One of the first things Gov. Kim Reynolds talked about at her Friday press conference on the state’s response to COVID-19 was her Thursday press conference.
“At yesterday’s press conference, we shared additional information about the metrics we have been using to assess and guide our COVID-19 mitigation efforts here in Iowa,” Reynolds said. “And many Iowans, they wanted to know more about the metrics and who put them together, and really what was involved in that.”
The reason the governor shared that additional information on Thursday was because the Press-Citizen had already published the checklist IDPH uses to determine the severity of the COVID-19 outbreak before recommending actions to Reynolds.
Dr. Caitlan Pedati, IDPH’s medical director, explained on Thursday that IDPH uses a map of Iowa that divides the state into six regions which “correspond to patterns of health care utilization.”
IDPH then uses a checklist that looks at 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 assigns a numerical value to each metric, on scales of either zero to three or one to three, according to the level of the severity of the metric. If the numbers for all four metrics add up to 10 or more, IDPH would recommend a shelter-in-place order for that region.
The governor said many of the questions her office had received after the previous day’s press conference were about the map, and in particular, why Linn County and Johnson County were in different regions.
Reynolds turned the question over to IDPH Deputy Director Sarah Reisetter.
Reisetter explained the map is meant to help officials understand the “health care system capacity” in the state. It is the product of a planning process that originally started in response to 9/11, in order to ensure hospitals wouldn’t be overwhelmed if a disaster occurs.
Johnson County tends to attract hospital patients from southeastern Iowa, while out-of-county patients in Linn usually come from northeastern Iowa. That’s why the two closely linked counties are in separate regions.
Of course, where out-of-county patients come from doesn’t reflect the patterns of daily life in a county. After the governor said repeatedly last month that county governments had the authority to issue their own local shelter-in-place, officials in Johnson and Linn worked together on plans for coordinating county-level shelter-in-place orders.
“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,” Johnson County Public Health Director Dave Koch said on March 23. “It just needs to be consistent between our two counties.”
As it turned out, Gov. Reynolds was wrong about the state law. Counties cannot issue local shelter-in-place orders. The governor, however, has the power to do so, or to grant local governments the power to do so. Reynolds has said she will not do either, because the metrics she is relying on do not currently indicate the need to do so.
But separating Linn and Johnson into different regions may also cause IDPH’s metric to fail to reflect the actual severity of the spread of COVID-19.
Linn has the highest number of infected residents of any county in the state. As of Friday morning, it had 118 confirmed cases of COVID-19. Johnson ranked third in case numbers at 83. But because of the IDPH map, the metrics regarding those infected populations are considered separately, regardless of how intertwined the two counties actually are.
That IDPH is creating regions based on health care utilization reinforces Dr. Eli Perencevich’s criticism of the department’s approach to COVID-19.
According to 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, the IDPH’s metrics effectively measure an ongoing severe outbreak, but doesn’t provide the information needed to slow the pandemic.
“Not one of the criteria has anything to do with how the virus spreads,” Perencevich told the Press-Citizen. “The decision should be about estimating how many people are infected.”
“It seems like waiting to see how many older Iowans become infected,” he said. “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. [Using the IDPH approach], we have to wait for older people to die before implementing maximum protective measures.”
“Not one of these [measures] correlate to anything that would be linked to predicting where we are and what exponential growth will look like.”
On Friday morning, IDPH reported another 85 Iowans had tested positive for COVID-19, including three residents of Johnson County and 14 residents of Linn County.
