Humboldt County, for two days this week, held the distinction of having the most coronavirus cases per capita of any county in Nevada.

It started with one case on March 27. Then, two more the next day. Now, a week and a half later, there are 14 confirmed cases of COVID-19 in the remote, rural county, home to fewer than 17,000 residents.

It’s still a fraction of the nearly 1,900 cases reported in populous Clark County, where roughly three-quarters of the state’s 3 million residents live. And Clark, which reported 144 new cases of the novel coronavirus Wednesday morning, once again leads the state in confirmed cases per capita, at 8.4 per 10,000 residents, with Humboldt a close second, at 8.3 per 10,000.

It makes some sense that Clark County, which is visited by 40 million people a year, would have a high number of cases per capita. More visitors means more possible exposure to the virus. But how did Humboldt, a sparsely populated county in the middle of the state, between Reno and Elko, get here? And what does it portend for potential case spikes in the rest of rural Nevada?

Multiple people familiar with the situation in Humboldt told The Nevada Independent the cases have been clustered within a family that held a large gathering that exposed many individuals to the novel coronavirus. Dr. Charles Stringham, the county’s health officer, said only that the virus was introduced by a visitor and that the original cases “had very close connections with each other.”

“But that has the potential to change,” Stringham said.

As of Tuesday morning, 146 people in Humboldt County had been tested for the virus with five results pending. Of the 14 positive cases, four were initially hospitalized, though one has since been released. Two of the three still hospitalized are intubated and on ventilators in Reno. The third is being cared for at Humboldt General Hospital in Winnemucca. The rest of the cases are self-isolating at home.

Humboldt General Hospital, one of the more well-equipped rural hospitals, has three ICU beds and three ventilators available to treat patients. But Stringham said the policy so far has been to transfer all patients who are intubated and on a ventilator to Reno for treatment.

“If we were to have a tremendous amount of people come in to be ventilated on the same day, it could be dangerous,” Stringham said. “If the ventilators and the number of cases in Reno allows, our preference would be to continue to transfer them.”

Local officials acknowledge the county’s high per capita rate of cases, but they aren’t yet seeing widespread transmission through the community because the cases have so far been clustered.

“We don’t have people going to Walmart and getting sick. We don’t have people going grocery shopping and getting sick,” said Captain Sean Wilkin, who helms the county’s emergency management efforts through the Humboldt County Sheriff's Office. “That has worked to the advantage of our community.”

But the cases do underscore a message local officials are trying to drive home to residents: Stay at home, wash your hands, disinfect frequently touched surfaces often, do not attend large gatherings, and, if you must go out in public, stay as far away from people as you possibly can.

“In the end, the most important thing for anyone to focus on in this pandemic is our behavior. No matter what the number of cases is, the behavior modification needs to be the same. The things we need to be doing are exactly the same,” Stringham said. “The problem is not combating the virus. It’s combating human behavior. It’s combating the fact that people are busy and don’t have the attention to be able to spend on something they don’t see as important.”

Despite the number of confirmed cases in Humboldt County, Stringham said there still are many residents who aren’t taking the virus seriously enough.

“We’re still seeing people congregating,” Stringham said. “People can recite the words that we’re telling them, but it’s not actually translating to people doing the right things.”

An additional complication in Humboldt, Stringham said, has been educating residents that their family members, friends, coworkers and neighbors are all potential sources of exposure to the virus. Someone in Las Vegas might go to the grocery store and exercise more caution because the store is filled with strangers; in Winnemucca, strangers are few and far between.

“In a small town where everybody knows everybody, the problem is when the virus comes to you, it will come in the form of a person who doesn’t look the way you expect them to,” Stringham said. “That’s one of the reasons it’s been so difficult to combat this virus because every one of us knows almost every one of us in town. Some of my very best friends in all of life are in Winnemucca. It’s hard to push those people away, but a person standing close to anyone else is a threat.”

To that end, Stringham has coordinated a volunteer health educator team, composed of off-duty EMS employees and others with health-related day jobs. The group, which had its first meeting on Tuesday, will focus on reaching out to local businesses deemed to have “significant risk of unintentionally spreading the virus” and other community education efforts, Stringham said.

But one of the benefits of being a small town is that many of those relationships already exist. For instance, County Manager Dave Mendiola said he tried to go to a hardware store in town over the weekend but left because it was too crowded. He later followed up with the owner personally about it.

“I said, ‘Hey, I just wanted to let you know this happened to me. I went somewhere else. I always do business with you, but I can’t until you put something in place that guarantees that I have safety, and the safety of other people too.’ The owner said,’ ‘You’re right. We need to look a little bit closer,’” Mendiola said. “People know people and if you have somebody that’s in town and they’re very concerned about it, they’re going to say something to each other and they’re going to take it in a friendly way.”

Local officials also have been in communication with the mines about their safety plans. Stringham said that while he was initially “very worried” about possible transmission of the virus aboard the buses that carry workers to the mines, the buses have been reconfigured so that they are “quite safe.”

Right now, Humboldt has enough capacity to treat the current cases of the virus, but county officials recently set up an auxiliary hospital with space to care for 90 patients at the Winnemucca Events Complex. That facility is expected to take in patients who require hospitalization and isolation but are not sick enough to require care at the actual hospital.

Wilkin said that if the county is short on medical personnel to staff the facility, it can put out a request for outside medical staff, the Nevada National Guard or other state agencies to step in and help.

“We’re in a good position here to take care of our community,” Wilkin said. “The off-site hospital gives us the ability to probably take care of far more patients than we would see.”

Mendiola noted that small town relationships also helped to quickly prepare that facility.

“We’re all friends, and they’ll pull out the stops, whatever they need to do,” he said. “We don’t have to come up with an MOU. Let’s just do it.”

Relationships don’t stop at county lines, either. Humboldt County is in the process of joining Elko County’s coronavirus hotline, which also serves Lander and Eureka counties.

“We’ve got our counties all working together, so we’re not having to reinvent the wheel on our own,” Mendiola said. “We talk with each other all the time, what are you doing, what are you doing.”

Community members are also stepping up to do their part. An unofficial group known as “Mucca Mask Makers” has come together to make about 700 masks for the community in a week. It started out with a simple Facebook message from Leanne Robertson, now the group’s lead volunteer coordinator, asking if anyone at the hospital needed masks. Now, 20 to 30 people are actively sewing masks.

Two women have volunteered just to focus on making bias tape for the masks. One man has volunteered to laser cut fabric. The quilt shop in town received an anonymous donation to supply fabric for the masks. The other volunteers are just sewing as many as they possibly can, between work and their own personal commitments.

“I have people from every walk of life imaginable. Some of them are out of work right now, so they’re using their time to help the community by sewing,” Robertson said. “I’m just amazed at our community and how much they’ve been willing to help.”

Robertson said that she has a running list of people on Facebook who have requested masks and offers curbside-style pickup of them out of her truck in a parking lot in town.

As far as the 14 cases, Robertson said she thinks people have felt more comfortable because the cases have been clustered, though she noted that there has been some concern among residents that some of the family members went around town after the gathering. But she said she does see more people, particularly older individuals, taking more precautions, such as wearing face masks.

“Me, personally, I feel like unless you live on another planet, you’re probably going to end up coming in contact with it. It’s on money, it’s on everything we touch, and everything we do,” Robertson said. “I do feel like we’re going to be a little more protected, sheltered from it, because we are isolated geographically. But we have it here. It’s not like we don’t.”