Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa. -promoted by Laura Belin

As I plan to write several posts in the coming weeks related to maternal-child health in Iowa, I want to introduce myself to Bleeding Heartland readers. For this piece, I’m going to provide some high-level information on the landscape around maternal health in Iowa from my perspective as a maternal-child health advocate.

But first, some background on myself and how I became involved in this work.

Since the Iowa Department of Public Health (IDPH) changed how it counts and reports COVID-19 deaths on December 7, fatality numbers on the official website coronavirus.iowa.gov have become more accurate in several respects. The state’s dashboard no longer routinely lowballs how many Iowans have died in the pandemic. Instead, the IDPH numbers track closely with weekly figures published by the U.S. Centers for Disease Control.

We now know that COVID-19 deaths accelerated in Iowa this fall even more rapidly than was previously apparent. Through the end of November alone, at least 3,308 Iowans had died in the pandemic. That number was more than 600 higher than the state website indicated before the IDPH began implementing the new counting method.

Two drawbacks have accompanied this important policy change. First, there is a greater lag time between when an Iowan dies and when that fatality tends to appear on the dashboard. In addition, updates to the state website have become more erratic, with IDPH staff adding few or no deaths on some days, and more than 100 deaths on others.

Now more than ever, media organizations that report COVID-19 statistics daily must put those numbers in context. Anyone following news on the pandemic needs to understand that changing totals from one day to the next on the IDPH website do not reflect how many Iowans died of COVID-19 during the previous 24 hours.

That said, the more accurate counting method is bringing the horrifying scale of the pandemic into focus.

Iowa’s new Infectious Disease Advisory Council will continue to meet behind closed doors, Iowa Department of Public Health (IDPH) interim Director Kelly Garcia confirmed on December 16. Garcia established the council earlier this month, naming 25 “external and internal subject matter experts” to help the agency develop guidelines for allocating limited supplies of COVID-19 vaccines and therapeutics.

Iowans are unable to observe council members as they consider how to balance the needs of disparate groups at high risk from the novel coronavirus. Ryan Foley reported for the Associated Press on December 16 that the council “has met twice this month without giving prior notice to the public, publishing an agenda or allowing the public to participate as required by the Iowa Open Meetings Act.”

The IDPH maintains that Iowa Code Chapter 21 does not apply to an advisory council created by a state agency. But not every expert on the law concurs.

Carl Olsen recounts the latest legal steps in his effort to reconcile state and federal drug laws. -promoted by Laura Belin

On November 10, just a week after the election, the U.S. Drug Enforcement Administration (DEA) denied our petition for a new federal regulation exempting state medical cannabis programs to be added as 21 C.F.R.

DEA explained that denying the exemption was necessary because it would create an exemption:

UPDATE: State officials changed their methodology for counting COVID-19 deaths in early December 2020. Original post follows.

The state’s official website on the coronavirus pandemic regularly understates the number of Iowans who have died of COVID-19, Bleeding Heartland’s analysis of U.S. Centers for Disease Control data indicates.

The Iowa Department of Public Health submitted information to the CDC indicating that 2,099 Iowans had died from COVID-19 through the week ending November 7. The latest figures published on coronavirus.iowa.gov show 2,206 total deaths, but account for only 1,920 deaths through November 7.

Sara Anne Willette, who maintains the Iowa COVID-19 Tracker website, has noticed the same discrepancy. It may explain why IDPH communications staff never answered Bleeding Heartland’s many inquiries about how the state counts coronavirus fatalities.

Iowa Medical Director Dr. Caitlin Pedati received a 45 percent raise this summer despite a state policy limiting within-grade pay increases, records obtained by Bleeding Heartland show.

Department of Administrative Services (DAS) Interim Director Paul Trombino III advocated for Pedati to receive the unusually large raise three weeks after informing state agency directors that they could give employees within-grade salary hikes of up to 3 percent.

State rules also require that “any within grade pay increase must be accompanied by a current performance evaluation,” Trombino reminded directors in the same memo. However, staff with the Iowa Department of Public Health (IDPH) and DAS did not answer questions about whether anyone has formally reviewed Pedati’s work this year.

