The coronavirus casino closure is ending, with cards to be dealt, dice to roll and slot jackpots to win starting Thursday in Las Vegas and throughout Nevada. (June 4) AP Domestic

LAS VEGAS It's thequestion at the heart of a quagmire Nevada has yet to figure out:Should casinos be open?

COVID-19 cases areclimbing here. Death tolls are breakingrecords. The positivity rateis almost five times higher than what the World Health Organization considers safe enough to reopen.Yet tourists keep coming.

When the USA TODAY Network asked Dr. Brian Labus an associate professor at UNLV's School of Public Health who sits on Nevada Gov. Steve Sisolak's Medical Advisory Team whether Nevada's casinos should remain open, his answer seemedsimple.

"From a public health standpoint," Labussaid, "no."

Butthe answer, he said, is more complicated.

"We cant figure out what is going to be the effect of all of these decisions that we make and we have to take all of those things in account to come up with something that is the right decision for Nevada," he said.

Labus said he doesn't envy the governor.

"I can focus on public health compared to focusingon everything."

Nevada Governor Steve Sisolak speaks about masks during a press conference in the Nevada State Legislature Building in Carson City on June 24, 2020.(Photo: JASON BEAN/RGJ)

Sisolak's first order shuttering casinos showed what happens when the state's central economic engine is shut down.

Thousands of jobless Nevadans jammedan ill-equipped unemployment system, frontline casino workers and their family members got sick and died, visitors testedpositive after Vegas vacations.

Since Nevada casinos opened on June 4, hundreds of thousands have strolled the Las Vegas Strip,packedcasinos, waitedshoulder-to-shoulder for the Bellagio fountains to dance again.Many wentmasklessand defiedsocial distancing rules.

"By leaving the casinos open a certain number of people will get sick and potentially die," Labus said. "By closing them you create all of these other problems where people are going to get sick and potentiallydie. Trying to figure out the math on that it is pretty much impossible."

(Photo: Getty Images)

Nevada State Public Health Laboratory director Dr. Mark Pandori said the question of casinos and if they should be openisn't one he could answer.

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But the question of why Nevada has seen an uptick in cases is aneasy one, he said:"It's whenuninfectedpeople are near the infected."

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In an email to Dr. Trudy Larson,another member of the state'smedical advisory team, the USA TODAY Network asked if the group would advise Sisolak to shut down Las Vegas casinos again.

Great question, Larson said in an email, and one the (medical advisory team) has not been asked.

It's a question many government officials are notwilling to address.

Nevada Gaming Control Board ChairwomanSandra Douglass Morgan did not make herself available for an interview.

In response to an interview request to Dr. Ihsan Azzam, Larson's medical advisory team colleague, the Nevada Department of Health and Human Services directed all questionsto the governors office.

Casino companiespoint to Sisolak, too.

"That decision would not be our call," Caesars Entertainmentspokesman Richard Broome said.Our focus is on running the business as effectively as possible under the new health and safety directives and protocols."

Asked whether casinos will be closed again to keep people from unknowingly spreading or contracting COVID-19 while onvacation, Gov. Sisolak's office issued a statement that did not directly address the question.

Related:More infectious mutation of COVID-19 tied to spike in Nevada cases

Instead, the response pointed to the governor's recent order closing bars and the state's response to landing in the "red zone" for COVID-19 cases.

"Based on data review, ongoing assessments of criteria, and feedback from localities," the statement said, "the governor will make determinations on if, what and when adjustments need to be made to mitigate the spread."

Nevada casinos only reopenedsevenweeks ago. In that sevenweeks, the number of new COVID-19 cases in Nevada hassurged.

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Nevadas daily death toll from COVID-19 reached its highest number with 28 new deaths reported Tuesday a record that was again tied on Wednesday.The previous daily record was 14 deaths on May 6.The new numbers bring the total COVID-19 death count for the state to 704 as of July 21.

The total number of positive cases statewide is 38,657. Most of those more than 33,000 are in Clark County, home of the Las Vegas Strip.

The states seven-day average positivity rate reached a record high this week at 22%. The World Health Organization recommends a positivity rate of 5% or lower for testing for at least 14 days prior to reopening.

When casinos reopened on June 4,the positivity rate in Clark County was 4.9%. Masks wouldnot become mandatory in all public places until almost three weeks later.

Nevada health experts likeDr. Thomas Schwenk, dean of the UNR School of Medicine, contend the Silver State would have far lower numbers if the state stayed closed for longer and masks became required sooner.

A lot of us in health care saw early on if we would really jump on this and shut this place down and mask everybody and really take it seriously and really get behind this and enforce it and have clear messaging on the state and federal level that the community would rise up and take charge of this, he said. We did not do it as dramatically as we should have early on.

It's a problem not unique to Nevada,Schwenk said.It is a problem across the country with poor leadership and direction at the highest levels.

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The Las Vegas Strip is a challenging place to corral a pandemic.

The tools have been there all along, Larson said in an interview.What hasnt been there is a public acceptance of these tools, because nobodys had to do it before.

Less than a week after the Fourth of July, health officials said anuptick in cases stemmed from contacts exposed during social gatherings, domestic travel and a lack of social distancing.

In Asia, they wear masks during respiratory season so they dont get influenza, right? And guess what: It works," Larson said."Its always worked, but weve never had to do that, and were a different kind of society than a lot of those countries.

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For almost two decades,Las Vegas was the "what happens here, stays here" destination a place people visit to forget about rules, worries and"to-do" lists.

"When you are on vacation you dont want to think about this outbreak, you want to get away from it," Labus said."But it is here too. It is following you. You cant get away from it because you are on vacation."

The tourists visiting Las Vegas despite the spread are not typical,he said.

"These are the people who definitelyarent interested in paying attention to all the requirements that we have in place," Labus said."If you are really scared about this outbreak, if you are concerned about getting sick, you arent going anywhere, especially you arent going to Las Vegas or Reno for vacation."

Contributing: Jason Hidalgo, Reno Gazette Journal.

Ed Komenda writes about Las Vegas for the Reno Gazette Journal and USA Today Network. Do you care about democracy?Then support local journalism by subscribing to the Reno Gazette Journal right here.

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Nevada's casinos and COVID-19: Should they be open? It's complicated, experts say. - Reno Gazette Journal