After months of rising cases and concerning hospitalization numbers, have we finally turned a corner in the pandemic?

UMC's director of infectious diseases explains where we stand.

Smoke from California's wildfires filled Nevada skies for several weeks this summer, and that had an impact on our health.

Now climate change and public health are intertwined.

Live entertainment is back in Las Vegas!

The Smith Center for the Performing Arts has welcomed back audiences and is now getting ready to host its first Broadway musical in months.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and additional supporting sponsors.

(Kipp Ortenburger) Welcome to Nevada Week.

Well, COVID numbers are finally going down after a summer spike that filled hospitals and concerned public health officials, but there are a lot of questions remaining including the role of boosters and whether we'll see a "twindemic" of flu and COVID.

Joining us to answer some of those questions is Dr. Shadaba Asad, the director of infectious diseases at UMC.

Dr. Asad, welcome back.

I was trying to remember how many times we've had you on the show.

I think it's three or four now going all the way back to the beginning of the pandemic in January of 2020.

Let's talk about the metrics right now.

It's a mixed bag.

I mean, we've seen decreasing trends, and now we're seeing a couple upticks.

Our test positivity rates are kind of leveling out.

We're seeing more deaths than what's been normal over the last 14 days or so.

I want to get more perspective on just what you're seeing, you and your colleagues are seeing, on the front lines right now and maybe give some context of where the pandemic is.

(Dr. Shadaba Asad) I think we're definitely in a much better position than what we were let's say in early August, which is really when the disease peaked once again for us in Las Vegas and in Nevada.

As of now clearly, you know, the number of cases are on the decline.

Our positivity rate, I was looking at statistics, is down to about 7%.

That has been quite low for the last several months now.

The positivity rate is going down, and that is reflected also in our hospitalization.

So we're clearly seeing a decline in the number of patients getting admitted both to the ICU and to our medical floors.

So yes, it almost seems like there is light at the end of the tunnel at this point.

Numbers are down, hospitalizations are down.

-Let's go back to a year ago in the summer when we saw a similar spike.

The changes in how severe or how many hospitalizations you've had, or how care and treatment has maybe changed from last summer to this summer.

-Yes, a lot has changed.

So firstly, you know, we have many more treatments now available for those who are diagnosed with COVID and get admitted to our hospital.

We have excellent antivirals that have now been shown in multiple clinical trials to be effective in reducing hospitalization as well as mortality.

We've learned how to use steroids to help these people better.

We have monoclonal antibodies, which we provide very early in the course of illness to people who have risk factors for severe disease, and we've seen excellent results in that it really prevents worsening of the illness and hospitalization in those patients.

We have learned how to manage these patients better once they get into a hospital from the perspective of oxygenation.

We also have learned more about what is referred to as "long COVID" or the long-lasting symptoms of COVID.

At UMC we've actually opened the state's first COVID recovery clinic for patients who continue to have lingering symptoms of COVID.

So in terms of treatment, we have many more tools in the box than what we had back last summer, and perhaps one of the most important interventions, we now have a way to actually prevent COVID from happening in the first place.

As of late December last year, January this year, we've started vaccinating, and we've clearly seen a decline in infections that is proportional to the rate of vaccinations.

Not only that, it is true every now and then we see breakthrough infections, but those patients are not very sick.

They almost never require hospitalization.

So things are very, very different.

We know how to prevent the disease and we have more effective ways to treat the disease now.

-Let's talk about the long-term impacts.

That's very, very interesting.

I think our viewers are very interested to hear about that.

One thing, how many are coming back and are seeking services for some long-term effects of this?

-So we know for a fact the majority of people who have COVID-19 will have some degree of lingering symptoms for several months after.

Now, the severity of those symptoms tends to vary from individual to individual, but some things that we hear almost everybody talking about is several weeks of fatigue, tiredness, brain fog, a lingering cough that takes much longer to resolve, shortness of breath.

So those relatively mild symptoms are very common in people who completely recover, and they can last for several months.

But then we have patients who have much more severe, longer-lasting problems, particularly heart disease after COVID infections, permanent lung damage after COVID infections, neurological syndrome.

