PANDEMIC

PANDEMIC. An outbreak is “a sudden rise in the incidence of a disease” and typically is confined to a localized area or a specific group of people. If an outbreak becomes more severe and less localized, it may be characterized as an epidemic. If it broadens still further and affects a significant portion of the population, the disease may be characterized as a pandemic. Among the best known pandemics was the Black Death, a plague which spread across Asia and Europe in the middle of the 14th century.

There have been a number of pandemics since the beginning of the 20th century: the Spanish INFLUENZA of 1918/19 (H1N1-which did not originate in Spain) and the flu pandemics in 1957 (H2N2)-Asian flu) and 1968 (H2N2-Hong Kong flu). The flu of 1918/19 struck in three waves. A mild wave in the spring of 1918 was replaced in September to November by a second wave resulting in a mortality rate over 2.5%. A third wave equally strong swept the world in 1919. It is believed the virus probably originated in the United States and then spread to Europe. The estimated worldwide number of deaths exceeded 50 million with young adults the largest group affected. The flu of 1957-58 (H2N2) originated in southern China in February 1957 and over three months spread to Singapore, Hong Kong, and Japan and in October to the United Kingdom and United States. A second wave was found in January 1958. There were between 1-4 million people killed worldwide. Children were the most affected by the virus. In 1968-1969 two waves (H3N2) struck during the winter. It originated in Hong Kong in July 1968 and when finished killed 1-4 million people. All age groups were affected. (1)

On March 16, 2020 the following announcement was made:

          At tonight’s City Council meeting, Dubuque Mayor Roy D. Buol 
          will declare a state of emergency in Dubuque in response to 
          the coronavirus.

          At this time, there are no confirmed cases of COVID-19 in Dubuque County 
          but the proclamation follows the Iowa Department of Public Health’s (IDPH) 
          notification of community spread of the virus in Iowa and recommendation 
          of the immediate implementation of mitigation measures to slow the spread 
          of the virus, as well as Iowa Governor Kim Reynolds’ recommendation that 
          all Iowa schools close for four weeks. 

          “One of the greatest responsibilities of an elected official is the protection 
          of the electorate served and the protection of the greater public health and 
          safety,” stated Boul. “I hereby determine that a state of emergency or public 
          danger exists.”

          Through tonight’s proclamation, Mayor Buol is prohibiting gatherings of 50 or 
          people on public property and strongly suggests private gatherings of 50 or more 
          on private property should be avoided. The proclamation follows a statement last 
          encouraging social distancing.

          In addition, the proclamation also orders the closure of some City buildings, 
          for the protection of residents and city staff.  Specifically, the City of Dubuque 
          is closing the following City buildings to public access beginning Tuesday, March 17, 
          through at least Sunday, April 12:

                         City Hall, 50 W. 13th St.
                         City Hall Annex, 1300 Main St.
                         Housing & Community Development Department, 
                         Historic Federal Building, 350 W 6th St.
                         Leisure Services Department Office and Bunker Hill 
                             Golf Course, 2200 Bunker Hill Rd.
                         Municipal Services Center, 925 Kerper Ct.
                         Multicultural Family Center, 1157 Central Ave
                         Comiskey Park Building, 255 E. 24th St.
                         Allison Henderson Park Building, 1500 Loras Blvd.

           City staff in these buildings will continue to work and provide services 
           to the public electronically, by phone, by mail, and when necessary, by 
           appointment. Details on payment options for utility bills, parking tickets, 
           and all permits and fees will be announced tomorrow. 

           Additionally, all City of Dubuque Leisure Services recreational programs 
           and Multicultural Family Center (MFC) programs are cancelled through at least 
           April 12. City staff will contact those registered and offer refunds and/or 
           credits. Registration for summer programs will not begin until at least April 
           13. Please note, all meetings and other gatherings scheduled at the Comiskey 
           Park building and the Allison Henderson building are cancelled. During the 
           shutdown, City staff will be sanitizing all areas of each of these facilities.

           City staff is currently working on a method that would allow the MFC’s Food 
           Pantry scheduled for Friday, March 20, to continue -- while keeping both the 
           pantry participants, volunteers, and staff protected by following the protocols 
           of the CDC and IDPH. City staff will be corresponding with Food Pantry 
           participants to provide updates. 

           For information and questions related to City services and programs, please 
           contact appropriate City department or submit a request through the City’s 
           Citizen Support Center at www.cityofdubuque.org. 

           For information about Coronavirus (COVID-19), visit https://idph.iowa.gov/
           Emerging-Health-Issues/Novel-Coronavirus.  For Dubuque County specific 
           information, call the Dubuque Visiting Nurses Association at 563.556.6200 
           (8 a.m. – 4:30 p.m., Monday-Friday), the Dubuque County Health Department at
           563.557.7396 (8 a.m. – 4:30 p.m., Monday-Friday), or the City of Dubuque 
           Health Services Department at 563.589.4181(8 a.m. – 5 p.m., 
           Monday-Friday).

The immediate cause of the announcement was a similar statement made by Iowa Governor Kim Reynolds on March 15th and similar statements coming from the White House in the previous days. The root of the issue was coronavirus, a disease which had reached pandemic proportions. The Merriam-Webster Dictionary defined pandemic as "an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population. Believed to have originated in China, the disease spread worldwide leading to a national lockdown in Italy, repeated requests by public health officials in the United States to limit travel and practice self-quarantine if recently outside the United States, accusations that it was simply a Democratic Party attempt to deny Donald Trump a re-election to the presidency, and most recently the shutdown of many high profile public events, sporting events, and public schools in the eastern United States.

One of the immediate results was a run on grocery supplies of toilet paper and hand sanitizers. By the end of the second week of quarantine, stores limited purchases.

