STATE OF IOWA KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR IO WA BO AR D O F ME DI CI NE KENT NEBEL, J.D, EXECUTIVE DIRECTOR kent.nebel@iowa.gov April 3, 2020 The Honorable Kim Reynolds Office of the Governor 1007 East Grand Avenue Des Moines, Iowa 50319 Re: State Response to the COVID-19 Pandemic Dear Governor Reynolds: We, the members of the Iowa Board of Medicine (Board), want to thank you and the Office of the Governor for your hard work, dedication, and diligence during this time of crisis in our State, nation, and the world. It is an unprecedented time in our state’s history and your leadership during this time has been significant. It appears the road ahead is to be a long one and your ongoing efforts to mitigate the damage this virus is causing have not gone unnoticed or unappreciated. We write this letter, not to criticize the work that has already been done but to implore you to take additional steps in this fight. While your proclamations to date have certainly been critical and necessary steps in slowing the spread of COVID-19, we believe more can be done to “flatten the curve.” We have been made aware that the public may be confused about what it means to effectively practice social distancing, that Iowans are disregarding your recommendation to stay home, and that supplies of personal protective equipment (PPE) continue to dwindle. This is all while our knowledge about this virus—and its alarming rates of contagiousness and mortality—continues to develop. We urge you to issue a formal shelter-in-place order in Iowa consistent with the vast majority of the other states across the nation. Dr. Anthony Fauci, physician, immunologist, member of the White House Coronavirus Task Force, and director of the National Institute of Allergy and Infectious Diseases stated “I don’t understand why” every state is not presently under a shelterin-place directive.1 As highlighted in a letter to your office dated April 1, 2020, by the Iowa LeBlanc, P. “Fauci: ‘I don’t understand why’ every state hasn’t issued stay-at-home orders,” CNN Politics, April 3, 2020, https://www.cnn.com/2020/04/02/politics/fauci-stay-home-coronavirus-states1 STATE OF IOWA KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR IO WA BO AR D O F ME DI CI NE KENT NEBEL, J.D, EXECUTIVE DIRECTOR kent.nebel@iowa.gov Medical Society, comprised of over 6,300 physician, resident, and medical student members, not having a shelter-in-place order in place in Iowa needlessly increases Iowans’ exposure to COVID19. As the most recent projections by the University of Washington Institute for Health Metrics and Evaluation show, without swift and aggressive measures to “flatten the curve” of new infections, the number of COVID-19 cases requiring hospitalization will exceed the number of available hospital beds by late April 2020. Knowing that we still have time to lower the number of new infections before we reach that peak, the time to take said swift and aggressive action is now. Entering a shelter-in-place order as soon as possible will strengthen and enhance the current restrictions you have already put in place to further slow the rate of transmission, it will enhance the effectiveness of the social distancing approach to reduce the strain and burden of the healthcare system, and, most importantly, it will prevent deaths. Importantly, we recognize that these are just projections derived from predictive models. We are also very aware of the economic harm that our State—and our country, our world—is experiencing right now and will continue to experience as this pandemic continues and long after its immediate threats lessen. While issuing a shelter-in-place order and ensuring enforcement may seem drastic right now, it is imperative to do all we can to mitigate this disaster. In time, we may never know whether or not these drastic actions were the product of being overly cautious, but it will be abundantly clear if we failed to do enough. With that in mind, we urge you to take every reasonable action in your power to stop the spread of this disease immediately. None of us is alone in this fight and as another arm of the State, we pledge to do all we can as the Board to encourage protective measures and support more stringent and formal rules in this regard, including working with you and your office to come up with the guidelines for the implementation of such a restrictive measure. In executing our duties as members of the Board, we act not just with concern for the standard and practice of medicine, acupuncture, and genetic counseling in Iowa, but with a serious concern for the welfare, health, and safety of all Iowans. In particular, the Iowans on the frontline of this pandemic, our healthcare workers and hospital staff that are placed at risk every day as a nature of their employment, are particularly vulnerable during this time. We should use every weapon in our arsenal to protect those individuals as they work to help others. cnntv/index.html. STATE OF IOWA KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR IO WA BO AR D O F ME DI CI NE KENT NEBEL, J.D, EXECUTIVE DIRECTOR kent.nebel@iowa.gov We ask that you issue a proclamation of disaster emergency requiring Iowans to shelter at home preferably until the threat of this virus is contained, but for a period of a minimum of two weeks, or until we are confident that our healthcare system can accommodate the public’s needs as the virus continues to spread. Sincerely, Kyle Ulveling, M.D. Chair, Iowa Board of Medicine _____________________ Mary Jo Romanco Public Member, Iowa Board of Medicine Diane Cortese Public Member, Iowa Board of Medicine Joyce Vista-Wayne, M.D. Physician Member, Iowa Board of Medicine Ronald L. Kolegraff, M.D. Vice Chair, Iowa Board of Medicine Warren Gall, M.D. Physician Member, Iowa Board of Medicine Nikhil Wagle, M.D. Physician Member, Iowa Board of Medicine Brian Wilson, D.O. Physician Member, Iowa Board of Medicine