So those are the very sick ones.

But in general it is very common to have symptoms that last way longer than the period of isolation.

-You've mentioned we have optimism here of course, our numbers are lower and our treatments are different right now, but also we're dealing and confronting the delta variant.

I want to talk about that, and let's look at the future now.

We went into another spike in the winter.

Do you foresee we're going to see some form of spike coming up in the coming months here first off?

-So you know, as winter comes we always start worrying because it's not just the pandemic that we're worried about, but we have other respiratory viruses that really pick up activity during the winter months, influenza and RSV in kids, those are important.

So definitely we are concerned that's going to add to the spike of patients presenting to the hospital.

We're preparing in that.

We're also encouraging patients to get vaccinated for influenza as they get their COVID vaccinations or boosters.

We now know that it's perfectly safe to get a flu vaccine and a COVID vaccine even at the same setting.

So that's one way we're encouraging it.

We're also making sure that we have adequate testing capability in our hospitals and urgent cares to test not just for COVID, but to keep in mind that during winter, we'll see other respiratory infections.

Now, if this year is anything like last year, we might be lucky and we may not see a whole lot of influenza because the very measures that we advocate for to prevent COVID work for influenza as well.

Probably last flu season was one of the best flu seasons that we've seen in years.

But still, you know, you can't let your guard down.

You need to remain vigilant that, you know, winter is coming.

There's RSV, there's influenza.

-We've got about a minute left.

Let's talk about the chances of another variant here too, and let's go back to what our vaccination rates have been.

We're about 54% statewide for those that can get the vaccine.

Is there concern that we could see another variant coming up?

-So Kipp, as long as there is a-- mutation in a virus, any virus, is a purely random event, right?

But the more virus that is multiplying, the greater the likelihood a mutation will occur.

Now, the majority of these mutations actually make the virus weaker and they don't survive, but every once in a while, completely randomly, a virus will emerge that will happen to be more contagious and more virulent.

So to some extent it is a chance event, but the chance increases when there is a lot of virus circulating in the community.

Our hope is that by immunity, whether it is through natural infection or vaccination, we'll be able to bring down the level of this viral activity in the community to the point where the chance of new variants emerging will go down significantly.

-Herd immunity increases, the chances of a variant decreases.

Dr. Asad, thank you so much for your time.

-Thank you for having me.

-Another summer of wildfires in California blanketed Nevada in wildfire smoke.

Las Vegas air was so bad at one point, people with certain health conditions were advised to stay inside.

As the effects of climate change impact wildfires, how will that impact people's health?

Well, joining us to talk about the connection between climate change and health are Marci Henson, director of Clark County's Sustainability Office, and Daniel Kiser, an assistant research scientist for the Desert Research Institute.

Daniel and Marci, thank you so much for being here.

It's such an important conversation, and Marci, it's not something that we think that's top of mind that climate change and public health are so linked.

But 200 medical journals recently have warned that warming the climate is the greatest threat to global public health.

I want to ask you in our region particularly, the Southwest, let's go a little bit bigger than Clark County.

How big of a threat is this?

(Marci Henson) It's a significant threat, and we're already experiencing it here in Southern Nevada.

We're seeing increased days of excessive heat; that can impact both our unhoused population and our workforce, particularly individuals that are working outside, and then also just all of us who are trying to go about our daily life and experiencing that excessive heat.

It can have impacts on air quality, ozone formation in particular.

So typically we think of ozone at higher levels of the atmosphere, and we've heard in the past that's good, right, that it provides a layer that protects us from increased UV radiation here on the surface of the Earth.

But ground-level ozone that is formed from a combination of compounds, that happens when we have high heat and lots of sunshine so we get that a lot here in Southern Nevada.

And ozone can form, that ground level ozone, and that can be extremely dangerous for us both from a respiratory and cardiovascular perspective.

So we're seeing that as well, and then the hazards that we can expect to see from climate change, so extreme weather events whether that's flooding or wind.

If we're out in that and we're caught off guard and our public infrastructure isn't strengthened to protect us from those sorts of events, we could have a safety event during one of those extreme weather events that we can anticipate from climate change.

