Nine months later, Iowa faces a similarly dire predicament in coming weeks as rural hospitals increasingly send their sickest patients to larger cities, unable to keep up with the near-vertical spike in COVID-19 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 told the Iowa Capital Dispatch.

New York City’s spring peak climaxed at 8,021 new cases 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, Perencevich said. Reynolds started with phased reopenings, with the hardest-hit counties reopening 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 allow it only if counties reach a 15% infection rate and there is 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.

Iowa surpassed 211,000 confirmed coronavirus cases and 2,200 deaths on Monday, and the state remains ranked third-highest in the nation for virus positivity rate with a seven-day rolling average of 44.7%.

There were 1,661 new confirmed cases on Monday and 13 additional deaths, according to the Iowa Department of Public Health. That raised the total number of cases identified in the state to 211,722, and the number of deaths rose to 2,205.

The daily number of cases has been ranging between 3,000 to 5,000 on most days this month and the low daily count Monday is likely due to a significant decrease in test results posted in the past few days.

For the state’s already struggling rural health care system, it’s burdensome because it doesnt 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 available. 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 Kusiak, 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,” Kusiak 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, Kusiak said.

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

On Nov. 15, Kusiak said, his unit tried to order more body bags and was told none were available.

“That’s the first time in my eight years that I’ve ever heard that we were low on body bags,” Kusiak 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 also are transferring in their sickest patients, who are spending longer in beds and require more attention, Kusiak 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.

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

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 need 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 more spread. After every holiday, Perencevich said, every country has seen a spike in positive cases.

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.

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