State Medical Director and Epidemiologist Dr. Caitlin Pedati is leaving the Iowa Department of Public Health (IDPH) in late October, the agency announced on September 22.

The leader of Iowa’s COVID-19 response had hardly been seen in public all year and granted few media interviews. Pedati was an occasional speaker at Governor Kim Reynolds’ televised news conferences during the first eight months of the pandemic, but had not appeared at one since November 2020.

The unexplained departure raised questions about whether Pedati walked or was forced out. Reynolds’ new spokesperson Alex Murphy told Bleeding Heartland via email that no one in the governor’s office asked the medical director to leave. “This was a personal decision by Dr. Pedati.” Murphy also said the governor won’t pick her successor; rather, IDPH Director Kelly Garcia “and her team will handle the hiring.”

I’ll be seeking records that could show whether Pedati (a board-certified pediatrician) disagreed with any aspects of Iowa’s COVID-19 mitigation strategy, such as grossly inadequate guidance for schools or the retreat from recommending masks, even for unvaccinated people crowded together indoors.

Whether or not Pedati had any private misgivings, she repeatedly failed to keep Iowans safe or adequately informed during this pandemic, which has already killed more than 1 in 500 Iowa residents who were alive eighteen months ago.

None of the following actions, listed in chronological order, were Pedati’s sole responsibility. The buck stops with Reynolds on all important decisions. But Pedati publicly vouched for several of the governor’s mistakes and didn’t make it a priority to fix some big problems.

Adopting a “matrix” to determine mitigation practices.

As discussed in more detail here, the IDPH developed a 12-point scale in March 2020. By assigning numbers to each of six Iowa regions, officials created the illusion that some objective criteria were used to determine whether to “dial up” or “dial down” its restrictions on business and gatherings. Email correspondence between Pedati and some Johnson County and University of Iowa public health leaders, which Bleeding Heartland obtained last year through an open records request, revealed that Pedati threw together this “matrix” over a few days.

The “arbitrary” and “backward looking” scoring appeared to be designed with a political goal in mind: to keep Iowa regions from reaching the number that would trigger a stay-at-home order. (Reynolds had already rejected that policy as a matter of principle.) After only a month, IDPH abandoned the matrix in favor of another misguided approach we’ll discuss in a moment.

Refusing help from the federal government to test workers in meatpacking plants.

Clark Kauffman was first to report for Iowa Capital Dispatch last year that in April 2020, Pedati twice declined offers from the U.S. Centers for Disease Control to help manage coronavirus outbreaks in meatpacking plants. At the time, the worst outbreaks in Iowa and nationally were in large pork or beef processing facilities.

Failing to get a handle on those infections seeded enormous community spread. To this day, most of the Iowa counties with the highest total COVID-19 case rates per capita contain packing towns or many workers who commute to plants in neighboring counties, such as Buena Vista County (Storm Lake), Crawford County (Denison), Wright County (Eagle Grove), Henry County (Mount Pleasant), and Woodbury County (Sioux City area).

Loosening restrictions in most counties before COVID-19 tests were widely available.

In late April 2020, Reynolds and Pedati rolled out a plan to relax restrictions on gatherings and business operations in 77 Iowa counties where virus activity was supposedly minimal. The governor insisted that testing would allow officials “to make evidence-based decisions about how to mitigate and manage the virus with precision, whether at a macro level or down to a specific county, community, or zip code.”

Reynolds spoke as if Iowa already had a testing regime fully engaged, delivering results from every county. Yet the state had only just signed the no-bid Test Iowa contract. The testing sites weren’t even up and running in major metro areas, let alone smaller communities where residents were at high risk due to crowded workplaces. The state had recently begun sending test kits or “strike teams” to identify cases among workers at large manufacturers.

Of the two dozen Iowa counties where the highest percentage of residents have tested positive for COVID-19, only two (Woodbury and Des Moines) were among the 22 counties where restrictions lasted a little longer. The others were all among the 77 that Reynolds insisted could open things up “in a very responsible and safe manner,” because the virus was not circulating widely.

At the news conference where this plan was announced, Pedati gave word salad answers (transcribed here) to straightforward questions such as: Is Iowa’s curve flattening? What makes you think a patchwork opening will keep the disease from spreading? And isn’t there a risk that asymptomatic people could bring the virus from counties with many cases to those where more businesses are open?