Governor Kim Reynolds isn’t on the ballot this November, but you wouldn’t know it from her schedule lately. She’s been putting in full-time hours at campaign events for other Republican candidates.

Since Reynolds’ last televised news conference on October 7, and even since Bleeding Heartland last reviewed this topic a week ago, key statistics reflecting the novel coronavirus pandemic have worsened. Iowa is reporting more deaths and setting new records for hospitalizations, as new daily cases and the fourteen-day test positivity rate also increase.

Governor Kim Reynolds found a way to make a bad situation worse.

In the past month, Iowa’s coronavirus deaths have accelerated, while hospitalizations have nearly doubled, far surpassing the previous peak in early May.

Despite numerous warnings from experts that Iowa is on a dangerous path, Reynolds refuses to take any additional steps to slow community transmission of the virus. Instead, she is sticking with the “trust Iowans to do the right thing” playbook, confident that hospitals will be able to handle the influx of COVID-19 patients.

The numbers speak for themselves.

Carl Olsen, the founder of Iowans for Medical Marijuana, brings us up to date on his efforts to reconcile state and federal drug laws. -promoted by Laura Belin

Retail sales of medical cannabis products began in Iowa on December 1, 2018, implementing Iowa House File 524, which lawmakers passed on the final day of the 2017 legislative session.

Iowans for Medical Marijuana submitted an application to the U.S. Drug Enforcement Administration in January 2019, seeking to exempt Iowa’s Medical Cannabis Program from federal drug laws. That application used the process in Title 21, Code of Federal Regulations, Chapter 1307, 21 C.F.R. §1307.03. I then began to lobby the state legislature and the Iowa Department of Public Health to support the application.

Less than a month into the new academic year, Iowa state officials changed guidance on student absences in a way that will make it difficult for school districts to hit a key metric for transitioning to online learning.

Update: Carver-Kimm amended her lawsuit in June 2021 to include the two claims originally filed with the State Appeal Board. She amended it again in August 2021 to add more plaintiffs and remove the third count related to First Amendment claims. You can read the latest version of the petition here. The case is scheduled for trial in the summer of 2022. Original post follows.

The Iowa Department of Public Health’s longtime communications director Polly Carver-Kimm filed suit on September 2, claiming she was wrongfully terminated, in violation of the state’s whistleblower law. Stephen Gruber-Miller first reported on the lawsuit for the Des Moines Register. I’ve enclosed below the District Court filing and Carver-Kimm’s parallel claims filed with the State Appeal Board.

Carver-Kimm was the lead media contact at IDPH for thirteen years before she was told to resign or be fired in mid-July. Her attorney, Tom Duff, has represented other well-known Iowans who have sued the state on whistleblower claims or alleging wrongful termination, including former criminal investigator Larry Hedlund (who had caught the SUV carrying then Governor Terry Branstad speeding) and former Department of Human Services Director Jerry Foxhoven.

The day she was ousted, Carver-Kimm told the Des Moines Register’s Tony Leys she was “embarrassed and saddened by the way the media has been treated during COVID.” She asserted that she was stripped of her duties and eventually removed for being too open with journalists seeking information about the pandemic.

Her court filing and an accompanying news release from Duff’s office are more specific about alleged violations of Iowa’s open records law.

If you visit coronavirus.iowa.gov and view the graphs on the “case counts” page, you might expect to learn how many Iowans were tested for COVID-19 on any given day, and how many of those tests came back positive or negative.

You would be wrong.

Every day, records of hundreds or thousands of old tests disappear from the website. Consequently, it is impossible to reconstruct an accurate picture of Iowa’s testing numbers or positivity rates, either statewide or at a county level.

The Iowa Department of Public Health is not tracking the rate of positive, negative, or inconclusive results from COVID-19 tests performed through Test Iowa, Ethan Stein reported for KCRG-TV on August 26.

