Iowa’s state epidemiologist thinks Iowa is not at a turning point with the delta virus, so far.
In an interview with IowaWatch July 16, Dr. Caitlin Pedati also called for Iowans to continue to get vaccinated, use social distancing, masks and other safety measures related to the coronavirus that officially arrived in Iowa in March 2020. She discussed the difficulties of public health and stressed the perseverance of health care workers.
“If I could leave you with anything it would be there really are some wonderful people in public health who never stopped working and are not going to stop even when it’s hard and even when it’s not perfect, because we believe that it’s important work. And we so appreciate the chance to get, you know, good messages out there,” Pedati said.
The number of Iowans getting COVID-19 vaccinations has dropped considerably since June and new cases are rising quickly. New cases and hospitalizations have trended up with daily positives doubling over the last two weeks from an average of 76 cases to 199 per day. As of July 21 there are 1,395 reported new cases of COVID19 in Iowa.
The state epidemiologist and medical director since mid-2018, Pedati spoke with IowaWatch for over an hour after repeated requests for an interview through the state hygienic lab and IDPH.
Here are key takeaways from the conversation between IowaWatch writer Andy Kopsa and Pedati.
Editor’s note: The following interview has been edited for brevity and readability. Listen to audio of the interview above. A guide to terms and acronyms used in this interview and more background on the reporting is here.
Educating the public
What happened to the IDPH website?
Andy Kopsa: Am I understanding the reporting correctly, that there’s not going to be any sort of notification of long term care facility outbreaks [on the website]?
Pedati: “So there is still a card under the positive case analysis page that says the number of long-term care facilities, so this is pretty similar. But I will absolutely say, I think I’ve said a million times, and I mean it, if things change, we’ll adjust, you know. If there’s a reason to change what we’re doing or how frequently or that sort of thing, we absolutely will make those changes.”
Tipping point for new cases
AK: Do you not think that we’re on the cusp of [needing to make changes to reporting]? The rapid spread of delta and looking at the rising cases in Missouri?
Pedati: “No. I have several calls a week with other partners, other states, other federal partners. I know that the director does as well, and many others throughout the department. We absolutely keep an eye on what’s going on. And not just not just with our neighbors. And not even just nationally. This pandemic truly was a representation of the way that the global community is impacted together. And as long as there are challenges in other places, there’s always going to need to be readiness and capacity for us, because of how people move and travel and all of those good things. I guess what I’m getting at here is it’s absolutely something we want to keep an eye on. We look at several things. One of the really important things lately is keeping an eye on our healthcare capacity. But, and I don’t mean to sound like a broken record, the best thing anybody can do at this point is get vaccinated. That’s the thing that, you know, that’s the public health control measure.”
The governor and Iowa elected officials
Background: Against the advice of medical experts, Governor Kim Reynolds signed a bill on May 20 that does not allow schools, cities or counties to require the use of a face mask “for any purpose.”
Reynolds posed for pictures as House Speaker Pat Grassley presented her with the bill for her signature. Beside her were two women holding signs making false claims that masks cause staph infection. Misinformation of this kind is circulated through conspiracy theory groups like QAnon, which are responsible for other health care misinformation especially about the safety and efficacy of vaccines.
U.S. Senator Joni Ernst, a Republican, has echoed some of QAnon’s inaccurate claims, which lied about death counts of Americans from the COVID-19 vaccine. Several state elected officials have pushed similar claims. Recently 17 GOP lawmakers picked up a QAnon anti-vaccination trope to push an independently owned Iowa healthcare system to explain their vaccination policy. One of the signers once called vaccination requirements “medical rape.”
AK: “When Iowa Governor Kim Reynolds poses with [Iowa women with ties to conspiracy theory QAnon] holding signs that falsely claim masks cause staph infection, doesn’t that make public health officials’ jobs harder? And doesn’t it make the jobs of the already burned-out Iowa healthcare workforce harder? I personally know of healthcare workers in Iowa who have gotten death threats over masks. Masks don’t cause staph.”
Pedati: “No they don’t. …. That’s absolutely the advice that I would provide as well. What I can say is there’s so many really good people in public health. And they’ve been working so hard for so long. I know that it doesn’t always get seen. I know it’s not always clear, but there are a lot of wonderful people who have made really significant sacrifices, personally and professionally over the past year and a half. We’re not going to stop because we believe that it’s important.”
Misinformation and masks
AK: Last week U.S. Surgeon General Vivek Murthy declared health-related misinformation a serious threat to public health. As Iowa and the nation see a surge in COVID-19 cases Murthy said it is a “moral and civic imperative” on the part of all Americans to stop its spread. It’s like fighting two pandemics. Scientific communities have been saying that COVID-19 misinformation is killing people.
Pedati: “I think you’re absolutely identifying a lot of the challenges that a lot of people have noted. And again, what I can tell you is every time I’m asked, I continue to extol the value of face coverings, social distancing, staying home when you’re sick and getting vaccinated. The scientific and medical advice that I provided and our local health departments continue to provide are those messages.”
Variants, reporting and Iowa Veterans Home
AK: On June 22, 2021, the Iowa Veterans Home in Marshalltown reported the facility’s fifth COVID-19 outbreak. This time it was reportedly a “new” variant. Not the original COVID19 nor the highly transmissible delta variant. This reporting caused a lot of confusion. People don’t know what variants are, which ones are out there and how variants are tracked.
Pedati: “When we talk about COVID I am sure we all know it is a virus and when it replicates it causes mutations just like almost every other virus. And that’s going to happen that’s completely expected for viral behavior. But you’re absolutely right, keeping an eye on which of those changes are consequential to understand whether it has an impact on things like transmissibility, health outcomes and whether it has an impact on the effect of things like therapeutics or vaccines.”