Ignoring University of Iowa modeling on virus spread and how to contain it.

During the early weeks of the pandemic, Pedati was eager to work with experts from the University of Iowa College of Public Health. The IDPH signed a contract in April 2020 to provide state data in exchange for “a model that will predict the number, severity and timing of future infections, hospitalizations and deaths.” Email correspondence indicated such forecasts and modeling were “priority projects” for the state medical director.

The University of Iowa team submitted a white paper in late April advocating for social distancing policies to “remain in place” to prevent a second wave of COVID-19 infections. A follow-up paper warned in early May, “Evidence shows that COVID-19 will continue to spread in Iowa, likely at an increasing rate.”

Pedati offered public support for the governor’s diametrically opposed approach, which lifted most restrictions on business activity and gatherings in May and June 2020. The governor liked to say the state’s experts were relying on “real-time data” to inform their “evidence-based decision making.” Pedati never embraced the university researchers’ recommendations on universal face shields or continued social distancing.

Knowingly publishing inaccurate data on case counts, testing, and positivity rates.

In August 2020, the official website coronavirus.iowa.gov began publishing county-level positivity rates, which would be used to determine whether schools could continue to safely provide in-person instruction. Pedati allowed this feature to launch, even though she knew the state’s dashboard had been backdating some new cases for months.

The state website lowballed case numbers for much of that summer by not counting positive results from antigen tests. And even after Pedati agreed to start counting antigen test results, the dashboard continued to make hundreds or thousands of old tests disappear on a daily basis.

Even now, the IDPH is still deleting old tests for many Iowans who have been tested multiple times. That’s one reason the county-level positivity rates on the state’s dashboard are usually much lower than those reported by the CDC. Erin Jordan reported last year for the Cedar Rapids Gazette on how the IDPH’s 14-day positivity rates appeared to be inaccurate, and “the explanation given by state officials doesn’t make sense – even to biostatisticians.”

In February, Sara Konrad Baranowski reported for the Iowa Falls Times Citizen on more tweaks to the state’s methodology: “Whereas before, the state calculated positivity rates by dividing number of positive individual tests by the number of individuals tested, now it will divide total number of positive tests by total tests administered, which results in a lower positivity rate.”

Pedati justified the change to reporters as follows: “As you move across time, it’s no longer helpful for the general public to know what happened last year as it is to know what’s going on in the past one to two weeks, with two weeks being the incubation period for the virus.” But that doesn’t explain why the 7-day positivity rates on the state website never seem to line up with CDC figures.

Failing to create a user-friendly way for Iowans to schedule their vaccinations.

For months, IDPH officials knew supply of COVID-19 vaccines would not be sufficient to meet demand in early 2021. Yet Pedati’s team did not create a centralized website or phone line where Iowans who qualified for a vaccination could schedule a shot.

From February through April, thousands of Iowans (including my own family) relied on the efforts of private citizens who donated their time to create vaccination scheduling tools. Three of those superstar volunteers were Brian Finley, keeper of the Iowa Vaccine Alerts Twitter account, Todd Brady, who created the Vaccine Hunter website, and Brooke Johnson, who set up Iowa Covid-19 Vaccine Updates.

Abandoning best practices for reducing virus spread in schools and day care settings.

Near the beginning of the 2020/2021 school year, Pedati’s team studied data from four school districts in Sioux County. They found that the three districts where masks were optional saw 30 percent to 130 percent more new coronavirus cases than the district that required students and staff to wear face coverings in school buildings. The IDPH should have mandated or at least strongly recommended mask mandates in all Iowa schools. Pedati instead relaxed quarantine rules so that students and staff would no longer need to stay home after close contact with a confirmed COVID-19 case, if both people had been wearing masks. The policy contradicted CDC guidance.

To her credit, Pedati was still encouraging face coverings and quarantines in some circumstances during the fall of 2020.

IDPH Director Garcia wrote to Iowa schools and day cares in May, saying masks should be optional and “exposed children should no longer be required to stay home, regardless of mask usage.” That letter went out several days before Iowa Republican lawmakers approved and Reynolds signed a statewide ban on mask mandates.

