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Iowa shows what happens when government abandons its role in protecting public health

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I lived in Iowa City for many years, and all three of my children were born there. It once was a pretty good state. Elaine Godfrey reports in the Atlantic:

IOWA CITY, IOWA—Nick Klein knew the man wasn’t going to make it through the night. So the 31-year-old nurse at the University of Iowa ICU put on his gown, his gloves, his mask, and his face shield. He went into the patient’s room, held a phone to his ear, and tried hard not to cry while he listened to the man’s loved ones take turns saying goodbye. When they were finished, Klein put on some music, a muted melody like you might hear in an elevator. He pulled up a chair and took the man’s hand. For two hours that summer night, there were no sounds but soft piano and the gentle beep beep beep of the monitors. Klein thought about how he would feel if the person in the bed were his own father, and he squeezed his hand tighter. Around midnight, Klein watched as the man took one last, ragged breath and died.

“I still don’t know if I’ve fully processed everything that’s going on,” Klein told me the day before Thanksgiving, as we talked about what the past few weeks and months at the hospital have been like. And with COVID-19 infections skyrocketing in his state, he added, “I don’t know when I will.”

To visit Iowa right now is to travel back in time to the early days of the coronavirus pandemic in places such as New York City and Lombardy and Seattle, when the horror was fresh and the sirens never stopped. Sick people are filling up ICUs across the state. Health-care workers like Klein are being pushed to their physical and emotional limits. On the TV in my parents’ house in Burlington, hospital CEOs are begging Iowans to hunker down and please, for the love of God, wear a mask. This sense of new urgency is strange, though, because the pandemic isn’t in its early days. The virus has been raging for eight months in this country; Iowa just hasn’t been acting like it.

The story of the coronavirus in this state is one of government inaction in the name of freedom and personal responsibility. Iowa Governor Kim Reynolds has followed President Donald Trump’s lead in downplaying the virus’s seriousness. She never imposed a full stay-at-home order for the state and allowed bars and restaurants to open much earlier than in other places. She imposed a mask mandate for the first time this month—one that health-care professionals consider comically ineffectual—and has questioned the science behind wearing masks at all. Through the month of November, Iowa vacillated between 1,700 and 5,500 cases every day. This week, the state’s test-positivity rate reached 50 percent. Iowa is what happens when a government does basically nothing to stop the spread of a deadly virus.

“In a lot of ways, Iowa is serving as the control group of what not to do,” Eli Perencevich, an infectious-disease doctor at the University of Iowa Hospitals and Clinics, told me. Although cases dropped in late November—a possible result of a warm spell in Iowa—Perencevich and other public-health experts predict that the state’s lax political leadership will result in a “super peak” over the holidays, and thousands of preventable deaths in the weeks to come. “We know the storm’s coming,” Perencevich said. “You can see it on the horizon.”

Warnings from doctors like perencevich are what prompted my visit to Iowa City, a college town in eastern Iowa that serves as a sort of liberal sanctuary in a mostly red state. The city is home to the University of Iowa, and also to its public teaching hospital, which employs 7,000 people and has more adult ICU beds than most other state hospitals. I spent two days there just before Thanksgiving, interviewing doctors and nurses outside the brick walls of the hospital in the frigid November weather, standing six feet apart in the front garden or, when it rained, near a vent shooting out warm air on the building’s south side. Through the glass windows of the lobby, I watched as nurses in face shields pushed sick people around in wheelchairs. Once, I stepped inside to thaw and was startled by how quiet it was, and how the silence belied the suffering going on just a few floors above.

The first cases of the coronavirus in Iowa were recorded here in early March, when a group of infected locals returned home from an Egyptian cruise. As cases rose, Reynolds closed schools for the rest of the school year and most businesses for about two months. But by May 15, she’d allowed gyms, bars, and restaurants in all of Iowa’s 99 counties to open up again. She did not require Iowans to wear a mask in public, ignoring requests from local public-health officials and the White House Coronavirus Task Force and arguing that the state shouldn’t make that choice for its people. “The more information that we give them, then personally they can make the decision to wear a mask or not,” Reynolds said in June. She also wouldn’t require face coverings in public schools, where she ordered that students spend at least 50 percent of their instructional time in classrooms. When Iowa City and other towns began to issue their own mask requirements, Reynolds countered that they were not enforceable, undermining their authority. (The governor’s office did not respond to multiple requests for comment for this story.)