On March 14, 2020 the closest of Iowa's seventeen cases was in Iowa City, in Wisconsin was in Dane County, and in Illinois McHenry County--a two hour drive from Jo Daviess County. Despite this, some restaurants like PANERA BREAD COMPANY pre-packaged packets of powdered creamer and sugar for customers, shoppers at HyVee were unable to use cloth bags for groceries, and clerks giving change at WALGREEN COMPANY wore gloves. (2) Mary Rose Corrigan, the public health specialist for the City of Dubuque, maintained it was not a question of "if" but when the disease would reach Dubuque. Wisconsin and Illinois announced all schools would be closed until March 30th. (3) After four more cases of the virus were discovered in Iowa, Governor Reynolds stated all schools should close for four weeks. (4) Such caution coincided with a study by United Kingdom epidemiologists that attempts to slow or mitigate--rather than actively halt or suppress--the virus could overwhelm the number of intensive care hospital beds and lead to an estimated 250,000 deaths in the UK and over a million in the United States. (5)

Signing up for new internet service meant picking up labeled boxes of equipment left outside.

As late at March, the United States was significantly slow in testing people for the disease. White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. The federal government’s $30 million Complex Crises Fund was eliminated. In 2017 and 2018, the philanthropist billionaire Bill Gates met repeatedly with John Bolton and his predecessor, H.R. McMaster, warning that ongoing cuts to the global health disease infrastructure would render the United States vulnerable to the “significant probability of a large and lethal modern-day pandemic occurring in our lifetimes.” An independent, bipartisan panel formed by the Center for Strategic and International Studies concluded that lack of preparedness was so acute in the Trump administration that the “United States must either pay now and gain protection and security or wait for the next epidemic and pay a much greater price in human and economic costs.” (6) Repeated assurances from the President that "this will just go away" and claims by his supporters that the disease was a "hoax," caused the total number of tests given in months in the United States to be far less than South Korean health officials were giving daily. Getting precise figures also met such challenges as Vermont no longer reporting non-Vermont resident cases of the virus. (7) Rapidly losing ground were attempts to trace the passage of the disease as it became "community spread" meaning people cannot identify how or where they became infected. (8)

Gatherings of friends/family took on new appearances. This 'safe distance' get-together at the Target parking lot on a sunny but cool Saturday morning was one of the most pleasant observed.

Reynold's proclamation of a "public health disaster emergency" ordered the closing of the state's bars and dine-in restaurants until March 31. Curbside, carry-out, and drive-through food service would be allowed. The declaration also closed all fitness centers, theaters, casinos and gaming facilities, senior citizen centers and adult day care facilities. It prohibited gatherings of more than ten people including social, community, spiritual, religious, recreational, leisure and sporting events. (9)

It was fair to say that nearly every occasion at which a crowd might be expected was either called off or about to be canceled by Tuesday, March 17th. The ARCHDIOCESE OF DUBUQUE following the example of many other churches which experienced either no services or very light attendance on Sunday announced that public celebrations of Mass would be canceled beginning March 19th. Parishioners could watch a live video of the archbishop delivering Mass at 9:00 a.m. each Sunday. He would also lead the rosary every Thursday. Further information could be obtained at DBQArch.org. (10) FIRST CONGREGATIONAL UNITED CHURCH OF CHRIST also announced video services. Like other organizations, the CARNEGIE-STOUT PUBLIC LIBRARY maintained a reduced staff, but closed the library at noon on March 17th.

Unique efforts at maintaining some degree of normal activity included those of the Carnegie-Stout Library. One March 18th the following notice was made by email from their website:

                        Use the library’s catalog www.dubuque.lib.ia.usto search 
                        for materials that you want to check out. Place a hold on 
                        the titles that you would like. Please limit the number to 
                        5 items per visit.  It will typically take a day to pull 
                        the items and check them out to you. Stop by the library 
                        during curbside delivery hours (Monday-Friday, Noon –6:30 
                        p.m. and Saturday, 9:00 a.m. –2:00p.m.) and telephone us 
                        589-4225 to let us know you are here for your hold.  We 
                        will run the material out to you. The pick-up location is 
                        Locust Street at the area where there is a short drive way, 
                        with no parking meter. Please have your library card with 
                        you or a photo ID. If you do not have access to the online 
                        catalog, call the library at 589-4225 for help placing a 
                        hold, or identifying a book to read. (11)

In March, city officials reallocated $330,000 in federal funds to be set aside toward emergency shelter to quarantine at-risk populations in Dubuque and, if needed, to provide temporary drive-thru diagnostic testing. (12)

Financial markets continued the radical swings seen for over a week. On March 17th after a government suggestion that checks might be mailed to everyone to mitigate job loss the Dow-Jones rose over 1,000 points. All of that was given up the next morning as another sell-off left the market just over 20,000--down over 9,000 points in less than two months. The investment firm of Basepoint Wealth offered a webinar on how to react to the first bear market in ten years. At the end of the day, March 18, the market had closed below 20,000.

Local businesses mirroring an action taken nationally stepped up the practice of employees working from home. Brad Pinchuk, president and CEO of Hirschbach Motor Lines, began requiring all workers to work remotely at least one day during the week of March 14th to have the experience. All office personnel were then given the opportunity to continue at home "for the foreseeable future." Those remaining in the office were required to clean their work stations multiple times per day and not to go out for lunch. The company had food brought to the office. DUBUQUE BANK AND TRUST COMPANY announced that all banking lobbies would be closed with the exception of its KENNEDY MALL and Farley Banking Center locations. All drive-through services remained open. Customers were encouraged to conduct transactions via mobile and online avenues whenever possible. The sudden increase in the number of residents working remotely led to the concern that the use could exceed the limits of the region's internet capacity. Richard E. (Rick) DICKINSON, president and CEO of the GREATER DUBUQUE DEVELOPMENT CORPORATION believed recent enhancement of the broadband infrastructure, extending access to rural areas and increased system redundancy would provide the needed flexibility. (13)

On Thursday, March 19, the DUBUQUE COUNTY COURTHOUSE was closed to the public. The following announcement was made by email:

                          The City of Dubuque is temporarily suspending water 
                          shut-offs on past-due. This will not alleviate the 
                          bill as late fees will continue to be charged until 
                          the balances are addressed. 

