
real-time
surveillance
that
we
use
where
we
look
at
the
ambulance
response
and
types
of
cases,
they're
responding
to
the
emergency
departments
and
admissions
into
the
hospitals.
F
We
have
a
an
intelligence
platform
that
provides
us
with
information
about
medications
that
are
sold
over
the
counter
at
pharmacies
and
drug
stores
in
our
communities,
and
then
we
also
use
disease
prevention
to
control
and
prevent
disease.
F
F
We
have
regulations
that
we
establish
for
a
number
of
types
of
establishments
and
operations
that
pose
public
health
threats
in
our
community,
and
then
we
mitigate
against
the
spread
of
disease,
and
I
think
people
become
quite
familiar
with
mitigation
from
the
coven
19
response
and
the
masking
and
social
distancing
and
some
of
the
reductions
in
the
capacities
occupancies
at
businesses,
but
other
mitigations
that
we
do
throughout
isolation
and
quarantine
of
individuals
that
have
been
exposed
to
diseases.
F
We
do
also
things
like
mosquito
abatement
and
boil
water
orders
when
a
water
system
has
been
disrupted,
and
then
communications
are
very
important
for
public
health
to
alert
our
community
to
public
health
threats,
so
they
can
respond
appropriately,
as
well
as
to
educate
them
on
healthy
practices
and
behaviors
next
slide.
Please.
F
The
slide
also
provides
information
on
the
membership
of
the
district
board
of
health,
and
we
have
about
166
ftes,
normally
operating
at
the
health
district.
That's
been
expanded
significantly
by
the
govit
19
response
and
I'll
talk
about
that.
Further
next
slide.
Please
I'm
going
to
run
through
the
different
divisions
that
provide
services,
community
and
clinical
health.
The
community
health
component
is
really
the
chronic
disease
prevention
program
in
washoe
county.
F
We
focus
on
tobacco
and
substance
misuse
as
well
as
obesity,
overweight
and
obesity
as
some
of
the
the
driving
factors
for
the
chronic
disease
burden
that
we
see
in
washoe
county
and
then
our
clinical
services
are
really
all
designed
with
a
public
health
intention
of
improving
community
health
and
reducing
the
transmission
of
disease
in
the
community.
So
we're
not
a
medical
care
clinic.
F
We
have
a
small,
maternal
child
and
adolescent
health
program
and
a
wic
program
that
provides
nutritional
support
for
infants
and
and
mothers,
as
well
as
education
and
counseling
regarding
nutrition
and
breastfeeding.
F
Our
sexual
health
program
works
to
prevent
the
transmission
of
sexually
transmitted
diseases,
as
well
as
testing
to
identify
and
then
treat
those
diseases,
and
our
hiv
program
also
involved
in
testing
for
hiv
and
connecting
people
that
are
found
hiv
positive
with
the
appropriate
medical
care.
Our
tuberculosis
program
also
does
testing
and
provides
treatment
for
tb
as
well
as
disease
investigation
of
those
that
might
have
been
exposed
to
people
infected
with
tb
in
our
community
next
slide.
F
In
emergency
response,
we
have
vital
statistics,
so
we're
responsible
for
recording
births
and
deaths
in
washoe
county,
as
well
as
issuing
those
birth
and
death
certificates
and
then
in
washoe
county
we're
kind
of
unique
in
that
the
health
district
has
the
oversight
of
our
regional
ambulance
franchise
for
services
through
remsa,
and
in
addition
to
that,
we
also
have
an
ems
program
which
is
focused
on
oversight
and
coordination
amongst
the
ems
partners
and
our
fire
agencies.
Dispatching
remsa
on
efficient
functioning
of
the
ems
system.
F
This
is
a
organizational
chart
of
the
different
programs
that
we
have
in
environmental
health
services
and
these
are
organized
to
prevent
public
health
threats
that
are
posed
by
establishments
and
up
different
operations
in
washoe
county.
So
there's
a
lot
of
information
on
this
slide.
You
can
see
the
different
types
of
establishments
that
we
regulate.
I
just
wanted
to
help
out
with
a
few
of
the
acronyms
that
are
on
this
page.
Under
food
safety.