State officials have declined to segregate data from Test Iowa so that the public could compare those results to COVID-19 tests performed in other settings. But I had assumed the state was collecting that information for its own analysis and quality control.

Not so, KCRG learned.

“Our state coronavirus website now includes the county by county 14-day average positivity rate for our school districts,” Governor Kim Reynolds announced at her August 6 news conference. “Schools and others will be able to check to see where each county stands on this important metric.”

State Medical Director Caitlin Pedati appeared via computer link at the same press conference, answering reporters’ questions about state policies on reopening schools.

Pedati acknowledged on August 19 that the Iowa Department of Public Health’s epidemiology team knew in late July that the positivity rates were inaccurate, because many recent COVID-19 cases were recorded as occurring weeks or months in the past.

An announced “fix” did not appear to solve the backdating problem. On the contrary: newly posted totals on the state’s coronavirus website increased the number of cases recorded for March and April.

Less than five months after the first Iowan succumbed to the novel coronavirus, the official count of COVID-19 fatalities reached 1,002 on the evening of August 18.

The pandemic has now claimed more Iowa lives than 60 years of foreign wars. Data compiled by the Iowa Department of Veterans Affairs shows 868 military service members died in Vietnam, as did two in Panama or Grenada during the 1980s, seven in the Persian Gulf war of the early 1990s, 64 in the Iraq War that began in 2003, and 31 in Afghanistan.

COVID-19 has killed more Iowans in five months than diabetes, the state’s seventh-leading cause of death, does in a typical year.

More Iowans have passed away of coronavirus since March than died in vehicle accidents during 2017, 2018, and 2019 combined.

Publicly available data show the pace of deaths has been accelerating, even before most Iowa students return to K-12 schools or colleges. Those official numbers almost certainly undercount the lives lost.

The Iowa Department of Public Health has erroneously recorded thousands of positive COVID-19 test results, distorting reported case numbers and positivity rates.

Rob Ramaekers, the lead epidemiologist for the department’s Surveillance Unit, acknowledged in an August 14 email that Iowa’s coronavirus website has recorded some recent cases as occurring weeks or months in the past. According to Ramaekers, state officials are aware of the problem and working on a fix.

The backdating means that publicly available numbers underestimate the positivity rate for COVID-19 tests conducted over the past two weeks, a key metric for measuring community spread.

The base pay for Iowa’s medical director and state epidemiologist Dr. Caitlin Pedati increased by 45 percent as the current fiscal year began on July 1, records obtained by Bleeding Heartland show. The additional $3,144 that Pedati began receiving per two-week pay period would translate to an extra $81,744 in base salary over twelve months.

The doctor leading the state’s COVID-19 pandemic response also received more than $55,000 in overtime pay from March through early July, even though her job class would not normally be eligible for overtime compensation.

Van Buren County had 24 confirmed COVID-19 cases as of July 29, according to Iowa’s official coronavirus website. But the local health department had recorded 46 cases in that southeast Iowa county by that date.

The discrepancy in one small county’s reported COVID-19 case numbers could point to big trouble for managing school closures this fall.

The old saying, the “The Devil is in the details,” applies to Governor Kim Reynolds’ July 30 press conference in more ways than just the policy she announced.

More than four months into the novel coronavirus pandemic, Governor Kim Reynolds and the Iowa Department of Public Health are finally acknowledging that slowing the spread of COVID-19 will require many more Iowans to routinely cover their faces in public.

Their “#StepUpMaskUpIA” campaign might have been more successful if state officials had pushed the message before reopening businesses and lifting other COVID-19 mitigation strategies in May and June. Instead, top officials waited until new coronavirus cases, hospitalizations, and deaths had been trending upward in Iowa for weeks.

Public health experts at the University of Iowa urged state leaders months ago to call for universal use of face coverings. But at her televised news conferences, Reynolds repeatedly asserted that expanded testing would allow the state to “manage” and “control” the virus. At the same events, the governor regularly portrayed face masks as something vulnerable Iowans might need, or a precaution people could bring with them in case they found themselves in a crowded setting.