-Yes.

I want to come back to the ozone.

It is surprising, and I know that-- I was reading that our ozone levels over the last 10 years have decreased, but they they've spiked recently.

What are some of the reasons for that?

I mean, is that just attributed to greenhouse gas emissions here?

-Well, one thing that we're doing is we're trying to find out exactly why and how ozone forms here in Southern Nevada.

So we have sort of a generalized characterization of that, but we really-- in order to target it effectively, we need to understand more about that.

So we have a research study underway with NOAA, the National Oceanic and Atmospheric Administration, to do some surveillance on compounds that form ozone here and start to help us understand how that ozone is forming and how we can better target it.

But definitely one thing that we've seen is a correlation between ozone exceedances, so days when we're exceeding the EPA standard and the Clean Air Act for ozone and wildfire events.

So four out of the last five years, we have had an increase in ozone exceedances that correlate with wildfire events that we're experiencing here in Southern Nevada.

The only year we didn't see that was 2019, and we didn't have a lot of wildfire influence here.

So it's definitely something that we expect we're going to see more of going forward, and that's why it's so important for us to be working not only locally but regionally because these wildfires in some cases are occurring hundreds of miles away.

-And I want to interject just because of that so when we're talking about wildfires, it's not Southern Nevada's wildfires, it's a much more regional concern, right?

-Absolutely.

So I mean, we can get wildfires in the Mojave, but they're much easier to contain.

There's not as much fuel load, and we've seen wildfire influence from obviously Southern California, Northern California, Idaho, Arizona and Oregon, and they're having significant influence on our air quality here in Southern Nevada.

-Daniel, I want to come to you.

This wildfire conversation and the smoke conversation of course, it's very prevalent for us here because we've seen a lot of smoke in Southern Nevada over the last couple of weeks particularly.

You and the department of-- I mean the Desert Research Institute have done a study that has linked smoke to COVID.

Explain some of the findings there.

(Daniel Kiser) Yes.

We're based in Reno, and we were looking at the positivity rate at Renown Health, which is the large regional hospital in Reno, and we were seeing if there was any association with that and particulate matter in the year.

Specifically we were looking at PM 2.5, which is particulate matter but it's smaller than 2.5 microns.

So that would be particulate matter that is considered fine particulate matter.

It can be inhaled deeply into the lungs, so we wanted to see, you know, okay, is there a link between this particulate matter in the air and COVID.

You know, there have been previous studies looking at like urban air pollution, and they're finding links between the spread of COVID-19 and urban particulate matter, but there hasn't been as much research done with wildfire smoke, and when we have wildfire events, the levels of PM 2.5 and other pollutants in the air tend to get, you know, orders of magnitude higher than what we would often see in urban pollution events.

-Can I ask you, that level of particulate matter, I mean, is that something that infiltrates homes?

Is it something you would just breathe outside?

-Yes.

So I mean, that would very much depend on the quality of the house, you know, how well the doors seal, the windows seal, what kind of ventilation system the building has.

My understanding is that air quality can vary quite a bit, depending on the building indoor, but that is certainly a concern for people.

We found, you know, about an 18% increase in COVID-19 cases that could possibly be attributed to the wildfire smoke event that Reno experienced in 2020.

-I mean, that seems significant, seems huge, and I don't want to hypothesize here, but I want to bring it back to Southern Nevada for a second.

We've seen spikes in COVID cases that do coincide with the smoke that has come in as well.

Of course there's other variables there, the delta variant being one of them, but I mean, can we link the two here do you think in Southern Nevada as well?

-Yes.

I mean, as you said, there are lots of confounding factors, so it's just kind of a difficult question.

You know, even our study in Reno is an observational study so there's a lot of things, you know, regarding human behavior, regarding policies that are difficult to take into account, so we always have to take these kinds of studies with a grain of salt.

But by and large the evidence is pointing to a connection between COVID-19 and PM 2.5 globally.

You know, there's been study conducted in Europe and in Asia that have also found a connection between PM 2.5 and the spread of COVID-19.

So it would make sense that we would also be seeing that in the Vegas area as well.

