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Iowa does not include subsequent COVID-19 infections of the same person in the number of newly confirmed cases it reports to federal health officials or in the weekly case updates on its website, even though other states do.
Further, Iowa Department of Health and Human Services officials say they are unaware of the state’s rate of those reinfections despite possessing the data necessary to calculate it.
A reinfection occurs when someone tests positive for the coronavirus more than 90 days after a first positive test.
“We are not reporting and do not have a calculated COVID-19 reinfection rate for the state,” said Sarah Ekstrand, a spokesperson for the Iowa Department of Health and Human Services. “Given the evolution of the virus and the emergence of new variants, COVID-19 reinfections are not rare.”
The state’s testing program is key to tracking the prevalence of the virus and its variants. The U.S. Centers for Disease Control and Prevention uses the state data along with reports from hospitals to determine the threat of infection in each county and to guide residents about how to avoid being infected. When the threat is high, for example, the CDC recommends wearing a mask indoors in public places.
Because those assessments are based on per capita infection rates, case undercounts can cause the CDC to underestimate the threats.
The state’s true number of new weekly infections in its most recent reporting period, which ended last Tuesday, could have been 28 percent higher than what was reported, according to state testing data.
It’s unclear why state health officials are not reporting cases of reinfections along with first-time infections. Ekstrand did not respond to a request for the rationale. A spokesperson for Gov. Kim Reynolds did not respond to requests to comment for this article.
The CDC does not dictate to states how they should report cases of reinfection, said Jasmine Reed, a CDC spokesperson. But some — such as California, Kentucky and New York — track and analyze them.
“CDC relies on data reported from jurisdictions across the U.S., and not many jurisdictions are able to collect or report reinfection data,” she said.
Missouri includes reinfections in its weekly case reports, said Lisa Cox, a spokesperson for the Missouri Department of Health and Senior Services.
So does Minnesota, and state health officials there are working to analyze reinfections to understand when they are more likely to occur, said Garry Bowman, a spokesperson for the Minnesota Department of Public Health.
“We are trying to learn more by looking at the timing between infections and how that relates to vaccination,” Bowman said. “Changes in behaviors, testing practices, predominant variants that are circulating, and availability of vaccine or treatment options all play a role in those interactions.”
In response to questions about how Iowans can stay informed about the virus to protect their health, Ekstrand said: “The best thing that Iowans can do to protect themselves from severe illness, hospitalization and death is to stay up to date with COVID-19 vaccines and boosters and follow CDC guidance for isolation if they become infected.”
Iowa significantly scaled back its coronavirus reporting in February, when Reynolds decided to shutter a dedicated COVID-19 website and reduce case updates from three times each week to one.
At the time, Reynolds said that after nearly two years of the pandemic it was no longer necessary to “treat COVID-19 as a public health emergency.” That was weeks after the state recorded its highest infection rates of the pandemic.
In the early part of the pandemic, when the threat of fatal infection was much higher, the state provided daily updates.
The web page prominently displays the number of positive tests for the past week, which is different from what is reported to the CDC. Those tests include first-time infections, reinfections, and duplicate tests for infected individuals who needed to test negative before returning to work or traveling, for example.
That means that the number of positive tests is likely an overcount of documented infections, whereas the case numbers reported by the state are an undercount because they don’t include reinfections.
The situation has been further clouded by the widespread availability of free, at-home rapid tests, which the state does not track. Polk County solicits those at-home test results to get “a more-detailed picture into our county’s positivity rate,” said Nola Aigner Davis, a spokesperson for the Polk County Health Department. She said the county has received about 1,650 of the self-reported infection confirmations since the start of July.
Reporting reinfections is increasingly important for tracking the virus because so many Iowans have already been infected once, said Eli Perencevich, a professor of epidemiology at the University of Iowa.
“Since people that are reinfected can spread it to you, knowing that there are a lot more cases out there would be important to gauge your individual, personal safety,” he said. “There’s still some people out there who are elderly, immune compromised, people that are undergoing cancer chemotherapy, that still need to protect themselves from COVID and other viruses, so I think it behooves the state to provide that data.”
State testing has conclusively confirmed that 27 percent of Iowans have been infected, but the actual percentage is likely much higher because of asymptomatic infections and people who became ill but did not seek testing. The CDC estimated that about 60 percent of Americans had been infected as of February.
Sara Anne Willette, of Ames, has been aggregating infection data since the start of the pandemic on her website, Iowa COVID-19 Tracker. She is a data specialist who has a severe immune deficiency and took on the task as a “passion project” while living mostly in isolation for more than two years.
Her site has about half the traffic it did at its peak this past winter, when the state’s infection rate also peaked. Even though public interest in her work has waned, Willette predicts more people will go to the site this winter if there is another surge of infections. Either way, she feels compelled to avoid scaling back her reporting, despite that trend among government agencies.
Even the CDC has slightly reduced its reporting, she said, and no longer gives Sunday updates.
“If the data is out there, in my mind, I should be trying to update it as often as humanly possible, because the more information we have, the more accurate, the better choices we can make,” Willette said.
The state’s COVID-19 death toll is expected to surpass 10,000 in the next weekly report.
This story first appeared in Iowa Capital Dispatch.