Governors of seventeen states have issued shelter-in-place orders to slow the spread of novel coronavirus (COVID-19). But Governor Kim Reynolds again maintained on March 24 that data do not support that action in Iowa. She and top Iowa Department of Public Health officials are betting that closures already in place, along with official efforts to encourage social distancing, will be sufficient to keep serious COVID-19 infections from overwhelming our health care system.

A growing number of local leaders disagree.

“WE NEED TO ACT”

Des Moines Mayor Frank Cownie urged Reynolds to issue a statewide order on March 23, he told the Des Moines Register.

People who contract the virus may be asymptomatic for about a week and can spread the disease, Cownie noted in his call for a statewide order. Meanwhile, Iowans continue to flock to stores and gather in parks, raising questions about whether they are taking the situation seriously enough.

“I’m concerned that if we don’t act now, we’re going to see an outbreak here not unlike what is being seen in Chicago or Washington,” Cownie said. “We’re ahead of it right now, but we need to act.”

Cownie said he is unsure if local officials like him have the authority to issue a stay-at-home order, a question he said is under review.

Iowa City Mayor Bruce Teague also supports state action, Jason Clayworth and Katie Akin reported. Johnson County has the most COVID-19 cases in Iowa, and Polk County the second-highest total.

Cedar Rapids Mayor Brad Hart wrote to Reynolds on March 24 “asking her to reconsider her decision not to issue a statewide shelter-in-place order,” Brian Morelli reported for the Cedar Rapids Gazette. Democratic State Senator Rob Hogg, who represents part of Cedar Rapids, has been calling for a statewide “hard quarantine” for several days.

The governor’s stance is that local officials can take that step if they want to.

REBUTTING A STRAW MAN

Reynolds told reporters on March 23, “We want to make sure that we’re making these decisions based on data and based on metrics so that we can be consistent in what we’re telling Iowans, to make sure that we’re not shutting down a state where we don’t need to.”

Iowa Department of Public Health Deputy Director Sarah Reisetter took the lead in defending the state’s approach the following day (video). After Reynolds again encouraged preventive measures such as washing hands, covering coughs, working from home if possible, and social distancing, Reisetter thanked Iowans who are following that guidance. She added (starting around 6:45),

We’ve heard your questions about shelter in place or stay-at-home orders, and we appreciate that Iowans want to do everything possible to keep themselves, their loved ones, and their communities healthy.

While sheltering in place is a tool that is currently being used in other states, we do not believe it is a mitigation measure that is necessary in Iowa at this time.

It’s important to understand that sheltering in place for two or three weeks will not cause the coronavirus to go away. That’s because this virus is circulating around the world and can be reintroduced into communities from different places.

There is no current treatment or vaccine available at this time. And that’s why it’s so important that we use the public health mitigation strategies that are available to us at the right times.

None of the experts who are advocating lockdowns claim such a policy would “cause the coronavirus to go away.” The whole purpose is slowing the spread of COVID-19, to avoid a sharp increase in critical cases.

Most of the states on lockdown have more confirmed COVID-19 infections than Iowa does. However, it’s worth noting that West Virginia’s governor issued an order when the state had only 20 recorded cases. At this writing, West Virginia has 39 confirmed infections, while Iowa has 124.

WHAT MIGHT CHANGE OUR APPROACH?

Reisetter told reporters the Iowa Department of Public Health recommendations may change depending on circumstances. “Think of this as a dial, not a switch,” that may be turned up or down. The four metrics they examine when considering “more aggressive community mitigation” are:

the percentage of population in a community over age 65;

the percent of identified COVID-19 cases requiring hospitalization;

the rate of infections per 100,000 Iowans in the last fourteen days;

the number of outbreaks in settings like long-term care facilities.

KCRG’s Beth Malicki pressed the issue later during the March 24 news conference. She noted that Dr. Tony Myers of Mercy Medical Center in Cedar Rapids has said that even after doubling their intensive care unit (ICU) beds, they project their system will be under great stress, possibly at capacity, in about three weeks. They “are begging for” a shelter-in-place order, along with the Cedar Rapids mayor and city manager. Was the governor confident her current approach will be enough?

Reynolds is sticking with the program. She noted that information is fluid and changes on a daily basis.

I appreciate what they’re saying, and I am taking that very seriously. So I don’t want Iowans to think that I’m making these decisions lightly. But I have to be consistent in using the data that I’m using to make the decisions that I’m making.

The governor said her team is in regular communication with the hospitals and has been working to address concerns like securing more protective personal equipment for health care workers.

A few minutes later, the Des Moines Register’s Clayworth asked Reisetter to provide more specifics about the criteria they are using. “How many confirmed coronavirus cases and related hospitalizations and deaths must there be in Iowa before a stay-at-home order is recommended, and do you have like a sliding scale of criteria to assess when such an order is necessary?”

Reisetter didn’t give any numbers. “We analyze all of these factors together.” One data point like a certain number of hospitalizations in a county wouldn’t trigger the recommendation, but the department might call for additional mitigation strategies if “in combination there’s a concern.”

That is a hell of a gamble. Flattening the curve is about acting before infections get out of control in a community. More than a week ago, National Institute of Allergy and Infectious Diseases Director Anthony Fauci said on national television, “I think we should really be overly aggressive and get criticized for overreacting.”

State Medical Director and Epidemiologist Caitlin Pedati has not participated in the governor’s last several media availabilities. If and when Dr. Pedati returns to the podium, reporters should ask her why Iowa Department of Public Health leaders differ from so many epidemiologists around the country and world, who have been calling for stricter limits on public movements.

UPDATE: KCRG reporter Chris Earl raised the same issue during Reynolds’ press conference on March 25. Earl noted that some hospital leaders in Johnson County oppose a shelter-in-place order because it could interfere with their supply chain. Here’s part of her response:

I think it’s consistent, it’s based on data, and as I said at the beginning, you know, a lot of things that we’ve already implemented are included in the shelter-in-place orders that states are putting in place. So I would say what else are we doing by doing that, except for potentially disrupting the supply chain, putting additional pressure on, you know, the essential workforce [….] What’s the benefit from taking that additional step?

Top image: Governor Kim Reynolds speaks during her March 24 news conference. Photo by Charlie Neibergall/Associated Press, pool.