Vulnerable Iowans grapple with continued COVID-19 risk as society drops pandemic safeguards

As case counts drop and health systems no longer face the dire threat of being overwhelmed, things have begun to relax.

Barring any development of coronavirus variants, some see may see this as the sign that the pandemic may be becoming endemic. But vulnerable groups have not left the pandemic behind just yet.

“We’re still here. This impacts us,” said Bob Cass, a 66-year-old recipient of a single lung transplant.

As Iowa approaches the second anniversary of COVID-19, the milestone marks a new phase in the pandemic. A year ago, there were fewer treatment options for coronavirus-infected patients and vaccines weren’t available.

Recent changes in federal and state public health recommendations signal a “normal” life returning for many, prompting them to drop pandemic safeguards such as wearing masks and physical distancing.

But for those who are immunocompromised, have chronic medical conditions or are otherwise vulnerable to serious illness if infected by the novel coronavirus, the risk still is very real. For some, the latest move from top officials suggests a lack of acknowledgment of the risk these vulnerable groups face.

“I still have a risk, I need to protect myself,” Cass said. “The chances are low for catching it, but it only takes once.”

Cass received his organ transplant at the Cleveland Clinic in August 2019 as a result of idiopathic pulmonary fibrosis, a progressive and serious lung disease that causes scarring in the lung, making it difficult to breathe. He and his wife moved to Iowa City in February 2020 to be close to the transplant center at the University of Iowa Hospitals and Clinics.

As a transplant recipient, Cass faces increased risk from all types of infections, even from something like the common cold. He was used to wearing masks in public and washing his hands frequently before it became common practice across society.

And he was accustomed to assessing his own risk when venturing in public spaces, such as a grocery store. But Cass recalled hearing from some people around him who believed the pandemic wasn’t a concern because they were healthy and likely faced little repercussions from COVID-19.

To Cass, those beliefs minimized his experience as an at-risk individual and reinforced his isolation

“Seeing resistance to vaccines and (to) wearing masks, that was frustrating for me. I felt like I don’t count,” he said.

Relaxing COVID public health measures

Many experts agree COVID-19 eventually will reach endemic stage. Though its unclear whether the United States has achieved point yet, top leadership has begun ending long-standing COVID-19 emergency response policies and recommendations in recent weeks.

Two weeks ago, the federal Centers for Disease Control and Prevention relaxed its mask guidelines, recommending continued mask use only for those who live in communities where high COVID-19 rates are straining local health systems.

Under this new guidance, most Iowans now can be in public settings without a mask. Only a few counties had a high level of COVID-19 as of this past week.

The COVID-19 pandemic has been on a downward trajectory in recent weeks, with infection rates significantly lower than they were at the peak of most recent surge in mid-January. This past Wednesday, hospitalizations in Iowa were at the lowest total since August, according to the latest statewide coronavirus data.

Despite this, things have not changed for medically vulnerable people or those with children under the age of five, who are not yet eligible for a COVID-19 vaccine, said Danielle Pettit-Majewski, director of Johnson County Public Health. Removing mitigation measures for the community puts pressure on those groups to take extra precautions moving forward.

“You’re telling people who are disabled or have young children, ‘you’re on your own,’“ she said. ”That puts a lot of the onus on people who have a lot of health care barriers, and that has a lot of social repercussions and social impacts.“

Gov. Kim Reynolds ended the statewide coronavirus disaster proclamation, which reallocated resources and suspended some state laws that were in place to bolster Iowa against COVID-19. But as of Feb. 15, the state’s management of the virus is “part of normal daily business.”

“The flu and other infectious illnesses are part of our everyday lives, and coronavirus can be managed similarly,” Reynolds said in her announcement last month.

Local public health departments already had scaled back some coronavirus response efforts before the governor’s decision to end the disaster proclamation. Both public health agencies in Linn and Johnson counties ended COVID-19 contact tracing in December and January respectively, suspending disease investigation efforts that had been taking place since March 2020.

Moving forward, Linn County Public Health will fold coronavirus follow up and education as part of the department’s day-to-day functions in the coming weeks or months, Director Pramod Dwivedi said. Officials will wait until after the spring break period, to see if there’s any change in case counts.

“Unless we see another variant, it seems like we are inching toward good outcome, but who knows,” Dwivedi said. “This virus has always thrown curve balls at us.”

To be prepared for whatever surprise comes their way, public health officials continue to emphasize the need for funding to support staffing and resources.

Public health officials are urging at-risk groups to continue to practice mitigation strategies as Iowa and the rest of the country navigates this latest phase of the pandemic.

“I think they’re still going to be at greater risk,” Pettit-Majewski said.

Weighing the risk versus reward

Immunocompromised individuals make up 2.7 percent of the U.S. adult population according to estimates reported in the Journal of the American Medical Association. But that doesn’t account for every person who faces serious risk from a coronavirus infection.

Age and certain chronic medical conditions also can increase people’s risk for complications from an infection.

Four out of six members of Sid High’s immediate household have chronic medical conditions. That includes High, an 18-year-old Marion resident who was diagnosed with epilepsy when he was 13. He also has postural orthostatic tachycardia syndrome, or POTS, and Ehlers-Danlos syndrome.

“If we get COVID, it could be very bad,” he said.

When COVID-19 arrived, the family began isolating, limiting interactions with friends and family, and wearing masks often. High, who is home-schooled, quit his job at Walgreens to minimize potential exposure.

Because of their risk, his family — like many who have vulnerable loved ones — has viewed the pandemic differently than some in the community.

While it is frustrating to see people minimize the dangers of COVID-19, High said he doesn’t judge them for their beliefs or choices. He said he can’t affect other people’s choices. So instead, High will continue to take precautions and be as careful as possible for the foreseeable future.

“My family has to be super safe, but other people don’t have to think about that. It’s more serious for us than it is for some people,” High said.

“I hope people will try to learn more about how people in chronic illness community see the world,” he added.

One family has had to balance the dangers of COVID-19 with creating a normal life for their young daughter.

Kade and Karen Hammes’ daughter Mila Hammes, who will be three-years-old in April, was born with cystic fibrosis, a genetic disorder that affects the lungs and other organs.

The Coralville couple has to weigh the risk versus the reward of aspect of their daughter’s life throughout the past two years, an effort that will continue the rest of her life, they said.

They’ve decided they would send their daughter to pre-school no matter what, but have stepped back on other activities that have low rewards. They had enrolled Mila in gymnastics, but pulled her out of classes after the highly transmissible omicron variant prompted cases to surge to record highs.

“We really want for her to live a normal life as possible, but we also know we have to keep her health in mind,” Karen Hammes said.

From their perspective, those around them have been cognizant of Mila’s medical condition and have taken steps to keep her healthy.

Kade Hammes said some of his family members are unvaccinated and generally don’t believe COVID-19 is a serious disease, but have urged the Hammes not to visit if they know they’ve been exposed to an infected individual.

“Even from those that, in my opinion, don’t take COVID very seriously, they still take Mila’s health very seriously,” Kade Hammes said.

Though he still has some apprehension in the near term, Bob Cass said he is optimistic for a future that holds low risk for him and others who are vulnerable.

Cass and his wife had canceled a trip to Florida to visit his father because of the most recent coronavirus surge, which was driven by the omicron variant. But if the virus continues its downward trajectory, he hopes to make the trip in the coming weeks.

“I know there’s risk in living and in doing normal things, but I can choose to minimize that as much as I can,” he said. “I don’t want to go around living in fear, but I try to be smart in the chances I take.”

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