• Allamakee County, 1 adult (18-40 years)
• Clayton County, 1 adult (18-40 years)
• Clinton County, 4 middle age adults (41-60 years), 1 older adult (61-80 years)
• Crawford County, 1 middle age adult (41-60), 2 older adults (61-80 years)
• Dallas County, 2 older adults (61-80 years)
• Dubuque County, 1 older adult (61-80 years)
• Fayette County, 1 middle-age adult (41-60 years)
• Henry County, 1 middle-age adult (41-60 years)
• Jackson County, 1 middle-age adult (41-60 years)
• Jasper County, 1 older adult (61-80 years)
• Jefferson County, 1 adult (18-40 years)
• Johnson County, 1 adult (18-40 years), 2 middle-age adults (41-60 years)
• Linn County, 1 adult (18-40 years), 2 middle-age adults (41-60 years), 5 older adults (61-80 years), 6 elderly adults (81+)
• Louisa County, 1 older adult (61-80 years)
• Lyon County, 1 middle-age adult (41-60 years)
• Marshall County, 1 adult (18-40 years)
• Monona County, 1 elderly (81+)
• Muscatine County, 1 adult (18-40 years), 1 middle-age adult (41-60 years), 1 older adult (61-80 years)
• O’Brien County, 1 middle-age adult (41-60 years)
• Plymouth County, 1 adult (18-40 years)
• Polk County, 6 adults (18-40 years), 6 middle-age adults (41-60 years), 1 older adult (61-80 years)
• Pottawattamie County, 1 older adult (61-80 years)
• Scott County, 4 middle-age adults (41-60 years), 2 older adults (61-80 years)
• Shelby County, 1 older adult (61-80 years), 1 elderly adult (81+)
• Sioux County, 1 older adult (61-80 years)
• Story County, 1 adult (18-40 years)
• Tama County, 3 adults (18-40 years), 1 middle-age adult (41-60 years), 1 older adult (61-80 years)
• Van Buren County, 1 adult (18-40 years), 1 older adult (61-80 years)
• Warren County, 1 adult (18-40 years), 1 middle-age adult (41-60 years)
• Washington County, 2 adults (18-40 years), 3 middle-age adults (41-60 years), 2 older adults (61-80 years)
• Woodbury County, 1 older adult (61-80 years)
The new cases bring the state’s total of people testing positive for the virus to 699.
At her press conference, Reynolds emphasized she has complete faith in the work IDPH is doing.
The metrics were developed by Dr. Pedati, who is in daily consultation with her team of epidemiologists in [the] Iowa Department of Public Health Center for Acute Disease, epidemiology [sic] and other experts in Iowa and across the country. These experts include local public health administrators and their teams, local emergency managers, clinical personnel and EMS providers.
Reynolds said Pedati also regularly participates in discussions with other state epidemiologists and the Centers for Disease Control and Prevention.
Reynolds was asked about Dr. Anthony Fauci saying that every state should have already issued a shelter-in-place order by now. (Iowa is one of only five states not to have a statewide or partial shelter-in-place orders.)
“I would say that maybe he doesn’t have all the information,” Reynolds replied. The governor repeated an assertion she had made at several previous press conferences that the actions she has already taken are the equivalent of a shelter-in-place order.
Reynolds suggested that if Fauci was fully informed of her actions, he would see that Iowa doesn’t need a shelter-in-place order.
The governor was also asked about the Iowa Board of Medicine, the body that licenses physicians and regulates the practice of medicine in the state, voting unanimously on Friday morning to recommend Reynolds issue a statewide shelter-in-place order.
The board, of course, knows exactly what actions the governor has taken.
“I have not received the letter yet from the Board of Medicine,” Reynolds said. “I understood that they took a vote, and, you know, we always want to hear from medical professionals. And I’m interested in reading the letter and seeing what their recommendations are.”
“I would love to have, maybe, representation from the board, and either get on a phone call with Dr. Pedati and our group and walk through again what we’ve done and what they think that we need to do that’s outside of the steps we’ve already taken.”
In addition to the Iowa Board of Medicine, the Iowa Medical Society, which represents 6,800 doctors in the state, has also sent Reynolds a letter asking for a shelter-in-place order.
A reporter asked Reynolds what she saw as the potential negative consequences of issuing a shelter-in-place order. The governor said she was worried about its impact on the mental health of Iowans.
“You have to talk about mental well-being,” Reynolds said. “Not just physical, but mental well-being. We are a connected community. We work. I mean, there’s just that side of it as well. In addition to suicides and domestic abuse. I mean, there are a lot of downsides to it [shelter-in-place] as well.”
Near the end of her prepared remarks at the beginning of Friday’s press conference, Reynolds suggested one of the problems the state is facing in its efforts to limit the spread of COVID-19 is some people lack the proper information.
“I’m asking every Iowan be informed about this issue, including the media,” she said. “We all have a responsibility and a role to play. You have an important responsibility at this time. So, please help elevate and amplify the message we are saying to Iowans.”
That message, of course, is that people should stay home voluntarily, and practice social distancing when they do have to go out.