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Coronavirus spreads

Johnson County is ground zero for COVID-19 in Iowa

IOWA CITY– Wash your hands. Cover your cough. Avoid touching your face. Stay home if you’re sick.
Officials for Johnson County, area hospitals and the State of Iowa reiterated the basic precautions to take to avoid the spread of 2019 Novel Coronavirus (COVID-19).
Fifteen of the state’s 22 COVID-19 cases are in Johnson County as of March 16, and most were passengers on an Egyptian cruise arranged through the Hills Bank and Trust Friends Club Feb. 19 to March 2.
But Gov. Kim Reynolds announced a third case of community spread in the state Sunday, March 16, and recommended the state close all schools for a period of four weeks.
Community spread occurs when an individual becomes infected without a clear source such as travel or exposure to other affected individuals.
Four new cases were announced Sunday by the Iowa Department of Public Health (IDPH). Two cases in Allamakee County are related to international travel. The third case is a middle-age Johnson County resident with no identified travel-related risk or exposure to a known COVID-19 case. The fourth individual resides in Polk County and is a middle-age adult and indicates a third case of community spread.
The IDPH announced the first three presumptive cases in Johnson County Sunday, March 8. By Thursday, March 12, the number of presumptive cases rose to 14, all but one of them are older adults. All have since been confirmed as positive.
Thirteen of the local cases were in self-isolation and recovering at home as of March 12; one was hospitalized at the University of Iowa Hospitals and Clinics (UIHC) and was initially listed in critical condition, although UIHC Chief Medical Officer Theresa Brennan said March 11 his condition improved.
The Johnson County individuals testing positive did not have symptoms when they first returned from Egypt and presented no risk to the community, noted Dave Koch, director of Johnson County Public Health (JCPH), during a March 10 press conference at the Johnson County Emergency Management Center.
“They are not actively contagious when they do not have symptoms, when they were asymptomatic,” Koch said. “I do want to assure the community and the public, that although they were in the community and continue to be in the community, they are not symptomatic, so therefore they are not risking the general public’s health.”
All but one person who tested positive are at home, recovering, with no indications the illnesses have gotten any more severe, he added.
The afflicted individuals have been extremely cooperative and have voluntarily confined themselves in their homes, he said.
Koch said his department is in communication with all of those individuals who had close contact and are in voluntary home confinement or are self-monitoring (taking temperature twice a day and reporting to staff).
Those self-monitoring call in twice a day, but are not 100 percent restricted. Koch said those showing no symptoms can go outside for a walk, but must avoid mass transit or areas heavily congested with people.
Two JCPH disease prevention specialists and a staff member from IDPH contact those identified and help trace their movements for possible points of contact with others, he said.
“We do this every day,” he said, noting JCPH tracks approximately 50 communicable diseases in Iowa.
According to the Centers for Disease Control and Prevention (CDC), 41 American deaths were caused by COVID-19 as of March 13. A total of 1,629 cases were reported in 46 states and the District of Columbia. Globally, according to the World Health Organization, 5,735 deaths were caused by the new virus, with 153,517 confirmed cases.
In Iowa, IDPH reported 156 cases currently being monitored as of March 13.
“This is emerging quickly,” observed Koch. “Every hour, every day, we’re learning more. Our contact list is growing. It’s a very rapidly evolving situation.”
Individual risk is dependent on exposure to the virus, he noted.
The IDPH requests Iowans returning from international locations where community spread has occurred (Italy, Japan, South Korea, China and Iran) voluntarily self-isolate for 14 days upon their return, Koch said.
Some people are at higher risk- older adults, those with underlying medical conditions or those with compromised immune systems. Infection in children is generally uncommon, Koch said, and those with COVID-19 have generally presented with mild symptoms.
Dr. Caitlin Pedati, IDPH medical director and state epidemiologist, said some of the early numbers indicate for children and younger people without underlying conditions, the mortality rate for COVID-19 may look lower than the flu.
Older adults and those with chronic health conditions are those more affected and more likely to have severe illness, she said during a separate online media call March 10.
About 80 percent of affected individuals will have milder symptoms, she said, with the other 15-20 percent (the elderly and those with underlying health issues) potentially impacted more severely.
The IDPH is encouraging long term care facilities where older populations with possible underlying conditions are gathered to limit non-essential visitors and to report when greater than two staff or residents are ill with respiratory symptoms without another diagnosis.
Pedati said the State Hygienic Lab would work with its federal partners to obtain additional supplies if needed. It is anticipated commercial labs will make assets available in the future, increasing the available venues for testing.
Currently, all COVID-19 testing is ordered and paid for by the IDPH, she added.
IDPH has provided guidance to clinics and other health care providers to evaluate the virus, prioritizing exposure factors and travel with the symptoms of cough, fever and shortness of breath.
The testing process includes a swab of the nose and throat, with the samples sent to state lab for processing.
The CDC is recommending that for the next eight weeks, organizers cancel or postpone in-person events that consist of 50 people or more throughout the United States.
“Large events and mass gatherings can contribute to the spread of COVID-19 in the United States via travelers who attend these events and introduce the virus to new communities,” a CDC announcement stated. “Events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene and social distancing. When feasible, organizers could modify events to be virtual.”
Older adults and those with chronic health conditions should stay away from others, who are sick, limit close contact with others in general, avoid crowds, and wash hands often.
“Limiting the times we’re around each other and certainly not going to something when you’re sick are important ways to help control the spread of the virus,” she noted.
If you develop symptoms– fever, cough, shortness of breath– contact your health provider and let them know ahead of time of any travel or exposure to someone infected, Koch said.
UIHC’s Brennan and Margaret Reese of Mercy Iowa City each indicated the hospitals are prepared to deal with COVID-19 patients.
Reese said Mercy Iowa City restricting and screening visitors to the hospitals and asking groups meeting at Mercy to postpone for a while and reassess in April.
“The health and safety of our patients and our colleagues and all visitors to the hospital are the most important thing, so we are just being very cautious.”