Iowa is reopening too early, but the public won’t see the consequences until weeks from now because of COVID-19’s incubation period, warns an infectious disease doctor.

Gov. Kim Reynolds announced she is lifting restrictions across the state starting Friday, allowing Iowans in all 99 counties to go out to eat, work out at the gym or get a massage.

But a lack of widespread testing and contact tracing means the state is opening without reliable data to determine the spread of COVID-19 and if rates are declining, said Megan Srinivas, an infectious disease physician in Fort Dodge.

While some Iowa counties are showing a decline or plateau in positive COVID-19 numbers, according to the state’s data, counties like Polk and Woodbury are still rising.

With more people going back to work and ending their self-isolation, reopening could accelerate the spread of COVID-19 before it even had a chance to decline. That could stress the state’s availability of personal protective equipment and hospital beds, Srinivas said.

The problem is, it could take up to five weeks for Iowans to see the consequences, Srinivas said. For some people, the virus has a two-week incubation period before it shows symptoms. Then, it may take another week or two before a person is potentially hospitalized.

“It’s just inadequate to be making any decisions at this time,” Srinivas said.

Difficulties projecting Iowa’s COVID-19 rates

Reynolds said Iowa is “reopening in a very responsible, safe and stable manner” and made it clear the decisions to reopen the state are based not on the prevalence or spread of the virus, during her press conference on Wednesday.

Rather, the determining factor is whether hospitals can cope with the number of Iowans who become seriously ill. She said the mitigation efforts put in place in March gave the state time to determine hospitals’ capacities to cope with the number of Iowans who may become seriously ill.

As of Tuesday, the state had 77% intensive care unit beds and 76% of its ventilators available.

With the reopenings, it’s extremely difficult for epidemiologists and medical professions to predict COVID-19 rates and provide accurate models of what may happen weeks in the future, Srinivas said.

But some indicators that should be used when lifting restrictions are continuing to go up, Srinivas said. The state’s rolling 14-day totals show hospitalizations and patients in intensive care units continue to increase, as well as death rates.

Guidelines from the White House suggest states should not reopen until they record a two-week decline in positive COVID-19 rates, indicating they are past the peak of infection.

Iowa hasn’t reached that point and it could be delayed even further now to a time that can’t be predicted, Srinivas said. As more people go out in public, the spread of the virus will accelerate, Srinivas said.

Though 448 intensive care unit beds and 707 ventilators are still available statewide, Srinivas said she fears Iowa’s medical professionals could still be overwhelmed by an increase of COVID-19 patients, leaving them without needed protective equipment or becoming infected themselves.

“Potentially, we might not even have the equipment we need to care for all of the people who get sick at once,” Srinivas said.

What happens now?

Srinivas said Iowans should continue to stay inside and only go out for essentials. If people do go out, she said they should wear face masks and practice social distancing.

She fears a second wave of infections is possible in the U.S. that’s similar to the 1918 Spanish flu. Iowa is at risk because it never imposed strict stay-at-home measures like other states that are now experiencing a decline in infection rates.

Random and repeated testing is needed, as well as widespread contact tracing before the state is clear for reopening, Srinivas said.

A total of 85,719 individuals have been tested since early March, according to the state, or a total of 271 people per 100,000. Researchers from Harvard University said states should be testing at least 152 per 100,000 people on a daily basis to understand community spread.

Without an understanding of the spread of the virus, vulnerable Iowans will continue to be at risk for COVID-19, Srinivas said.

“We’re going to lose a lot more lives than we need to,” Srinivas said.

Reporter Linh Ta comes to Iowa Capital Dispatch from the Des Moines Register, where she covered trending news, public safety and the suburbs.