When COVID-19 first took root in the United States, Iowa City resident Nora Boerner joined many nationwide in staying home as much as possible to keep her husband and four children safe. However, these precautions weren’t enough to prevent her from contracting the disease in mid-April.
“Because of when I got sick and the journey that I took with it, I in some way walked this journey of COVID-19 with the country,” Boerner said. “I was taking it seriously before, but now, this is life and death.”
Boerner’s experience began on April 17 when she “all of a sudden felt really tired” and called the University of Iowa Hospitals and Clinics (UIHC) out of an abundance of caution. After being asked some questions, she was told to isolate and immediately quarantined.
“I had significant symptoms, and even while I was rushing to get my items to the basement, I was short of breath down the stairs,” Boerner said. “It was a very quick onset, and I was sick from then on.”
At the time that Boerner realized she was ill, COVID-19 cases in Iowa were steadily increasing. The state hit its high of 757 new confirmed cases in a single day in May, according to the Iowa Department of Health’s COVID-19 information database. (This record was beat on July 17, as the virus resurged in Iowa.)
Once she began quarantining, Boerner met with the Influenza Like Illness (ILI) Telemedicine Clinic, who suggested she get examined. She received a throat-swab COVID-19 test on April 21 after being told the hospital had run out of nasal swabs, and tested negative.
However, after coming out of isolation following the test, Boerner continued experiencing symptoms. Two days later, a provider in a follow-up appointment with the ILI Clinic told her that “all signs point to [Boerner] having COVID-19,” despite the test results. Every medical provider Boerner met from then on agreed she had COVID-19.
“That was frustrating for my family, because we’d been trying not to expose any of them,” she said. “It’s been an experience overall of being aware of how little the medical community knows about this. Nearly every person I talked to had a different perspective.”
University of Iowa Clinical Professor of Internal Medicine and Neurology Dr. Brian Gehlbach noted that while the hospital’s administration did their best to keep staff informed and safe, early pandemic stages were “characterized by anxiety” as the hospital scrambled to handle a new pathogen and avoid personal risk.
“We spent a staggering amount of time as an institution trying to figure out how to prepare for the surge of patients while also maintaining safety for staff,” Gehlbach said. “A lot of things were considered in advance, but it’s impossible to imagine every single one of the hundreds of details involved in day-to-day interactions until you actually start.”
Despite extensive planning, medical staff experienced a shortage of personal protective equipment, or PPE, early on. Gehlbach spent several weeks with patients in the intensive care unit and recalled that, for a time, doctors did not wear face coverings at all times in an effort to preserve PPE, and adopted a reuse policy for respirators and N-95 masks. Years of throwing masks away after being used briefly “seem like an amazing luxury now,” he said.
Several months after her diagnosis, Boerner remains plagued by symptoms including breathing difficulties, heartbeat irregularities and a metallic taste in her mouth. She took around a month off work in April and May to recover and halted much of her previously “very busy” lifestyle. Two of her children also contracted the disease and experienced mild symptoms, but have since recovered.
Physical ailments aside, Boerner suffered mental health issues due to her guilt for placing extra burdens on her family as a result of her illness, and feeling disregarded by others in the community and across the country not taking the pandemic seriously.
“It was really challenging to wonder for a time whether I was going to live or not,” she said. “I was really active, healthy, had no preexisting conditions, and COVID-19 just leveled me. It’s been emotionally hard in that way that I feel unheard.”
Gehlbach noted that a common mental health effect on patients, particularly for those who received intensive care unit treatment, is post-intensive care syndrome (PICS). PICS is a condition often developed after an individual survives a critical illness and can lead to issues like cognitive impairments, weakness, post-traumatic stress disorder, depression or anxiety.
Mental health effects extend to the medical caregivers as well due to the stress involved with handling a new virus with insufficient or inconsistent government support. Gehlbach said that at times, he and other physicians have to step away from the news to avoid becoming demoralized.
“We’re all there to direct our concern [to others], but it can be difficult when you feel like your ability to do that is hampered,” he said. “Everyone in the healthcare mission is still human, too. Seeing all the suffering involved of the patients and the patient’s families and then all the strain on healthcare providers when so much of it feels unnecessary is definitely very stressful.”