F
We
have
the
hassip
operational
plans,
that
is
hazard,
analysis,
critical,
compo
control
points,
so
these
are
plans
around
critical
points
within
a
food
service
establishment
for
addressing
risks.
That
would
come
out
of
those
we're
trying
to
take
a
very
risk-based
approach
with
our
our
regulatory
oversight
for
these
different
entities
under
the
food
safety.
Under
special
events,
you
see
epi
and
fbd
complaints.
We
respond
to
epidemiology
and
foodborne
disease
complaints
in
that
program
area.
F
Under
our
commercial
plans,
permitted
facilities,
you'll
see
ibd,
we
regulate
invasive
body
decorations,
so
your
piercing
and
tattoo
parlors,
and
then
we
also
regulate,
what's
listed
as
rv
and
mhp.
Those
are
our
rv
and
motor
home
parks
and
then,
under
our
waste
management
functions,
you'll
see
ust,
that's
underground,
storage,
tanks
that
we
provide
permitting
for
construction
of
the
there's,
a
typo
under
land
development,
commercial
water
systems
is
properly
called
community
water
systems,
but
most
of
those
are
commercial
systems
that
we
oversee
so
a
broad
range
of
services
in
environmental
health.
F
Next
slide,
please
we're
unique
in
nevada.
In
that
we
provide
air
quality
management
programs
under
state
statute.
The
health
district
is
designated
to
implement
the
clean
air
act
in
washoe
county,
and
so
that's
the
federal
program.
Since
we
have
a
network
of
monitoring
stations
and
we
put
out
daily
air
quality
information
and
alerts
as
necessary.
F
We
have
a
planning
area
where
we
work
to
try
to
prevent
deterioration
of
our
air
quality
in
washoe
county.
So
we
have
a
wood
stove
program
that
addresses
use
of
certified
clean
burning
stoves
and
issuing
burn
codes.
When
we
have
inversions,
we
have
also
a
smog
check,
program
and
programs
to
address
ozone
precursors
coming
from
vehicles.
F
Our
permitting
program
addresses
stationary
air
pollution
sources
as
well
as
surface
disturbances
for
dust
control
and
demolition
and
remodeling
activities
in
regard
to
asbestos
abatement,
and
we
do
do
inspections
and
enforce
if
we
find
problems
with
those
permitted
facilities
next
slide,
please,
the
office
of
the
district
health
officer
falls
under
myself
directly
and
we
work
to
support
the
board
of
health
and
their
monthly
board
meetings.
F
We
also
are
an
accredited
health
district
received
our
national
accreditation
in
2019,
and
so
we
work
with
other
the
other
divisions
across
the
health
district
to
maintain
that
accreditation
status.
F
We
we
lead
our
quality,
improvement
and
workforce
development
efforts,
as
well
as
our
communications,
and
I'm
going
to
talk
about
that
in
a
little
more
detail.
As
we
get
to
the
copen
19
information,
but
I
also
wanted
to
acknowledge
our
government
affairs
liaison
joelle
guttmann
dodson,
and
so
you
may
see
her
presenting
a
testimony
public
comment
or
communicating
with
you
during
this
session
next
slide.
Please.
F
This
is
our
24
million
dollar
budget.
This
is
our
our
budget
for
fy2021.
F
Without
the
additional
funding
that
we've
received
for
covet
19,
our
largest
funding
comes
from
the
general
fund
transfer
from
washoe
county
at
about
40
percent
of
our
budget,
we're
also
under
statute
able
to
charge
for
fees
and
and
for
services
for
permitting
and
other
regulatory
oversight
activities
that
we
do.
We
do
collect
some
revenue
from
the
sale
of
tires
in
nevada
that
supports
our
some
of
our
solid
waste
management
efforts
through
the
tire
fees
and
our
air
quality
program
is
supported
through
a
dollar
per
smog
certificate.
F
That's
issued
in
washoe
county
in
the
federal
and
state
grants
that
compose
just
over
25
percent
of
our
budget.
That's
mostly
federal
funding.
That's
either
direct
or
passed
through
from
this
through
the
state,
as
was
mentioned,
nevada
has
a
very
low
investment
state
investment
in
public
health,
and
so
we
receive
1.8
percent
of
our
budget
from
the
state
funding
that
we
receive
through
grants.
