'Cruise Ships on Land': As Las Vegas Reopens, a Huge Test for Casinos

It was among the last of the big conferences before the coronavirus pandemic shuttered the massive casinos lining the Las Vegas Strip in March. More than 1,000 people gathered at MGM Resorts International’s Mirage Hotel & Casino for the Women of Power Summit, after organizers of the networking event for executive women of color assured attendees that the risk of attendance was “extremely low.”

That seemed a reasonable bet, given that Las Vegas had yet to record a single coronavirus case. What no one realized was that one of the conference speakers, a New Yorker, had already contracted the virus by the time she landed at McCarran International Airport on March 6. Two days later, she was in the hospital.

Nevada’s case count now stands at more than 9,600, and as of Sunday afternoon, 438 people had died. But the case involving the Women of Power speaker is nowhere to be found in those grim totals, despite the fact that she stayed, tested positive, was hospitalized and recovered in Las Vegas.

That is because the state’s coronavirus tally does not include visitors who get sick there or soon after returning home. Instead, only state residents who test positive are counted.

If one of the trickiest aspects of containing the pandemic is figuring out when and where people contract the virus and then quickly tracing their contacts, then there is perhaps no place in the nation where that is as tricky a task as in Las Vegas, where last year guests outnumbered residents by 20 to 1.

Casinos along the Strip last week reopened their doors to a flood of visitors, masked and unmasked but equally eager to test their luck after a 78-day hiatus. An over-the-top water show set to Elvis’ “Viva Las Vegas” at the Bellagio Hotel marked the occasion, and a marquee sign at the Aria Resort & Casino summed up Sin City’s new social distancing ethos: “Think dirty thoughts, but keep your hands clean.”

As Nevada embarks on one of the most epidemiologically complex reopening experiments in the nation, Gov. Steve Sisolak says he is confident that “every precaution possible” has been taken to ensure that the famed resorts can both serve guests and protect public health. Dealers and players are separated by Plexiglas, dice are doused in sanitizer after every throw, and guests, encouraged though not required to wear masks, are subject to mandatory temperature checks.

“I don’t think you’ll find a safer place than Las Vegas,” the governor said during a recent call with reporters. But he added that he is closely tracking the state’s case numbers and will “pull back if it causes any type of problem.”

But as the MGM case illustrates, those numbers offer only a partial picture of virus spread, one that could prevent officials from seeing and acting upon dangerous spikes in real time. Moreover, the state cannot readily identify clusters of cases among employees at a given casino. And while the contact-tracing challenges faced by Las Vegas are extreme, they highlight larger national systemic problems.

People wait in line to enter after the reopening of the D Las Vegas Hotel & Casino Thursday in Las Vegas.
Credit…John Locher/Associated Press

The resident-focused tallying method used by Nevada is shared by states across the nation, adopted to avoid counting the same cases multiple times.

The problem with that methodology, experts say, is that it can obscure whether a venue with super-spreading potential is becoming a hot spot, particularly in tourist destinations where visitors from around the world gather en masse.

Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the system, which assigns the lead investigatory role to officials in a person’s state of residence, worked fine for past outbreaks of diseases such as Legionnaires’ disease. But Covid-19, he said, is different.

“Here you have not only an issue of magnitude, but also a long incubation period and the factor of super-spreaders — one person can go into a casino and infect 200 people,” he said. “It’s a real challenge for any place with a high concentration of visitors, and it needs to be addressed.”

A handful of states keep a separate, public log of cases involving visitors who test positive for Covid-19 within their borders. Florida, home to snowbirds and Disney World, is one. Nevada is not.

“If you are drawing a map, you don’t leave out mountains because that would be an incomplete map,” said Alberto Moscoso, a spokesman for the Florida Department of Health. “It’s the same thing here.”

Last year, 42.5 million visitors flocked to Las Vegas. A little over one-fifth came from California, while another fifth were foreigners. Only a very small percentage of guests on the Strip were from Nevada.

Much depends on Las Vegas’ ability to lure those visitors back: Nevada casinos generated nearly $8.8 billion in revenue last year, and the state’s unemployment climbed to 28 percent during the shutdown, the highest in the nation.

Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University, is an infectious disease expert advising the Vatican as well as Wynn Resorts, which operates two casinos in the city, on reopening risk mitigation. Asked which was more complicated, she didn’t hesitate: “Vegas!”

“This is a group of folks working to find a way to reopen in a way that is safe, but it’s really hard,” she said. “If I get on a plane and show up in Las Vegas, and I go to three restaurants and play cards and go to a pool, there’s no national system in place to say, ‘Hey whoever came into contact with me needs to get tested.’”

