Iowa Governor Kim Reynolds COVID-19 Press Conference Transcript May 22

Kim Reynolds: (02:05) So, good morning? In the early weeks of the pandemic, our focus was on mitigating the spread of the virus to protect those Iowans that were at most risk of serious illness and to ensure that Iowa's healthcare resources would remain stable. We've made significant changes to the way that we live, work. We closed schools and businesses and limited our time away from home and in public, all with the goal of avoiding overwhelming our healthcare system. And to make sure that Iowans would have the care that they needed and deserved no matter the circumstances, Kim Reynolds: (02:35) we saw models projecting staggering numbers of positive cases, hospitalizations and deaths across our state that would threaten to cripple our healthcare system. So we did what Iowans always do when faced with a problem. We created solutions. In March, I met with leaders from Iowa's large health systems to discuss their response, but more importantly, how we would plan to respond as one healthcare system to collectively serve Iowans. And what I've seen since is an unprecedented level of collaboration among healthcare systems and providers working together across regions and across organizations, all in the best interest of Iowans. Kim Reynolds: (03:17) Iowan system approach ensured that we have the healthcare capacity, resources and expertise needed to care for every patient. Because we're working together as one team, we're ready to care for Iowans whenever and wherever there's a need. I'm extremely proud of Iowa's healthcare systems from our large multi-regional healthcare systems to our rural hospitals and primary care and specialty clinics, home health care teams and our longterm care facilities. And I am humbled and inspired by the work of every physician, nurse, CNA, medical assistant, lab technician, respiratory therapist, every clinician and non-clinician, who's caring for Iowans with COVID-19. Today I want to celebrate the good work happening in healthcare in our state. Not only are our healthcare providers on the frontline caring for patients across the continuum of care, they're also conducting research on emerging treatments that will help Iowans recover and ease the severity of the virus until a vaccine is available. Today I've asked the team from the University of Iowa Hospitals and Clinics to share their expertise and unique perspective about caring for Iowans throughout the COVID-19 pandemic. Kim Reynolds: (04:33) First I'd like to introduce the group. Suresh Gunasekaran who is the CEO of University of Iowa Hospitals and Clinics. And Suresh, I'm sorry if I butchered your last name. Dr. Katie Imborek, associate professor of family medicine and medical director of offsite primary care, Dr. Bradley Manning assistant professor of internal medicine, and Dr. Kevin Doerschug, who's the medical director of the Medical Intensive Care Unit at the UIHC. So thank you for joining us today and for everything that you've done for Iowans these last few months. Suresh, why don't you kick things off for the group this morning? Dr. Bradley Manning: (05:12) Suresh. Kim Reynolds: (05:23) Suresh I can't hear you. Suresh Gunasekaran: (05:23) Can you hear me better now? Kim Reynolds: (05:30) Yay. Okay, you're good. Suresh Gunasekaran: (05:34) Here at the University of Iowa, we are learning how to use the mute button. [crosstalk 00:00:05:38]. Kim Reynolds: (05:39) Yeah, us too. Suresh Gunasekaran: (05:42) Thank you Governor Reynolds for your leadership and the support of your entire administration during this time. This has indeed been an extraordinary time in healthcare as we've had to change the way we operate in a short period of time to continue safely delivering care for all Iowans. I can't even begin to describe how proud and grateful I am for what our healthcare team has been able to accomplish. At a time when the rest of the world was self-isolating, Iowas healthcare workers have stepped forward to tackle this challenge head on driven by their fierce dedication for patients. This success is due in part because of the staff who've stepped up to spearhead innovative treatments and implement new operating procedures to keep all of our patients and staff safe. I've asked a few of them here to tell you about their work. Dr. Katie Imborek: (06:39) Thanks Suresh. Early in March, UI healthcare set in motion a plan to care for patients in the community with symptoms of this Coronavirus with a focus on decreasing overall rates of transmission to patients and healthcare workers alike. The first part of the plan included directing patients with COVID symptoms to telehealth visits, where they would be evaluated by a healthcare provider, either via video or telephone at which time a determination would be made whether the patient needed to be evaluated in-person by a provider and/or if they met criteria for testing for COVID. Over 100 physicians and advanced practice providers across our primary and specialty care departments have provided care for over 8,000 Iowans with respiratory symptoms like fever, cough, and shortness of breath in the comfort and safety of their own homes via telehealth. Dr. Katie Imborek: (07:33) The second part of our plan was the creation of a dedicated respiratory clinic, where in-person evaluation, testing