F
We
have
received
an
additional
16.8
million
dollars
from
federal
funds
for
the
covet
19
response,
in
addition
to
this
24
million
dollar
budget.
So
you
can
see
that's
a
significant
additional
source
of
funding
and
a
big
lift
that
we've
done
in
the
coveted
response.
Next
slide,
please!
F
We
activated
our
department
incident
command
system
back
in
january
of
january
17th
of
last
year,
and
we
had
our
first
case
that
occurred
in
march
march
5th,
and
then
in
march
we
moved
to
a
regional
response
and
we've
been
at
it
ever
since
the
these
show
a
number
of
slides
of
our
response.
We've
learned
and
improvised
as
we've
as
we've
moved
through
and
learned
more
about
the
disease,
and
so
you
hear
see
here
some
historic
photos
that
span
our
pre-mask
days
and
our
our
mask
days
and
response
next
slide.
Please.
F
So,
since
the
pandemic
started,
we
stood
up
a
drive-through,
kobe
19
testing
operation,
which
we
had
operational
within
one
and
a
half
days
of
having
our
first
case
identified
in
washoe
county
on
march
5th,
and
we've
learned
and
improved
that
operation
since
that
day
one
and
have
expanded
it
dramatically.
F
We're
now
using
that
same
facility
that
we've
accepted
established
for
our
covet
19
vaccination
pod,
and
we
set
a
new
record
last
friday
with
1800
people
that
we
vaccinated
on
over
1800.
On
friday
alone,
we've
stood
up
a
covet
call
center.
We've
got
24
people
now
dedicated
to
staffing
that
that
takes
the
does
the
scheduling
for
testing.
F
We've
increased
our
disease
investigators
from
three
to
over
50
to
contact
the
positive
cases
and
have
them
isolate
and
identify
close
close
contacts
for
quarantine,
and
we
have
over
85
people
that
are
working
on
our
field
operation
for
the
testing
and
the
vaccinations
that
I'll
show
you
some
pictures
of
so
much
like
what
ms
aker
was
talking
about
in
carson
city
space
has
been
a
requirement,
as
we've
expanded
the
the
staffing
when
I
send
out
a
email
to
all
public
health
district
staff.
F
So
we've
benefited
from
many
people
that
are
remote
working
being
able
to
take
up
some
of
the
space
that
they
used
to
occupy
scott
oxford
who's.
Our
communications
manager
has
done
a
phenomenal
job
on
communications
and
we
put
out
over
330
press
releases.
Over
the
last
year,
I've
held
over
60
media
briefings
over
the
course
of
the
year
he's
led
our
regional
information
center
they've
created
two
websites,
one
on
the
kovit
19
response
and
the
other
specifically
on
the
vaccine.
F
Now
that
it's
available
and
how
we're
managing
that-
and
they
have
several
social
media
platforms
and
accounts
that
they've
also
established.
We
couldn't
have
done
all
this
without
the
partners
that
we
have.
We
have
the
national
guard,
that's
integrated
into
our
operation.
We
have
the
cert
community
emergency
response
team
volunteers,
as
well
as
the
medical
reserve
corps
volunteers
that
are
helping
us
with
our
operations.
F
Next
slide,
please
so.
The
coven
19
has
really
laid
bare
the
the
social
inequities
that
we
have
in
our
community
that
we've
known
for
for
quite
a
while
led
poor
health
outcomes,
and
what
we've
seen
is
that
we
have
communities
that
are
many.
People
are
just
at
the
margin
and
they
have
to
work
to
keep
food
in
their
for
their
families
and
keep
a
roof
over
their
heads.
So
these
are
essential
workers,
many
of
them
working
jobs
that
earn
them
below
the
median
wage,
they're
not
able
to
work
remotely.
F
F
And
so
I
think
we
also
need
to
understand
that
the
the
data
on
testing
shows
that
the
number
of
the
hispanic
population
being
tested
is
also
disproportionately
low
to
the
population
of
hispanics
that
we
have
in
nevada,
and
so
these
these
numbers
may
not
be
reliable.
