Karl Keeler, president of MercyOne Central Iowa Medical Center, told staff during a May 5 information session that “We have a lot of work to do” to stay safe from novel coronavirus, since Iowa is among five states with the highest level of community spread. The hospital group has adopted new rules requiring patients and visitors as well as staff to wear masks at its facilities.

Keeler also said the 77 patients hospitalized with COVID-19 infections at MercyOne’s Des Moines and West Des Moines facilities as of May 5 was “the highest we’ve had.” The number of Iowans in the hospital because of coronavirus has steadily climbed, reaching a new statewide high of 414 on May 6.

MercyOne operates six hospitals and dozens of clinics in central and southern Iowa, employing “more than 1,000 physicians and allied health professionals” and more than 7,000 total staff.

Keeler and two other senior executives for the region recorded the town hall on May 5. I’ve enclosed the whole video at the end of this post. Here is the relevant clip:

Keeler explained that Iowa is one of five states with an Rt value above 1.0, indicating “active spread” of COVID-19. Rt represents “the average number of people who become infected by an infectious person. If Rt is above 1.0, the virus will spread quickly. When Rt is below 1.0, the virus will stop spreading.”

The latest available data on this website tracking Rt for every state shows five states with values above 1.0: Nebraska (1.06), Minnesota (1.06), Wyoming (1.03), Iowa (1.02), and Wisconsin (1.01). Kansas is sitting right at 1.0.

Governor Kim Reynolds joined four other Republican governors, including the leaders of Nebraska and Wyoming, to co-author an op-ed for the Washington Post on May 5 titled, “Our states stayed open in the covid-19 pandemic. Here’s why our approach worked.”

School and business closures and other steps to encourage social distancing brought Iowa’s transmission rate down from an estimated 1.23 in mid-March, but not below the 1.0 level where most states have been since early to mid-April.

Last week, Reynolds relaxed some COVID-19 mitigation measures statewide and lifted other restrictions in 77 counties. She flew to Washington, DC on May 6 to update President Donald Trump on Iowa’s approach to managing the pandemic.

To limit the spread of COVID-19, MercyOne has adopted new internal rules on masks. “Everyone in the organization is to be wearing a mask” in every open space, Keeler emphasized during the May 5 town hall. All visitors to hospitalized patients will be required to wear masks at all times. Patients need not wear them in their own hospital rooms but must do so in other areas. MercyOne “is encouraging people to bring in their homemade masks” but will supply them if needed, Keeler said.

The governor’s latest public health emergency proclamation allowed Iowa hospitals to resume elective surgeries. Those procedures had been prohibited for more than a month in order to preserve personal protective equipment (PPE).

MercyOne’s vice president of planning and business development Sandy Swanson updated staff on plans for reopening facilities during the town hall. Phase one, to begin later this week or early next week, will involve “urgent, immediate need, and elective services” in outpatient settings. Then “semi-urgent” procedures will restart at larger medical centers. Eventually, depending on the prevalence of COVID-19 in the community and MercyOne’s confidence in adequate medications, staffing, and PPE supplies, all elective services will resume in all locations. Medical staff have developed an algorithm to determine which procedures will be cleared for each phase.

Because COVID-19 case counts in Appanoose and Jasper counties remain relatively low, Swanson said, MercyOne’s hospitals in Centerville and Newton should be able to resume all elective procedures this week. All patients will be tested for COVID-19 prior to elective procedures.

Seventeen of the 77 COVID-19 patients hospitalized in MercyOne’s system as of May 5 were in the post-anesthesia care unit (PACU), Keeler said. That would seem to present a barrier to resuming elective surgeries, since patients typically go to PACU after such procedures.

Reynolds has touted serology testing as a way to determine which Iowans have recovered from COVID-19, possibly without having any symptoms. Answering a question about MercyOne’s plans for such testing among staff, Keeler referred to the Infectious Disease Society’s recent primer on COVID-19 serology tests. That organization warned,

Tests to detect antibodies to SARS-CoV-2 vary widely in performance, and remain clinically unverified, opening possibilities for both false positive and false negative results. In addition, with little to no clinical evidence that having antibodies against the virus confers immunity among recovered patients, IDSA cautions the tests not be used as a basis for decisions on whether personal protective equipment – PPE – including masks — are needed.

For those reasons, Keeler said, MercyOne is not currently looking at widespread serology testing among staff. As for the more common PCR tests using samples collected from nasal swabs, Keeler said that because supplies are limited, MercyOne is reserving those for where there is a demonstrated need, rather than testing all employees. Last week, the organization had more than 700 staff tested (Keeler didn’t specify in which units) after learning that a few patients and colleagues had tested positive for COVID-19.

UPDATE: On May 8, the website tracking Rt adjusted its model. The new calculations estimated Iowa’s transmission rate has been below 1.0 since April 22, dropping to a current level of 0.97. That’s a much more promising forecast, although this projection still shows Iowa has the ninth-fastest estimated spread in the country.

LATER UPDATE: The website posted new estimates on May 11. Now only four states have Rt above 1.0. Iowa’s transmission rate is projected to be 0.92, the seventeenth-highest in the country.

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Appendix: Full video from the May 5 town hall featuring leaders of MercyOne Central Iowa Medical Center