Despite the pandemic’s longevity, there is hope among medical experts. University of Iowa Director of Clinical Research Support and Clinical Professor of Internal Medicine Dr. Alejandro Comellas has been involved in testing potential COVID-19 vaccines and says he is “optimistic” about future progress.
The University of Iowa is currently in Phase 3 of vaccine trials, meaning that thousands across the country are participating in a nationwide study on vaccines that displayed some level of protection and patient improvement in past trials. Trials are expected to finish by early fall, and Comellas anticipates that a vaccine will be approved by the beginning of next year.
“The amount of progress that has occurred in such a short time has been amazing,” Comellas said. “It’s been an incredible and historic moment to see all these vaccine platforms developed.”
In the meantime, questions remain about what this upcoming fall will look like as flu season approaches and individuals continue to ignore expert health guidelines. Despite having the highest rates of COVID-19 per capita in the Midwest, Iowa is one of very few states with no statewide face covering requirements and a state government trying to restrict local control over mask mandates and school reopening procedures.
Boerner is especially critical of state and federal responses to the pandemic. She called the federal response a “complete failure,” saying, “We are failing the people of Iowa, we are failing our children and we are placing economic and political agenda ahead of human life.”
Comellas warned that with nearly 30,000 UI students returning to Iowa City (and moving into residence halls) throughout August, a surge in cases is possible, especially if students do not take proper precautions. This surge could result in another “crisis” in hospitals, he said.
While younger individuals are less likely to die from COVID-19, Gehlbach noted they are still capable of serving as vectors of transmission to vulnerable individuals or contracting the disease and suffering in a nonfatal manner. In fact, growing numbers of young people testing positive for the virus were cited as the reason for Iowa’s uptick in cases in July, with younger people more likely to socialize and cause community spread.
“It’s not just death or survival; there’s a lot of pain and suffering that can come from everything in between,” Gehlbach said.
Increases in cases are particularly dangerous for certain communities of color, Comellas said, as evidenced by a large number of immigrant patients that came to UIHC after developing COVID-19 from meat processing plants throughout the state. The COVID Racial Data Tracker found that Black, Hispanic and indigenous individuals are significantly more likely to die from COVID-19 — including in Iowa, when numbers were last reported.
To better care for patients from different backgrounds, UIHC established a respiratory illness clinic with four bilingual doctors, including Comellas, to help COVID-19 patients that no longer require hospital care. The clinic allows patients to receive pulmonary function tests and blood work. Patients can also join a registry to be contacted for future research or if therapeutics are developed.
The CDC currently recommends that individuals wear masks when around others and avoid close contact by maintaining at least a six-foot distance from others whenever possible. Additionally, Comellas advises the community to avoid staying in enclosed public spaces for extended time periods because there is less air circulation indoors and a higher risk of inhaling infected particles.
“We don’t have the luxury of waiting; these things have to be done now,” Comellas said.
This week, Iowa surpassed 50,000 confirmed cases and 1,000 deaths due to COVID-19. An alleged bug in IDPH’s reporting system has also sparked concerns about the months-long misreporting of Iowa’s COVID-19 data as schools across the state begin to send kids back into classrooms.
Gehlbach stressed that while concerns about the economy are reasonable, progress can only occur if certain precautions are taken by all members of a community.
“The sooner that everyone recognizes how much stronger we are rowing together in the same direction, the sooner we’ll be able to begin to see deaths come back down, and the better our economy will be as well,” he said. “We can save lives and livelihoods by wearing a mask, being socially distant and making good choices with our activities.”
Boerner said that after being rendered immunocompromised by COVID-19, she “takes it personally” if individuals disregard the impact of their actions on more vulnerable individuals like herself. She implores community members to consider how their decisions may determine whether someone lives or dies.
“My fear is that my 3-year-old will never know a world where he doesn’t have to wear a mask or be afraid that he’ll get his mom sick,” Boerner said. “I would get COVID-19 again if it meant nobody else had to get it, because nobody should have to go through what I went through.”