F
I
would
expect
that
the
number
of
cover
19
cases
that
we
have
in
the
hispanic
population
have
been
actually
much
greater
than
than
what
we've
seen
and
then
we've
also
seen
this
devastating
impact
to
our
elderly
population,
with
a
number
of
deaths
occurring
in
that
segment
of
our
of
our
population.
F
Next
slide,
please
so,
fortunately,
we're
trending
better
with
the
number
of
cases
that
we're
experiencing
in
our
community
and
well.
These
this
figure
was
from
last
week
as
of
yesterday,
our
seven-day
moving
average
for
new
cases
in
washoe
county
is
down
to
90,
and
our
positivity
rate
has
declined
to
11.1,
which
was
not
so
long
ago,
closer
to
22
positivity.
F
So
we're
grateful
to
see
this
we're
not
out
of
the
woods
yet
and
we
want
to
continue
to
see
these
numbers
decrease,
but
we
think
we
are
seeing
some
some
real
outcomes
of
everybody
working
together
and
those
mitigation
measures
and
the
the
pause
that
the
governor
has
instituted.
F
Sadly
we're
at
616
deaths
that
have
been
reported
in
washoe
county
today,
and
I
can
tell
you
when
we
were
surging
here
in
washoe
county.
It
was
very
frightening
where
our
health
system
was
under
great
stress
and
we
were
seriously
looking
at
the
possibility
that
we
would
need
to
be
rationing,
medical
care
that
could
be
provided
to
individuals
in
our
community.
So
I'm
I'm
very
relieved
to
see
these
numbers
going
down,
as
they
are
next
slide.
Please.
F
This
is
a
picture
on
december
15th
of
our
first
shipment
of
pfizer,
arriving
at
the
health
district
and
we're,
fortunately,
we're
able
to
obtain
an
ultra
cold
freezer
device,
so
we're
able
to
receive
and
store
the
pfizer,
as
well
as
the
moderna
here
at
the
health
district.
Next
slide.
Please,
and
we
have
a
number
of
points
of
dispensing
providing
vaccine
in
the
community,
so
we're
doing
that
at
the
reno
sparks
livestock
events
center.
F
The
renown
has
a
pod
set
up
at
their
south
meadows
facility.
We
have
a
retail
pharmacy
vaccine
program
where
we
have
pharmacies
that
are
vaccinating
staff
and
residents
of
long-term
care
facilities,
and
we
have
community
partners
that
are
doing
pods
strike
teams,
so
our
fire
agencies
are
have
been
engaged
in
providing
pods.
A
community
health
alliance
also
is
providing
vaccines
in
a
pod
at
their
parking
lot.
Thanks
clyde.
A
F
A
F
Yeah
I've
got
just
a
few
pictures,
it's
really
the
rest
of
my
presentation.
So
this
is
an
aerial
view
of
the
six
lanes
about
three
quarter
of
a
million
square
feet
that
we
run
at
the
arena
livestock
event
center
and
the
next
slide
shows
you,
the
the
vehicle
stacked
up
in
those
six
lanes
and
the
testing
stations
that
we
use
next
slide.
F
These
are
the
those
connex
stations
with
the
modular
roofing
that
we've
had
put
together,
and
the
next
slide
shows
the
inside,
where
the
vaccine
is
dispensed
by
pharmacists
and
we
collect
the
paperwork,
and
the
next
slide
is
our
vaccine
distribution
statistics
and,
as
of
today,
with
our
pod
word,
over
29
000
vaccine
doses
that
we've
administered
through
the
health
district.
This
slide
is
for
the
washoe
county
total,
and
the
next
slide
provides
you
with
the
website
for
our
vaccination
information.
F
A
G
A
I
believe
vice
chair
peters
has
a
question.
I
will
turn
it
over.
B
Thank
you
chair
and
thank
you
for
the
presentation
and
for
all
of
your
hard
work.
B
I
I
know
wash
county
has
had
a
particularly
difficult
time
because
our
homeless
population
has
been
increasing
as
well
as
winter
months
having
hit,
and
so
we
have
this
balance
right
now
that
I
just
like
to
hear
a
little
bit
about
with
treating
a
home
and
testing
our
homeless
population
and
managing
care
for
them,
or
at
least
you
know,
covered
sorry
having
them
in
facilities
that
are
accommodating
to
the
need
and
how
you
guys
are
balancing
that.