The Community Development Advisory Commission members voted unanimously to recommend that $300,000 received by the city to aid low to moderate income residents be put toward an emergency shelter if needed to quarantine at-risk populations in Dubuque. The shelter would provide temporary drive-thru diagnostic testing. Approval for this action was still needed by the city council and the federal government. (14)

As of March 21, 2020, Dubuque County had reported one case of the virus, while the State of Iowa announced the number statewide was 68. (15) On March 23rd, the county had identified six cases in Dubuque County, the third highest in the state. The location of the cases in the county were not reported. Iowa by this time had reported 105. (16)

The lunch distribution at Prescott Elementary

Officials of the DUBUQUE COMMUNITY SCHOOL DISTRICT and local partner organizations organized by March 24th to offer free grab-and-go meal services to families who could reach one of the distribution points. These included AUDUBON ELEMENTARY SCHOOL, BOYS' AND GIRLS' CLUB OF GREATER DUBUQUE, COMISKEY PARK, CONVIVIUM URBAN FARMSTEAD. DUBUQUE DREAM CENTER, STEPHEN HEMPSTEAD HIGH SCHOOL]], HOOVER ELEMENTARY SCHOOL, LINCOLN ELEMENTARY SCHOOL, MARSHALL ELEMENTARY SCHOOL, PRESCOTT ELEMENTARY SCHOOL, Terrace Heights, and Resources Unite. (17)

News of shortages of medical masks led some local companies like DUBUQUE MATTRESS COMPANY to begin making them. Manufactured of polyester cotton blend, the masks included a filter similar to one used in a furnace. Mid concerns of whether the masks provided adequate protection. According to the CDC website, masks of this type were only used with COVID-19 patients as a last resort. MERCYONE DUBUQUE MEDICAL CENTER posted that it would no accept any of the masks until further notice. Neither the City of Dubuque nor Dubuque County Public Health Incident Management had any requests for the masks. Local businesses and individuals were asked to donate N95 masks, gowns and face shields. (18)

On March 23, 2020 the Dubuque County medical liaison officer estimated that based on CDC projections there were probably 200 unconfirmed cases of the virus in the county. This was using the confirmed count of 4 people. (19)

Although he preferred the action be taken by the governor, Mayor Buol announced on March 26, 2020 his consideration of issuing an order for residents to shelter in place due to the virus. State health officials on the previous day had announced 21 new cases, a 21% increase, which brought the state total to 145. The Iowa governor had not followed her peers in Illinois and Wisconsin by issuing an order closing all nonessential businesses, restricting all nonessential travel and urging people to stay at home. Local officials, however, had been petitioned by health officials for further action fearing the hospitals would be overwhelmed. (20)

Social distancing, a key factor in controlling the spread of the virus, was identified as a mental health threat. Regular positive interaction with friends and a sense of loss of control over one's life were important for mental health. As these were removed by government edicts, chronic loneliness increased the body's stress response and increased the risks of alcoholism, dementia, depression and high blood pressure. A 2015 review of medical literature found that social isolation increased mortality by 29%. (21)

Shutting down businesses led owners to face the lengthy and complex application procedures to receive financial assistance. To help in the situation the GREATER DUBUQUE DEVELOPMENT CORPORATION, Northeast Iowa Community College, and the local Small Business Development Center partnered to provide solutions. A help-line was established with staff members trained to understand the details of existing programs and study the new programs being developed. (22)

City officials on March 27th warned that the estimated lost revenue, estimated at $2.5 million, could complete delete the city's cash reserves. The result could be delayed hirings, canceled city projects, and a reconsideration of tax rates and fee increases for the beginning fiscal year. There was a 24% increase in virus cases on March 26th bringing the total to 179 including six in Dubuque County. This led to the announcement by Governor Kim Reynolds of additional business closings such as furniture and clothing stores and non-essential dental procedures and surgeries. The proposed vote on a new FIVE FLAGS CIVIC CENTER was postponed indefinitely. (23)

Directions explained for controlling traffic in a grocery store.

Blue-tape arrows as traffic directors.

Further efforts to prevent the spread of disease at HyVee.

As of Thursday, March 26th there were 82,000 confirmed cases of coronavirus in the United States--the most in the world. Local grocery stores, convenience stores and pharmacies remained open while adjusting to huge changes in demand. Initially shelves of toilet paper were left bare as customers hoarded it. At a Walgreens, four cases brought in overnight were sold in three hours. Hand sanitizers became so scarce that Hartig Drug began making it up in 4-gallon batches. It was not enough to stock the shelves, but could be used by employees and customers in the store. "Sneeze shields" were installed at HyVee between the cashiers and customers. Food shortages were not reported although more cooking at home resulted in increased demand for flour. (24) The ability to enter places of business varied. Happy Joes Pizza allowed customers to enter the premises to pick up their phoned-in orders while Pizza Hut posted signs asking customers to phone the store once they had arrived for a clerk to bring their order to them. Panera Bread canceled their usual delivery charges for items brought to homes or places of business. A common sight was people entering restaurants for something to eat and then consuming the product while sitting in their cars--just to have time out of the house. (25)

Using what had been observed over the past weeks in other areas of the world, tri-state hospitals and clinics began establishing procedures in the event similar conditions struck locally. Using a Facebook Live event, Dr. Bobby Koneru, medical liaison for the Dubuque County Emergency Response Team stated the region faced different conditions than those of badly struck New York City. The lack of population density, however, also meant that the number of ventilators and resources were fewer. Neither the Dubuque County Emergency Director nor Public Health Director knew how the county was supplied with ICU beds. Attempts by reporters of the Telegraph Herald for answers to create a "profile of area hospital capacity including the number of intensive care and general occupancy beds, typical occupancy, and plans for increasing bed count or staff in case of a surge went unanswered by both hospitals. A statement regarding overall preparedness from MERCYONE DUBUQUE MEDICAL CENTER read: "This includes a multi-phased approach for bed placement as the number of patients with COVID-19 increases." Officials of UNITYPOINT HEALTH-FINLEY HOSPITAL stated the hospital already had "features like airborne infection isolation rooms with negative pressure to help in situations like this pandemic and that protocols existed for staff members to be screened tested and monitored. (26) As of March 28th, there were eight cases confirmed in Dubuque County.

