Shelter-in-place? Gov. Reynolds opposes mandatory restrictions, and Johnson County health leaders worry about ‘panic’

An image of the CDC’s COVID-19 diagnostic panel — Centers for Disease Control and Prevention

At her Wednesday afternoon press conference, Gov. Kim Reynolds reiterated her belief that voluntary efforts by Iowans are the key to combating the spread of COVID-19 in the state.

“Now is the critical time, when each of us can make a difference on the impact that COVID-19 will have in Iowa,” Reynolds said. “We all have a role and responsibility to mitigate the spread of the virus, and protect the health of our fellow Iowans.”

“So, as I’ve said at every one of these press conferences, please do your part and help us all protect our vulnerable. I also want to assure Iowans that the state is doing our part to ensure that we are prepared to do whatever may be necessary to protect Iowans during this time.”

“Every day, we are assessing our mitigation efforts to slow the spread of the virus, and determining whether or not it’s time to turn the dial up or turn the dial down.”

The governor said she believes “the dial” — a metaphor for the level actions the state is mandating Iowans take — should stay as it is.

Reynolds has already closed the state’s schools, ordered bars and many other businesses where open to the general public to shut down, banned dine-in service at restaurants and ordered that gathering in public places be limited to 10 people.

“It’s important also we keep Iowa open for business in a responsible way that protects the health of our people and our economy,” the governor said. “We are working to provide relief to Iowa business and employees out of work, and making sure that they can access the resources they need.”

Gov. Reynolds did acknowledge that others are imposing shelter-in-place orders. On Wednesday, Minnesota became the 19th state to do so. The governor said there was no need for such a step yet in Iowa, because “many of the steps that we have already taken are equivalent to the stay-at-home orders that we are seeing in several of these states.”

COVID-19 outbreak USA stay-at-home order county map

Above: A map of counties in the United States that have imposed stay-at-home orders. (Dark blue: came into effect before March 22; light blue: came into effect before March 29) — Minh Nguyen/CC0

At the governor’s Tuesday press conference, Sarah Reisetter, deputy director of the Iowa Department of Public Health (IDPH), listed the four major metrics used in the Reynolds’ administration’s decision-making process: the percentage of the population 65 or older; the percentage of identified cases requiring hospitalization; the rate of infection per 100,000 residents over the previous 14 days; and the number of outbreaks in setting like long-term-care facilities. At Tuesday’s press conference, Reynolds was asked a two-part question about those metrics.

Gov. Reynolds Wednesday 3/25 COVID-19 Update

WATCH: Gov. Reynolds provides updates on the state's COVID-19 response.

Posted by KCRG-TV9 on Wednesday, March 25, 2020

The first part asked what specific levels would those metrics have to reach before the governor would issue a shelter-in-place order. Reynolds turned the question over to Dr. Caitlin Pedati, medical director of IDPH.

In reply to the question about specifics, Pedati replied it was “important to keep a couple of big-picture things in mind.”

When we think about this virus, there’s a few things we do know and things we continue to learn. One of the things we know, again, is that this is spread by droplets that move from a sick person to somebody else. Again, I know it sounds overly simplistic, but those measures of doing things like six feet away from other, and truly staying home when you’re sick and practicing frequent handwashing are examples of personal health measures that are really important. And are going to continue to be important for this, and for all other illnesses.

The doctor then went on to praise the work being done health care professionals treating COVID-19 patients.

The second part of the question asked how the data DPH is using to determine the number of people infected in the state can be considered accurate, given how little testing is being done.

Instead of addressing the issue of using limited data to make decisions, Pedati discussed how one goes about getting tested.

I appreciate concerns around testing, and again, what’s important to keep in mind is that we want people to call ahead, consult with a clinician by phone, determine if your somebody who needs to be evaluated in conjunction with your health care provider, and then we’ve continued to work to support testing that continues to expand at our State Hygienic Laboratory as well as at commercial laboratories throughout the United States.

The question of how the relatively small number of tests conducted in Iowa create unreliable data did not come up again in the course of the press conference.

Officials in Linn County and Cedar Rapids are currently considering issuing a county-level shelter-in-place order to limit the spread of COVID-19, but have said they believe a statewide order would be more effective. On Wednesday, Cedar Rapids Mayor Brad Hart sent the governor a letter urging her to issue a statewide order.

The possibility of a county-level shelter-in-place was a main focus at a Monday afternoon press conference at the Johnson County Emergency Management Agency.

Dave Koch, director of the county’s Public Health Department, said there are ongoing discussion about the possibility of order, but there many factors to consider, both in terms of the public health and economic impact of such a move.

The county is discussing the move with IDPH and working closely with Linn County officials, Koch explained.

“Likely if one county orders a shelter-in-place, it would be in step with the other county, just because of the nature of the Corridor and the [amount of commuting] between the two communities,” Koch said. “It just needs to be consistent between our two counties.”

Koch said the two counties are still in the process of deciding what the correct metrics are for making a decision to issue county-level shelter-in-place orders.

COVID-19 Update for Johnson County – March 25, 2020

Live coverage of a press conference on March 25, 2020, at the Johnson County Emergency Operations Center to update the public on the latest information regarding COVID-19 in Johnson County. Comments will not be monitored live. Questions will be followed up as soon as possible by staff.

Posted by Johnson County Public Health on Wednesday, March 25, 2020

But two of the leaders of Johnson County’s medical establishment who spoke at the press conference said they weren’t in favor of either county-level or statewide shelter-in-place.

Dr. J. Brooks Jackson, vice president for medical affairs for UIHC and dean of the University of Iowa Carver College of Medicine, said, “There are reasons to believe we may be able to do this without an order to stay in place.”

Jackson said the average age of Johnson County residents — 30, which is eight years younger than the national average — along with the high levels of education and general good health of the population, may mean it won’t require more mandatory measures to stem the spread of COVID-19 in the county.

“One of our concerns about putting an order to stay-in-place is one, it’s economically very disruptive,” Jackson said. “And we do worry about it impairing our supply chain, which is already under stress as it is.”

Jackson said there were also concerns that an order might be disruptive for both UIHC staff, and the area small businesses UIHC relies on for services.

“It also disproportionately adversely effects low-wage earners, and the small-business owners as I said, and minorities in particular,” he said.

Speaking at the press conference, President and CEO of Mercy Iowa City Sean Williams echoed many of Jackson’s points.

“Mercy Iowa City does not support a shelter-in-place that’s being contemplated. We believe this would not only disrupt our supply chain and our staffing, but also create anxiety, in some cases panic. And we would expect a number of healthy individuals,” Williams said.

There have been 43 cases of COVID-19 confirmed in Johnson County, including six new ones announced on Tuesday morning by IDPH. The agency reported a total of 21 new cases on Tuesday.

• Allamakee County 1 middle-aged adults (41-60 years)

• Benton County, 2 middle-aged adults (41-60 years)

• Hancock County, 1 middle-aged adults (41-60 years)

• Johnson County, 4 adults (18-40 years), 1 middle-aged adult (41-60 years), 1 older adult (61-80 years)

• Linn County, 1 middle-aged adult (41-60 years)

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

• Polk County, 3 older adults (61-80 years)

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

• Scott County, 2 middle-aged (41-60 years)

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

These cases bring the number of Iowans diagnosed with COVID-19 to 145.

Gov. Reynolds started her press conference on Wednesday by offering “the thoughts and prayers of our state” to the family of the first person in Iowa to die from COVID-19.

The death occurred on Tuesday night. According to IDPH, the individual was between the ages of 61 and 80, and was a resident of Dubuque County.

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