and treatment of patients with suspected or confirmed Coronavirus would take place. Our dedicated team of nurses, paramedics and medical assistants have performed over 10,000 swabs to test patients for the Coronavirus, the vast majority of them collected without the patients ever having to leave their vehicle. The physicians and advanced practice providers in our respiratory clinic have cared for over 1,500 patients with symptoms of COVID, including treating a number of COVID positive patients with IV fluids and electrolytes when there were signs they were becoming dehydrated. I am confident that the efforts of our amazing team not only prevented hospitalizations, but also positively impacted patient outcomes by efficiently identifying patients at risk for COVID complications early in the course of disease and appropriately escalating their care to an inpatient setting. Dr. Katie Imborek: (08:34) And finally, I strongly feel that UI healthcare's early and decisive actions regarding how to best care for non-hospitalized patients with respiratory illness decrease the overall rate of Coronavirus transmission in our community. Dr. Bradley Manning: (08:52) Thanks Dr. Imborek. My name is Brad Manning. I'm one of the hospitalists at the University of Iowa Hospitals and Clinics, and I'm going to talk briefly about the COVID-19 Home Treatment Team, which is a program that we developed- Dr. Bradley Manning: (09:03) ... to care for COVID-19 patients at home, hopefully keeping them out of the hospital. The way this program works is that when one of the patients tests positive for COVID-19, usually in Dr. Imborek's clinic that you described, we send them a kit to their home that includes a pump blood pressure cuff, as well as a pulse oximeter, which is a little device that you put on your finger that monitors your pulse and your oxygen level in your blood at home. Then we follow those patients closely by phone with our physicians, as well as our nurses. We call them, find out how they're doing, monitor their vital signs that are checked with those devices at home. Dr. Bradley Manning: (09:44) And then if the patients are decompensating, if we find that their vital signs are getting worse, we can bring those patients into the hospital in a controlled fashion, rather than coming through the emergency room or through a waiting area. We bring them directly into the room. That decreases the risk of transmission to our healthcare workers as well as to other patients and everyone else. Most importantly, for the patient, sometimes they don't realize how sick they are at home, and this is an opportunity for us to bring them in early and provide them early excellent care. Dr. Bradley Manning: (10:14) Over the course of this pandemic, we currently are following 70 patients in this program. We currently have one who's hospitalized right now. We do have one patient who passed away. And we've had 500 patients discharged from the program as recovered. So we're very proud of that success and thankful for that result. If any other healthcare providers in the state would like to talk more to us about this or our other experiences at the University of Iowa, we'd be happy to share that with them. And I'll pass along to Dr. Doerschug here. Kim Reynolds: (10:52) Uh-oh. Can't hear you, Doctor. Kevin Doerschug: (10:57) Sorry, again, I'm still learning to use that mute button. So I've been working in the medical intensive care unit for a long time. And our specialty has always been taking care of people with severe respiratory failure. So when COVID-19 hit Iowa, it really was our thing to do to step forward and take care of these patients. From a medical perspective, taking care of critically ill patients with COVID-19, it was very similar to what we'd been doing for a long time. Again, this is our specialty, having these patients with severe oxygen requirements, trying to keep them off the ventilator, using advanced oxygen techniques, or when they do need to go onto the ventilator, knowing exactly how to fine tune that ventilator to optimize their outcomes. Again, that's something we've been doing for a long time. We're just now doing it on a much bigger scale than we have. Kevin Doerschug: (11:52) We're aggressive with using physical therapy. Even when patients aren't able to stand on their own, we can continue to work with them to keep them from losing strength and to get stronger. Kevin Doerschug: (12:05) Our ICU has always been a unit that values teamwork, recognize that every role is essential to the safety of our patients. We have a team of doctors, advanced practice providers, nurses, respiratory therapists, physical therapists, many others that are well-practiced in state of the art critical care and will work really well together. The street signs say we stand together, but this is more than a slogan for us in the intensive care unit. We're feeling this every second of every day. Our teams are growing closer and closer. And our patients are doing really well, much better than we expected based upon other hospital's experiences. Obviously we never want anyone to be admitted to an intensive care unit, but we're honored to be able to care for these patients during their worst moments. And we're really proud of our results. We've seen amazing outcomes. Everyone is shining. We really love our jobs and