Nevada is no stranger to disease outbreaks like the coronavirus.

For at least a century, illnesses of international concern have prompted event cancellations, the resurgence of face masks and an aggressive public health response in the Silver State.

To date, two people in Nevada have tested positive for coronavirus, including a Clark County man with an underlying health condition who had recently traveled to Washington and Texas — states where cases of the virus have been confirmed — and a Washoe County man who had been on an affected cruise ship. There have been no deaths, but Nevada officials have taken steps such as monitoring and calling for “self-quarantines” of people who have traveled to countries with a high incidence of the illness.

The state is also ramping up its capacity to test for the coronavirus.

Below is an overview of how Nevada responded to five major outbreaks over a 100-year span.

Spanish Flu (1918-1919)

This pandemic, which infected about one-third of the total world population and is believed to have killed as many as 50 million people, also took a heavy toll on Nevada.

In 1918, the Nevada State Board of Health reported nearly 4,000 flu cases in a state whose population was just 77,000.

An exhibit at the Nevada State Museum in 2018, the centennial of the pandemic, said that the Las Vegas City Commission adopted an ordinance during the outbreak mandating people wear masks in public. The health board enacted a quarantine in October 1918 on schools and “public places of amusement.”

The exhibit includes minutes from the Goldfield Women’s Club, which canceled its November 1918 meeting because of the flu, and said that chairs were removed from public places so people would not linger, according to the Las Vegas Review-Journal.

At the time, Las Vegas had a population of about 2,000 and a hospital with only 12 beds and a few doctors, according to the exhibit. Families cared for sick loved ones in homes, marking them with quarantine signs, and had to build coffins out of boards when the local undertaker got sick.

The vast scale of the pandemic is attributed to a mutation in the virus that made it more deadly, and the movement of troops in World War I that spread the disease, especially in crowded settings such as trenches. Historians also blame the pandemic on officials’ hesitance to impose quarantines, such as among employees in factories producing supplies of war.

Number of cases in Nevada, 1918: ~4,000

Number of deaths in Las Vegas: 40 

Number of deaths in the U.S.: 675,000

Number of cases worldwide: 500 million

Number of deaths worldwide: 20 million to 50 million

SARS Outbreak (2003)

Caused by another type of coronavirus that causes respiratory illness and flu-like symptoms, the SARS (severe acute respiratory syndrome) outbreak started in the Guangdong province of China in November 2002 and was contained in about eight months. 

There were an estimated 8,098 SARS cases worldwide — less than 10 percent of the latest number of confirmed COVID-19 cases. It spread to 26 countries, resulted in 774 deaths worldwide, and had a case fatality rate of 9.63 percent, which is much higher than the mortality rate observed so far from COVID-19.  

Ultimately there were eight confirmed cases of SARS in the U.S. in people who had traveled to areas where the pandemic had spread, which included Toronto. None of the sick patients died and cases were mostly distributed along the U.S. border with Ontario and Quebec. 

On March 15, 2003, the Centers for Disease Control and Prevention issued the first health alert related to SARS in the U.S. — mostly travel advisories and precautions for those traveling from Hong Kong or China. The CDC received hundreds of reports of suspected cases from various states in the following months. 

The World Health Organization announced on July 5, 2003 that the SARS outbreak had been contained worldwide, meaning that the last known onset of the case had occurred 20 days (two consecutive incubation periods) prior to the announcement.

SARS had a minimal impact on Las Vegas’ tourism. Reporting by the Las Vegas Review-Journal found that lower-than-usual attendance at one convention was likely driven by travel advisories that had been issued by health officials.  

SARS was primarily transmitted from person to person, although animal-to-human transmission was also possible. The virus is believed to have been originally transmitted to humans from civet cats. 

Number of cases in the U.S.: 8

Number of deaths in the U.S.: 0

Number of cases worldwide: 8,098

Number of deaths worldwide: 774

H1N1 (Swine Flu) Outbreak (2009-2010)

On April 29, 2009, Washoe County Health District officials confirmed the first case of the H1N1 “swine flu” virus in Nevada — in a 2-year-old girl. 

Then-Gov. Jim Gibbons urged Nevadans not to panic in a statement following the confirmation. 

“Many people are suffering through needless anxiety,” Gibbons said. “This is not a time for over-reaction, fear or panic. At this time, there is no vaccine for this strain of the flu, however, swine flu is easily treatable.” 

A few days after these cases were confirmed, the Centers for Disease Control and Prevention (CDC) began working on a vaccine. After the FDA had approved four vaccines for the swine flu in September, the federal government ordered 195 million doses. Five different vaccinations had been FDA-approved by November. 

