After the state’s biggest one-day increase in cases, Iowa’s COVID-19 team was questioned about race, their definition of ‘outbreak’

IDPH Deputy Director Sarah Reisetter wore a Raygun tee reading “This is my fighting COVID-19 shirt” to Gov. Kim Reynolds’ April 7 press conference. — video still

Iowa saw its biggest one-day increase in the number of reported new cases of COVID-19 on Tuesday, as the Iowa Department of Public Health reported 102 more people tested positive for the virus and the state’s total number of confirmed cases reached 1,048.

The newly reported cases include 16 residents of Johnson County and 11 residents of Linn County.

• Benton County, 1 middle-age adult (41-60 years)

• Black Hawk County, 3 adults (18-40 years)

• Buena Vista County, 1 middle-age adult (41-60 years)

• Delaware County, 1 older adult (61-80 years)

• Des Moines County, 2 older adults (61-80 years)

• Dubuque County, 1 adult (18-40 years), 1 middle age (41-60 years), 1 older adult (61-80 years)

• Greene County, 1 middle-age adult (41-60 years)

• Hamilton County, 1 adult (18-40 years)

• Henry County, 1 child (0-17 years), 1 adult (18-40 years), 2 middle-age adults (41-60 years)

• Johnson County, 10 adults (18-40 years), 4 middle-age adults (41-60 years), 1 older adult (61-80 years), 1 elderly adult (81+)

• Linn County, 4 adults (18-40 years), 5 middle-age adults (41-60 years), 2 older adults (61-80 years)

• Louisa County, 7 adults (18-40 years), 3 middle-age adults (41-60 years), 3 older adults (61-80 years)

• Mahaska County, 1 middle-age adult (41-60 years)

• Marion County, 1 adult (18-40 years)

• Marshall County, 2 adults (18-40 years)

• Muscatine County, 2 children (0-17 years), 3 adults (18-40 years), 3 middle-age adults (41-60 years), 2 older adults (61-80 years)

• Polk County, 1 adult (18-40 years), 1 older adult (61-80 years)

• Pottawattamie County, 1 middle-age adult (41-60 years)

• Scott County, 6 adults (18-40 years), 5 middle-age adults (41-60 years), 3 older adults (61-80 years)

• Story County, 1 middle-age adult (41-60 years)

• Tama County, 3 older adults (61-80 years), 3 elderly (81+)

• Warren County, 1 middle-age adult (41-60 years)

• Washington County, 1 adult (18-40 years), 1 middle-age adult (41-60 years), 2 older adults (61-80 years), 1 elderly (81+)

• Woodbury County, 1 adult (18-40 years)

IDPH also reported a resident of Benton County who was over the age of 81 died from the virus. That death brings the state’s total number of COVID-19 fatalities to 26.

Most of the questions at Tuesday’s press conference focused on what data IDPH is collecting about the spread of the virus and its decision-making process.

IDPH uses a map that divides the state into six regions based on how people in those areas access health care resources. Each region is scored on four metrics — the percentage of the population over 65, the percentage of COVID-19 patients requiring hospitalization, the rate of infection per 100,000 residents during the past 14 days and the number of outbreaks in long-term care facilities — and if a region scores 10 or higher out of a possible 12 points, IDPH says it will recommend the governor issue a shelter-in-place order for that region.

The governor said on Tuesday this decision-making approach allows the state to “make sure that we’re preserved the hospital capacity for COVID-19 patients.”

But IDPH’s approach has been criticized for indicating only where health care crises are occurring, rather than looking at information aimed at preventing those crises.

“Not one of the criteria has anything to do with how the virus spreads,” Dr. Eli Perencevich told the Press-Citizen. “The decision should be about estimating how many people are infected.”

Perencevich, a professor of Internal Medicine and Epidemiology at the University of Iowa Carver College of Medicine and a member of the Iowa Infection Prevention Research Group, said, “It seems like waiting to see how many older Iowans become infected. Instead of tracking the spread of disease to protect older Iowans, we are using them like a canary in the coal mine to determine how bad things are.”

But according to IDPH Deputy Director Sarah Reisetter, the department is almost ready to start using the sort of models Perencevich is talking about.

A reporter asked Reynolds if she could provide the public with the state’s projection of how many cases of COVID-19 there will be in Iowa.

The governor turned the question over to Reisetter. The short answer is the state doesn’t currently have a projection to provide to the public.

We’re working on modeling, and we’re looking at an agreement with the University of Iowa College of Public Health. We’ve been actively working to get that agreement in place.

The first part of that work will involve analyzing the existing models that exist [sic], like the University of Washington model that we have talked about previously. There are a number of different models out there.

We’ll first be asking them to analyze that information that currently exists, and then from there the plan is to transition into more modeling and forecasting for Iowa to the extent that there’s interest in continuing to modify those existing models.

So, we’re working on it. We don’t have it in hand yet. But its actively work in progress.

Reisetter said there is no “firm date” for when the projections and models will be ready, but “we hope to have it in the days and weeks to come.”

The first confirmed cases of COVID-19 in Iowa were reported on March 8. The first confirmed case in the United States was reported on Jan. 20.

Reynolds was also asked if IDPH would provide information on the racial breakdown of the state’s COVID-19 cases. On Monday, the state of Louisiana reported that more 70 percent of its COVID-19 fatalities were black, even though only 32 percent of the state’s population is.

Again, Reynolds turned the question over to Reisetter.

“At this point in time, we don’t have plans to release case counts by race and ethnicity. At the end of every outbreak, we do do an outbreak investigation report,” Reisetter said. “Once we get to that particular point in time, we might be ready to release some of that information.”

“At this point in time, the way that the information is collected by the department, we don’t have statistics that we would consider to be accurate and complete related to some of that race and ethnicity information,” she explained.

Reynolds and Reisetter were also asked the state’s statistics regarding outbreaks in long-term care facilities. At the beginning of the press conference, Reynolds said 11 percent of the state’s 1,046 positive cases were either residents or members of the staff of long-term care facilities, and residents of those facilities account for 46 percent of the state’s deaths.

IDPH reports outbreaks of COVID-19 in long-term care facilities, but defines an outbreak as three or more residents testing positive. A reporter pointed out IDPH criteria for declaring a flu outbreak at a long-term care facility is one laboratory-confirmed case and “other respiratory illnesses on the same floor.” Also, the state of Minnesota defines a COVID-19 outbreak in a long-term care facility as one resident, staff member or contract worker testing positive for the virus.

Why has Iowa adopted a more stringent definition for COVID-19 outbreaks?

Reynolds had Reisetter reply to the question. Reisetter’s reply did not explain why there is a discrepancy in the definitions of outbreak.

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