The rest of the summer and early fall brought on a mix of business closings and reopenings in counties around the state. (Complicating the picture, a data glitch at the Iowa Department of Public Health deflated case numbers in late summer.) Infections exploded in meatpacking plants, where managers were allegedly taking bets on how many workers would get sick. After students returned to schools and universities in the early fall, Iowa had the highest rate of COVID-19 infections in the country. In October, when Iowa was in the thick of community spread, Reynolds showed up, maskless and smiling, at a campaign rally for Trump at the Des Moines airport. (Her let-them-get-sick attitude toward the pandemic hasn’t been unusual among Republican governors, though there have been exceptions, including Mike DeWine of Ohio and Larry Hogan of Maryland.)

By late November, the number of new COVID-19 cases in Iowa was higher than at any other point in the pandemic, and as many as 45 Iowans were dying of the disease every 24 hours in a state of just 3 million people. Outbreaks were reported in 156 nursing homes and assisted-living facilities in Iowa, and the virus ran rampant in the state’s prisons.

Doctors have been warning for weeks that the state’s health-care system is close to its breaking point. The University of Iowa hospital reached a peak of 37 COVID-19 inpatients in April, but by Thanksgiving, it had 90. That number may not seem overwhelming until you consider that COVID-19 patients require dozens of staff and that many spend weeks or months in hospital care. To meet the demand, administrators have had to reschedule hundreds of nonessential surgeries and converted multiple wards into COVID-19 units. Doctors told me that they’re already short on ICU beds, and are having to decide which critically ill patients receive one. There are not enough specialists to oversee common life-support techniques, such as extracorporeal membrane oxygenation, or ECMO, for people with severe cases of COVID-19.

And the University of Iowa hospital is actually in a better position than many others in the state. Smaller institutions, which have fewer specialized doctors and fewer staff overall, are being overwhelmed across Iowa, and many face bankruptcy, in part because they’ve been forced to cancel elective procedures.

Worst of all, health-care workers are sapped. They are used to death. But patients don’t usually die at this pace. They don’t usually die in this way, with tubes sticking out of their throats and sucking machines clearing the mucus from their lungs. They don’t usually die all alone.

Joe English, a 37-year-old respiratory therapist, spends every day traveling between hospital units, hooking up seriously ill COVID-19 patients to ventilators or ECMO machines. When there’s nothing left to be done, English is the one who turns off those machines; he’s done so at least 50 times in the past few months. “What I’m seeing [among health-care workers] is just frustration, desperation,” English told me. “People have been acting like we’ve been fighting a war for months.”

There is a name for this feeling, says Kevin Doerschug, the director of the hospital’s medical ICU: moral distress, or the sense of loss and helplessness associated with health-care workers navigating limitations in space, treatment, and personnel. Just a few weeks ago, a man in his 30s with no medical problems arrived in Doerschug’s unit with a severe case of COVID-19. After a week on a ventilator, the man’s health had greatly improved. Nurses removed his breathing tube, and his vitals were stable. But just a few hours later, the man was dead. “Our whole team just sat down on the ground and cried,” Doerschug told me outside the hospital, his voice muffled by his mask and the sound of the heating vent. Trauma like that compounds when a hospital fills up with critically ill patients. “The sheer enormity of it—it’s just endless,” Doerschug said.

What makes all of this suffering and death exponentially more painful is the simple fact that much of it was preventable. A recent New York Times analysis clearly showed that states with the tightest COVID-19 restrictions have managed to keep cases per capita lower than states with few restrictions. Reynolds is in an admittedly complicated situation. She, like other governors, is facing enormous pressure to protect people’s livelihoods as well as their health. But a mask mandate is free. And failing to control the virus is, unsurprisingly, very bad for business. “We want to take care of people … It shouldn’t be this hard, and that makes us mad,” Dana Jones, a nurse practitioner in Iowa City, told me. “There are people to blame, and it’s not the patients.”

When Reynolds finally announced a spate of new COVID-19 regulations on November 17, the rules limited indoor gatherings to 25 people, and required that Iowans wear masks inside public places only under a very specific set of conditions. Four of the doctors and nurses I interviewed laughed—actually laughed—when I asked what they thought of the new regulations. The policies will do basically nothing to prevent the spread of the virus, they told me.

State lawmakers’ response to Reynolds’s handling of the pandemic breaks down along partisan lines. “She’s done a good job balancing people’s constitutional rights with a few restrictions that have been commonsense,” Representative Dave Deyoe, a Republican from central Iowa, told me, arguing that tighter restrictions in more liberal states haven’t led to lower death rates. Although this is a common argument among Iowa Republicans, it’s an unfair one. Many Northeast and West Coast states have had more total deaths because they were badly hit by the virus early in the pandemic, before strong measures were put in place. In the past seven days, Iowa’s death rate has been at least twice as high as that of New York, New Jersey, and California.

Democrats in Iowa believe that Reynolds’s inaction has always been about politics. Early on, . . .

Continue reading.

Written by Leisureguy

3 December 2020 at 6:11 pm

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