As recently as last week, Reynolds was photographed in close proximity to others, with no one’s face covered. Even now, she refuses to delegate authority so local governments can issue enforceable mask orders.

This project started with the goal of clearing up some confusion surrounding Iowa’s novel coronavirus (COVID-19) death statistics.

Specifically, I wanted to debunk a conspiracy theory making the rounds on Facebook, Twitter, and Reddit.

I also planned to explain why the number of deaths for a given day on the state’s official website (coronavirus.iowa.gov) didn’t always match the number of new deaths that had been announced on that date. Many readers had asked about the discrepancy.

I was almost ready to publish in early July, but I needed to nail down one detail. Did the total fatalities on the state website (793 at this writing) reflect all of what the U.S. Centers for Disease Control describes as “multiple cause” COVID-19 deaths, or only what the CDC labels “underlying cause” deaths?

After asking that question more than half a dozen times over two and a half weeks, I still haven’t received an answer. So much for the Iowa Department of Public Health’s supposed “transparency” and “constant communication with media” on the pandemic.

“I am embarrassed and saddened by the way the media has been treated during COVID,” Polly Carver-Kimm wrote in an email to the Des Moines Register on July 15. “You are not receiving timely answers and you are getting scripted talking points when you do get an answer.”

Carver-Kimm discussed the state’s handling of press inquiries hours after being shown the door as communications director for the Iowa Department of Public Health.

Carl Olsen recounts his long battle to reschedule cannabis and the latest legal steps in his effort to reconcile state and federal drug laws. -promoted by Laura Belin

Last month, I filed a petition with the Iowa Department of Public Health, asking the agency to start the process of obtaining a federal exemption for Iowa’s medical cannabis law.

I had presented this idea to Iowa’s Medical Cannabidiol Board in August 2019. The board members unanimously approved the concept and recommended in January 2020 that the legislature protect schools and long-term care facilities, which “are hesitant to allow medical cannabidiol products to be administered and stored at the facilities due to the current scheduling of Cannabis at the federal level.” The board suggested “Developing language to protect these facilities or seeking exemption for Iowa’s program from federal drug laws.”

Instead of adopting my proposal, Republican lawmakers approved and Governor Kim Reynolds signed House File 2589, which instructed the Department of Public Health to “request guarantees” from federal agencies that they would not withhold federal funding from educational or long-term care facilities that allow patients to possess or staff to administer medical cannabidiol.

That approach makes no sense, because it would put Iowa in direct conflict with federal drug law. As I wrote in my petition, “There is no formal process for requesting guarantees from federal agencies not to withhold funding for violation of federal drug laws.”

Here’s why Iowa should take a different path.

At least 702 Iowans have died from novel coronavirus infections, according to the state’s official website at midday on June 26. Less than four months since the state recorded its first case, the death toll from COVID-19 alone is higher than the number of Iowans who have died in any recent year of flu or pneumonia, which has been the state’s eighth leading cause of death. Those fatalities occurred despite social distancing and other unusual precautions like restricted nursing home visits since March.

Statistics archived by the U.S. Centers for Disease Control indicate that 697 Iowans died of flu or pneumonia in 2018, reflecting a worse than usual flu season. Iowa deaths in that category numbered 582 in 2014, 618 in 2015, 504 in 2016, and 578 in 2017.

Novel coronavirus (COVID-19) infections and deaths could increase or decrease substantially in the coming months, depending on how many Iowans practice social distancing or wear personal protective equipment (PPE) routinely in public, according to a modeling app designed by University of Iowa faculty and graduate students.

Six professors of biostatistics or epidemiology collaborated on the model, while a group of graduate students worked on the app and translated materials for a Spanish-language version. The university’s College of Public Health COVID-19 Response Team “developed this tool as a free public service to state and local policymakers, business leaders, and others to assist in guiding the community response to the coronavirus pandemic.”

