The Iowa Board of Medicine voted unanimously to send a letter to Iowa Gov. Kim Reynolds encouraging her to issue a shelter-in-place order for the state of Iowa due to the risks to healthcare providers on Friday morning.
Dr. Nikhil Wagle opened the discussion saying he has received “numerous” calls from the area as well as other physicians in his area. Wagle also said he’s done a lot of research looking at what other states have done. Currently, Wagle said, according to models, Iowa will hit its peak number of cases around April 30.
“When you look at states that implemented a shelter or stay-at-home mandate, they have been shown to do better and to possibly affect the curve even a little bit if not more,” Wagle said.
California, which Wagle said has a similar population to New York City, put an order in place weeks in advance and has fewer cases and less death than New York City. He also pointed to Ohio as a state that put such a measure in place early and noted Ohio is in a better position than Michigan or Louisiana.
Iowa is one of only four or five states he said that has not mandated a shelter-in-place or stay-at-home order.
“In my own neighborhood I see people still not doing what they’re supposed to be doing,” he said. “I understand that it’s difficult, but even if we could affect 30 percent of the population, that is still something, if a statement is made. Right now we’re talking about what’s in the best safety interest of Iowans.”
Wagle called such an order “extremely important” in efforts to protect the public.
“Even if only 30 percent of the public listens to it, it’s still 30 percent more than would be listening to it if we didn’t have it,” he said.
Wagle noted that golf courses in Iowa are still open and people continue to congregate in areas. He noted many people from Illinois are coming into Iowa because the state doesn’t have any order to shelter in place or stay home.
“People influxing into our state as well could be causing some issues,” he said. “Moreover, healthcare workers who are taking care of the public, and if we don’t have a state mandate and they get sick, then we’re having fewer people taking care of the people who need to be taken care of as well. In my sense, there’s no negative for putting a state mandate in, but there are only positives that can happen.”
Wagle finished by noting that such an order may have a negative impact on the economy but said the board is supposed to deal with the safety and health of Iowans.
Dr. Kyle Ulveling, chair of the board, noted the importance of tone to the letter. He also said that while the board’s main interest is the health and safety of Iowans, it is not ignorant of other issues, such as the economic impact, an order would bring.
Dr. Joyce Vista-Wayne, another board member, said restrictions in shelter-in-place orders and stay-at-home orders seem to be similar. She discussed steps taken by California and New York.
“As a seated board member, my charge is protection of the public,” she said. “And we do that in this case by protecting the people who are taking care of the public.”
However, she questioned the enforcement of such an order. Currently, a violation of the Governor’s emergency proclamation is a simple misdemeanor. Vista-Wayne asked if the board was wanting to escalate that.
No answer was ever provided.
She asked if the Board of Medicine participates in the emergency response task force Gov. Reynolds has set up.
The board does not.
“The question in my mind is, how is the Governor getting advice then,” Vista-Wayne said. “Is it just from one person? It’s very important to know, who also is at the table that she seeks advice and guidance from?”
The Board of Medicine does, however, talk with the Department of Public Health on a daily basis.
Dennis Tibben, the director of external affairs for the Iowa Medical Society, said that the group sent a letter earlier this week asking for a minimum of a two-week shelter-in-place order.
Katie Strickler, the general counsel of the Iowa Medical Society, said the Governor does have health partners who are part of the state emergency response and that the group includes the Medical Society, hospital association, both organizations for long-term care in Iowa, Iowa Primary Care Association and representatives from the major health systems in the state.
Strickler noted the group meets primarily on a daily basis.
“The Governor’s office has been very responsive to input received,” Strickler said.
Pam Williams spoke from the Iowa Academy of Family Physicians’ point of view. The executive committee of that group is also discussing steps to result in more isolation of the population. There is a lack of consistency that Williams said results in some “high-risk” behavior that contributes to a “cavalier” attitude by the “naysayers.”
“We understand there might be some concern about what the term shelter-in-place means, the implication for enforcement, how long it would last,” she said. “But overall we feel like we need to have more encouragement of isolation from the public.”
The letter will be drafted and then each board member will have an opportunity to review it.
Vista-Wayne said she’s hoping that a unified message from the “boots on the ground” in terms of healthcare workers will spur action and remove the politicization from the process.
“What I’m afraid is happening right now is there is so many political undertones to this, which is unfortunate,” she said. “I would rather that if anything happens, it’s not because members of the congressional delegation pressured the administration or Governor to do this or because we are one of only 11 states that have not mandated shelter-in-place or because we’re a state with a Republican Governor.
“If the Governor or Governor’s office did anything, shelter-in-place, it’s because it was a message conveyed from the very people who are helping protect the Iowa citizen. If this is a message that comes from the boots on the ground, the healthcare workforce, that would take away all the political partisanship from it.”
Wagle noted near the end of the discussion that the letter needs to be done quickly. He said there is still time for an order to work, but it’s on a deadline.
“If we wait too long, then it’s too late to put a shelter-in-place,” Wagle said. “If it’s put into place, it certainly could make a difference.”
The motion for sending Reynolds a letter encouraging her to issue a shelter-in-place order passed with unanimous support.