Not forgotten was the class of 2020 which after nearly four years of classwork and social events were left with little hope of those final activities enjoyed by others--prom and graduation. Classes had been put on hold or completed through optional home assignments. Among the feelings expressed by students interviewed by the Telegraph Herald was a realization of how easy it was to take many things--seeing friends every day, classes, and "stuff," for granted. Opportunities to at least see close friends were available through social media. Many could not understand the reaction of their peers and others who ignored health warnings like social distancing of at least six feet. For some, the constant barrage of news stories of increased death proved a cause of anxiety and they chose to limit their watching of news and "be in the moment and be present." (27)

The results of the U. S. Census were used to distribute billions of federal dollars and determine legislative districts among other things. The best laid plans of local officials concerning getting census forms turned in were completely disrupted. Plans had been made to set up and staff three kiosks around town to help residents with the forms. Included in the staff were individuals who spoke Spanish and Marshallese. Census bureau representatives were also scheduled to attend local community events. The cancellation of events, social distancing calling for a space of at least six feet between people, and a statewide ban on gatherings of more than ten people undid all these ideas. In reaction, census bureau officials extended the period for people to respond by two weeks and continued efforts to count the local homeless population. Work to place print and broadcast advertisements were continued. (28)

Dubuque County public health and medical leaders on March 30th announced plans to prepare for a surge in COVID-19 cases they expected in two weeks. This was expected to be the first peak and not necessarily the last. Dubuque as of March 30th was tied for the fourth-highest (21) number of cases. Unity Point Health officials would be able to quickly increase capacity by doubling patient room occupancy and converting ambulatory into patient care space. MercyOne officials also planned to double the capacity of patient rooms. Grand River Medical Group was having its nurses call every patient to administer a COVID-19 questionnaire before arrival. They were also isolating patients with similar symptoms to those of COVID-19. Officials with MEDICAL ASSOCIATES CLINIC PC (THE) said traffic patterns were being redesigned to screen patients before they entered the clinics. Temporary office space was moved into parking lots so that patients could be inspected for symptoms. All agencies agreed that they would work together. (29)

On March 31st, following the identification of an employee testing positive for COVID-19, the entire operations of the JOHN DEERE DUBUQUE WORKS was closed down for a "thorough disinfection. Company officials stated that the disinfection would "meet or exceed local and state health-department guidance including third party industrial hygiene assessments." Deere was considered "essential" by the U. S. Department of Homeland Security and production was to resume on a staggered course over the next several weeks. (30)

With many people at home, either alone or with their family, the DUBUQUE REGIONAL HUMANE SOCIETY was encouraging pet adoptions by lowering adoption fees, increasing efforts to divert new admissions, and encouraging community members to open their homes for fostering. With no evidence that pets spread the COVID-19 disease, humane society officials were anxious to get their animals out of cages and into homes where they could bring some companionship to those in quarantine. (31)

Concentrated populations posed serious health risks. Outbreaks in places like jails could be serious. To avoid what could have important health consequences, local officials were doing what they could to lower the number of people incarcerated. This involved cooperation between the county attorney, jail staff, local defense attorneys and local judges. Some inmates received reduced sentences while other were released with monitoring devices. Small bonds were replaced with unsecured appearance bonds. On March 1st, there were 186 inmates in jail. On April 1st there were 127 of which ten were serving sentences with the rest awaiting court hearings or being held on out-of-state warrants. (32)

The concern about the effects of long-term isolation led to many interventions. Daily calls among friends became common. For-profit internet sites offering e-cards for most occasions saw an increase in business. For an annual fee, an unlimited number of cards could easily be sent utilizing email address lists pre-established by the customer. With better weather, outdoor visits to shut-ins at nursing homes increased. By standing or sitting outside an opened window, conversations could easily be handled. Organized groups like Take Off Pounds Sensitively (TOPS) had callers who reached out to members to chat.

As of April 4th, Iowa was one of only eight states (all with Republican governors) which had not issued "stay in place" orders. These would limit people's movements to necessary driving to groceries, pharmacies, or doctors' appointments. People could continue to take walks in their neighborhoods keeping in mind social distancing. Issues nationwide had been raised whether the government could restrict such meetings as religious services.

AIRPORT officials during the week ending April 4th, reduced the number of daily flights from three to two. The reduced schedule was to remain in place through April. In May the airport would reduce its schedule to one flight per day. Comparisons to the days following the terrorist attacks on September 11, 2001 were made as to the effect on the aviation industry. In that instance it took the industry nine months to return to normal. (33)

The governor announced during the first week of April that public school district had three options from which to choose to provide educational opportunities for their students. Districts could require their students to participate in online educational services; provide online optional enrichment opportunities; or offer no continuous learning between April 10th and April 30th. Continuous learning would offer students a choice whether to participate and no grades or credit would be given. The district could also offer required educational services in which students had to participate with attendance taken and grades given. If districts chose not to offer continuous learning they would need to make up educational hours missed between April 10th and 30th. Dubuque officials announced their plans to begin "pretty significant voluntary options" starting on April 8th. These would include teacher-produced videos and lessons focused on key areas. Questions existed as to how to serve students receiving special education services and those who spoke English as a second language. There was also a concern about whether students had internet access at home. (34)

The city received nearly $650,000 in federal grant funding through the COVID Recovery Community Development Block Grant program which was tied to the the Coronavirus Aid, Relief, and Economic Security Act of 2020, a $2.2 trillion dollar emergency bill passed by Congress to respond to the pandemic and its impacts. (35) On April 22, 2020 it was announced that members of the Community Development Advisory Commission had voted unanimously to recommend that funds from this grant which in part was to help workers laid off pay rent and utilities be used to provide high-speed internet access to low-income households with students to support online learning. Areas affected lay along the BEE BRANCH, COMISKEY PARK and other low-to moderate-income areas where school officials saw the greatest need for access. The city partnered with ImOn Communications to construct wireless access in the greater downtown and below the bluffs. The company also added a location for free Wi-Fi access downtown. (36)