AK: The IVH is a state owned and operated facility. I called the Veterans Hospital in DesMoines and spoke to a public affairs official who said he didn’t know that there was an outbreak at the IVH, noting the Des Moines facility sees patients from the IVH. There was no communication it seems? And it was a breakthrough infection. Why didn’t they know about the outbreak?
Pedati: “No, that’s helpful. No, I definitely hear you and I, I certainly appreciate your frustrations for sure. You know, and I appreciate you giving examples.”
What variant caused the outbreak at the Iowa Veterans Home is still unknown. A spokesperson from CDC headquarters in Atlanta told IowaWatch, “We rely on the states to submit data and samples so we can track variants,” adding, “if a state public health department needs help and requests it the CDC sends out help.”
The CDC aggregates regional data to determine trends in variants around the country. A variant cannot be identified by the CDC if a state doesn’t submit enough tests. And a state gets to determine what it will – or will not – disclose. However, long-term care facilities are mandated by the U.S. Centers for Medicare and Medicaid Services to report even one positive COVID-19 test from a resident or staffer.
Workers at the Iowa Veterans Home are not required to be vaccinated.
Dr. Michael Pentella from the state hygienic lab confirmed to IowaWatch they are running all sequencing for IDPH at this time. The program of coordination between the CDC, commercial labs and the consortium for public health labs began in November 2020. According to an IDPH/SHL press release the state started participating in the program at the end of June 2021.
The CDC needs a minimum of at least 300 COVID-19 DNA sequences per month from a state to determine if there is an emerging variant. Iowa is one of a handful of states that has yet to reach that threshold. However, capacity is increasing. Pedati addresses that in the interview with IowaWatch. However, the process of how the IDPH and SHL coordinate to report those findings to CDC is unclear. Iowa had not met the threshold at the time of publication.
Background: In an April 23 letter IDPH Director Kelly Garcia asks the CDC if the allowable use for the $95 million in federal funding changes beyond school testing, because Iowa would like “the opportunity to seek reconsideration of our acceptance of this funding.” According to the TAGGS website the $95 million is not yet reflected as rejected. A revised Iowa Legislative Services Financial Services document issued after the governor’s announcement to walk away from funding still lists $95 million for school testing in their overall planning guidance. According to CDC guidance, there is broad latitude in how a state can use this funding including reimbursing school districts for testing, hiring additional public health laboratory staff, and expanding existing lab capacity under previous programs.
Why is Test Iowa closing?
AK: Why has Test Iowa been shut down? Why are we testing fewer and fewer people? Isn’t testing critical when we talk about mitigation strategy – not just response? The governor rejected $95 million for surveillance testing in public schools.
Pedati: “Over time at the beginning of this experience there were a lot of limitations on resources, unfortunately. Our state hygienic laboratory did really well to stand up capacity really quickly, and they’ve offered a significant amount of support for the state throughout this response, especially for people who might not have had a provider, or who might not have had another way to get testing, which is so important.”
AK: Is there some sort of strategy to get at-home tests into people’s hands and make sure they know how to use them?
Pedati: “We are working on this and all of this takes collaboration and development. We’re absolutely working on ways to increase the awareness and knowledge about the at-home COVID testing in particular. We’ll do that through the state, through the lab, through stories that people write, through the partners who will be pick-up sites, through our local partners, through clinicians, hopefully through social media, through word of mouth, all of those ways.”
Vaccination is critical, workforce burned out
Pedati: “That’s why I took this job, that’s why I am still in this job, is because I think public health is that important. And so right now a lot of the work we’re focusing on and working with our lab and with the CDC and other states on is related to monitoring and we’re also looking at how we make this [public health system] sustainable moving forward. It’s been a year and a half that we’ve had a public health workforce at the state and local level, working really with no breaks. And that is not sustainable. At the end of the day, as a clinician, and as a public health professional, my mind is always going to what is the control measure? That is the vaccine. The vaccine really is the most important thing that we can talk about, that I can give people information on, that I can encourage others to encourage other people they know to take advantage of. That is the answer and the fact that we have not one, but three vaccines in such a short period of time, I would argue is maybe the most significant scientific breakthrough of all time.”
Andy Kopsa is a freelance writer and native Iowan who occasionally reports and writes for IowaWatch.
Background on this story
This story started after residents and staff at The Iowa Veterans Home (IVH) in Marshalltown experienced the fifth outbreak of COVID-19 in June. Laura Belin of Bleeding Heartland and the Marshalltown Times-Republican posted stories, followed by other news media. Belin used letters received from concerned family members issued by the facility indicating the outbreak wasn’t due to the delta variant but instead due to a “new” variant. Iowa Department of Public Health (IDPH) spokesperson Sarah Ekstrand responded to Belin stating “an already-existing variant of the virus identified at the Iowa Veteran’s Home is not a variant of interest or variant of concern.”
But questions remained. This led to IowaWatch reporting across state and federal agencies including the U.S. Centers for Disease Control and Prevention( CDC), the Centers for Medicare and Medicaid (CMS), Iowa State Hygienic Lab (SHL), the Iowa Department of Public Health (IDPH), numerous conversations with healthcare providers in Iowa, analyzing hours of county boards of supervisors’ meetings, accessing the U.S. Department of Health and Human Services grants website – Tracking Accountability in Government Grants System (TAGGS), the CDC Variant Classification and Tracking System and numerous other resources.
For daily information on active cases, trends and long-term care facility outbreaks Iowan Sara Anne Willette aggregates data from CDC and CMS databases and provides analysis and county level data on her website Iowa Covid19 Tracker.