The metrics guiding Gov. Reynolds’ COVID-19 decisions revealed — and met with criticism

The Iowa Department of Public Health’s regional map used for planning the state’s response to COVID-19.

On Thursday, Gov. Kim Reynolds signed a new public health emergency proclamation that extended the business closures and regulatory waivers in her previous proclamations through April 30. It also extends through the end of April a ban on “nonessential and elective” medical and dental procedures that use personal protective equipment.

Reynolds, however, did not mention that she has backed off her claim that the ban on nonessential medical procedures applied to surgical abortions. Just before a Wednesday afternoon hearing on an emergency injunction on the ban, attorneys for the Reynolds administration reached an agreement with the ACLU of Iowa that allows surgical abortions to continue.

“I am also ordering that school closures are through April 30,” Reynolds said at her Thursday afternoon press conference on the state’s response to COVID-19. “Keeping Iowan students out of classrooms is a very difficult decision, but it remains necessary for now.”

Reynolds said, “it is important for Iowa schools to provide continuous learning opportunities for their students.” She added, “School districts that choose not to provide continuous learning will be required to make up the instructional time lost beyond what has been waived by the legislature.” At the moment, that would require a district to make up the instruction hours previously scheduled for the month of April.

“Continuous learning opportunities” are not the same as having regular classes online. A school district cannot require students to participate in the opportunities, or offer official grades for student work done in a distance learning setting, unless the district can guarantee equitable treatment for students with individual education plans or other special needs. Doing either would violate federal law, and jeopardize the district’s federal funding.

“At this time, I am not ordering schools to close for the remainder of the school year, as we have done with all COVID-19 mitigation decisions,” Reynolds said. “We will continue to monitor the situation, assess the measure that we have in place and use data to make the right decisions at the right time.”

Most of the questions asked at the press conference focused on the sort of data Reynolds is using to make all her decisions regarding the state’s response to COVID-19.

On Wednesday, Zachary Oren-Smith of the Press-Citizen published a story on the guidelines IDPH and Reynolds are using to make decisions regarding COVID-19. Included in the story was a copy of a checklist of conditions that Reynolds and her public health advisers are using to guide their actions, which had not been made public before.

The governor’s office made the IDPH document available online on Thursday morning, since the Press-Citizen had already published it.

The four metrics on the checklist — 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 — that were first disclosed by IDPH Deputy Director Sarah Reisetter at the governor’s press conference on March 24. What was new in the Press-Citizen story is how IDPH is using the four measurements.

IDPH has divided the state into six regions. The regions “correspond to patterns of healthcare utilization,” IDPH Medical Director Dr. Caitlan Pedati explained at the governor’s Thursday afternoon press conference.

The IDPH checklist is used to assess the severity of the COVID-19 infection in each of the regions. IDPH has assigns numerical values — either between zero and three, or one and three — to the level of severity of each of the metrics. For example, if 15 percent or more of a region’s COVID-19 patients require hospitalization, that rates a three; between 12 and 14 percent is a two; 3 to 11 percent is a one and less than 3 percent is rated 0.

If the numerical values assigned to all four metrics add up to 10 or more, IDPH guidelines recommend the governor order a shelter-in-place order lasting 14 days for the region. The need for that order would be reviewed every day.

Currently, the two regions that cover eastern Iowa and the north central Iowa region are all at seven on the IDPH scale. South central Iowa and southwest Iowa rate a six. Northwest Iowa is a five.

Dr. Pedati discussed why the IDPH is using this method at the Thursday afternoon press conference.

“Just like with any new illness, any new thing, we have a framework that we use. Lessons from previous pandemics or previous epidemics, or other viruses, and we integrate new knowledge as we go along,” Pedati said.

The doctor said an advantage of the method IDPH is using is that it is flexible.

“It’s important we remain flexible, because it’s important that we remain able to adjust over time,” Pedati said. “In part how we do that is by looking at the information we have, and understanding its impact as we go along.”

But Dr. Eli Perencevich, a professor of Internal Medicine and Epidemiology at the University of Iowa Carver College of Medicine, said the metrics IDPH are relying on are the wrong ones. Perencevich is a member of the Iowa Infection Prevention Research Group and an expert on mathematical modeling in epidemiology.

“Not one of the criteria has anything to do with how the virus spreads,” he told Oren-Smith. “The decision should be about estimating how many people are infected.”

According to Perencevich, the IDPH tracks crises as they occur, instead of trying to determine the spread of disease throughout the population to prevent a potential crisis.

“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.”

The Institute for Health Metrics and Evaluation (IHME) of the University of Washington’s medical school is publishing updated-daily models that attempt to predict the growth of the disease. The White House Task Force on COVID-19 is using IHME’s models to help guide its decisions.

Gov. Reynolds dismissed the IHME’s state-level model for Iowa at her Wednesday press conference, noting it doesn’t take into account all the restrictions on public activity she has already ordered.

At Thursday’s press conference, Dr. Pedati was asked about the IHME model’s latest prediction that 1,488 Iowa are likely to die of COVID-19 by Aug. 4. (On Wednesday, the model only predicted 1,367 deaths by that date.)

“Is that a reasonable number for what could happen?” a reporter asked Pedati.

In her reply, Pedati talked again about the metrics IDPH is using. She did not, however, answer the question.

IDPH reported on Thursday that another 66 Iowans have tested positive for COVID-19, including four residents of Johnson County and nine residents of Linn County. The new cases bring the state’s total to 614.

• Allamakee County, 1 child (0-17 years), 2 adults (18-40 years), 4 middle-age adults (41-60 years), 1 older adult (61-80) years

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

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

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

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

• Cedar County, 1 adult (18-40 years), 1 middle-age adult (41-60 years)

• Cerro Gordo County, 2 middle-age adults (41-60 years)

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

• Clinton County, 2 adults (18-40 years), 1 older adult (61-80 years)

• Dallas County, 1 adult (18-40 years), 3 middle-age adults (41-60 years)

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

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

• Johnson County, 1 adult (18-40 years), 3 middle-age adults (41-60 years)

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

• Linn County, 3 adults (18-40 years), 4 middle-age adults (41-60 years), 1 older adult (61-80 years), 1 elderly adult (81+)

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

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

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

• Polk County, 2 adults (18-40 years), 1 middle-age adult (41-60 years), 3 older adults (61-80 years)

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

• Scott County, 3 middle-age adults (41-60 years), 1 older adult (61-80 years)

• Tama County, 2 adults (18-40 years), 1 middle-age adult (41-60 years)

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

• Warren County, 1 adult (18-40 years), 1 middle-age adult (41-60 years)

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

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

• Woodbury County, 2 adults (18-40 years), 1 middle-age adult (41-60 years)

IDPH also reported two more deaths from COVID-19. Both were residents of Linn County, between the ages 61 and 80. Those deaths bring the state’s total to 11. Four of the deceased were residents of Linn County.

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