F
Some
of
the
pictures
that
you
saw
in
that
first
slide
on
covid
were
actually
testing
that
we
were
doing
over
at
the
reno
event
center.
We
utilized
that
facility
so
that
we
could
provide
additional
distancing
for
the
sheltered
population
since
there's
limited
space
that
was
at
the
record
street
community
assistance
center.
F
The
county
also
has
been
able
to
stand
up
the
new
facilities
for
women
and
families
at
the
nams
campus,
and
so
that's
an
additional
capacity
there.
A
men's
shelter
has
been
established
on
4th
street
to
increase
the
area
and
the
population
that
could
be
housed
there,
and
I
think
a
real
positive
thing
that's
come
out
of.
This
has
been
the
work
together
across
the
region
on
plans
for
a
a
homeless,
larger
area.
F
A
campus
and
complex
an
area
called
the
the
governor's
bowl
and
then
also
just
on
the
people
that
are
homeless
and
tested
have
tested
positive
for
kovitt
19.
F
We
have
a
contract
regionally
with
well
care
and
they're
able
to
accept
those
people
that
don't
require
hospital
level
care
to
be
able
to
provide
them
with
support
services
and
housing
during
their
isolation
period.
B
Thank
you
so
much,
and
if
you
have
data
related
to
the
the
virus,
contraction
and
rates
in
our
homeless
population,
as
well
as
some
of
these
demographics,
it
would
be
really
great
to
see
those
if
you
could
follow
up
with
staff.
On
that.
A
Thank
you.
I
don't
see
any
other
messages
about
any
questions,
but
if
you
have
one,
do
you
want
to
wave
here
on
the
group
chat
and
I'll
be
able
to
call
you
out.
A
I
think
we're
okay,
so
thank
you
so
much
for
your
presentation,
mr
dick
and
I
will
move
to
our
last
presentation
of
the
day,
which
is
southern
nevada
health
district.
I
believe
we
have
mr
and
I
our
doctor.
Oh
I'm
gonna,
I'm
just
gonna.
A
Yes,
I'm
gonna,
let
you
just
introduce
yourself
and
congratulations
on
being
appointed
to
the
permanent
position
that
you
have
now.
So
I
will
turn
this
over
to
you
and
I
know
that
we
have
about
15
minutes,
but
I
know
our
members
have
plenty
of
questions
as
well
for
you,
so
I
will
let
you
get
started.
Thank
you.
H
Well,
thank
you
for,
for
the
record,
my
name
is
ferming
legend,
the
street
health
officer
for
southern
nevada,
healthy
street
field,
the
next
one
please.
H
H
In
addition
to
that,
we
have
right
now
more
than
680
employees
with
which
is
a
significant
growth
from
our
previous
numbers.
Okay,
about
two
years
ago,
we
had
less
than
500
employees
here.
H
There
are
five
divisions
in
our
healthy
street
community
health
division,
environmental
health,
critical
services,
the
administration
and
the
federal
qualifier
health
center.
I
I
should
tell
you
that
the
federal
qualifier
health
center
is
a
new
development
within
the
healthy
street.
We
we
receive
an
award
from
hersa
in
september
2019
and
we
were
able
to
start
the
acq
operations
and
recently
we
received
a
second
award
from
hersa
that
allowed
our
operation
for
the
next
three
years.
So
right
now
we
are
still
developing
our
health
center,
but
it's
already
fully
functional
for
the
community.
H
Also,
we
we
have
a
similar
duties
than
the
ones
presented
by
our
our
colleagues
before
so
I
didn't
include
a
slides
about
the
organizational
chart
or
or
divisions
how
they
operate.
Those
are
pretty
common
among
the
healthy
streets.
I
I
can
send
that
to
the
committee.
H
If
there
is
any
interest
on
that,
but
I
just
wanted
to
to
emphasize
some
of
the
areas
where
we
have
a
a
different
approach,
which,
for
example,
we
recently
two
years
ago,
we
started
offering
here
a
preventive
medicine
program
and
and
that's
and
that's
something
that
that
was
created
here,
because
there
is
a
need
for
preventive
medicine,
physicians
in
nevada
and
and
we
saw
the
opportunity
to
contribute
to
that
effort.