FLEXSTEEL INDUSTRIES, INC., impacted by the virus, laid off forty people during the first week of April. Those affected were in sales, customer service, or other corporate functions. All worked at the company headquarters and were expected to be laid off three months. In March, the company shut down its plant on Seippel Road for two weeks. In connection with the construction of the $25 million plant, the company had received $2 million in state incentives and the City had committed to ten years of tax-increment financing. Since these incentives were tied to the number of employees on the Seippel Road facility, the headquarters reductions did the affect those agreements. (37)

Between Friday, April 3 and Saturday, April 4th the number of virus cases reported in Iowa rose 12% to reach a total of 786. This included two new cases in Dubuque County bringing its total of 24. (38) Each county was responsible for tracking the prior movement of those confirmed to have the virus. In Dubuque County, that responsibility belonged to the DUBUQUE VISITING NURSE ASSOCIATION. The VNA staff interviewed patients, physicians, and the labs where positive tests were processed.

When a laboratory found a positive result, it notified the facility that conducted the test. The facility contacted the patient and the VNA. Immediately a case investigation was formed of basic information including:

                      a) if the person lived in a long-term care or correctional facility,
                      b) if the person was homeless,
                      c) where the person was in the course of the disease,
                      d) where the person was believed to have been exposed,
                      e) if the person had recently traveled
                      f) if close contacts had symptoms or were diagnosed

The VNA staff provided isolation guidance, reviewed symptoms with the patient, and followed their progress daily. The VNA had over twenty years experience as the communicable disease tracer for Dubuque County. (39)

By April 9, 2020 the employees of DUBUQUE MATTRESS COMPANY had manufactured and distributed more than 10,000 masks. These were not intended to be used by health care workers dealing directly with COVID-19 patients. They could offer some protection to first responders and individuals. Doug Dolter, owner of the business, decided to shift the manufacturing of the company from mattresses to masks in March following state mandates to practice social distancing. He also understood that many area fire departments lacked an adequate supply. Assisting Dolter was Joann Fabrics which donated 200 yards of material and the members of the nonprofit Key City Creative Center which undertook the job of cutting the filter that went into the masks. In addition to cutting filters they cut straps for the masks and sewing. When the federal Centers for Disease Control and Prevention revised their early recommendations and encouraged the wearing of masks even more help was needed. Dolter found an estimated thirty local residents willing to sew the masks in their homes and return them to his business. First priority for masks was given to fire departments and nursing homes. Individuals could pick up masks at Dubuque Mattress Company for free with the option of donating funds if they wished. (40)

As individual federal relief checks began being mailed around April 11th, more than a dozen eastern Iowa businesses received the initial grant funding to help them financially. The Iowa Economic Development Authority awarded a maximum of $25,000 per recipient. The Iowa Small Business Relief Program offered financial assistance to offset revenue lost due to closures or declines in business. Primary consideration was given to those industries who had to close earliest. Four rounds of grant recipients were announced during the week ending on April 12th. A second pool of grant funding would soon be available however recipients would be chosen fro earlier applications and no new applications were being accepted. A total of 14,000 businesses applied seeking a total of $148 million, however, the state only had $24 million available. (41)

The sudden influx of at-home workers and students placed tremendous pressure on internet providers. At work, employees communicated over either able or a private circuit. The questions became how much spare capacity did the circuit have and did employees at home have the needed bandwidth and speeds to support their work. Estimates of the number of people likely to have problems were as high as 20%. In reality, it was found that only a small number of people were negatively affected. These people usually lived in remote, rural areas which was expected. An estimated 22% of rural residents in Iowa lacked access to high-speed internet. Efforts to reduce this in Iowa included $1.3 million awarded in 2018 to reduce or eliminate areas in the state unserved or underserved by broadband service. This funding increased to $5 million in 2019. (42)

City officials in Dubuque accelerated broadband access with fiber to homes and businesses. Using agreements with providers, city conduit was used to reach new customers at a lower cost. Between 2017 and 2020, the city quadrupled the amount of active fiber for broadband. From 2015 to 2020, the city went from two legacy carriers and one wireless carrier to ten active carriers. (43)

Installing fiber networks into urban and rocky areas was very expensive. An agreement between the city and the Wisconsin Independent Network LLC in 2017 allowed city conduit to be used to extend fiber optics from the JULIEN DUBUQUE BRIDGE to near UnityPoint Health-Finley Hospital. Through the agreement, 100-megabit speeds--five times faster than the city was receiving were available along with the ability to double the bandwidth every three years. Federal block grants were being considered to accelerate broadband access to low-income households with students. The use of "hotspots" would allow students to 'take the internet home with them.' Mediacom opened 19 hotspots for public use near the PORT OF DUBUQUE and sites downtown for free of sixty days beginning on March 16th. Mediacom offered free 60-day service to low-income families with students in K-12 who were eligible for free- or reduced-price lunches who signed up and connected by May 15. The installation of community Wi-Fi would give students several choices for public access. (44)

On April 12, 2020 officials of DUBUQUE INITIATIVES announced that the nonprofit would make up to $2 million available for small businesses affected by the virus. "Bridge financing" of up to $10,000 would be available per business that employed fifty or fewer workers. Qualifying businesses would be referred to the East Central Intergovernmental Association which would assist them in the application process. The funding would assist companies which had been approve for other governmental funding to weather the time between the acceptance of their application and the actual receipt of funds. (45)

On April 11, 2020 there were 1,510 confirmed cases of the virus in Iowa with 32 in Dubuque County. (46)

Testing individuals for the COVID-19 virus was in the news on April 14th. A committee including representatives of each Dubuque County hospital and clinic together with public health, city and state officials began meeting as a committee on March 16 to develop a plan if an expected surge in cases exceeded local capacity to test people. Sites were developed all over the county in various ways. The committee chose a Dubuque parking garage for a local site if the service was needed.

