COVID-19: Gov. Reynolds fears ‘over-mitigating’ as Iowa’s care facilities flounder

Gov. Kim Reynolds answers questions from the press during her Tuesday, Nov. 24 press conference. — video still

Iowa had the fifth-highest rate of new cases of COVID-19 in the country last week, according to the latest White House Coronavirus Task Force report. The report, which was sent to the governor’s office on Sunday and published by ABC News on Tuesday, said Iowa had the third-highest positivity rate in its COVID-19 tests of any state.

The report did sound a positive note about the new mitigation steps, including the limited statewide mask mandate Gov. Kim Reynolds introduced on Nov. 16. (The task force has for months been calling for a statewide mask mandate in Iowa.)

“Encouraged by the steps the Governor is taking to decrease transmission; this is the first week where the rise in cases is less than previous weeks,” the report said. But it cautioned, “COVID-related hospitalizations will continue in the coming weeks; however, with increased strong mitigation.”

At her news conference on Tuesday, Gov. Reynolds said more than once she would continue to review information about the spread of COVID-19 in the state and might increase mitigation efforts, if she believes it is necessary.

Asked what further actions to limit the spread of the virus she is actively considering, Reynolds replied, “I’m not going to list out what we’re looking at.”

The governor did say she is “grateful and hopeful” that effective vaccines are likely to begin to be distributed next month, and by the “encouraging news with the therapeutics.”

During her prepared remarks on Tuesday, Reynolds said she spoke with members of the Trump administration on Monday regarding the distribution of vaccines. According to the governor, it is expected the federal government will receive 22.5 million doses of the vaccine being manufactured by Pfizer and 15 million doses of the Moderna vaccine, which will be immediately allocated to the states. The amount each state receives will be based on its population.

Reynolds said the Iowa Department of Public Health already has a strategy for distributing the vaccinations in the state.

“At first there will be limited supply of the COVID-19 vaccine, so our immediate vaccination efforts will focus on those critical to the response, including those who provide direct care, and maintain critical infrastructure, and those at highest risk for development of serious illness from the virus,” she said.

The governor cautioned, “It will take some time for the vaccine to become widely available. In the meantime, we must be patient and do everything that we can to prevent getting and spreading the virus.”

The uncontrolled spread of the virus in Iowa continued on Tuesday, bringing to an end the five-day-long decline in the number of hospitalizations, as IDPH reported 1,351 confirmed cases of COVID-19 among patients, an increase of 18 cases from the previous day. One hundred and sixty-five of those patients had been admitted within the previous 24 hours, and 275 were being treated in intensive care units.

At 10 a.m. on Tuesday morning IDPH reported another 3,860 Iowans, including 133 residents of Johnson County and 212 residents of Linn County, had tested positive since the same time on Monday. The new cases brought the total number of people in the state who have tested positive to 215,582.

During that same 24-hour period, IDPH also reported another 19 deaths from the virus. Among the deceased were three residents of Linn County. At 10 a.m., the state’s COVID-19 death toll stood at 2,224.

A banner hangs outside of Heritage Specialty Care in Cedar Rapids where people can leave positive messages for the nursing home’s residents and staff members. April 20, 2020. — Izabela Zaluska/Little Village

But the most troubling statistic on Tuesday was the increase in COVID-19 outbreaks at nursing homes and other long-term care facilities. By Tuesday afternoon, IDPH had reported another 30 outbreaks, an increase of 25 percent since Monday. According to the department, 150 long-term care facilities, or slightly more than a third of all such facilities in Iowa, have ongoing outbreaks.

That number, however, understates the spread of COVID-19 in Iowa’s long-term care facilities. In its latest report, the White House Coronavirus Task Force noted that nearly 70 percent of Iowa’s long-term care facilities had at least one staff member with a confirmed case of the virus.

Iowa doesn’t report that a long-term care facility has any cases of COVID-19 until the facility meets its definition of an outbreak: three residents testing positive for the virus within 14 days. That’s an unusually strict definition for an outbreak, which keeps the number of outbreaks IDPH reports low. In Minnesota, by contrast, any long-term care facility where any resident, staff member or contract worker tests positive is considered to be experiencing an outbreak.

Reynolds was asked during her news conference what mitigation efforts she undertaking to address the problem in long-term care facilities. The governor said her administration was continuing its efforts to make sure facilities had testing supplies and providing guidance on staffing issues.

She also noted that last week she allocated $14 million in federal CARES Act funds to assist long-term care facilities with testing and staff issues.

Some patient advocates have said the state should report the number of COVID-19 staff deaths, in order to give the public a better understanding of the staffing problems at long-term care facilities. IDPH currently reports positive cases and deaths by the facility, without distinguishing between residents and staff members.

Reynolds was asked why IDPH doesn’t report the number of staff deaths separately.

“There’s a difference between, you know, whether it’s for the public health or the public good or the public interest,” she said. “We list the outbreak status on the website. We list the deaths in aggregate and that’s what we’ll continue to do.”

An employee at the Sports Column in downtown Iowa City arranges patio furniture on July 14, 2020. — Emma McClatchey/Little Village

The White House Coronavirus Task Force report said outbreaks in long-term care facilities are being driven by community spread and “mitigation and messaging needs to be further strengthened as other states have done. Effective practices to decrease transmission in public spaces include limiting restaurant indoor capacity to less than 25% and limiting bar hours until cases and test positivity decrease to the yellow zone.”

Only Lucas County was in the yellow zone (50 or fewer new cases per 100,000 residents) in the latest task force report. Iowa’s other 98 counties were in the red zone (101 or more new cases per 100,000 residents).

Reynolds was asked on Tuesday if she believed she has done enough to limit community spread and keep it from reaching the residents of long-term care facilities.

“We’ve been, I think, very aggressive in how we’ve handle it,” the governors said, before going on to suggest the question was unfair.

“It’s easy to look back and see if you maybe should have done more or done less, or handled it a little bit differently,” Reynolds said. “I’ve tried to be very targeted in the mitigation efforts that we’ve put in place.”

The governor pushed back even harder when asked why she didn’t take impose new mitigation measures as the current surge was building in October.

“Yeah, well, it’s easy to second guess,” Reynolds said, obviously annoyed. “So I appreciate that, the opportunity that you all have.”

The governor said it was the responsibility of the media to amplify her calls for Iowans to voluntarily take basic precautions such as washing their hands frequently. She also pointed to the bar closures she mandated in six counties that were experiencing spikes in COVID-19 cases.

But the order to close those bars was issued in August, not October. The governor spent much of October campaigning across the state for Republican candidates at events where few people wore face masks or practiced social distancing.

Defending her decision not to take any actions as the current surge was building, Reynolds said “you have to careful about over-mitigating” and it was important that people “still feel like they’re part of the answer, the solution, and we’re not over-asking.”

The governor pointed out, as she frequently does, that states that have relied on mandatory measures instead of her preferred approach of voluntary compliance are also seeing an increase in virus spread. The new task force report supports this, describing community spread as “aggressive, rapid, and expanding” in the United States as a whole.

But Iowa remains in a much worse position than most states. According to the new report, Iowa had 875 new cases of the virus per 100,000 residents last week, more than twice the national average of 356 new cases per 100,000 residents.

Iowa also had 5.7 deaths from COVID-19 per 100,000 residents last week, according to the report. The national average was three deaths per 100,000 residents.

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