So
that's
a
partnership
between
us
and
unlv.
H
The
the
residents
spend
the
first
year
doing
the
their
mph
program
there
and
then
the
second
year.
They
do
the
clinical
and
management
and
rotations.
Here
we
also
treat
at
healthy
street
and
we
also
have
been
working
in
in
other
projects
as
regarding
opioid
reduction,
and
we
receive
a
grant
from
the
cdc
for
a
overdose
data
to
action,
which
is
something
engaged
in
surveillance
and
prevent
preventive
action
for
a
a
drop
over
those
nests.
H
This
is
our
our
budget,
as
as
it
was
at
the
beginning
of
this
fiscal
year
in
july.
First,
it
was
a
98
million
dollars.
H
H
H
We
we
do
have
concerns
about
our
budget
coming
next
year
fiscal
year,
because
so
our
budget,
normally
we
see,
receive
almost
between
25
and
28
percent
of
our
budget-
is
coming
from
property
taxes,
local
taxes
and
our
expectation
is
that
those
taxes
might
decrease
next
year
and
and
that
will
have
a
negative
impact
in
our
activities.
So
this
is
something
that
we
have
been
talking
with
with
the
county
and
I'm
monitoring
and
also
we're
trying
to
prepare
for
that
for
next
year.
Next,
please.
H
So
we
we
have
there
the
the
the
current
number
of
cases
that
have
been
reported
in
in
county
and
also
we.
We
have
the
hospitalizations
on
that
on
that
side
and
and
then
in
the
in
the
main
area
of
the
of
the
dashboard.
H
There
are
seven
seven
areas
where,
where
people
can
click
and
and
get
additional
information,
whether
it
is
cases
also,
we
have
a
sick
data
by
basic
code,
information
and
mapping.
So
people
can
look
at
the
other
area
there,
and
and
also
in
the
area
of
of
characteristics.
H
H
H
And
this
is
the
the
incidence
of
in
ocron
county
by
a
race,
ethnicity
and,
and
what
we
have
seen
in
grant
county
since
beginning
of
the
of
this
pandemic,
is
that
the
hispanic
population
has
been
they.
They
won
with
the
with
the
the
largest
impact
in
terms
of
of
cases
and
and
these
have
been
a
very
consistent
through
the
pandemic.
H
H
This
is
our
a
c
code
map,
and
this
is
something
that
that
we
use
in
addition,
in
addition
to
the
the
cumulative
one
for
the
whole
pandemic,
this
is
we
use
for
this
one,
a
more
recent
data,
the
last
the
last
14
days,
so
that
helped
identify
new
areas
that
could
be
affected
by
by
the
pandemic.
So
what
what
you'll
see
here
is
that
most
of
our
high
incidence
areas
are
in
the
central
part
of
the
of
the
county.
H
Those
areas
belong
mostly
to
cities,
las
vegas
and
city
of
north
las
vegas,
and
I
I'm
on
I'm
mostly.
What
you
see
to
you
right
is:
is
the
the
east
area
of
las
vegas,
a
sick
goat,
a
nine
one,
one,
zero
and,
and
one
for
two
and
the
others.
So
those
are
the
areas
where
we
consistently
have
seen
the
the
largest
impact
of
the
pandemic.
This
these
these
areas
also
are
a
highly
populated
by
members
of
the
hispanic
community
as
well.
H
Yeah-
and
this
is
of
course,
the
first
day
that
they
were
seeing
arrived
to
to
craic
county,
it
was
the
the
december
14
and
and
we
and
we
distribute
the
vaccine
immediately
as
we
receive
that.
H
I
also
I
also
want
to
mention
that
we
that,
for
the
fascination
campaign,
we
have
developed
a
very
strong
partnership
with
with
the
county
and
local
jurisdictions.
We
also,
we
say
local
universities,
toro
unav,
rozman
university,
also,
the
college
of
southern
nevada
and
other
institutions.
All
of
them
are
participating
in
the
pandemic,
whether
it
is
a
supporting
part
or
providing
staff
to
to
participate
in
in
our
operations.