The testing had strict guidelines. An individual would need to call a health care provider who would determine if testing was appropriate. The site would only be opened in the event of a surge so that hospitals and clinics could avoid exposure to other patients at clinics and emergency rooms. The site could be up and running in 72 hours. To increase the likelihood that a surge could be predicted ahead of that, health care providers were developing a reporting system (see: DUBUQUE VISITING NURSE ASSOCIATION. (47)

Reporting on the pandemic was the subject of an editorial on April 14th. Amy GILLIGAN, executive editor, reported that use of the TH website had soared from 177,361 in February to 522,206 users in March. Article views nearly doubled, exceeding two million for the first time. In addition, the core group of eight news reporters plus an additional half-dozen other writers wrote more than 600 local stories. To facilitate getting the news to its readers, the TH officials decided to place any story dealing with public health, safety, security and supply chain as well as cancellations and closures in the front of the paper, before the paid section, for everyone to read.

Getting the news to the public, despite recurrent rumors circulated in social media, that most people were really not at risk, came at a huge cost. Subscriptions did not pay the cost of publishing the paper. With businesses closed down, advertising dried up leading to staff reductions, permanent pay cuts, and possible failures of some papers. Gannett, publisher of the Des Moines Register, suspended its dividend and required those making at least $38,000 annually to take an unpaid furlough for a week in April, May and June. (48)

From March 19 through April 19, Dubuque County saw its confirmed cases of COVID-19 cases rise from 1 to 43 with 1 death amid sweeping efforts to protect hospitals from being overwhelmed. Iowa experienced, by April 19th, 2,513 confirmed cases and 74 deaths; 29,160 confirmed cases and 1,259 cases in Illinois; and 4,199 cases and 211 deaths in Wisconsin. (Note: The following day, Iowa reported 389 new cases approximately double the previous high for a one day report. Of these, 261 were attributed to testing in meat processing facilities. (49) Among the measures taken to slow the spread of the disease was the closure of schools in Iowa for the rest of the academic year, closure of all non-essential businesses, and mandated social distancing measures designed to keep people at least six feet apart. Some grocery stores instituted 7:00-8:00 a.m. as reserved times for shopping for the elderly and the production of home-made masks soared. States were left to bid against each other and the federal government for supplies as state governors came under increased pressure by the President of the United States to ease their restrictions as he once declared himself to have the 'complete authority' to decide when business would resume across the United States. This assertion was quickly backpedaled as governors and presidential aides quickly responded this was not the law. (50)

Local, state and federal assistance was directed at helping small business and families. The $2.2 trillion federal assistance bill, named the CARES ACT, gave $1,200 to qualified individuals. Some families received checks for multiple workers and families with children received an additional $500 per child under 17. If the pandemic was long-lasting, additional checks were possible according to U. S. Senator Charles Grassley. Small businesses were aided by multiple programs including the Paycheck Protection Program and the Economic Injury Disaster loan program. Iowa's Small Business Relief Program offered $24 million in assistance, but was quickly exhausted. Officials of the GREATER DUBUQUE DEVELOPMENT CORPORATION announced that 350 Dubuque County businesses had applied for assistance but did not receive it. (51)

COVID-19 had enormous impact on the medical community. While a patient in intensive care usually remained there for up to four days, the normal COVID-19 patient remained fifteen days. The need for heavy sedation led to a lack of critical sedatives in some of the nation's medical institutions. New techniques were learned including "proning," placing a patient on his or her stomach for lengthy periods of time to improve air movement in the lungs. Physicians also became aware of the rapid descent of patient's health with the disease. Many patients required oxygen and finally intubation within hours of being admitted to the hospital. Nationally a lack of PPE, personal protective equipment, left physicians without sufficient supplies of masks and gowns when dealing with patients. Fear of bringing the virus home to their families caused some professionals to self-quarantine themselves from their families. (52)

Long-term care facilities in the future were likely to see new procedures being mandated as a result of the virus epidemic. Nearly half of all deaths in Iowa were linked to infections at nursing homes. While, as of April 19th, Dubuque County had not seen news of outbreaks of the virus in these institutions, the news from other counties was far worse. There had been ten COVID-19 outbreaks across the state.

                         County         Outbreaks           Cases
                  
                        Bremer              1                 21
     
                        Linn                2                123

                        Muscatine           2                 25

                        Polk                3                 61

                        Tama                1                 49

                        Washington          1                 24

Patients at long-care facilities were there because of their advanced age and often serious health conditions making them more vulnerable. Since the fear of bringing the virus into these facilities has been the primary concern, the Iowa Department of Inspections and Appeals Health Facilities Division suspended all but certain inspections. Nursing homes were prohibited from discharging residents for nonpayment during the crisis. The governor ordered all hospitals and nursing homes to begin intensive screening for employees and any new admissions were placed in isolation for two weeks. Complete lockdown of the facilities resulted in family members being unable to visit. To ensure that sufficient PPE was available, Governor Reynolds issued an order restricting who at health care facilities should use PPE materials and guidelines for making supplied last longer--including provisions for safe reuse. (53)

In April, Flexsteel announced 58 additional layoffs with unknown affects on the agreements mentioned previously in this entry. (54)

In February, Dubuque County had an unemployment rate of only 3.4% and recorded 60,300 jobs. By March the volume of new unemployment claims had spiked by an estimated 13 percentage points. Nationally about 22 million Americans had sought 22 million Americans jobless benefits in that month--the worst period of U. S. job losses on record. (55) According to a report from the University of Northern Iowa, over 85% of Dubuque County businesses were negatively impacted by the virus with 60% forced to use some form of employee restrictions. Data for the study was gathered from March 17th through 23rd. Dubuque County businesses were seeing a 52% decline in revenue. (56)

