Models are critical: A Q&A with the incident commander for Nevada's COVID-19 response

With confirmed Nevada cases of the coronavirus rising above 2,000 this week, state officials continue grappling with how to coordinate their response. The coronavirus crisis cuts across agency silos, straining not only the health system but social services and the supply chain.

To coordinate the logistics of the effort, Gov. Steve Sisolak last week announced a new operation structure for the state’s response, including the activation of the Nevada National Guard.

Caleb Cage, a former chief of the Division of Emergency Management and Homeland Security Advisor, is serving as incident commander, a civilian position in the new operations structure. Cage stepped down from his post last year. He answered questions this week about how prepared the state was for the pandemic and how data could inform decisions going forward.

“Models are critical for us predicting what’s going on, and also critical is [that] the models are based on how well people are following the guidelines to stay home, and to isolate and quarantine during this time,” Cage said in an interview on Tuesday. “From what I’ve seen, that is the single best factor for determining how we fare in the state. And it just cannot be reiterated and emphasized enough that we’ve got to do that: Stay Home for Nevada.”

This interview has been edited for length and clarity.

What can people expect right now from the activation of the National Guard? Where would they expect to see that presence?

I don’t want to speak for the Guard and their mission. But what I will say is the activation of the National Guard was intended to put some structures in place in order to help with the coordination process and to really manage this from the standpoint of what are our strategic objectives and how do we coordinate everybody to get there? I don’t know if it’s public yet — where the deployments are — but right now I think what we’re seeing is a small number of National Guard members in support roles throughout the state.

What does assistance mean in terms of the National Guard? Will they be in hospitals or…

I believe that right now, what I mean by support role is really providing that logistic support that I was just talking about a minute ago, and really supporting that mission. And we’re still working on the paperwork with the federal government to get all of that lined up. But that’s where I’m seeing it, is very much on the logistic side and that’s frankly where I expect to continue to see it.

Did the Division of Emergency Management ever do drills or draft guidelines for this type of scenario, a pandemic, like what we’re seeing right now?

Absolutely. This has been one of the top hazards that’s been identified by the state for years as something that would be hugely disruptive. We’ve been working directly with… the Public Health Preparedness [program], which is essentially the [Centers for Disease Control] for the state… In the four years that I was there previous to my departure — about nine months ago — we were regularly working with Public Health Preparedness and other agencies in order to do exercises, plans. It was a part of our threat and hazard identification risk assessment, something that we do on an annual basis, as well as our comprehensive emergency management plan.

You were involved in the response to October 1st. Are there any lessons learned that are being applied in this response?

I’ve had this conversation a number of times so far… I’m not the most experienced emergency manager in the country, but I’ve got a little bit of experience, and I’ll tell you that this is probably the most challenging emergency that we have faced. Not to diminish the extraordinary tragedy of the previous emergencies, but the long-term nature, the slow moving nature of this crisis — this is really significant. That said, we definitely have some lessons learned….

Engaging the private sector early on was a lesson learned, at least for me, from 1 October, and what came from that tragedy. Being able to bring those resources to bear in what we call a whole community approach was just critical.

Nevada’s health care system often lags with other states. Is that factored or considered in emergency preparedness plans?

Yes…The number of patients a nurse can oversee, the square footage that each hospital needs to have for patient care. All kinds of those things fall under what’s called crisis standards of care.

The Department of Health and Human Services updated their plan — I believe in 2018 or 2019 — and then based on that plan, the Medical Advisory Team made some recommendations to the governor. And those made it into… [Emergency Order] 11 for this emergency. It specifically deals with workforce and licensure and crisis standards of care. So, that’s a great example of preparedness efforts being implemented during an emergency.

I am curious how you’re tracking the real time data and some of the projections going forward. We’re seeing lots of different models. How important are projections to the state’s response? And a lot of people are looking at the peak right now. How is the peak if at all, correlated to how the state is responding?

Models are predictive in nature… It’s very difficult to use predictions for data-driven policy analysis and so on. However, what I have seen is real analysis — and this is on a daily basis — real analysis by experts who are able to choose models based on what fits Nevada’s current situation… And so, given a little time…and seeing the data as it’s coming in, we can assess those models and determine which model fits closely to Nevada right now and base our decisions based on that. You’re seeing Washoe County and Clark County build up their capacity for hospital beds and you’re seeing [personal protective equipment] orders, and you’re seeing all of these things happening from an organizational level and otherwise…

The short answer is data is critical. Models are critical for us predicting what’s going on, and also critical is [that] the models are based on how well people are following the guidelines to stay home, and to isolate and quarantine during this time. From what I’ve seen, that is the single best factor for determining how we fare in the state. And it just cannot be reiterated and emphasized enough that we’ve got to do that: Stay Home for Nevada.

I think some people have had maybe confusion or frustration with the fact that the state releases data, but then the counties also release their own data. It’s not updated in real-time. Are there any efforts to coordinate some of that public-facing data?

One of the first things we did in the last week was establish what’s referred to as a Joint Information Center, and this is to coordinate all of that data. It’s always going to be difficult because of the model of emergency response. The model of emergency response says the lowest level of government that can handle it, handles the emergency. So, in this case we’ve got tribes and counties across the state that are really the leaders in taking charge for their local communities, which is amazing to see the capacities that they’ve built over time.

The state provides a support role through the Division of Emergency Management for those functions. And one of the things that we’ve attempted to do in the last…week is to really find a way of coordinating that information in a manner that is consistent and communicated across the board. So, that’s bringing together local and tribal and state public information officers. That’s vetting that data and making sure it’s put out in a consistent manner as well as we can. … I’m afraid that in every emergency, the communications portion is always a critique. It’s always a work in progress. But I will say that we’ve taken affirmative steps to make sure we’re addressing it here.

— This story was used with permission of The Nevada Independent. Go here for updates to this and other stories.