Yesterday, the fear of exponential spread of the coronavirus became realized in Iowa: 23 new positive cases on Saturday were announced, by far the largest jump in one day. Today, there are 22 new cases, increasing Iowa’s total to 90. The previous biggest daily increase before this weekend had been nine, and most days saw just a handful of new cases.

The reality is that far, far more Iowans have likely contracted the virus, whether they know it or not. Gov. Kim Reynolds, upon just three cases of COVID-19 not related to travel, admitted Iowa now has “significant community spread.” Whether the state ever knows the full extent depends upon if we ever finally ramp up our testing capability.

Not having the full data is a major problem, one that is hampering our ability to measure the effectiveness of the state’s actions and to fully realize how extensive the problem is (or, eventually, whether we’re improving).

On Thursday, Reynolds’ office said the state has 800 tests, and the state hygienic laboratory can process about 170 per day. The next day, the number of available tests were down to 620, but Reynolds has said the supply does go up and down as they receive more. Iowa has a population of over three million people.

As Reynolds has noted often, seemingly in a way to calm nerves, there are many private testing options that have come available in recent weeks. The problem, however, is that for a private test to get processed at the Iowa lab, the patient must match the state’s extensive checklist. Otherwise, those tests get sent out of state, which the Des Moines Register reported can take many more days to get processed.

The lack of available state tests has been a problem since the very beginning of this crisis, though it’s certainly not a situation that Iowa is alone in. The Trump Administration’s decision to not use the WHO’s initial test, as well as the CDC’s mistake-prone option that plagued state labs with problems at the outset, put the United States far, far behind other developed countries in testing.

But individual states do have agency, and it seems beyond belief that Iowa leaders haven’t yet figured out a way to produce or acquire significantly more testing kits on their own. Here in Iowa, a lab in Coralville said earlier this month that it could soon create five million coronavirus tests per week.

Early on, Reynolds and the Iowa Department of Public Health seemed to downplay the problem, insisting that 80% of people will experience a mild form of COVID-19 and should simply stay at home if they feel ill. It wasn’t too relevant, it seemed, whether someone is actually infected; staying home helps prevent the spread, so just do that.

This, of course, does not address the reality that many studies and mass tests have shown that many infected people are asymptomatic and may be spreading the virus without realizing it.

And lacking full data in the biggest public health crisis Iowa has ever seen seems utterly insufficient from a public policy decision-making standpoint. Some of the early suggestions of how individual Iowans should react seemed more geared toward dealing with the problem of insufficient testing capacity.

Consider the case with Johnson County, where 15 of the early confirmed COVID-19 cases in Iowa were connected to people coming back from an Egyptian cruise. Amazingly, not every person who was on the cruise was tested, nor were those who lived in the same household of those who were positive. It was suggested they practice social distancing and stay home, but how sure are we that all that happened?

Johnson County is now the center of the outbreak in Iowa, and there’s increasing spread in surrounding counties. Here’s Iowa’s COVID-19 confirmed cases map as of early Sunday afternoon:

Iowa City is a place where there’s significant foot traffic in downtown and plenty of bars and restaurants where a virus could spread. When you have that many people returning to a community from an international trip where many people contracted the virus, certainly you’d want to quickly test everyone and more in town to determine if there’s instant community spread. By March 11, there were 13 confirmed cases in Johnson County alone, all from the Egypt trip. Knowing how widespread the problem was early on beyond that could have led to faster actions there that limited the quick spread we’re now seeing.

Who knows how many other lessons we’re not learning right now, today, about spread in other areas that could lead to more informed responses by the government or by local business.

This past week, several large businesses in Des Moines have been impacted. The Principal Building, the state’s largest skyscraper, is doing a deep-clean of 20 floors after it was found that a visitor tested positive for COVID-19. How many other large businsses where employees are still required to show up at have the virus running through its workplace undetected right now?

Reynolds at least appears to be getting the message of how concerned Iowans are over testing. The state put back up the metrics on the total tests run by the state lab after inexplicably removing them earlier last week, and the private labs will also start reporting their tests run on Iowans. And she mentioned at her Friday press conference that the state was continuing to explore public-private partnerships to increase their capacity.

Hopefully that’s the case. Widespread testing wouldn’t just simply help the anxiety of Iowans who worry they might have the virus, it should also assist in these aspects:

Drive Home The Seriousness To Skeptics

It’s come as no surprise in the Trump era that many people (including Trump himself for a while) have seen the coronavirus crisis as a hoax or a huge overreaction by a sensationalized media.

But even outside the conspiracy-minded or Fox News-watchers, you can understand how people in certain parts of the state or country might react to this with frustration due to the drastic measures being implemented, which have cost many people their jobs.

Imagine you live in one of the many counties in Iowa that has no confirmed cases, including none within two counties of you. The media reports possible dire death tolls, but the actual numbers haven’t matched the scariest predictions yet.

How likely are these people to fully lock themselves up in their homes right now? Or, seeing no firm evidence of local spread, how many will continue chatting with neighbors at gas stations, driving over to their older relatives’ houses, or insisting their employees still show up to work at businesses not ordered to shut down?

Significant testing in every county will almost certainly mean confirmed cases in nearly every county, which would change locals’ behaviors more quickly. You can recommend or even mandate things all you want, but if people view it as a far-off threat, they may not change their routines fast enough to limit spread. If they know that dozens of their neighbors have tested positive for it, even if those neighbors haven’t required hospitalization, you’ll see organic, life-saving behavior changes take place among a far larger portion of the population.

Measure The Effectiveness Of State/Local Actions

After falling behind other states’ more proactive measures for several days, Reynolds caught up last week on several fronts with school closures, shutting down bars, restaurants, casinos, fitness centers and more, and by limiting most gatherings of more than ten people. But other states and localities are now going further with shelter-in-place directives, something Reynolds said at a recent press conference she’s not currently interested in.

And perhaps that is enough. But without widespread testing, we won’t know the answer to that until weeks down the line, evidenced simply by how overwhelmed our hospitals do or do not get. And by then, it’ll be too late.

Iowa may well need to implement a full, shelter-in-place type of order to finally get a handle on the virus’ spread. Or it may not. Iowa’s mores spread-out population and small towns could naturally limit the spread in a way major cities like New York and San Francisco simply cannot. Or perhaps some counties like Polk, Linn, Scott and Johnson need a stay-at-home order, while other smaller, rural counties do not.

A total shutdown of all business and life will damage Iowa’s economy even more. Employers will lay off even more workers, and more businesses will be forced to close for good.

And, again, that may very well be what has to happen in Iowa to control this crisis. But in some places, it might not. And if it’s possible that you can limit the economic damage to some towns without raising risk of virus spread, we should know that. But we don’t without full data.

Let Us Know When We Can Go Back To Normal

Most Americans seem resolute or at least understanding of what’s needed to be done to confront this pandemic. But after staying in their homes for weeks or months, losing their jobs and seeing their local economies collapse, many will soon start to anxiously wonder when it’s safe to get back to life as normal.

Extensive testing will be crucial for that to happen.

What if you order a shelter-in-place, but enough people continue to slip out of their homes, see friends and neighbors, and keep the virus spreading throughout their community? You may end the order after a few weeks or a month, but the virus will simply hit again in a second wave once people return to somewhat normal lives. And then we’ll all have to start this process over again, extending the economic and societal pain.

by Pat Rynard

Posted 3/22/20