IOWA CITY — On a day when Johnson County reported 107 new COVID-19 cases in a 24-hour period — its first day ever in the triple digits and continuing a recent spike of infections — the top executive at the University of Iowa Hospitals and Clinics said Wednesday he is “significantly concerned.”
“From a public health standpoint, this is very, very alarming for Johnson County,” UIHC Chief Executive Officer Suresh Gunasekaran told The Gazette. “This is the single greatest five-day positivity in terms of total number of people in the county that are positive. And so this gives me great concern.”
That increase — plus a surge in the number of people seen at UIHC’s flu-like-illness clinic, aligns with the return of tens of thousands of students and employees to the UI campus for classes beginning this week.
“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.”
Telehealth appointments through the UIHC flu-like-illness clinic created earlier this year in response to the novel coronavirus had been hovering in the 200s or 300s a day earlier this month until screenings jumped into the 400s Sunday and Monday, ballooning to 524 Tuesday, according to UIHC statistics.
That rise in screenings has translated to a spike in actual clinic visits — with 587 recorded Wednesday — and a jump in UIHC’s positivity rate of symptomatic patients who get a COVID-19 test.
Where the hospital had been reporting positivity rates of symptomatic patients in the 10- to 15-percent range, the rate — the percentage of all tests the UIHC runs that turn out to be positive — has more than quadrupled in recent days, reaching 48 percent Sunday, 32 percent Monday and 38 percent Tuesday.
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Before UI residence hall move-in began in earnest Aug. 17, the hospital’s COVID-19 positivity rate for symptomatic patients was as low as 6 percent Aug. 10 and 8 percent Aug. 11.
When asked whether those increases are among 18- to 25-year-olds, Gunasekaran said nearly all are. And because UIHC doesn’t test asymptomatic patients unless they’re being screened for surgery, for example, the positivity rate it reports publicly involves only symptomatic patients.
Despite the increases, though, UIHC has not seen an uptick in its COVID-19 hospitalizations — which sat at 22 adults and one child Wednesday. Gunasekaran said most of those are in the 50 to 60-plus age range.
And he said UIHC is not seeing an increase in positive cases or hospitalizations of children.
“I know that we’re not seeing any significant positivity in the under-18 crowd,” he said. “I don’t know how many tests have been in that range. But I can tell you not many positives. The positives have been in the range of 18 to 25-year-olds.”
The hospital — which has been working in coordination with the main campus and UI Student Health to test symptomatic patients — has enough resources now to handle testing demands and inpatient needs, including personal protective equipment, staffing, and treatments like the drug Remdesivir and convalescent plasma.
But, Gunasekaran said, “this week isn’t the issue.
“If this keeps up for another week or two, there will be very, very grave consequences in terms of what this will mean in terms of health care in Iowa,” he said. “We very much need to get this under control.”
This needs to be the peak of the wave, so to speak, and cases need to begin ebbing, he said.
“The longer we stay at this very high level, or even continue to go up, that’s going in a couple of weeks to lead to the hospitalizations, and potentially lead to infections, in people that are not 18 to 25 but are older.”
Then, he said, the hospital faces a much greater challenge in caring for COVID-19 patients.
“That’s the bigger concern,” he said. “The question is two, three, four weeks from now — do we have enough Remdesivir and plasma.”
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The UIHC “surge plan,” should COVID-19 hospitalizations spike, allows for 400 to 500 of its 800-plus beds to be used for coronavirus patients. But, Gunasekaran said, if the hospital were committing half its inpatient space to COVID-19 patients, “We’d have to do a lot less of a lot of other things.”
“We would have to put off a lot of patients that need important stuff,” he said, noting UIHC would need to work with regional health care partners in such a situation.
The UI — like Iowa State University and the University of Northern Iowa — this fall brought tens of thousands of students back to campus for a hybrid learning experience after sending them home in March as the pandemic began to spread. Although the campuses are prioritizing in-person instruction, they’re supplementing it with online learning and offering students the option of shifting away from in-person learning depending on their circumstances.
UI students and instructors in recent days have called on the administration to revert to all online instruction. The campus has a set of metrics it’s considering for whether and when to do that, but Gunasekaran said he personally has not weighed in.
Story County, home to ISU, like Johnson County also saw a triple-digit increase with 123 new cases in a 24-period ending at 11 a.m. Wednesday. That marks its second highest single day since it added 174 Aug. 14 — when the campus was requiring testing for all students before residence hall move-in.
All three of Iowa’s public universities have seen off-campus student partying in recent days, including crowds without masks at downtown bars, prompting administrators to threaten suspensions.
Gunasekaran said he believes there is the time and the potential to reverse the trend and correct the bad behavior.
“The real question is, is there a reason that the university campus can’t be compliant?” he asked. “Is there something about the campus community that makes that possible? I’m optimistic.”
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