After receiving the $650,000 grant (see above), the city returned the $330,000 it had reallocated back to the rehab of rental units, housing inspections, road work and ash tree removal in low-income neighborhoods. With the new funding the Community Development Advisory Commission recommended the city provide: (57)

                    a. $180,000 for temporary shelter, if needed, to quarantine homeless
                       people or families doubled up in a home,

                    b. $100,000 to install community Wi-Fi to support online learning in
                       low- and moderate-income areas,

                    c. $20,000 for up to three months assistance per family to pay rent
                       and utilities,

                    d. $72,000 in grants to nonprofits providing assistance to families
                       affected by the pandemic including potential for additional
                       funding to provide no-cost, grab-and-go sack lunches for children

                    e. $104,146 to support staff and operations of city recreation programs
                       to potentially open later in the summer

                    f. $41,695 as funding of last resort for a drive-thru COVID-19 diagnostic
                       testing facility

                    g. $129,460 for administration of the funds and activities

On April 21st, the state of Iowa reported 3,159 confirmed cases. This included the record high number of cases (389) on April 19th and the second highest number (257) on April 20th. Dubuque County had 46. The number of deaths as of April 20th in Iowa was 79. The increasing number of deaths by April 17th had led Governor Reynolds to link Dubuque County with others in a 14-county region. Residents of this region were ordered to stay home for everything but work and essential errands. Exceptions could be made for occurrences like weddings and funerals, but only ten or fewer visitors could be present. (58)

On April 21st Governor Reynolds announced that $26 million would be directed online screening and developing drive-through testing sites. TestIowa.com was a website to help assess and direct those needing it toward testing. All Iowans were encouraged to go to the site and complete the five-minute online assessment. An editorial in the Telegraph Herald also suggested that school administrators should look at starting school earlier and lengthening the school year in 2021 to make up for time lost this year (59)

City officials announced on April 23, 2020 that unfilled public safety positions, canceled city projects and "stagnant" wages would be common as the city estimated a $16 million loss in revenue in combined 2020 and 2021 fiscal years. A month previously, officials had estimated a loss of $2.5 million. In the previous four weeks, more than 210,000 jobless benefit claims had been filed including a record 67,344 in the first week of April. That soared above the 64,600 jobless claims filed from May 2008 to January 2010 during the height of the last recession. (60)

On Saturday, April 25th the State of Iowa, for the fourth time in a week, reported a record number of COVID-19 cases. A total of 648 new cases with eight new cases in Dubuque County brought the state-wide total to 5,092 conformed cases and a total of 112 deaths. Governor Reynolds stated that the number of confirmed cases was likely to continue to grow as her testing initiative, Test Iowa, expanded the number of people who could be evaluated. Dubuque County had reached a total of 70 confirmed cases. (61)

Despite growing numbers of confirmed cases, Governor Reynolds announced "we must learn to live with COVID virus activity without letting it govern our lives" prior to announcing her decision to allow some businesses in 77 of Iowa's 99 counties permission to operate again, with some limitations, starting May 1st. The counties that could partially reopen either had no confirmed coronavirus activity or have seen a downward trend in positive COVID-19 cases over the past 14 days. The Republican governor also lifted statewide restrictions on spiritual and religious gatherings that had been in place since March 17, as long those institutions followed social distancing guidelines and sanitized gathering spaces.

Among the businesses that could operate in those 77 counties:

                 Restaurants could open at 50% of their normal operating capacity, 
                 could not seat more than six people at a table, and all tables had 
                 to be at least six feet apart. Restaurants could not have buffets 
                 or other self-serve items.

                 Malls, fitness centers, libraries and retail stores could open at 
                 50% of their legal occupancy capacity, which was determined by fire 
                 code. Mall operators had to keep play areas and other common seating 
                 areas, such as food courts, closed.

                 Race tracks, other than those conducting horse or dog races, could 
                 reopen as long as they did not permit spectators.

                 Social, community, recreational and leisure sporting events were limited 
                 to 10 people or fewer.

The governor also eased some of her restrictions. Effective May 1st, Reynolds lifted Iowa’s ban on nonessential surgeries and allowed farmers' markets to open again. Other businesses would remain closed through May 15 — two weeks after the governor's initial emergency proclamation closing businesses was set to expire.

Reynolds said she was moving from an "aggressive mitigation strategy" to a focus on targeted containment so Iowa could begin to resume its economy. She acknowledged COVID-19, the respiratory illness caused by the virus, was likely to be in the state until a vaccine is developed.

Some states had begun lifting restrictions put in place to slow the spread of the virus. Conservative activists organized anti-quarantine protests at several state capitols, even though national polling showed a majority of Americans opposed lifting restrictions too quickly for fear the pandemic could worsen. Reynolds noted that most of the state's cases were in a handful of counties, and did not allow those counties to reopen. They included the state's largest — Polk — as well as counties with virus outbreaks including Black Hawk, Louisa, Linn, Tama, Johnson, Allamakee, Benton, Bremer, Dallas, Des Moines, Dubuque, Fayette, Henry; Iowa; Jasper; Marshall; Muscatine; Poweshiek; Scott; Washington and Woodbury. (62)

Medical officials advised caution. Dr. Hans House, professor of emergency medicine at the University of Iowa Hospitals and Clinics, said he thought it was too soon to reopen any part of the state, urging the governor to instead wait for "a stable case count." "I would like to see a decline in cases before we restart most interactions and reopen businesses like restaurants," he said. "We are still very much on the upswing. Iowa officials expect the state's positive cases of coronavirus to peak in the next few weeks, meaning more patients will be using medical resources such as hospital beds and ventilators. Having people interact too soon and potentially spread the virus may overwhelm Iowa's health systems." House said.

In a statement, the Iowa Medical Society, the state's largest professional organization for physicians, sounded a similar note of caution, saying Iowans need to continue limiting travel outside the home and following health guidelines to ensure that increased social interaction doesn't "overwhelm" the health system.