At the point of the first confirmed case, Nevada had about 140,000 courses of antiviral treatment available and was expecting more from the federal government. 

Vaccines, which were injectable or intranasal, were also given at a no-cost, first-come first-served basis throughout the state, including the Washoe County Health District buildings. 

According to a report by the Nevada State Health Division, Washoe County had the majority of the confirmed cases, with 1,065 cases compared with 318 in Clark County. However, more people died from the virus in Clark County, which had 36 deaths compared with three in Washoe County.  

By January 2010, Nevada had 2,451 confirmed cases of the swine flu and 62 probable cases total. 

The state provided public information on the virus by having general information updates available via a bilingual hotline, bimonthly meetings with Nevada State Health Division representatives and the Nevada Broadcasting Association aired radio spots on flu prevention in English and Spanish across the state. 

The H1N1 “swine flu” virus was first detected in Central Mexico in March 2009. By April, the virus had spread to the United States, with the first confirmed case being a 10-year-old girl in California.

In June, the World Health Organization (WHO) categorized the outbreak as an alert level six, its highest level and officially pandemic status. By the end of the month, the CDC had confirmed at least a million cases in the U.S.

The swine flu virus was an unusual virus in that it had strains of bird, swine and human flu viruses, a combination that had reportedly not been seen before. Antiviral drugs Tamiflu and Relenza were prescribed by doctors to help with symptoms.  

The pandemic began to wind down by November 2009 and WHO declared the outbreak in the “post-pandemic” stage in August 2010. Las Vegas local news stories from 2009 found that the H1N1 virus had a minimal impact on the tourism industry. 

Number of cases in Nevada: 2,451 (As of Jan. 2010) 

Number of deaths in Nevada: 40 (As of Jan. 2010) 

Number of deaths in the U.S.: 12,469

Number of deaths worldwide: 151,700 - 575,400 (following a 2012 study co-authored by members of the CDC Influenza Division) 

MERS Outbreak (2012-2015)

Just like COVID-19, Middle East Respiratory Syndrome (MERS) was a respiratory illness caused by a coronavirus. The illness was identified in 2012 in Saudi Arabia, and as of November 2019, 2,494 cases of MERS have been identified globally with a death rate of 34.4 percent.

McCarran International Airport in Las Vegas was one of 22 airports in the country to post CDC warnings for travelers visiting the Arabian Peninsula. Signs warned about the virus and urged travelers to wash their hands, avoid touching their face, and avoid contact with sick people.

According to the CDC, only two patients in the U.S. have ever tested positive for MERS. Both of these patients were tested in May 2014 and both were health care providers who had worked in Saudi Arabia, where it is suspected they were infected. One patient was from Indiana and the other was from Florida. No cases were ever identified in Nevada.

Nevada’s health organizations sent out preparatory materials, including a bulletin from the Nevada Division of Public and Behavioral Health and a guide from the Washoe County Health District.

These materials gave providers information on how to identify and isolate symptomatic patients and contact information to have them approved by the office of epidemiology for testing. No patient could be tested for MERS without that approval.

While the outbreak did affect tourism in South Korea, the country with the highest number of cases outside of Saudi Arabia, a similar effect was not seen in Nevada.

Number of cases in Nevada: 0

Number of cases in the U.S.: 2

Number of deaths in the U.S.: 0

Number of cases worldwide: 2,494

Number of deaths worldwide: 858

Ebola Outbreak: 2014-2016

The 2014 Ebola Virus Disease (EVD) epidemic began in West Africa but spread across the globe. By the time the World Health Organization (WHO) removed their Public Health Emergency of International Concern status in 2016, the disease had infected more than 28,000 people and resulted in roughly 11,000 deaths worldwide. 

In response to the epidemic, then-Gov. Brian Sandoval directed the Nevada Department of Health and Human Services to form an advisory board to oversee training, communication, and precautionary measures. 

Airline passengers experienced a false alarm in October 2014 amid reports that a patient who had recently traveled to Africa vomited on board. The plane was quarantined on the tarmac at McCarran International Airport while health officials responded before determining the person didn’t meet the criteria for Ebola.

Although 11 patients with EVD were treated in the U.S., four patients became ill after they returned to the U.S. following exposure to the disease in a health care setting or somewhere in West Africa.

The CDC reported that only one patient in Dallas, Texas died from the disease after he came back from a trip to West Africa.

Number of cases in Nevada: 0

Number of cases in the U.S.: 11

Number of deaths in the U.S.: 1

Number of cases worldwide: 28,625

Number of deaths worldwide: 11,325