Over the past few weeks, Dana Jones has grown increasingly alarmed at how Iowans are handling Covid-19, with hospitals running out of intensive care unit beds and the state surpassing a 45 percent positivity rate.
So, Jones, a nurse in Iowa City, initially felt relieved to hear Monday that Gov. Kim Reynolds would sign a proclamation that included a statewide mask mandate — but then she read it.
The proclamation only requires face coverings in public when someone is within 6 feet of other people for 15 minutes or more, and there are a number of exceptions. Bars and restaurants can stay open, but have to close by 10 p.m., and masks are not required for people exercising in gyms.
“It’s not enough,” said Jones, 39. “I know it’s better than nothing, and at this point I’ll take anything we can get, but I was frustrated there were so many carve-outs, because I am so afraid, I just don’t know what these coming months will bring.”
Iowa has the third highest rate of new Covid-19 cases nationally, behind North and South Dakota. The entire state of Iowa, like much of the Midwest, is in the "red zone," according to the latest White House coronavirus task force report, meaning there is a high rate of positive cases. Iowa saw a record 39 coronavirus deaths Wednesday, according to NBC News’ tally.
Health professionals say the crisis is worsening, but testing remains hard to find in Iowa and elected officials are still only taking baby steps in terms of mitigation efforts, leaving doctors and public health experts afraid the situation won’t improve in the near future.
Reynolds, a Republican who positioned herself as a booster of President Donald Trump, had resisted instituting a mask mandate for several months, instead saying that she trusted Iowans “to make the right choice.” Immediately after the election, she pointed to Iowa voters picking Trump, re-electing Republican Sen. Joni Ernst, and choosing to expand the GOP majority in the state Legislature as evidence that Iowans endorsed her approach.
“Iowans said in this election they want to get through this, they want to figure out a way to move on,” Reynolds told reporters at a Nov. 5 press conference. “They, you know, agree with how we’ve handled Covid-19.”
But two weeks later, the number of new Covid-19 cases had doubled. Hospitals started to enact surge plans. The health department for Polk County, where Des Moines is located, called the situation "terrifying" in a statement Monday, warning that cases would likely increase after Thanksgiving.
“There's a sense that no one is listening to us,” said Dr. Nicole Gilg, a top physician at Broadlawns Medical Center in Des Moines, which has run out of ICU beds. “And it really does feel at times as if you know we're in the field, we're fighting the fires and yet people continue to set fires, giving us more work to do.”
At a Nov. 12 meeting, the Iowa State Board of Health, a mostly Republican body appointed by the governor, voted 7-2 to urge Reynolds to issue a mask mandate. Face coverings had been discussed in previous meetings. But two board members said in emails this week that as public health groups raised concerns about the increasing severity of the pandemic in Iowa, the board voted to recommend a mask mandate hoping it would convince people to wear masks.
Last weekend, the White House coronavirus task force also urged Iowa's government to implement stricter mask measures, test teachers and students in schools and pause extracurricular school activities. Federal officials told Iowa to expand the state's free public testing sites to target young people, to find asymptomatic carriers.
Reynolds responded with her proclamation late Monday. She amended it Wednesday to permit group exercise classes.
“It’s too weak and comes with too many loopholes,” said Dr. Michihiko Goto, an infectious disease specialist at the University of Iowa Carver College of Medicine. “But what bothers me most is the way she's communicating the message to people in Iowa.”
Reynolds said in a Tuesday press conference that “there's science on both sides” of whether wearing a mask is effective at preventing the spread of the coronavirus, and noted that other states that already had mandates were also seeing rising cases. She also did not urge Iowans to stay home.
“We’ve been trying to communicate, to put the right message out to people so we — I hope — can protect ourselves,” Goto said. “When politicians or elected officials tell people something otherwise, we feel like we’re getting stabbed in the back.”
A spokesman for Reynolds did not respond to requests for comment.
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Health officials believe the lack of a coordinated message has created confusion for the public, and it’s been ramped up by elected officials. In August, Ernst appeared to suggest at a local town hall that the number of Covid-19 deaths was inflated by health care providers seeking more money. (She later walked back her comments in a statement.) One small-town mayor in Iowa similarly claimed this fall that Covid-19 numbers were inflated to make Trump look bad.
“It makes it challenging because then people say they don't know who to trust or what to believe,” said Danielle Pettit-Majewski, the public health director in Washington County.
Pettit-Majewski said that while public health officials regularly plan for steps to take in a disease outbreak, “what we don't plan for is this disjointed response from our government.”
Allison Wynes, an ICU nurse at the University of Iowa, described on MSNBC on Wednesday how she had recently treated a patient who was gravely sick with the coronavirus, and a family member of the patient was on the phone upset about visitation restrictions and insisting that Covid-19 is a hoax.
"I don't have time to fight with people over the phone whether this is real or not," Wynes said, adding, "There's not enough of me to go around to fight the misinformation while clearly taking care of the patient."
As high as the case counts are in Iowa, health experts fear there are many more that are not being detected because testing is severely limited. The state set up a network of free testing sites called Test Iowa, but after closing multiple locations, there are now just 26 across the state with limited appointments. Reynolds said last week that the state will spend $3.4 million to purchase additional tests.
But in the meantime, Pettit-Majewski said they’re missing asymptomatic carriers who continue to spread the disease without knowing they have it. Other states, like California, have widespread testing available to anyone who thinks they’ve been exposed.
“It means we are constantly running uphill,” she said. “We’re always behind and we see that, we see our hospitals filling up, we see our case numbers skyrocketing, we know we can't stop this, we just keep stressing that people can only change this with their behavior.”