-Geographically, does Nevada pose any more of a risk than California or anywhere else in the Southwest as far as why this particulate matter is so effective?

-Not that I'm aware of, no.

-You mentioned policy.

I want to come back to that for a second.

That might be a little bit of a surprise, that policy might be able to change some of these things.

What kind of policy have you seen maybe that can vary the amount?

-Well, that's not something I have specifically looked into.

You know, it's something that we try to take into account when we're modeling these things, but in terms of actually studying like okay, you know, we see this much change the spread of COVID, but it's not something that I've done any research on.

-Marci, I want to come to you with that question too.

The assumption on policy is obviously when there's poor air that we've got some level of advisory on being able to stay home, shelter in place, those types of things, which can vary too.

Let's talk about Clark County specifically and maybe some of those policies when we do have high smoke days.

-Sure, absolutely.

So the smoke itself is not necessarily regulated under the Clean Air Act, but the components that are in the smoke in some cases are.

So for particularly the PM 2.5., that's a regulated pollutant under the Clean Air Act so our organization, the Department of Environment Sustainability, serves as the air pollution control agency here for Southern Nevada, so we monitor PM 2.5 and also regulate for it.

So for instance business and industry that might be emitting 2.5, they're required to have a Clean Air Act permit with us, and we go through an analysis and we figure out what controls would be appropriate to place on that business whether it's operating hours or, you know, filters or control devices that need to be included so we can decrease those emissions.

Of course the big player in 2.5 beyond wildfire that we see is vehicle emissions, and interestingly enough, we're responsible for air quality but we don't have the power to regulate vehicle emissions at the local level.

That is primarily a federal regulatory space by the EPA and the Federal Highway Transportation Agency.

But we do have the ability to work with the state.

Under the EPA they are allowed to adopt more restrictive vehicle emission standards, and Governor Sisolak actually has carried forward a policy known as the Nevada Clean Cars Initiative, and that is to adopt emission vehicle standards that are stricter and more in line with what California requires.

So that's moving through the regulatory adoption process right now.

We're hopeful it will be adopted, and that will highly influence vehicle emissions here in Southern Nevada.

Some of the other things we do in terms of policy is more supportive, educating the public about doing things like minimizing our personal car use, taking public transit instead, minimizing vehicle miles traveled and, you know, actively using scooters or bicycles or our own, you know, capabilities here to get around town so we don't see so many PM 2.5 emissions.

-And it's important to note that when we're talking about lowering the greenhouse gas emissions that we have in the valley, that has a direct impact on our local air quality.

This isn't just a regional or global thing although it is impacting those areas as well, correct?

-Yes, absolutely.

I mean, all of those emissions, greenhouse gas emissions, and those regulated under the Clean Air Act, all influence our air quality here locally, so in addition to the pollutants that are regulated under the Clean Air Act, Clark County has also in the last 18 months or so started an initiative known as All In Clark County, and that has to deal specifically with greenhouse gas emissions.

So we have been working with the Southern Nevada Regional Planning Coalition on updating our local greenhouse gas emissions inventory.

And again, that will point us in the right direction of where to prioritize our actions and policies that we might take.

So it's imperative that we start understanding where those emissions are coming from and enacting policies and programs to reduce those emissions.

It has an impact here locally.

That feeds into our state goals related to the Nevada Climate Initiative to reduce greenhouse gas emissions and obviously has an impact on global emissions.

-And planning is such an important part of that all the way through, as you mentioned, locally, regionally and then globally as well.

I want to talk about equity for a second.

That is a big part of this conversation as well.

As a matter of fact, the Biden Administration is in the process of opening a new office, and that is the Climate Change Public Health and Equity Office.

I think that's an important part of the conversation.

I want to go to something that Daniel said about particulate matter in houses, because maybe I made-- I don't want to make too much of an assumption, but a more low-income house might not have the same filtration systems, might not be as tightly constructed.

More of that particulate matter could get into a house, and that's one example.

How disproportionate are some of our more low- and moderate-income populations to air quality in this case?

-Sure.

You'll hear this referred to as an "environmental justice issue," and environmental justice is the idea that there is equitable treatment and meaningful involvement by all residents and all citizens regardless of race, national origin or income status on both the development of environmental policy and the implementation.