we love being able to provide this care to our patients. Kevin Doerschug: (13:03) Thank you, Suresh. Suresh Gunasekaran: (13:05) Thanks, Dr. Doerschug. I've actually had the opportunity to visit the medical ICU and see firsthand the work that Dr. Doerschug and his team are doing. And I was not only incredibly impressed, but I was really touched in the manner that they did it. It's the combined efforts of all these teams to provide better screening upfront, to establish a separate dedicated unit for patients with COVID, to create a protocol to care for patients with milder cases of COVID at home, to establish our own COVID testing lab to provide more testing capacity. All of these things have helped us keep the hospitals safe for all patients we serve regardless of their healthcare needs. Suresh Gunasekaran: (13:44) And we're committed to keeping UIHC one of the safest places in Iowa, but we do have one final ask for everyone. The improving circumstances in our state are because Iowans are doing their part practicing good safety habits such as maintaining social distancing, wearing masks, hand washing and sanitizing. I encourage each and every one of you to keep that up as we continue well into our recovery. Also remember healthcare is available when you need it in a safe environment. Don't put off your essential healthcare. Please call your provider. Thank you again for all that you do. And thank you, Governor Reynolds. Kim Reynolds: (14:23) Thank you, Suresh. And thank you to all of you for joining me today and really sharing your experience and your innovative treatment and teams of healthcare providers that are making a difference for Iowans all across the state and especially in your area. And I love the 500 that have recovered. Those numbers are exciting and I completely concur with your final comment, Suresh. Iowans are doing a great job, and we need them to continue to do what they're doing, and we're going to continue to see the positive outcomes. And so we're in this together and we just honestly appreciate so much all that you're doing. Healthcare is both a science and an art and hearing about the compassion and care that you and your team and healthcare providers across the state have delivered to Iowans these last several months, it's just been incredible. So keep up the good work and thank you for joining us today. I appreciate it very much. Thanks for your leadership and for the partnership. It's very much appreciated. Kim Reynolds: (15:20) So yesterday I announced that the criteria for Test Iowa has been open to allow any Iowan to be tested regardless of symptoms or potential exposure to the virus. As of 8:00 a.m. this morning, nearly 1700 appointments were scheduled at sites across the state. For Iowans returning to work at restaurants and retail stores or other establishments that serve the public, this is a resource that you can use at any time to ensure your health and wellbeing. For healthcare workers, first responders and law enforcement who are at high risk of exposure at work, having the ability to be tested frequently is important. And for anyone who's symptomatic or thinks that they may have been exposed, getting tested as soon as possible is critical whether it's a Test Iowa site or through your own doctor. Increasing the number of Iowans tested is one of the best things that we can do for the overall health of our state. Kim Reynolds: (16:15) So if you're interested in being tested, remember the first step is to complete an assessment on testiowa.com. Even if you've already taken an assessment, you'll need to take it again or be sure and take it when you get the reminder if you've taken one before. Your health changes from day to day, and the information you provide tells us about your condition, and it might also identify other information that's important for public health and may identify new trends that will help us continue to better understand the virus. Once you've completed the assessment, you'll be prompted to schedule an appointment for at a test site near you. And remember that you have to have an appointment before you can get tested. Through information provided in the assessment, we're also able to identify communities where a site could be beneficial. New test sites will be opening next week in Burlington, Council Bluffs, Marshalltown and Sioux Center. Test Iowa's mobile testing model, it really does make it possible to quickly operationalize a temporary site in a community where virus activity is increasing or where access to testing is limited. Kim Reynolds: (17:27) Over time, when we see that the test volume decreases, sites are moved to other community where we see that there's a need. The Sioux City site, which opened on May 4th, will close today when testing concludes at 6:00 p.m., but testing does remain available in the area through the local FQHC, which has provided a great share of the tests that have been conducted there already. And the new Test Iowa site in Sioux Center will also be an option. While life is beginning to feel more normal, we can't forget that the virus still remains in our communities. We must continue to take- Kim Reynolds: (18:03) ... personal responsibility for our health and the health of others just like you have done over the last 11 weeks. As we move into the Memorial holiday weekend, please enjoy