In March, Iowans watched videos of overwhelmed nurses and pop-up emergency tents as New York City tried to handle the overload of sick patients on its crumbling hospital system.

Nine months later, that is a potential reality in Iowa in the next few weeks as rural hospitals are increasingly sending its sickest patients larger cities, unable to keep up with the near-vertical spike in COVID-19 rates and hospitalizations, said Eli Perencevich, professor of internal medicine and epidemiology at the University of Iowa Carver College of Medicine.

“I would guess, looking at the numbers, we’re a couple of weeks away from New York City-style collapse,” Perencevich said.

New York City’s spring peak climaxed at 8,021 new cases on April 15 and declined after the government enforced strict stay-at-home orders. Face masks were mandated as early as March 20. Restaurants weren’t allowed to resume indoor dining at 25% capacity until Sept. 30. Schools waited to resume until Sept. 29, but closed again Nov. 19 after the city’s 7-day average positive rate reached 3%.

Iowa’s position is different than it was last spring. Medical professionals know better how to treat the virus and people are more aware of best practices, such as wearing face masks, maintaining six-feet social distancing and frequent hand washing.

But opening too soon and the lack of restrictions in the state have created an environment that allowed the virus to spike in Iowa, Perencevich said. Reynolds started with phased reopenings, with the hardest-hit counties reopening their restaurants May 15. Bars reopened May 28. Schools reopened in late August and were required to provide at least 50% in-person lessons. District could ask for permission to move online, but state guidelines recommended it only if counties reached a 15% infection rate and there was rising student and staff absenteeism.

In the last week, New York City averaged 1,727 cases per day, according to the New York Times, with adequate testing samples of at least 260 people per 100,000, according to the city’s website.

Iowa averaged 3,861 daily cases per day last week, and tested an average of 6,833 people in the last seven days. Hospitalizations have spiked so quickly that they nearly tripled in the last 30 days from 534 patients Oct. 21 to 1,447 on Nov. 20.

For the state’s already struggling rural health care system, it’s burdensome because they don’t have enough critical-care doctors, nurses or respiratory therapists.

Though the state’s website says there are 3,000 beds still available, that’s not reflective of the number of staff who are able to care for them. A rural hospital with 20 beds, but only four nurses may only take eight to 10 patients. Any more must be transferred to a larger hospital like UI, said Erik Hosiak, a cardiac nurse at University of Iowa Hospitals and Clinics, who works with COVID-19 patients.

“I want people to know that this is not a hoax,” Hosiak said. “The hospital and health care system is being pushed to the brink and it doesn’t have to be.”

The increase in hospitalizations is weighing heavily on nurses as they work nonstop, 12-hour shifts, Hosiak said.

Since the beginning of the pandemic, the hospital steadily maintained about 20 COVID-19 patients. That has quadrupled in recent weeks where there are nearly 80-infected patients.

On Nov. 15, Hosiak said his unit tried to order more body bags after some were used by another unit. He said his unit was told they could not order more because they were being saved for another unit.

“That’s the first time in my eight years that I’ve ever heard that we were low on body bags,” Hosiak said.

The patients they’re seeing are sicker because they waited for medical care this year, either due to restrictions on elective surgery or fears of getting the virus. Other hospitals are also transferring in their sickest patients, who are spending longer in beds and require more attention, Hosiak said.

Suresh Gunasekaran, CEO of the university hospital, told the Iowa Board of Regents Nov. 18 that rural hospitals are hitting their maximum patient capacity on a daily basis.

The university plans to enter its next surge plan phase as hospitalization numbers keep rising.

Gunasekaran said the hospital will keep capacity open for COVID-19 patients until at least the end of the year.

“I just want people to know it’s not a question of if this will affect you, but when,” Hosiak said. “If a family member needs to go to the hospital for any reason at all, they might not be able to.”

For Iowa to get the virus under control, Perencevich said Iowa needs a statewide mask mandate with enforcement similar to Utah, where residents must wear masks in public and within six-feet of anyone not from their household.

Bars and restaurants needs to shut down and be supported financially. Schools should not open until the infection rate is under 5%.

Then the state needs to wait one to two months before reopening, Perencevich said.

“If we do that, then we turn the corner,” Perencevich said.

But with Thanksgiving approaching, he fears Iowans will spread the virus as they travel to see family, infecting people in states with lower rates. After every holiday, Perencevich said every country has seen a spike in positive cases.

But if Iowa keeps going at the current rate, the health care system will collapse, he said.

“I don’t think we’ll make it to January,” Perencevich said.


The Iowa Capital Dispatch is a hard-hitting, independent news organization dedicated to connecting Iowans to their state government and its impact on their lives.