New coronavirus infections are increasing in Iowa and most other states, putting more scrutiny on how states have handled “reopening.”
Iowa has fully reopened over the past 2.5 months as Gov. Kim Reynolds ended all closures and restrictions meant to prevent the spread of the virus. She has repeatedly said “data and metrics” were driving her reopening strategy, but the data and metrics she said her decisions were based on have shifted over the course of the pandemic.
Reynolds ordered schools and certain businesses to close in mid-March when there were just a handful of confirmed COVID-19 cases in Iowa.
“I fully understand the impact that these decisions have on Iowans and your daily lives,” Reynolds said at the time. “But the more that we do now on the front end, the sooner that we will get through this, and we hopefully can get our lives back to normal.”
In early April, Iowa was one of a few states that did not have a formal shelter-in-place order. State officials instead createda six-region point system to guide decisions about tightening or relaxing social distancing measures. It was based on each region’s infection and hospitalization rates, long term care facility outbreaks, and the share of residents over 65.
When the northeast region of Iowa hit the threshold for a shelter-in place order April 16, Reynolds ordered a stricter social distancing policy for two weeks there, but stopped short of calling it a shelter-in-place order. Reynolds was asked why.
“I’ve said it all along, we’re going to dial it up, we’re going to dial it down,” she said. “So we’re dialing it down a little bit more.”
Less than two weeks later, she announcedsome businesses could reopen in 77 of Iowa’s 99 counties starting May 1, completely disregarding the regional point system. Houses of worship were also allowed to reopen that day across the entire state.
Reynolds said additional testing capacity through Test Iowa—which was brand new at the time and not even close to fully operational—meant the state could “drill down” and analyze virus data in individual counties.
“Knowing this, we can take a targeted approach to loosening restrictions on businesses and counties where there’s no virus activity, or where virus activity has been consistently low and shown a downward trend,” she said.
Reynolds said those counties satisfied White House guidelines that recommended reopening only after a 14-day downward trend in new confirmed cases or the percent of people testing positive. She also said she’d look at putting some restrictions back in place if COVID-19 cases started spiking in those areas.
“We’re hoping we don’t have to go there,” Reynolds said. “But there has to be an understanding that potentially as a community, as a town, if we see a spike, we might have to take some additional steps to make sure we’re doing this in a responsible manner.”
Several counties included in that first round of reopening have since seen huge spikes in coronavirus cases. Wapello County, for example, was reporting 10 cases when the governor announced it could start to reopen. Since then, more than 700 residents tested positive for coronavirus and more than 30 people died.
The state established Test Iowa sites in some counties with increasing virus activity, but never put restrictions back in place.
A week later, Reynolds allowed some businesses in all counties to start to reopen, regardless of how many virus cases they had.
“It was a fairness issue in really opening up retail statewide,” Reynolds said.
On May 7, Reynolds announced she was shifting the focus of the state’s coronavirus response to the capacity of the health care system. She pointed to the fact that the state had about three-fourths of its intensive care beds and ventilators available and never ran out.
Reynolds said early on, state officials didn’t know how many Iowans would get sick and how many people the hospitals could care for.
“We have sufficient resources to not overwhelm our hospital systems and to make sure we still have the capacity in case we do see some type of a surge,” Reynolds said.
She said her use of data changed over time as state officials learned more about the virus.
Des Moines infectious disease specialist Dr. Rossana Rosa said it’s important to always reassess the data and to think of case numbers in the context of hospital capacity.
“The numbers of new cases you are seeing inform your hospital capacity but also inform how many people are going to die,” Dr. Rosa said. “I think that also needs to be taken into consideration. Not just whether we have a bed, but essentially what is the loss of life that is considered acceptable?”
Reynolds said every death is “horrific.” But she has mostly highlighted the consequences of keeping restrictions in place, like mental health issues related to social isolation, high unemployment and economic disruptions.
She said COVID-19 will remain in the state for a while, and Iowans must learn to live with it.
“Our recovery is contingent on our ability to protect both the lives and livelihoods of Iowans,” Reynolds said. “We can’t prioritize one over the other, we must prioritize both to move forward.”
From mid-May to mid-June, Reynolds allowed the entire state to open back up, against the advice of University of Iowa public health experts. They warned Reynolds that reopening too soon, especially without a face covering policy, would lead to a second wave of infections.
Deaths and hospitalizations in Iowa decreased dramatically in June. The state also saw the percent testing positive decrease over time. But new cases are rapidly increasing again as Iowans are back out in their communities, and hospitalizations and the percent of people testing positive have started to tick back up.
It’s now clear that when Reynolds started to reopen the state in early May, new confirmed cases were at their first peak.
Rebecca Fischer is an infectious disease epidemiologist at Texas A&M University.
“From an epidemiologic perspective, we want to only suggest to people that it’s really safe to move about the community freely when we are not only over that peak, but so far down the other side of the peak that we are fairly confident that something like a small community outbreak could be contained and not turn into a massive surge in cases once again,” Fischer said.
Iowa has greatly increased the number of residents being tested each day and has demonstrated sufficient hospital capacity for now. But the stateisn’t even close to having the number of contact tracers public health researchers believe are needed to contain virus outbreaks.
Fischer said while reopening decisions and the data used to make them should be somewhat locally tailored, there hasn’t really been any consistency across the country.
“It just looks like there’s a lot of patchwork and difference of opinions,” Fischer said. “A lot of it is political, and a lot of it seems to ignore public health tenets.”
Fischer and Dr. Rosa said analyzing virus data takes a trained eye, and states are probably looking at more granular information than what’s publicly available.
But Dr. Rosa also said looking at new daily case counts is still important, and daily numbers in Iowa above 150 are concerning. The state’s 7-day average hasn’t been that low since April.
Dr. Rosa said Iowans should keep social distancing, wear a mask or face shield, and stay informed as community spread of the virus continues.
“I don’t think we’re out of the woods,” Dr. Rosa said. “We all still need to be very vigilant and very safe.”
Reynolds last week acknowledged the increasing cases, especially among young Iowans, and said she is considering next steps.
