Spike in coronavirus cases a harbinger of even higher death toll, experts say

DES MOINES - An 18 percent increase of Iowa deaths during May compared with a year ago helps illustrate the severity of the coronavirus pandemic and provides a dire warning for the spiking number of cases being reported now, experts say.

Federal data tracks weekly deaths, and experts say comparing the number of deaths in a given year to historical trends can illustrate the impact of public health events like a pandemic. Medical experts often use the metric, for example, to determine the severity of an annual flu season.

In 2019, 2,247 Iowans died in calendar weeks 18 through 21, the four weeks that ended in May of that year, federal data shows. In the same four weeks in 2020, 2,650 Iowans died - an increase of 18 percent.

Iowa's first wave of coronavirus cases and hospitalizations surged through April and peaked in early May, state data shows, just before the increase in year-over-year deaths.

'That is certainly one of many measures to confirm the fact that the coronavirus is in fact a phenomenon unlike anything we have seen in recent memory,” said Dr. Austin Baeth, an internal and palliative medicine physician at UnityPoint Health in Des Moines. 'It is proof to the denialists that the coronavirus is actually a killer. It clearly shows that this is more serious than influenza. … This data is one of many pieces of information that add weight to the fact that this is a historic crisis that we're seeing.”

As of Friday afternoon, nearly 1,100 Iowans had died as a result of COVID-19, the disease caused by the new coronavirus. Over nearly six months, more than 62,000 positive cases of the virus have been recorded in Iowa.

The increase in Iowa deaths started in early April, and the difference widened until that stretch in May, according to federal data.

Drilling down further, during consecutive weeks ending May 9 and May 16 of this year, the number of deaths in Iowa spiked at 22.3 percent and 26.5 percent increases over the same week the previous year.

State data, which is compiled monthly instead of weekly, shows roughly the same. The number of deaths in Iowa increased 17 percent in May, according to state public health data.

'It's of great interest,” said Dr. Louis Katz, Scott County Health Department medical director and an infectious disease specialist. 'We've used (excess deaths) for years and years with influenza, counting excess deaths during the influenza season in order to have a corroborating metric for the case reports. And that's what it is: a corroborating metric for (measuring) the impact. It's important stuff.”

The increase in deaths gradually lessened in the weeks following that May spike, and 2020 deaths have been more closely tracking 2019 since mid-June, the federal data shows. Iowa deaths increased just 2 percent in June over the previous June, according to the state data.

But Katz and Baeth warned that with coronavirus cases, hospitalizations and deaths all on the rise again in Iowa. With the number of new cases even higher now than during the first peak back in May, the state could be headed for another stretch where excess deaths far exceed the previous year.

With those numbers increasing, Gov. Kim Reynolds this week for the first time since she reopened the state after the first closures in April reinstituted some mitigation strategies.

She ordered bars and nightclubs closed in six counties, primarily those with universities and colleges including Johnson and Linn counties. The areas are seeing spikes in new cases as college students return for the fall semester.

Earlier this week, University of Iowa Hospitals and Clinics Chief Executive Officer Suresh Gunasekaran told The Gazette the spike in Johnson County cases was 'very, very alarming.”

Nearly all the case the UIHC was seeing were in the 19-24 age group - like college students.

'We can't scientifically associate it with the return of students to campus because we don't actually ask that information - there's privacy around that,” Gunasekaran said. 'So we are assuming these are related.”

As the number of new cases and deaths only worsens, other public health experts share his sense of alarm.

'I am certainly concerned that we are heading toward catastrophe,” Baeth said.

'Death is a lagging indicator,” meaning deaths typically show up in the data a few weeks after new cases and hospitalizations, but 'we are already seeing deaths on the rise and we are seeing cases rise even faster than that, meaning even three weeks from now, it's going to be much worse. I think we are in for a very bumpy ride in the weeks and months ahead, in our state in particular.”

It could be several weeks until the full impact of the current wave of cases and hospitalizations is known, Katz said.

'You can see that the surge in March and April, that first part of the first wave, was reflected more than a month later in excess deaths,” Katz said. 'So the surge that we're seeing now in Iowa, which is considerably larger, will not be reflected until probably late September or October, maybe even longer.”