April 1, 2020
The Honorable Kim Reynolds
Office of the Governor
1007 East Grand Avenue
Des Moines, Iowa 50319
Re: State Response to the COVID-19 Pandemic
Dear Governor Reynolds:
On behalf of the more than 6,300 physician, resident, and medical student members of the Iowa Medical Society (IMS) and Board of Directors, thank you for your leadership over the past several weeks as our state has worked to respond to the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19). As scientists, we appreciate the data-driven approach you have taken, in close coordination with Caitlin Pedati, MD, and the experts at the Iowa Department of Public Health, to implement measures to help slow the spread of COVID-19 across our state.
IMS also greatly appreciates the extensive efforts you and your staff have made to ensure that healthcare leaders have regular contact with your office and necessary state agencies to identify issues and collectively work to design solutions to this unprecedented strain on our healthcare delivery system. The speed with which you and your team are working to address problems identified by IMS and others should be commended. Iowa will emerge stronger from this challenging time because we worked together to respond.
The Iowa Medical Society recognizes the difficult position in which you find yourself – needing to balance the health and safety of all Iowans, the well-being of Iowa’s economy, and ongoing operations of essential industries like our agricultural and food production sectors that help to feed the world. The measures you have implemented to order closures of retail facilities, bars and restaurants, houses of worship, and other sites of mass gatherings, will certainly have a significant impact on thousands of Iowa families. Given the current absence of an effective vaccination or treatment protocol for COVID-19, we believe these closures are absolutely critical as we look to flatten the curve and prevent overloading our already strained healthcare system.
The physicians of Iowa are on the very front lines of the fight against COVID-19. Over the past several weeks, we have worked to overcome a wholesale breakdown of the medical supply chain that has resulted in too few testing kits to determine the true spread of the disease in our state and a dangerously short supply of personal protective equipment (PPE) to ensure that clinical staff are not putting their personal safety in danger as they test and treat patients. Our colleagues in industries like dental, biotechnology, and manufacturing have helped to overcome these shortages, donating thousands of pieces of PPE to help fill this gap. Meanwhile, everyday Iowans have turned on their sewing machines and begun to produce fabric masks to help stretch our resources until additional medical-grade supplies can arrive. Iowa’s medical community will be forever grateful for these efforts to provide short-term relief to these dangerous shortages. Unfortunately, as you know, additional supplies from commercial vendors and the federal stockpile have been slow to arrive and not in sufficient quantity.
This limited supply of PPE and other critical equipment has resulted in potentially dangerous efforts to reuse or otherwise conserve medical resources. Some practices report less than a two-day supply of PPE at current optimized use rates, and Iowa physicians live each day in fear that we are unnecessarily exposing ourselves and our families to illness as a result. We know that additional resources are on the way and we commend the State for its efforts to speed supplies to practices with the greatest need as quickly as it can, but greater efforts are needed.
Iowa is now experiencing extensive community spread of COVID-19. We see the daily number of positive diagnoses growing exponentially and sadly, we see the number of Iowans in need of hospitalization or who have died as a result of the disease growing as well. Despite these concerning developments, we continue to witness individuals disregarding our collective calls for voluntary social distancing and several businesses continuing operations. Several industries, such as construction, are utilizing protective equipment that could be repurposed to fill the urgent need in healthcare, unnecessarily placing workers in close working conditions at a time when community spread of COVID-19 is on the rise, or risking workplace injuries that will further stain our emergency departments.
You and Dr. Pedati have often referred to the State’s response to COVID-19 as a dial – when circumstances warrant, we must dial up our efforts to further restrict potential exposure and when we see signs that our social distancing efforts are working, hopefully very soon, we can dial these restrictions back down. Given the severe lack of PPE and ongoing issues with segments of our population not voluntarily social distancing, IMS believes the time has come to temporarily dial up our state’s response efforts. The physicians of Iowa request that you implement a more stringent shelter-in-place order for a period of at least two weeks.
We recognize that placing additional restrictions on industries will negatively impact Iowa’s economy and enforcing more stringent social distancing requirements will place an additional burden on first responders. We also know, based upon the experiences of other jurisdictions around the world, that these more stringent efforts will make a difference. By placing short-term, enforceable restrictions on greater segments of the economy, we can further slow the progression of the disease until resupply shipments of PPE and other critical medical equipment can arrive. This temporary measure will also allow Iowa businesses that are stepping up to retool and begin in-state production of critical medical supplies, to come online. Finally, this measure will further protect front-line medical workers.
Iowa’s healthcare providers are dedicated public servants. Regardless of supply shortages and dangers to our personal safety, we will continue to respond to the needs of our communities. We will continue to test and treat our patients, regardless of the circumstances because the practice of medicine is a calling, not a job. We understand that intentionally causing greater harm to an already stressed economy and further restricting the liberties of everyday Iowans is not a decision to take lightly, however, we believe that in the immediate future it is one that must be made to protect those of us on the front lines in this fight against COVID-19.
We appreciate your thoughtful consideration of this request and thank you again for your tireless leadership during this difficult chapter in our state’s history. The physicians of Iowa continue to stand ready to help you and every Iowa patient in any way that we can.
On behalf of the IMS Board of Directors,
Marygrace Elson, MD, MME, FACOG