the weekend and the extra time with family and friends, but do so in a safe and responsible manner. Over the weekend, the state of Iowa will be conducting planned system maintenance, which starts later today and it'll run through 6: 00 AM on Monday. So some state agency websites will be down or in some cases, not updating and that would include the coronavirus.iowa.gov site. So during this timeframe, the website will not reflect current information, but instead to keep Iowans updated, our office will be releasing updated numbers through a press release. Kim Reynolds: (18:52) So finally, as I wrap up, I heard a story yesterday I think that represents what's best about Iowans. And I want to leave you with that today. It's Heather Kiddoo, who is the co owner of Live Action 563, and that's a gym in Bettendorf. So when COVID-19 hit her business hard, she reached out to the state for assistance through the Small Business Relief Grant program. After applying for and being notified that she'd been awarded the grant, this is the note that we received from her, "I received notification that I qualified for the second round of the grant money, but we did receive a payment... Excuse me, a Paycheck Protection Program loan forgiveness since applying for the grant. So we would like the money to be passed down to someone who is suffering more than us. We're allowed to reopen this weekend, so thank you for your consideration, Heather Kiddoo." Kim Reynolds: (19:44) So thank you, Heather, and we appreciate that and we hope things are going well, and thanks for your consideration of other small business owners as we move through COVID-19. With that, we'll open it up for questions. Kathy: (19:58) One question about the childhood inflammatory disease, Dr. [inaudible 00:02:02], that you mentioned earlier this week. You mentioned there were two cases. Have there been any more cases reported and on that? Speaker 2: (20:13) Yeah. Thank you for the question. There have not yet been any additional reports, but we have issued, as you saw, all of that reportable order. And so we do continue to want to make sure that we're making our partners aware and sharing information about that. Kathy: (20:26) Are those children recovering? Speaker 2: (20:28) Those children are stable, yes. Kathy: (20:29) Okay. Governor, sorry, I'm getting questions from a lot of other reporters here. Are you going to lift the prohibition on bottles and can redemption? Lots of people are asking about that. Kim Reynolds: (20:46) Yeah. So we're going to continue to know what expires on the 27th or the 28th next week. And so we're reviewing the entire declaration and we'll be making those decisions moving forward. For a while, Kathy, I don't anticipate us removing a lot of those regulatory amendments that we've put in place, but we're going to continue to look at that and we'll give Iowans an update next week. Speaker 3: (21:11) Governor, what factors led to the closure of those Sioux City and Waterloo Test Iowa site? Kim Reynolds: (21:16) Well, as I've indicated, as we start to see the numbers decrease... And actually, Dr. [inaudible 00:21:22] this up this morning and we were able to look at the data. As of today or yesterday, I think one in 11 Iowans in Woodbury County on a per capita basis have been tested. And actually, as I indicated, a majority of their tests are already being done by a local healthcare provider. So they're still going to have access to testing. This just gives us an opportunity to take that Test Iowa site and actually move it up to Sioux Center, which is still relatively close and in the area. So they'll have access to significant testing. We just, as we look at the numbers and we look at the numbers tested and we start to see a decline, then that gives us an opportunity to reallocate and relocate some of our Test Iowa sites. Kathy: (22:01) We're still hearing some reports from people though, who have been on the site multiple times, can't get an appointment, including people here in Polk County. Do you anticipate that changing? Kim Reynolds: (22:11) This is one tool, Kathy. So this isn't the only way to get tested. And in three weeks, we've done a significant ramp up and I gave the numbers in my remarks, the number of individuals that were running through. In fact, this morning as of 8:30, we had over 1,600 Iowans who have scheduled a test, not just in Polk County, but throughout the state. And so as we ramp up and we continue to enhance the processes, we're going to get better at that and we're going to be able to meet the expectation of Iowans. But in the meantime, again, this is one process we're going to have... You can still go to clinics, you can still go to your hospitals. There's a lot of other options that are available for Iowans. And when you take a look at that holistically, we are providing incredible testing opportunities for the citizens of Iowa and it's going to be extremely helpful as we continue to open up and recover, and to really maintain and manage and contain the virus activity in the state of Iowa. Speaker 4: (23:09) With the new unemployment figures coming out today, is there any talk of additional stimulus for Iowans on top of what the federal government's already considered? Kim Reynolds: (23:17) Yeah. So that's what I was referring to yesterday. There's a lot of different things that