Shutting down the Test Iowa program before a reliable alternative was in place.

The IDPH announced in June that the Test Iowa program, which offered free COVID-19 tests in many communities, would shut down by mid-July. The idea was that Iowans would easily be able to obtain tests elsewhere, or could order free home testing kits from the state.

As case numbers have steadily increased over the late summer and early fall, coronavirus tests have been in scarce supply. I regularly hear from Iowans who have trouble finding a place to be tested, or have waited for days to get results from the sample they mailed to Test Iowa.

Now some health care providers from large cities to small towns lack adequate testing supplies. UnityPoint, one of Iowa’s largest groups of hospitals and clinics, has asked asymptomatic people exposed to COVID-19 to “consider other testing options in your community such as local pharmacies and public health departments.” Pedati and her team should never have allowed this to happen.

Scaling back Iowa’s COVID-19 dashboard as the Delta variant became dominant.

In early July, the IDPH switched to updating coronavirus.iowa.gov only once a week. Pedati’s team also eliminated almost all useful information about nursing home outbreaks from the dashboard.

It was a bad idea as the Delta variant was spreading rapidly across the state. Iowa’s COVID-19 hospitalizations have increased more than tenfold since the early summer and are now at the highest level since December 2020. The state is also recording more than 1,000 new cases daily. Children account for a large share of the recent infections.

Early this month, the IDPH announced plans to begin updating the dashboard three times a week. But the Monday and Friday updates are static pages. The interactive pages are still revised only on Wednesdays. Another problem: the published hospitalization statistics still create the false impression that Iowa has lots of beds available. In reality, Iowa ICUs have been full for weeks.

Remaining silent as officials stopped encouraging even the voluntary use of masks.

In August, the IDPH issued new guidance for Iowa school districts, which did not recommend masks even for unvaccinated people, on a voluntary basis.

Meanwhile, the governor who once postured as an advocate for face coverings began to spread misinformation about masks, especially for kids. In several interviews or public appearances, Reynolds cited non-existent evidence on “both sides” about whether face coverings keep children safer and reduce virus spread in schools.

Perhaps Pedati didn’t support those moves. She told freelance journalist Andy Kopsa in July, “every time I’m asked, I continue to extol the value of face coverings, social distancing, staying home when you’re sick and getting vaccinated.” That could explain why the state medical director’s name didn’t appear on the May letter from Garcia or the revised recommendations for schools. It may even explain why she is heading out the door now.

I will be seeking relevant records from IDPH. All I can say with confidence is that Pedati didn’t use her platform or leverage to speak out against dangerous decisions. Now we see the predictable results: Iowa hospitals are strained, health care workers are burning out, and many Iowans are dying unnecessarily.

I wouldn’t have objected to the state medical director getting a 45 percent raise last year (far beyond what state law permitted) if Pedati had been coordinating an effective pandemic response. Iowans didn’t get our money’s worth.

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Full text of September 22 news release:

(Des Moines, IA) – The Iowa Department of Public Health (IDPH) announces today that Dr. Caitlin Pedati, State Medical Director and Epidemiologist, plans to leave the  agency effective late October.              

Dr. Pedati has served in the role since June 2018 and worked as medical epidemiologist for the Nebraska Department of Health and Human Services prior to joining IDPH. Dr. Pedati plans to pursue new career opportunities.

“I want to thank Dr. Pedati for her outstanding service to the people of Iowa, especially throughout the pandemic,” stated Governor Reynolds. “She has been instrumental to our state’s strong COVID-19 response and a valued member of my team. I wish her much success and happiness in all that she pursues.”

IDPH interim Director Kelly Garcia shared, “The work of the last 18 months has been difficult at best and I remain immensely appreciative of Dr. Pedati’s steadfast partnership throughout. I, along with our teams at IDPH and the Department of Human Services will miss her. Her personal sacrifice is to be commended and we wish her the very best as she begins this new chapter.”

IDPH will work quickly to fill the position.  

Top image: Dr. Caitlin Pedati speaks at Governor Reynolds’ televised news conference on June 4, 2020. Photo by Jim Slosariek/Cedar Rapids Gazette (pool).