Researchers at the University of Iowa warned Gov. Kim Reynolds' administration it should keep COVID-19 mitigation efforts in place within the state or "a second wave of infections is likely."

The warning was included in a 12-page report sent last week to the Iowa Department of Public Health from a team of researchers at the University of Iowa College of Public Health. The report said researchers found signs of a slowdown in COVID-19 infection and mortality rates in Iowa, "but not that a peak has been reached."

"There is considerable uncertainty still in how many cases and deaths Iowa could eventually have, with possible projections between 150 and >10,000 total deaths. Therefore, prevention measures should remain in place. Without such measures being continued, a second wave of infections is likely," according to the report.

About a week after receiving the report, Reynolds announced plans to begin reopening parts of Iowa's economy starting this Friday. As she announced plans to allow some businesses and religious institutions to resume operations, she said she favors a targeted mitigation strategy.

"We must learn to live with COVID virus activity without letting it govern our lives," Reynolds said Monday.

Reynolds' office released the University of Iowa report to the Des Moines Register on Tuesday, after multiple requests for the document over several days.

Data shows several metro areas in Iowa have seen large increases in cases of the respiratory disease, according to a New York Times analysis.

Dr. Eli Perencevich, an epidemiologist at the University of Iowa and one of the authors of the report, has been vocal about his concerns over the state reopening too soon. On Tuesday, before the release of the report, he tweeted that Reynolds and state public health officials "have made a tragic error" in how they've interpreted available data about cases.

State-specific modeling

The report includes three state-specific COVID-19 models and predictions based on publicly available data. It includes predictions on COVID-19 activity in Iowa, including expected hospitalizations and deaths.

After the Register reported about the document's existence on Monday, a top official at the Iowa Department of Public Health emphasized that researchers had used publicly available information to make their assessments. Researchers are still completing additional work that uses more information from the state.

It's unclear what role the report played in Reynolds' decision-making on reopening the economy. On Friday, Reynolds announced plans to lift Iowa’s ban on nonessential surgeries and allow farmers' markets. On Monday, she gave some businesses in 77 of Iowa's 99 counties permission to operate again, with some limitations, starting Friday.

Pat Garrett, a spokesman for Reynolds, declined to elaborate on how much weight Reynolds put on the report, but he said: "We're going to continue to make decisions based on what we have in front of us."

Garrett also told the Register that the governor's orders to begin reopening Iowa will continue to involve mitigation guidelines for all Iowans.

"The governor thinks Iowans will do the right thing, and when we reopen, they'll act and behave responsibly," he added.

Iowa Department of Public Health officials had indicated that they view state-specific modeling as one tool in determining their next policy decisions.

Dr. Caitlin Pedati, Iowa's state medical director and epidemiologist, implied at a news conference on Thursday that predictive information around COVID-19 activity in Iowa is not yet available.

"We're still working on putting together some Iowa-specific numbers, and when we have that we'll be making it available," she said.

Joe Cavanaugh, head of the biostatistics department at the university’s College of Public Health and one of the researchers behind the report, has been developing COVID-19 modeling for the public health department as part of a contract signed earlier this month.

Cavanaugh told the Register that the report is separate from that work, but he noted the modeling in it will help his team tailor the final phase of his research.

► More:The latest on the coronavirus outbreak in Iowa

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"I am pleased that the IDPH has released the two reports that our modeling team has prepared for and provided to the state," Cavanaugh said Tuesday in a statement to the Register. "I believe that transparency is vitally important to the citizens of Iowa as we all struggle to contend with the pandemic."

Iowa has recorded a large increase in COVID-19 cases in recent days, as officials ramp up testing in areas with suspected outbreaks. On Saturday, the state reported 648 new cases, a record for a one-day increase. The number of COVID-19 cases in Iowa has climbed to 6,376 as of Tuesday, including 136 deaths, according to data the state has released.

Amy McCoy, a spokeswoman for the state public health department, noted in an email that the UI researchers still have the third phase of work to complete.

"There are three work products expected with this contract," McCoy said. "The ones that have been delivered are based on publicly-available data, not specific investigation data that IDPH has provided. That Iowa-specific data model is part of the third product, and I do not have a date for when that will be provided to IDPH."

Cavanaugh said the report with state-specific modeling has "been formulated by our team, and the results that have been subsequently compiled, represent a considerable investment of time and effort. We have attempted to prepare and present these results with the utmost adherence to scientific objectivity."

Cavanaugh said the third phase of the project is intended to refine the state-specific models using data prepared by IDPH "so that the models are uniquely tailored to Iowa."

Cavanaugh told the Register that researchers hope to have "initial results" of the third phase within the next two weeks.

"We will continue to refine our models based on new data, both from publicly available sources and from the IDPH," he said Tuesday. "At present, however, the conclusions featured in the [report] remain relevant."

Researchers also turned in another report, as part of the first phase of their work, that critiqued a frequently cited model developed by researchers at the University of Washington. Reynolds' staff also released that report on Tuesday. It concludes that the model's April 7 estimate of a range of 263 to 711 total deaths through June 1 is a plausible outcome, but "a substantial risk of more severe spread remains."

Read the two documents. Below and here or here.

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.

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