H
So
it
is
a
at
this
point.
In
intra
county,
we
have
a
minister
more
than
200
thousand
doses.
Actually,
until
yesterday
was
a
214
000
doses,
those
those
were
seen
have
been
offered
all
all
over
the
county.
We,
we
have
a
big
big
fascination
size,
a
catchment
center
and
also
we
offer
at
a
western
high
school
and
mark
a
middle
school
which
is
in
the
in
the
east
side
of
the
city,
also
in
doral
high
school
and
and
recently
we
opened
the
las
vegas
convention
center
to
offer
a
second
second
those
vaccinations.
H
H
Hecarim
workers
at
this
point
represent
more
than
40
percent
of
the
individual
who
have
been
vaccinated
in
in
clark
county
also
in
terms
of
race,
ethnicity,
41
percent
are
white,
10
percent
asian
10
percent,
hispanic
percent
percent
african-american,
and
then
we
have
about
30
percent
of
of
the
individual
who
are
either
older
or
unknown.
H
So
it
really
makes
a
a
complicated
the
issue
of
race,
ethnicity,
analysis,
but
it's
important
to
to
know
that
and
in
terms
of
who
administered
the
vaccine
city
top
64
000
those
who
have
been
emanated
by
hospital,
which
represents
more
than
30
percent
of
of
those
of
those
doses
and
88
by
the
healthy
treat
and
encouragement.
D
H
One-
and
this
is
a
single
map
where
we
show
the
the
distribution
of
doses
in
clark,
county
and
and
what
we
wanted
to
to
highlight
here,
is
that
until
on
the
last
week
the
the
numbers
in
clark
county
vaccine
distribute
it
don't
match
the
what
is
happening
with
the
incidence
of
coronavirus
in
clark
county
next
one
please
so
the
next
here
you
can
see
to
you
left
is
there
is
the
incidence
a
cycle
map
and
the
uri
is,
is
a
vaccine
administration?
H
The
waxing
administration
is
not
matching
geographically,
the
the
the
the
incidents
by
sicko.
As
many
of
you
are
aware,
all
of
you
probably
are
aware
that
there
were
recent.
H
Comments
or
declarations
about
the
health
inequality
in
in
grant
county
and
and
and
the
way
that
we
distribute
the
vaccine
and-
and
I
believe
that
that
that
was
an
unfair
comment,
because
so
until
now,
more
than
40
of
the
vaccines
are
have
been
distributed
to
healthcare
workers,
who
have
a
very,
very
high
number
into
into
the
vaccine.
The
vaccinations
also
we
have
issues
with
the
with
the
race,
ethnicity,
in
terms
of
the
weight
of
the
unknown
and
and
others.
H
Now.
Having
said
that,
we
we
do
have
a
plan
on
how
to
to
address
health
inequalities
in
track,
county
and
and
some
of
the
things
that
we
want
to
do
is
to
to,
in
addition
to
the
large
mega
vaccination
sites
that
we
have
and
and
and
plan
for
the
future.
H
We
we
will
be
targeting
those
those
sick
calls,
those
communities
with
with
smaller
teens,
whether
it
is
a
nobody,
unis
or
or
or
close
close
spots
in
in
collaboration
with
elected
officials
and
representatives
for
community-based
organizations
or
or
of
those
areas
that
would
allow
us
to
when
we
offer
the
vaccine
in
in
in
one
site
most
of
the
population
who
receive
the
vaccine,
there
will
be
the
one
who
actually
live
in
the
area,
and
this
is
and-
and
this
is
an
issue
that
is
important
to
mention,
because,
for
example,
last
week
I
was
reading
an
article
from
the
new
york
times.
H
That's
not
the
case
in
in
clark
county.
Our
spots
are,
are
all
within
within
the
the
areas
where
we
have
more
cases.
Cashman
is
just
in
the
middle
of
all
that
action
and
also
all
those
schools
where
we
we
have
open
pots.
The
thing
is
that
the
registration
is
open
to
everybody
and
we
want
everybody
to
register
so
those
those
large
vaccination
parts
don't
allow
for
for
that
kind
of
control.
