Iowa Governor Kim Reynolds speaks during a press conference updating Iowan’s on the status of COVID-19 cases on Thursday, April 2, 2020, in Johnston, Iowa. (Photo Credit: Brian Powers/The Des Moines Register)

DES MOINES, Iowa – Gov. Kim Reynolds extended her public health emergency declaration that closed businesses and schools, suspended gatherings of more than ten people, and suspended nonessential and elective medical and dental procedures through April 30. 

“Keeping Iowa’s students out of classrooms is a very difficult decision, but it remains necessary for now. We anticipate the number of positive COVID-19 cases in Iowa will continue to grow. And keeping schools closed for an extended amount of time will help protect the safety of our students, educators, and school staff, reduce the burden flatten the curve on our health care system and workforce, and of course, reduce the risk to our most vulnerable Iowans and ultimately save lives,” she said during Thursday’s press conference at the State Emergency Operations Center in Johnston.

Reynolds said that at this time she was not recommending schools close for the remainder of the school year, but did say that schools are responsible for continuous learning opportunities for their students. 

Public schools and accredited non-public schools have until April 10 to inform the Iowa Department of Education what continuous learning option they choose to implement between April 13 through April 30. Schools that do not do that are required to reschedule the time missed after April 13.

On Thursday morning, The Iowa City Press-Citizen first released an internal document it obtained that outlined how the Iowa Department of Public Health scored the metrics that are the basis of Reynolds’ decisions during this pandemic.

The criteria are:

  • The percentage of the population who are 65 or older
  • The percentage of reported cases requiring hospitalization
  • The rate of infection among the population per 100,000 people in the past 14 days
  • The number of outbreaks in settings like long-term facilities where the elderly and those with underlying health conditions live.

Dr. Caitlin Pedati, the state epidemiologist, during the press conference, revealed that regions within the state receive scores. Those regions, she said, are based upon state resources. 

A region where less than 15 percent of the population is 65 or older receives a score of one. If 15-19 percent of a region’s population is 65 or older, the region gets a score of two. If 20 percent or more, then the region is given a three.

With the percentage of cases requiring hospitalization, under 3 percent is zero, 3 to 11 percent is one, 12 to 14 percent is two, and 15 percent or higher is three.

The rate of infection per 100,000 in the past 14 days: 0-5 cases receive a zero, six to 20 cases receive a one, 21 to 49 instances receive a two, and fifty cases or more gets a three.

The number of outbreaks in long-term facilities, if there are none in a particular region, they receive a zero. If there one outbreak, they receive a one; if two, they receive a two, and if three, they receive a three.

A score of 0 to 3 would put a region in a “preparation and awareness” phase that included guidance and recommendations such as washing hands, covering one’s cough, and staying home when sick.

A cumulative score of 3 to 9, which is the range the entire state is in, is the “social distancing and mitigation” phase that has led us to our current restrictions. 

Cumulative scores of ten or more would mean a shelter-in-place order that would limit movement to only essential activity for 14 days and would be subject to daily review.

“We look at that score day by day, and usually multiple times a day to help us understand the activity level and trends and patterns that we see across Iowa. And as you’ve heard before, we use that to help us either move up or down on some of the public health mitigation measures that we have available to us,” Pedati said.

“One of the things that I think is really important to keep in mind is that these mitigation measures are effective as long as we all follow them,” she added.

Dr. Dustin Krutsinger, assistant professor of medicine at the University of Nebraska Medical Center, said the scoring system “at first glance, is a reasonable start.” 

He said he wasn’t sure if monitoring the percentage of the population that is 65 or older is particularly helpful since those numbers don’t fluctuate over the timeframes considered. He also doesn’t think scoring outbreaks in longer-term care facilities is useful as those facilities are already locked down.

“The biggest concern is overwhelming the hospital system, specifically the ICU/ventilator capacity. They are trying to do this to a degree with the Rate/100k and % hospitalized variables,” Krutsinger told Caffeinated Thoughts.

“The problem is that the numbers we see today reflected the situation one-four weeks ago. Exposure to illness is five-seven days; there is often a sudden worsening ~2 weeks, death, if it occurs, is usually three-four weeks post-exposure. So you can’t wait until the hospital is overwhelmed or almost full to do something because then it is too late. On the flip side, capacity can be modified, it is slow, but non-ICU units can be (and are actively being) converted to ICUs. Ventilators can be moved around from stockpiles if they have not been exhausted and can be made. So capacity a month or six months down the road will be different, and thus the threshold for increasing how aggressive mitigation/SIP measures should change,” he stated.

Krutsinger noted that increased testing could lower the hospitalization rate and change the score.

“This formula should not be used as the end-all-be-all for the decision. These factors do not paint the entire picture and if the situation worsens in ways that is not fully captured by this formula then more aggressive measures may be warranted, even if the score does not reach 10,” he added.

He said the Governor and those at the Iowa Department of Public Health are not in an enviable position.

Listen to the entire press conference.

Read Reynolds’ proclamation below:

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