On Monday July 27, IMS submitted a joint letter to Governor Reynolds calling for an immediate, statewide public face mask order for all Iowans over two years of age. IMS was joined in this letter by leadership from 14 healthcare organizations representing more than 12,000 physicians, providers, and public health professions from across the state. Previously, the IMS Board of Directors met in an emergency meeting to discuss the need for such an order and voted unanimously to support IMS moving forward in leading Iowa’s healthcare community in this call for statewide action.

The letter reads as follows:

Dear Governor Reynolds:

The Iowa Medical Society and the coalition of healthcare organizations listed in this letter represent the unified voice of the more than 12,000 physicians, clinicians, providers, pharmacists, health care facilities, public health professionals, and providers-in-training across the state of Iowa. In these roles, we have a professional and ethical duty to protect the safety and well-being of our patients and our fellow Iowans. It is through this lens that we view the current challenges facing our state and our nation. We have been proud to work with your office and the Iowa Department of Public Health over the last several months as part of the evolving response to address the impact of the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19). In that spirit of partnership, we write today to ask you to immediately move forward with the next critical step in our state’s response to this pandemic – a statewide public mask order for all Iowans over the age of two.

We had all hoped that our ongoing efforts to flatten the curve and mitigate the spread of COVID-19 would find our state in a position of community containment by this point in the year. That is, unfortunately, not the case. In the past week alone, we have seen the number of Iowans with active COVID-19 infections rise to 6,565 – a 64% increase from the 3,993 reported cases on June 20 when we were all optimistic that we were starting to see the downward trend stabilize. As new numbers of daily positive tests continue to be reported by the hundreds, and results from tests administered over the weekend are released, the number of infected Iowans is positioned to climb steadily closer to the previous peak active infection figure of 7,381 that was reported on May 6.

Through the course of this pandemic, we have seen the prevalence of infections shift away from older Iowans and those with pre-existing conditions, to the greatest number of infections now occurring among our younger, healthier populations. More than 48% of infections are currently among adults aged 18-40 and less than 23% of those testing positive report a pre-existing condition. It is also worth noting that it is not simply a case that these are infections among young people with mild symptoms. Hospitalizations due to COVID-19 continue to rise. More than 32% of those hospitalized are requiring intensive care treatment and to date, 829 Iowans have lost their lives.

At the same time, vulnerable populations continue to also be impacted in large numbers by this pandemic. Older Iowans, particularly those in a nursing facilities and other congregate living settings, continue to see steady infection rates in new facilities across the state. The rising rates of infection in many counties have kept long term care providers from easing COVID-19 restrictions, and allowing further access for family and friends to their loved ones. With over 441 deaths occurring in long term care settings in Iowa, taking aggressive steps to mitigate infection rates through statewide public mask order could directly impact the lives of vulnerable, older Iowans.

As you know, this pandemic is not simply impacting Iowa’s urban, more densely-populated communities. Iowa’s rural communities are facing similar rates of infection, with some counties’ daily positive rates exceeding both the statewide average and the infection rates of the most heavily-hit urban counties. The risks of these dramatically increasing infection rates overwhelming response efforts in rural communities is further amplified as rural providers operate with significantly fewer resources to manage acute illness than their urban counterparts.

The fight against COVID-19 has proven arduous and constant. While there is much we are still learning about this virus, there is much we do know and knowledge we do have about effective ways to fight this type of illness. We know the best way to fight virus spread is to prevent it. Guidance from public health experts and numerous research studies, including a recent University of Iowa College of Public Health study, are clear: consistent, widespread use of cloth masks in public settings will dramatically slow the spread of COVID-19 and save lives.

The Iowa Medical Society and this coalition of healthcare organizations strongly support use of all available policy mechanisms, including a statewide order, to ensure Iowans more widely adopt public use of masks for the duration of the pandemic. As data-driven organizations, we are confident in the University of Iowa research that shows that mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate and an estimated 250,000-450,000 COVID-19 cases potentially avoided across the 15 states that had such mandates in place at the time of the study. Thirty states, under the leadership of both Democratic and Republican governors, have now enacted statewide protocols mandating masks in public places and areas in which social distancing cannot be guaranteed. It is imperative that Iowa join their ranks.

As you have noted many times, we each have a role to play in our state and our nation’s response to COVID-19. You have consistently called upon Iowans to do their part and remain vigilant in exercising the precautions necessary to slow the spread of the virus. Unfortunately, voluntary efforts have proven to not be enough. We have seen infection rates continue to climb. We have seen businesses forced to re-close due to positive infections among their staff. In addition, healthcare facilities and community businesses who have attempted to establish their own masking policies have faced backlash and enforcement challenges in the absence of a statewide policy.

It is now apparent that stronger measures are necessary to better protect our fellow Iowans. Requiring public use of cloth masks represents an immediate opportunity to drastically reduce the spread of COVID- 19 in our state. A statewide order, appropriately structured to account for young children and other special health considerations, further enhances the state’s efforts to protect patient safety and safeguards our initial progress toward economy recovery.

The shutdowns of large swaths of Iowa’s economy, schools, and many non-urgent medical procedures earlier this year inconvenienced nearly every Iowan and rendered a significant blow to countless Iowa businesses, including many medical practices. While these measures were necessary at the time to slow the spread of the virus and preserve critical resources for front-line COVID-19 response efforts, we do not want to go backwards on our state’s recovery efforts. A statewide mask order is the surest way to ensure that our schools, businesses, and health care facilities are able to reopen and stay open, and that our medical practices are able to continue to offer a full array of care for Iowa patients.

Iowa’s healthcare community remains committed to doing all that we can to help respond to the ongoing pandemic. The time has come that mandatory public mask use must be a part of those efforts. We thank you for your ongoing leadership during this difficult chapter in our state’s history and look forward to continuing to partner with you and your administration in responding to the challenges of COVID-19.

Sincerely,

Brian Privett, MD, President, Iowa Medical Society

James Bell, MD, President, Iowa Academy of Family Physicians

Daniel Wright, DO, President, American Academy of Pediatrics, Iowa Chapter

Stacey Marlow, MD, President, American College of Emergency Physicians, Iowa Chapter

Melinda Seering, MD, President, Iowa Society of Anesthesiologists

Tim Daley, MD, President, Iowa Academy of Ophthalmology

Kevin Locke, MD, President, Iowa Association of County Medical Examiners

Sakeer Hussain, MD, President, Iowa Oncology Society

Anne Gentil-Archer, ARNP, President, Iowa Nurse Practitioner Society

Stacy Crill, ARNP, President, Iowa Association of Nurse Practitioners

Natalie Weber, PA, President, Iowa Physician Assistants Society

Julie Thorson, Board Chair, Leading Age Iowa

Ron Kemp, Board Chair, Iowa Primary Care Association

Connie Connolly, RPh, President, Iowa Pharmacy Association

Lina Tucker Reinders, MPH, Executive Director, Iowa Public Health Association