CORONAVIRUS

UI researchers advised 'prevention measures should remain in place' to prevent 2nd wave of COVID-19

Without them, 'a second wave of infections is likely'

University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo tak
University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (The Gazette)

IOWA CITY — University of Iowa health researchers told state officials days ago there is “considerable uncertainty” over how many COVID-19 illnesses and deaths the state will see and warned that “prevention measures should remain in place.”

“Without such measures being continued, a second wave of infections is likely,” cautioned a report the UI College of Public Health COVID-19 Response Group delivered to the Iowa Department of Public Health.

The researchers made reports to state officials April 8 and April 20, days before Gov. Kim Reynolds announced Monday her plans to loosen some restrictions in three-quarters of Iowa’s 99 counties. Effective Friday, restaurants, fitness centers, malls, libraries, race tracks and other retail establishments in 77 identified counties can reopen in a limited fashion, according to the governor’s order.

They must maintain social distancing between groups of customers and must limit capacity by half.

The areas where restrictions are easing do not include Des Moines, Cedar Rapids, Iowa City, Waterloo and Davenport and others in 22 counties still considered hot spots.

But the move to lower restrictions in most counties doesn’t jibe with the UI public health advisement that mitigation policies have helped slow infection and death rates, which researchers say have not peaked.

“There is considerable uncertainty still in how many cases and deaths Iowa could eventually have, with possible projections between 150 and >10,000 total deaths,” according to the UI report. “Therefore, prevention measures should remain in place.”

A spokesman for the governor did not say Tuesday how much weight she gave the UI research in deciding to start reopening parts of the state. In her announcement Monday, Reynolds said that “the reality is that we can’t stop the virus, that it will remain in our communities until a vaccine is available. Instead we must learn to live with COVID virus activity without letting it govern our lives.”

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The state’s Public Health Department on Tuesday announced another 508 positive cases — bringing Iowa’s total to 6,376. Nine more deaths from the disease were announced, bringing the death toll to 136.

One week ago — the day Reynolds unveiled a new “Test Iowa Initiative” to dramatically ramp up testing across the state — Iowa had confirmed 3,641 positive cases since the disease was found here March 8.

The UI research came after college leadership in March reached out to the state Public Health Department to offer help, according to emails provided to The Gazette in response to a public records request.

“I just wanted to reiterate my offer of assistance from our collegiate and other faculty in areas such as COVID-19 modeling, infectious disease epid (sic) and risk communication,” UI College of Public Health Dean Edith Parker wrote in a March 29 email to state Public Health Director Gerd Clabaugh.

The next day, a data sharing coordinator with the Public Health department asked Parker whether UI could help the state with predictive modeling “that would be for our internal use and decision making.”

Parker said the university could, but would need time.

“We don’t expect it to inform policy in the next week or so,” she wrote. “We do imagine this as a longer-term tool for policymakers around when to back off or strengthen social distance policies.”

The UI Public Health team, in modeling the estimated progression of COVID-19 in Iowa, took three different approaches: a short-term look, a medium-term prediction, and a view evaluating the potential impact of policies and practices — like, for example, how the disease could spread “if social distancing measures are implemented at various points in time.”

“Taken together, these approaches should allow the team to understand the current and immediate state of the COVID-19 outbreak in Iowa, quantify the size and scope of the outbreak in the coming months, and characterize how various actions may affect the trajectory of the outbreak,” the team wrote.

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In its medium-term assessment, the team found evidence that the mitigation efforts are working — with “cumulative mortality increasing more slowly than would be expected without such mitigation.”

But that modeling still found a “huge range of possible outcomes” — from relatively few deaths to “catastrophic loss of life.”

“These models assume that the current measures taken to limit contact in Iowa remain in place,” according to the report, which also surmised current measures might not be enough.

“While we see evidence that the epidemic intensity has decreased from the initial period of uncontrolled spread, there is not sufficient evidence in this data set alone to conclude that current measures will necessarily be sufficient to prevent a return to higher rates of transmission and corresponding mortality.”

Thus the model, according to UI researchers, indicates “great caution is needed at this early stage before loosening of potentially insufficient containment measures is considered.”

Barring additional interventions like more contact tracing to identify those who came in close proximity to someone known to have the disease, the UI researchers advised “reopening society to its pre-COVID-19 status anytime in the next four months will lead to a second wave of infections that will necessitate reimplementing our current social distancing policies.”

The UI modeling — in considering a possible reopening in Iowa — assumed an adaptive strategy if daily cases fell below 150, 100, 50 or 10. In all cases, according to the modeling, a “second peak” emerges — requiring reinstatement of social distancing measures.

According to the research, widespread use of personal protective equipment could help limit transmission, as could continued restrictions on large gatherings and other events.

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Even assuming “full social distancing” continued through May, the UI model projected between 263 and 711 total deaths in the state by June 1.

“We believe that outcomes in this range are plausible, but that a substantial risk remains of higher mortality,” according to the report.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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