Governor Kim Reynolds announced more new restrictions on March 22, as the number of confirmed novel coronavirus (COVID-19) cases in Iowa rose to 90, affecting residents of 24 counties.

However, Reynolds continues to resist steps that some public health experts feel are necessary to slow the spread of the disease, such as a statewide “shelter in place” order or mandatory closure of non-essential businesses. Even more concerning, the governor continues to emphasize that Iowans should stay home if they’re sick, which could give those who don’t feel ill a false sense of security about keeping up their normal routines.

People without symptoms can have and spread COVID-19, early research on the virus indicates. The number of patients needing critical care could soon exceed hospital resources in Iowa and across the country.

That is why some state and local governments have moved aggressively to shut down businesses and order citizens to avoid unnecessary trips outside the home.

Reynolds recommended on March 15 that public schools suspend classroom instruction for at least four weeks. Two days later, she ordered the closure of venues including fitness centers, theaters, and casinos. The same executive action required restaurants and bars to move to take-out, drive-through, or delivery only.

At her March 22 news conference (audio, video), Reynolds announced that Iowa “salons and barber shops, medical spas, massage therapy, tattoo establishments, tanning salons, and swimming pools” will be closed through March 31. The new proclamation “suspends all foreclosures on residential, commercial, and agricultural real property,” and relaxes some professional licensing requirements to allow some “to step up and serve in medical professions.”

Earlier, Reynolds waived late fees for property taxes and temporarily suspended evictions from apartments or manufactured housing (mobile home) communities.

The governor’s office also said in its March 21 and 22 news releases,

Iowans who have traveled recently for business or spring break vacations, whether internationally or domestically outside of Iowa, should strongly consider self-isolating for 14 days. This will support Iowa’s ongoing efforts to mitigate the spread of COVID-19, and limit the introduction of the virus from other points of travel.

But Reynolds has undercut that advice at every recent public appearance, by stressing the importance of staying home if you’re sick.

One television journalist noted today that some viewers have expressed concern about local businesses accommodating large gatherings or otherwise not complying with the governor’s order, risking others’ safety. “Is there any way to formally report that, or how can they be held accountable?”

Reynolds didn’t answer the question. My transcript, starting at 17:25 on Radio Iowa’s audio file:

Reynolds: Well, first of all, we’re Iowans, and we should all hold ourself accountable. And we should do the right thing. And I’ve said it over and over and over. To prevent a surge in crashing our health care system, we need to be responsible. If you’re not feeling well, stay home. I just don’t think I can reiterate it enough. We have a role to play in protecting the health of our fellow Iowans, and this is how you do it. […]

You can do your part by staying home, social distancing if you’re sick, even mildly sick. Stay home for the seven days, though the incubation period. And if we all do this, if we all do this, we will get through this, and we’ll get life back to normal in a quicker timeline than if we don’t.

Follow-up question: We’d all like to think that every Iowan is playing their part. But for those who aren’t, is there any way to report–

Reynolds: Well, I would just encourage every Iowan to encourage everyone in your family. Get on social media, say I’m doing my part, are you doing yours. Let’s use social media, let’s talk to your friends. As you’re social gathering through social media, then, you know, encourage them, look for opportunities to do things like that.

But I have to also manage our law enforcement and our first responders to make sure that we’re utilizing them in a responsible manner too. So if they’re not abiding by what we’re asking you to do, by staying home if you’re sick, by social distancing, by taking this seriously, you’re also impacting and just stressing our resources from a law enforcement perspective as well, from our first responders. So this is a way that we can really have a big impact on all of those areas.

Another revealing exchange began around the 21:00 mark.

WHO-TV reporter: Governor, you keep saying that you’re not considering a shelter in place [order]. But you also keep asking Iowans to do their part, stay home, self-isolate, make sure to have social distancing. But wouldn’t it be easier to mandate shelter in place, just to make sure that people are actually following those guidelines?

Reynolds: No, because I think we can manage it if Iowans will do what I’m asking them to do. We have a lot of essential services. We have a supply chain. We have a health care system that we need to stand up. And so we need to make sure that we have a workforce that’s able to meet those needs.

And if people do their part, if they are sick and they stay home for the incubation period, if they have a fever, a cough, respiratory issues, if they will pick up the phone and call their doctor, they will walk through an assessment with them, they will determine whether maybe they need to take a test for the flu, and then decide if maybe that’s why they’re ill. And if that’s not the case, then maybe they would move to a test for the COVID-19.

So those are steps that individuals can take to help us mitigate and manage, and helpfully, as I’ve said over and over, bend the curve, and prevent, really, crashing our health care system, for lack of a better word.

And so at this point, you know, we’re going to continue to re-evaluate every day. We’ll sit down with the [Iowa] Department of Public Health, we’ll look at the CDC [federal Centers for Disease Control] guidelines, we’ll look at what’s happening in other states, and we’ll evaluate what we’re seeing in the state of Iowa, and where the hot spots are, and we’ll make that decision going forward. But right now, we’re not at the place where we’re ready to implement that order.

Doctors are not able to order a coronavirus test for every Iowan who is sick and tests negative for flu.

But more important: people can carry COVID-19 and spread the infection without feeling ill. As Blog for Iowa commented on Twitter during today’s news conference, “Every time a person in authority says ‘stay home if you’re sick’ many people think that means ‘if I’m not sick I don’t have to stay home.'”

Dr. Eli Perencevich, an infectious disease specialist and epidemiologist at the University of Iowa, has been warning that state government is not responding quickly enough to the threat posed by COVID-19. He tweeted today that many stores remain open while hundreds of Iowans are likely bringing infections back from spring break. “Instead of closing malls and encouraging social distancing, we’re focusing on tattoo shops. Iowa not leading. Our hospitals are at risk.”

Every day that social distancing measures are delayed can exponentially increase infections in a community. A shelter in place order will be far less effective if Reynolds waits until COVID-19 is out of hand and causing a huge spike in hospitalizations. Even in a “moderate” scenario for spread of the virus, Iowa hospitals may not be able to accommodate all of the patients needing critical care.

We may look back on this past week as a missed opportunity with deadly consequences.

Top image: Screen shot of Governor Kim Reynolds from her March 22 news conference.