This incredibly useful resource was derived from publicly-available data, so is not subject to restrictions on release state government imposed as part of the contract the Iowa Department of Public Health and UI College of Public Health signed in April to develop Iowa-specific modeling for COVID-19. Governor Kim Reynolds and state health officials largely ignored that modeling when drafting plans to reopen businesses and venues in May and June, saying “real-time data” was informing such policies.

Occupational Safety and Health Administration (OSHA) staff conducted on-site inspections of two more Iowa meatpacking plants this week, the Iowa Division of Labor confirmed to Bleeding Heartland on June 2.

Documents provided the following day show regulators closed at least four coronavirus-related complaints against Iowa pork processors with no inspection.

Inspectors toured the Tyson Foods turkey plant in Storm Lake and the Perdue Premium pork facility in Sioux Center on June 1. Both site visits stemmed from “media referrals” rather than complaints, meaning officials acted on unspecified news reports or information relayed to OSHA by a journalistic source.

A little more than two months after Iowa recorded its first death attributed to novel coronavirus, the number of reported COVID-19 deaths in the state has surpassed annual deaths by suicide in recent years.

UPDATE: Hours after this piece was published, the plus/minus feature disappeared from the state website. Original post follows.

The state of Iowa’s official website for information about the novel coronavirus pandemic incorporated a few tweaks this week. The most noticeable: Department of Public Health staff update various statistics throughout the day, rather than once in each 24-hour period. During her May 18 news conference, Governor Kim Reynolds asserted that the new practice would make data on COVID-19 more “transparent.” Critics pointed out that the frequent updates would make it harder for Iowans to keep tabs on daily changes in coronavirus cases, tests, hospitalizations, and deaths.

Reynolds didn’t announce another addition to the website, which has attracted relatively little notice. Several of the bar graphs can now be adjusted to project the number of daily cases, tests, hospitalizations, or deaths weeks or months into the future.

The trouble is, those projections are not grounded in any principles of epidemiology.

The Iowa Department of Public Health does not intend to limit the use of exemptions to mandatory vaccinations during the novel coronavirus (COVID-19) pandemic, spokesperson Amy McCoy confirmed on May 19.

A company hired to ramp up Iowa’s capacity to test for novel coronavirus has been sending messages to sick Iowans that could discourage them from seeking a COVID-19 test.

Some people who reported respiratory symptoms when completing the Test Iowa online assessment, but did not qualify for an appointment at a drive-through site, received a message warning that COVID-19 testing “is quite invasive and uncomfortable” and that tests should be reserved “for those who need it the most.”

Neither Nomi Health nor state officials have clarified whether the Iowa Department of Public Health helped write or approved the wording.

Religious institutions across Iowa are now allowed to hold large services, under Governor Kim Reynolds’ latest proclamation related to novel coronavirus, which took effect on May 1. While most churches declined to schedule in-person services for this Sunday morning, some are looking at ways to modify their space or practices in order to resume face-to-face worship soon.

In mid-March, the governor temporarily prohibited religious or spiritual gatherings of more than ten people. Her April 27 order lifted that ban, provided that houses of worship “implement reasonable measures […] to reduce the risk of transmission of COVID-19 consistent with guidance issued by the Iowa Department of Public Health.” Among other things, the department recommends that people practice good hygiene and adjust the layout so congregants not from the same household can “sit at least six feet apart.”

That advice is insufficient to keep those carrying the virus from infecting others.

For weeks, Governor Kim Reynolds told reporters at her daily news conferences that “data” and “metrics” informed her approach to slowing the spread of novel coronavirus (COVID-19) in Iowa.

That narrative flew out the window on April 27, when she unveiled her plan to lift some mitigation measures statewide and allow many kinds of businesses to reopen in 77 Iowa counties, effective May 1.

Reynolds and Dr. Caitlin Pedati, the state medical director and epidemiologist, sought to spin the new policy as “evidence-based.” In reality, they are betting Iowans’ lives on the potential for data collection that has barely begun.