Credit…Ronda Churchill/Agence France-Presse — Getty Images

In the case of the Women of Power Summit at MGM’s Mirage, casino executives said the woman who became sick initially felt unwell on the plane, but did not immediately realize what was wrong. She gave her speech and interacted with guests and staff before telling hotel security she needed to go to the hospital.

After she tested positive for the coronavirus, Dr. Fermin Leguen, the acting chief health officer for the Southern Nevada Health District, said he notified New York that it had a case involving a woman hospitalized in Nevada, issued a public notice and asked summit organizers to notify attendees.

It is unclear what organizers did with that information or if other participants got sick; Caroline Clarke, chief brand officer for Black Enterprise, which hosted the event, declined to comment.

But John McManus, MGM’s general counsel, said that when the resort did its own contact tracing it found that three senior resort employees who had been in contact with the woman were infected, two of whom had to be hospitalized.

That cluster was not, however, readily apparent to either health officials or the public, even though it involved Nevada residents.

That is because while local heath districts are capable of tracking cases to certain workplaces — they currently do so for nursing homes, prisons and preschools — the database they use does not allow officials to sort cases by casino.

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The Coronavirus Outbreak

  • Frequently Asked Questions and Advice

    Updated June 5, 2020

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How do I take my temperature?

      Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How do I get tested?

      If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.


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“That information might be available within the history of a case, but we’d have to go over each case to find it,” said Dr. Leguen.

That is what Dr. Leguen’s staff did when asked by The New York Times to provide case totals involving casino employees from the beginning of the outbreak through April 2, to include the two-week incubation period after the governor’s March 18 shutdown order. The answer, he said, was at least 27.

But Dr. Leguen seemed unaware of the three MGM cases linked to the conference presenter’s case, incorrectly stating that “none of the hotel employees” in contact with the woman had developed coronavirus. He declined to explain that discrepancy, saying he could not comment on individual cases.

He did, however, note that the district uses the Center for Disease Control and Prevention’s Covid-19 Case Report Form to collect case information, a form that does not require health departments to list a person’s employer. Understanding a casino’s role in virus spread is made more difficult by the fact that what happens in Vegas does not necessarily stay there; guests, who on average spend three to four nights in Las Vegas, might contract the virus at a casino but become symptomatic only after returning home.

Reopening regulations require casinos to notify health authorities if they learn of a Covid-19 case at their property. But they are under no obligation to follow up with guests after they leave, and different resorts have adopted different policies.

MGM is providing a contact email and asking guests to voluntarily notify the company if they test positive within two weeks of their stay. But other casinos, including two owned by Wynn Resorts, have decided to leave that job to health officials.

Dr. Leguen said that ultimately he relies upon health officials in other states or countries to notify him if a person who visited Las Vegas during the incubation period tests positive after they leave.

But understaffed health departments can barely keep up with what is happening within their own states. Dr. Leguen received only 17 such out-of-state notifications through April 2, according to a spokeswoman, even though by that point the virus was raging.

And visitors to Las Vegas tend to mill about in ways that present a contacting tracing nightmare. Nearly three-quarters of visitors to the Strip gamble, according to the Las Vegas Convention and Visitor Authority, hopping not only from table to table but from resort to resort, and more than half of them see shows.

Consider the scale of Wynn Resorts alone: On any given day before the shutdown, some 10,000 visitors walked through its doors, where they consumed an average of 34,000 drinks and 17,000 meals among 19 restaurants.

“Cruise ships on land” D. Taylor, the president of UNITE HERE, a union representing casino workers, calls the mega-casinos.

Credit…Ethan Miller/Getty Images

Mariano Mintero, 64, works in housekeeping at the Bellagio, another MGM property. He was eager to return to work after so long without a paycheck, but worried, too. In the days following the shutdown, he said, he had heard that a number of housekeeping employees had contracted the virus.

“I know we are working for a good company,” Mr. Mintero said, “but I’m a little scared.”

Both MGM and Wynn Resorts are going beyond Nevada’s minimum reopening requirements. Wynn required all returning employees to be tested, for instance, while MGM will offer on-site tests to guests who feel unwell. Both said they also would be willing to support making it easier to track employee cases by casino.

“I’m in favor of anything that gives all of us more information during this period of time,” Mr. McManus said. “You have to come at this virus from every angle, because the last thing we want is for people to get sick and for us to have to shut down again. No one wants to go through this again.”

Danielle Ivory contributed reporting.

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