Las Vegas casino venues are suspected of being ground zero for the spread of COVID-19. It’s almost impossible for health authorities to implement contact tracing, the one tool that gives officials hard evidence of the spread of a virus. In the case of Vegas casino visitation, customers come to Vegas, visit the resorts and then return to their homes across the United States. The sheer number of travelers makes contact tracing in the midst of a pandemic unlikely.
Contact tracing is the most important tool that health authorities have to stop a pandemic. It’s a labor-intensive process in which officials track down everyone who has had any contact with an infected person. Once the people who have had contact with an infected person have been identified they can be notified that they need to quarantine which can reduce further spread. But the United States has no national system in place to facilitate contact tracing.
Currently, contact tracing in the United States is carried out by individual localities. The various health agencies often don’t communicate with one another.
Joshua Michaud, associate director of global health policy for the Kaiser Family Foundation is an epidemiologist who specializes in identifying and halting the spread of “cluster outbreaks” and “superspreading events. “The way it’s set up right now, contact tracers are not looking for clusters that might identify outbreaks tied to traveling to a casino or other specific locations,” said Michaud. “You’re not actively looking for it, so you might miss that event. Contact tracing is not set up to answer those questions, so you’ll still be in the dark.”
Las Vegas Trips
ProPublica commissioned an analysis of smartphone data to address concerns about the limitations of interstate contact tracing. Tectonix and X-Mode analyzed travel to and from Las Vegas over a four day period in mid-July.
During the four day period that covered Friday through Monday the companies identified approximately 26,000 devices on the Las Vegas Strip. After those four days the companies found the devices had returned, with their owners, in Arizona, Texas, Milwaukee, Cleveland, Chicago, Detroit, Southern California and New York. Devices returned to every mainland state except Maine.
The study highlights the dangers of having Las Vegas reopen. Oscar Alleyne, an epidemiologist and chief program officer with the National Association of County and City Health Officials points out that “people have been highly mobile, and as a result, it makes sense why we see the continuation of the surge.”
When it comes to Las Vegas, the data isn’t shared by local health agencies. Kimberly Hertin, disease surveillance supervisor for Southern Nevada Health District’s Office of Epidemiology and Disease Surveillance, which is responsible for Las Vegas, believes that the lack of communication is making it impossible to get a complete picture in real time.
In the weeks following Las Vegas’s reopening, the number of daily COVID-19 cases in Las Vegas increased tenfold. There are now more than 50,000 cases in Clark County and the number of new cases remains high. The Harvard Global Health Institute has recommended that Clark County implement stay-at-home orders though none have been put into place.
Hertin explains that the challenge to facilitate contract tracing during the coronavirus pandemic is tremendously challenging. COVID-19’s incubation period can be up to two weeks. That means that, by the time it’s discovered in a traveler who visited Las Vegas, that person would likely have returned home. Hertin says that it’s “pretty much impossible” to identify the source of the cases.
She explained that contact tracing efforts focus on the person with a confirmed case to ensure that they don’t spread it to others, rather than identifying the source of that person’s infection. “Once you’ve reached the point of community spread with this virus, it’s hard to jump to that conclusion of any clusters or outbreaks,” she said.
“Our systems are in place for doing this when diseases are not highly prevalent,” like an E. coli or salmonella outbreak traced to lettuce or onions, said Alleyne. COVID-19 is different. It affects hundreds of thousands of people which “magnifies and overwhelms the system.”
Casinos say that they are on board with helping to identify situations in which casino patrons may have been infected while they were guests at the casinos. MGM Resorts International, which owns the Mandalay Bay Bellagio, Aria and other properties asks guests to email the resort if they test positive. But the company would not share information about how many times it has received emails or how many times it has notified the Southern Nevada Health District about possible transmission.
Michaud is unimpressed. He says that MGM’s policy of putting the responsibility to email the company on the guests is unrealistic and unlikely to succeed. It’s “a lot of steps in a chain where you could miss a connection,” he said. “If someone gets tested when they get back home and don’t email them back, it’s a piece of information they would never get.”
Vegas reopened in June and ever since the number of visitors has increased steadily. Many casino visitors drive into Vegas from neighboring states. In June alone more than a million passengers arrived via the airport. That’s about a quarter as many as June 2019 but still accounts for a significant number of people who get infected in the city and then return to their home states.
Alleyne says that the cellphone data analysis demonstrates how travel to Las Vegas may be fueling the pandemic, “In this rush to reopen and reposition the economic activities, all we’ve been doing is spreading and amplifying the reach of this disease.”
Many public health experts are calling casinos a high-risk environment for the spread of COVID-19. The venues are crowded, indoors and filled with individuals who are prone to taking risks. That makes casinos a fertile ground for spreading COVID-19.
Crystal Watson, senior scholar at The Johns Hopkins Center for Health Security commented. “There is a serious opportunity for spreading the virus, especially for people who are mildly sick or don’t know they’re sick.” Up to 40% of those infected with COVID-19 show no symptoms. “We’ve seen big outbreaks kicked off by these types of situations.”
Nevada regulators are allowing casinos to set many of their own safety measures. They set minimum standards for COVID-19 protections but workers feel that they are not protected. Gaming companies have significant political power in Nevada and critics say that that has influenced the easy conditions for reopening.
The Vegas economy depends on tourism and it’s to the benefit of the casino industry, politicians and others who earn their livings from tourism to keep the casinos running. Las Vegas Mayor Carolyn Goodman has been an early and vocal advocate for reopening despite dangers involve. She appeared to suggest that her city serve as a sort of “control group” for a nationwide experiment. “How do you know until we have a control group?” she asked. “We offered to be a control group.”
Michael Green, a historian at the University of Nevada, Las Vegas, explained: “The casino industry is the tail that wags the dog. It may also just be the dog.”
Vegas’s casinos have made some changes. Workers are checked for symptoms daily. Capacity is limited Seats at gaming tables and slots are spread apart. There are plexiglass barriers to separate dealers and players. Hand-washing and sanitizing stations are set up throughout the properties.
But critics say that the regulators, for the most part, gave the casinos a pass on more important restrictions and limitations. Guests were not required to wear masks when the casinos reopened but shortly thereafter, Gov. Steve Sisolak ordered face coverings for everyone in a public space after COVID-19 cases started rising.
Even among the casino operators, there were differences in their reopening strategies. MGM had no policy in place for employees to be tested while Wynn required testing. Enforcement is also uneven – customers can take off their masks to eat or drink so some customers spend their entire casino visit with a drink in their hand.
The Culinary Union has been proactive in trying to protect its workers. They have documented many cases where guests did not distance or wear masks, protective equipment for staff was unavailable and even times when the casino ran out of hand sanitizer The union has filed suit against several properties because of the lack of protections for workers.
Presently, the union and casino operators have agreed to work together to establish protections for workers including social distancing, hand-washing and standards for cleaning.
Is reopening Las Vegas gambling with lives? History will determine the casinos’ role in either promoting new cases or helping to restart a significant industry’s economy.