That's
why
we
we,
we
will
emphasize
this
the
small
operation
when
it
comes
to
a
health
inequality.
A
And
I'm
sorry
doctor,
we
are
about
to
get
kicked
out
of
this
and
I
want
to
make
sure
we
have
an
opportunity
to
get
to
our
public
comment,
but
but
thank
you
so
much.
I
know
that
there
were
some
people
that
had
some
questions
that
you
answered
them
in
the
middle
of
your
presentation.
I
did.
I
did
have
a
request
from
several
members
and
I'm
hoping
you
might
be
able
to
do
that,
and
this
goes
for
some
of
the
other
agencies
that
may
have
presented
if
they
are
still
on
the
line.
Here.
A
I
was
wondering
if
you
had
any
kind
of
breakdown
by
our
assembly
districts
of
the
kobit
positivity
and
vaccination
rates
that
you
might
be
able
to
provide
to
our
committee
staff,
so
we
can
bring
those
over
to
our
members,
I'm
not
sure
if
you
have
that
or
if
it's
just
listed
by
zip
code,
if
it
is
by
zip
code.
I
know
people
can
go
ahead
and
get
that
information,
but
if
you
do
have
it
or
have
the
ability
to
do
that
fairly
easily,
that
would
be
the
request.
H
A
Okay,
thank
you.
Thank
you
so
much
and
thank
you
for
your
presentation.
I
know
a
lot
of
times.
People
didn't
know
exactly
what
the
health
districts
did.
Obviously
we
know
what
they
are
all
responsible
for
and
now
we
have
a
pandemic
on
that
they're
also
responsible
for
so
we
do
appreciate
all
the
challenges
that
you
are
doing
and
the
unique
and
creative
responses
that
all
of
your
agencies
are
trying
to
accommodate,
and
you
know
thrive
in
this
situation.
A
A
Okay,
wonderful!
Well,
I
will
close
public
comment
and
just
some
business.
I
was
probably
a
little
optimistic
for
wednesday's
agenda,
as
you
can
see
we're
doing
an
overview
of
mental
health
in
nevada,
as
well
as
the
division
of
public
and
behavioral
health.
A
I
have
asked
them
to
kind
of
keep
it
to
some
topics
that
I
think
will
be
important
for
us
to
know
as
a
committee
going
forward
with
some
of
the
bills
that
we
will
be
seeing
and
we
will
have
very,
very
short
presentations
from
the
re
regional
behavioral
health
policy
boards,
because
I'm
trying
to
avoid
having
a
meeting
on
friday-
and
I
think
I
had
laid
out
that
I
want
to
try
to
be
as
efficient
with
our
time
as
possible.
A
I
would
ask
everyone
to
come
prepared
for
the
two
bills
that
we
are
going
to
be
hearing.
One
is
assembly
bill,
62
and
I'm
gonna
send
out
an
email
to
the
committee,
but
I
would
recommend
that
in
preparation
for
assembly
bill
62,
if
you
have
more,
if
you
want
to
obtain
more
information
about
the
nevada
able
savings
program,
this
was
addressed
last
session
with
assembly
bill
130,
and
I'm
going
to
have
patrick
ashton
send
an
email
with
some
links.
A
So
if
you
want
to
get
a
more
overview
of
that
existing
program
and
how
this
so
you'll
be
prepared
to
hear
ab62
on
wednesday,
I
think
that
would
be
beneficial
and
we
also
have
our
first
personal
bdr
ajr1
from
assemblywoman
titus.
That
will
also
be
presented
on
that
day.
Again,
I
would
encourage
everyone
to
reach
out
to
our
policy
analyst
or
legal
karli
o'krent.
If
you
have
any
questions,
they
might
be
able
to
prepare
and
do
some
of
that
research
in
advance.
A
If
you're
reviewing
those
bills
and
have
some
specific
questions
about,
you
know
any
legal
questions,
I
would
ask
you
to
reach
out
to
them.
So
with
that,
do
we
have
any
comments
or
questions
from
the
committee
members
and
I
am
putting
it
in
a
full
screen
gallery
view,
so
I
can
see
if
you
can
wave
if
you
have
any
questions
or
comments.
That
would
be
great.