Dr. Glenn Hurst: The nursing homes know that if they accept one COVID-19 patient in their facility, they will likely be sending ten new patients to either the hospital or the coroner. -promoted by Laura Belin

As we look to reopen the U.S. economy, many questions arise regarding whose interests the economy serves. In the health care sector, the answer is large health systems, often at the expense of some of the most vulnerable populations in our state. Their vertical integration of the profitable components of health care provision, hospitals, surgery centers, rehab and physicians, and the casting off of components such as nursing care and hospice have acutely left the older generation at grave risk.

Today’s crisis illustrates the problem. The continued outbreak of novel coronavirus (COVID-19) cases in Iowa nursing homes should be shocking. The response to calls for assistance to protect these patients should be met with the same distress.

“I do want to encourage every Iowan to go to TestIowa.com and take the assessment,” Governor Kim Reynolds said as she rolled out a program to increase the state’s coronavirus testing capacity during an April 21 news conference. The governor announced the following day that more than 80,000 Iowans had completed an initial assessment during the first 24 hours the website was online.

However, the online survey at the new site is not accessible to all Iowans in high-risk groups for COVID-19 infections and complications. Representatives of the governor’s office and Iowa Department of Public Health did not respond to Bleeding Heartland’s repeated questions about barriers to taking the survey.

The Iowa Department of Public Health has refused to disclose the state’s pandemic emergency response plan, Barbara Rodriguez reported for the Des Moines Register on April 20.

Bleeding Heartland has tried without success to obtain the department’s current guidance on rationing ventilators, should that become necessary in Iowa hospitals.

Three weeks ago today, Iowa Department of Public Health Deputy Director Sarah Reisetter told reporters our state’s novel coronavirus (COVID-19) infections might hit “a first peak in the next two to three weeks.” But Iowa has racked up more confirmed cases and deaths attributed to COVID-19 during the past three days than in any previous three-day period. Outbreaks continue to be identified in long-term care facilities and meatpacking plants, where one infected person can pass the virus to many others.

Governor Kim Reynolds imposed stricter limits on socializing outside the household in fourteen northeast Iowa counties on April 16. The next day, she ordered all schools in the state to remain closed through the remainder of this academic year. But even as the governor encouraged Iowans to stay home if they can, she asserted on April 17 that “there are a lot of really positive signs” and suggested officials may be ready to start opening things up in parts of the state soon.

Meanwhile, the country’s most widely-cited model for COVID-19 now projects that use of hospital resources and coronavirus deaths in Iowa will peak on May 7 and 8, respectively. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington also indicates that “relaxing social distancing may be possible” in Iowa after June 29. By comparison, the same model projects that the states of Washington and California already passed their peak for deaths and hospital resource use and may be able to scale down mandatory social distancing on May 18.

Why hasn’t Iowa turned the corner?

UPDATE: The state altered testing criteria again on May 6, but the changes were minimal (see new policy at the end of this post).

Iowa’s State Hygienic Laboratory posted new testing requirements on April 17 for people who suspect they have novel coronavirus (COVID-19) infections. The updated criteria are nearly identical to earlier versions, with a change designed to reduce the risk of asymptomatic patients bringing the virus to assisted living facilities.

Also on April 17, Iowa Department of Public Health Deputy Director Sarah Reisetter confirmed that some workers without symptoms will be tested at meatpacking plants where other employees are known to have COVID-19 infections.

Democratic State Senator Janet Petersen is the Iowa Senate minority leader. -promoted by Laura Belin

When trouble hits our state, Iowans want leaders who talk straight and make sure all Iowans can be part of the solution.

That’s true when we are helping fellow Iowans recover from flooding, tornados and other natural disasters. And it’s certainly true of our efforts to battle the COVID-19 pandemic.

Joe Gorton is a criminology professor at the University of Northern Iowa. -promoted by Laura Belin

During her March 19 press conference, Governor Kim Reynolds presented her social distancing strategy for protecting Iowa from the novel coronavirus (COVID-19 or SARS-CoV-2) pandemic. Unfortunately, she failed to discuss or even acknowledge any of the significant risks associated with her particular approach.

The purpose of this article is to provide information about the unreported hazards the Reynolds plan incorporates.

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.