And the reason why that is is because we do see disproportionate impacts on those communities that are of lower economic status.

They can live in housing that's more vulnerable to pollution.

They can have materials that those houses were built out of that off gas more, things like volatile organic compounds.

They can have less weatherization, which can also influence the pollution they're experiencing in their home.

It also leaves them more vulnerable to natural disasters that we'll see more of as a result of climate change, and they can't absorb the shock of those natural disasters both in terms of displacement and having somewhere to go let alone some of the price implications that happen when those events might occur.

So it's well understood that those communities are more highly impacted.

Now, both in terms of air conditioning, so even if these homes have air conditioning, they might not be able to afford to run the air conditioning in the summertime and so experiencing greater heat.

-Yes, so many variables, and you addressed many of them.

Marci and Daniel, thank you so much for your time.

We really appreciate it.

Now, the Smith Center for the Performing Arts has been Las Vegas' home for Broadway musicals, intimate jazz and classical music for years, but last year it went dark because of the pandemic.

Now live performances have returned.

The Nevada Week team checked it out.

Located in the center of Downtown Las Vegas is the "Heart of the Arts."

Since 2012 the Smith Center, a premier performing arts center, has served its community.

(Myron Martin) Back when we were looking at world-class cities and determining kind of what things set those cities apart, the arts was a big part of what made great cities great.

Prior to 2020 the Smith Center offered audiences an average of 400 performances per year.

But like many Las Vegas businesses, the COVID pandemic forced the Smith Center to close.

-Yes.

When the pandemic hit, we were in the middle of a Broadway show.

It hit us like a ton of bricks.

I'll never forget the day the stage manager met me at the stage door and said I don't think we can go on today, and we that morning made the decision that was the day that we would shut down for the pandemic.

Little did we know it would last 18 months.

The Smith Center recently opened to much fanfare.

We've been open for a week or so now, and we've been packed for our shows which tells us the pent-up demand here in Las Vegas for the Smith Center was great.

Both audiences and employees are excited to be back at the Smith Center.

(Venus Carter-Ramirez) So I was gone for over a year, and coming back has been exciting and energetic and busy.

It's like starting new.

You're starting where you left off running, but you're starting brand new.

Sarah Thielman helped open the Smith Center nearly a decade ago and has returned for its reopening.

(Sarah Thielman) It's almost surreal.

It's a little bit different than the first time because we have different technology.

We have different programming.

With our programs, there are QR codes instead of actual handout programs right now.

Technology such as digital and cashless payment options are supporting COVID protocols.

There's also constant disinfecting and healthy air systems, and guests must prove vaccinations or negative COVID tests.

The Smith Center was one of the very first places to close during the pandemic.

We said then we'd probably be one of the last to reopen because we were going to wait until we could do it right, and we were going to wait until we could have houses full of people sharing this experience of music, theater and dance.

Venus Carter Ramirez, who has a theater degree from UNLV, helps recruit and train the Smith Center's many volunteers.

I feel very blessed to be a part of the Smith Center, a part of its mission in Las Vegas especially since this is my town, and I look forward to many more years and more opportunities here.

There's plenty of opportunity at the Smith Center.

Folks can find job openings, volunteer positions, educational offerings for students and of course, new shows for audiences.

-Whether it's music, theater, dance, whether it's jazz or rock n' roll, there is something for you at the Smith Center.

We were built for those of us who live here.

We deliver the most incredible talent to the people of Las Vegas, and if you've never been, you've got to come check it out.

Now that it's back in business, the Smith Center is offering audiences huge Broadway hit shows, much-anticipated premieres, music and dance.

And in these uncertain times, the Heart of the Arts offers up a much-needed slice of normalcy.

For Nevada Week, I'm Heather Caputo.

Thanks, Heather, and thank you, as always, for joining us this week on Nevada Week.

For any of the resources discussed on the show, please visit our website at vegaspbs.org/nevadaweek.

You can also follow us on Facebook and Twitter at @nevadaweek.

Thanks for joining us, and we'll see you next week.

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