we have to look at when we're looking at, not only managing the health of Iowans, but we also have to look at the livelihood of Iowans and the state of our economy. And so that's why with testing and the significant robust case investigation that we're able to put in place with the new serology testing that the Iowa State Hygienic Lab is bringing on board, all of that information really gives us the opportunity to continue to open up Iowa's economy, and to do that in a safe and responsible manner. And so as we move and continue to move into the recovery phase and we continue to ease the mitigation restrictions that we put in place, that's going to help I think with Iowa's unemployment numbers and it'll help us kind of continue to look at where we can be impactful with the additional CARES money that the state has been able to allocate from the federal government. Kim Reynolds: (24:15) Debbie, Department of Economic Development with the small grant loan program in place and that really was bridge financing that got a lot of our small businesses through their opportunity to apply for the PPP loans from the federal government. Iowa did very well. Over 50,000 businesses, almost $5 billion was able to be brought into the state to help our small businesses stand up and get through this difficult time. They have a second round out there. So we're still having small businesses have the opportunity to apply for that. And then as we begin to open up and get Iowans back to work, then hopefully businesses will see their numbers continue to kind of come back and rebound from COVID-19. Kathy: (24:56) A lot of people are following the website very closely as they're making their own decisions about whether they go out or not. One question we get often is are you going to release zip code level numbers that you've talked about here in this forum? And secondly, people being confused with the new website on how to track deaths. Today, if you add up the numbers, it's not going to add up necessarily to what gets reported. People are confused by that. Kim Reynolds: (25:27) So the overall death rate is accurate. The number is right, it just the time legs with when it comes in, and so the overall case reflects the actual number. And that's based on the date on the death certificate. So sometimes that lags in how we report them. So even though we have a number that's reported today, sometimes that's actually reflected over the previous three to four days, depending on when it comes in. So the number is right. You will just continue to see... Am I explaining this right? Okay. I want to verify, but as I'm going through it too, I spend a lot of time on that website, just like Iowans looking at the data. But as it comes in, then we will adjust the numbers based on the day of death that's on the death certificate. Kathy: (26:15) You may not want to do this, but people are asking, would you consider returning to announcing the numbers? Kim Reynolds: (26:22) They can get it every day. You all announce it every day. Before I come into the press conference, I get alert after alert from the media that's recovering. You just can't focus on one thing. We need to look at three-day trends, we need to look at 14-day trends. We need to look at the positivity rate, that's continuing to go down and that's great. Yesterday I think it was, what? Seven, seven or almost 8% overall, it's like 14.1%, and that is really kind of a reflection of the testing that we're able to do. So, I mean, the more that we test, that is going to fluctuate. So our positive numbers are going to continue to go up, but we need to look at the trends and we need to look at the positivity rates- Kim Reynolds: (27:03) ... and we need to look at the days to double. I think that's at 23 right now, which really speaks to the spread of the virus, so that's a really positive number. I think our hospitalization numbers were down 14 yesterday. They've been extremely stable. Now, we're watching that every day. I'm laying in wait for that report to come in about three o'clock every day so I can see how we're doing as a state and how Iowans are doing to respond to the pandemic. Kim Reynolds: (27:33) There's a lot of positive things, and again, nothing is a mandate. People have to be personally responsible. If they feel comfortable, go out there, tiptoe into it. Take your face covering if you can't social distance, and businesses, I just continue to be so incredibly impressed at the responsible and thoughtful manner that they're taking in reopening their businesses. Speaker 5: (27:59) Just zip code. Kim Reynolds: (28:00) Oh, I don't ... You want to talk about that? Speaker 5: (28:04) No, I would just say thank you for the question. Again, I think we fully appreciate that when things change, it can be a little bit hard. I think that our goal all along has been, as we learn more, to turn around and make that information as readily available for people as quickly and clearly as we can. We are looking into ways to do that, to make sure that again, as we receive information that helps Iowans to make safe and healthy choices, we're making that available. Kim Reynolds: (28:32) That's what our whole intent of the website is, so that Iowans can get some sense of what's happening in their community. But you know with any website and any new venture, there's bumps along the way, and so I don't want to cause a lot of concern when we shouldn't. We just want to make sure that the data that we're collecting is good and sound, and it is, and I've got an epi team that's also pouring over it every single day and the department of public health that's poring ... Got a lot of eyes on it. Our goal is to continue to provide information so Iowans, so that they can be informed and make their decisions based on what they're seeing. Speaker 6: (29:06) Channel 13, go ahead. Speaker 7: (29:09) Thank you Governor. Two questions, although they're both relatively quick. I just want to clarify, so when you say anyone can be tested, you mean anyone? I went ahead and took the test, because I was specified again as someone who is asymptomatic and did not qualify for a test. Then my second question is, there have been somewhere around 40 deaths within the last 48 hours. Could you tell us a little bit more? Are they in longterm care facilities? Are they people with underlying conditions? Any more details about that? Kim Reynolds: (29:40) The overwhelming majority fall into the 20% that we've talked about from the very beginning, which are older adults and/or with underlying conditions. We have about 57% of the deaths that are tied to our longterm care facilities. Do you have anything that you want to add? Speaker 8: (30:01) Governor, she got it right. 50% percent of our deaths are among residents of longterm care facilities. You were spot on. Speaker 6: (30:10) Caroline Cummings, go ahead. Speaker 9: (30:11) What's your office's guidance recommendations to Iowans who can't access Test Iowa? People who maybe don't have internet to take an assessment, people with disabilities that rely on public transportation and can't drive through sites, or maybe people who live hours away from some of these Test Iowa sites. What about these people who can now technically get a test if they want one, but in reality can't actually access it? Kim Reynolds: (30:39) Well, you have to remember, Caroline, that this is one tool in the toolbox. There's many other options for them to get a test. They can call their doctor, they can call their clinic, they can go to one of the ... Is it an FQHC? To an FQHC. That's the provider up in Woodbury County. There are a lot of options and there are going to continue to be options. Pretty soon I believe you're going to be able to do a saliva test. Just every day things change, more options become available. If you don't have internet access, find a trusted friend that can help you move through the process, or again, call your doctor, call your clinician and look at some of the other methods that are available. But overall, I think we're working really hard. There are a lot of people across the state that have worked really hard to provide additional opportunities to test Iowans. We're going to continue to see the method in which we do that I think evolve, with innovative and new technologies being developed all the time. Speaker 6: (31:37) Two more questions. David [Dead 00:04:43], go ahead. Speaker 10: (31:41) Yes, Governor, a couple of quick questions. I wondered if you're still on modified quarantine or if that's ended for you personally. Then the second question, I want to just follow up on Monica's question. If someone takes the assessment and they're not asymptomatic- Kim Reynolds: (31:53) Oh, I forgot to answer that. Speaker 10: (31:55) Not anyone can get a test. They have to fall into a category to suspect that maybe they should be tested? Could you clarify that please? Kim Reynolds: (32:02) Yeah. I am off quarantine Wednesday. I completed I think 10 days of taking the test. I am off quarantine, but I continue to do what I'm asking Iowans to do, and that's to when I ... I don't go out a lot, but when you go out practice social distancing, have a face cover in hand. If you can't do that, practice good hygiene. And if I'm sick, we're going to stay home and isolate myself. I am out of the modified quarantine. Oh, so anybody can test. There's no requirements anymore, so if it didn't say that she qualified, go on and take it again. If we continue to see issues with that, let us know and we'll look into it. But there are no restrictions through the Test Iowa site, so go back on, try it again. And again, if you have any issues, let us know and we'll look into it. We'll do a little digging into it. Speaker 6: (32:50) Last question, Kay Henderson, go ahead. Speaker 11: (32:53) Governor, have the additional unemployment claims triggered an increase in the taxes Iowa businesses pay into the unemployment fund? Kim Reynolds: (33:02) Yeah, no, not yet. We're going to continue to monitor that. When we originally put that trigger in place, Kay, we weren't sure if we'd be able to use the Cares funding for the trust fund, the unemployment trust fund. Now that it's been clarified that we can, so we're monitoring that on a weekly basis, and then we'll make a decision next week on how we're going to move forward with handling the trigger and really make monitoring what we're going to do with the trust fund and how that ... Because that impacts businesses across the state. We're going to continue to monitor that, but they did provide clarification from the administration that Cares money could be utilized to refill or to put funds into the unemployment trust fund.