                  A sudden influx in social interactions is all but certain to cause 
                  a spike in new COVID-19 patients and potentially overwhelm our 
                  healthcare system. No area of our state is immune from these concerns. 
                  Until an effective treatment protocol is identified or a vaccine is 
                  discovered, we must accept that we will not be able to return to the 
                  normal routines we enjoyed just a few months ago. (63)

On April 29, 2020 members of the city council voted 7-0 to approve amended collective bargaining agreements with labor unions representing police, fire, public works and transit personnel. Because of the current and projected financial impact of the pandemic on the city, each of the unions' memberships had voted to ratify the new agreements which rescinded the previously negotiated 1.5% increases. The city agreed to increase the pay increases scheduled in 2022 from 1.75% to 3%. The renegotiated agreements resulted in $730,934 for the fiscal year beginning July 1st. All city staff, not just those in bargaining agreements, gave up their pay increases. City leaders were estimating a $16 million financial loss in 2020 and 2021. As of April 30, 2020 top city staff had not agreed to any pay cuts. (64) In response to an e-mail sent to Councilman Danny Sprank, the following response was made: "To answer your question every city employee is going to have pay freeze. No one is getting a raise this year. This does include city staff making over 100K and elected officials." (65)

Officials of the GREATER DUBUQUE DEVELOPMENT CORPORATION estimated using unemployment claims filed with the State of Iowa at the first of May that unemployment in the county had reached nearly 21%. In February that same indicator had stood at 3.4%. Since March 15th there had been nearly 9,800 unemployment claims filed in the county. (66)

Unemployment was not felt as much by the 'gig-economy,' a term used to describe jobs entered into usually to get just extra income. Food delivery, available even through grocery stores, thrived and hot meals were delivered to residents in isolation or self-imposed separation. The employment of drivers was also a positive for restaurants or businesses in need of business. EatStreet, a local delivery service, saw orders double from mid-March to the end of April. The number of employees entering menu data into its system quadrupled. In response, the number of drivers grew from 30 to 50. The number of restaurants working with Eat Street grew from 59 to 84. Some gig-economy businesses like Airbnb in which homeowners rented out spare rooms or ride-sharing businesses witnessed a sharp decline in business. They joined other businesses in appealing for lawmakers to create a safety net for those employed in the 'gig-economy.' The passage of the CARES Act, a $2.2 trillion federal stimulus package, allowed independent contractors to apply for unemployment benefits, the first time in U. S. history such a benefit was extended to such workers. (67)

The pandemic brought many changes to policing in Dubuque. Concern of a potential outbreak among inmates led to measures that after arrest and booking led many to be released pending trial. Those arrested on warrants for failure to appear in court for misdemeanor crimes including traffic violations were released after arranging to turn themselves in after the heal crisis lessened. Enforcement officers in the county were advised to issue citations or court summons instead of arrest and detention for nonviolent misdemeanors such as operating a vehicle while intoxicated or simple drug possession. Calls of police service, traffic stops and inmate encounters dropped significantly during the three months ending in May. The jail population was the lowest it had been since 2006. (68)

Telehealth appointments in Dubuque were virtually non-existent prior to the onset of the virus. In an implemention that would usually take from three-to-six-months, MEDICAL ASSOCIATES CLINIC PC (THE) with the direction of Dr. Brian Sullivan in a matter of days established a practice by which 80% of all clinic appointments were done through telehealth. By the middle of May when restrictions began to ease, in-person appointments increased, but telehealth still involved 25% of all visits. Between mid-March and June 20th, the Clinic staff had conducted more than 15,000 such appointments.

The advantages of telehealth appointments made it an option that was likely to last. Patients in acute care and emergency could be seen by a physician within five minutes. Such appointments also removed the inconvenience of travel during bad weather and reduced the number of people going in and out of hospitals and nursing facilities. (69)

College officials wrestled with the problem of making refunds for board and room to students who had left campus as classes moved online and now to distribute federal funds available through the Coronavirus Aid, Relief, and Economic Security Act (CARES). Officials of area colleges chose to offer refunds for shortened stays in residence halls. Students with meal plans were also getting a portion of those payments refunded by the college. Schools eligible to receive CARES funding were required to distribute at least half of what they received for emergency aid grants for students. (70)

On May 8th the figures were:

Dubuque County (confirmed cases 175) Deaths-4 (71)

                Child (0-17)---------------2%

                Adult (18-40)-------------41%

                Middle Adult (41-60)------37%

                Older Adult (61-80)-------14%

                Elderly (81--  )---------- 5%

Iowa (confirmed cases 11,457) Deaths-231

United States (confirmed cases 1,265,541) Deaths-78,185

United States unemployment rate reaches 14.7%

Retail stores in 22 counties including Dubuque reopened on May 8th with capacity restrictions. Relaxed rules also applied to dental offices and fitness centers. This was despite the governor's own admission that these counties had been experiencing high or rising numbers of confirmed cases. One week earlier, the remaining 77 counties had been allowed the relaxed rules because the number of cases were either extremely low or were declining. On March 26 when the governor announced the closing of nonessential businesses across the state fewer than 10 CVID-19 had been confirmed in Dubuque County. On May 7th officials announced 13 more confirmed cases in Dubuque County bring the number of 175. One week earlier there were 102 cases--a 70% increase in seven days. (72)

On May 6-8, an estimated 1,000 selected Dubuque County residents, primarily residents and staff of long-term care facilities and individuals identified through contact tracing as having possible exposure to positive COVID-19 patients were scheduled for COVID-19 testing. The testing was done at no cost to those being tested. This marked the largest wave of testing to-date in the county. The testing was sparked by the first outbreak of the virus at Dubuque Specialty Care, a long-term care facility in Dubuque County the previous week. In that incident, three residents and one employee tested positive. Prior to the outbreak, a state COVID-19 strike team had been requested for Dubuque County. When the request was denied, local officials requested a Test Iowa testing site be established in the county and if this was not possible that local care providers be able to test and send collected samples to a Test Iowa site.

Local officials were denied the testing site or the authority to test those individuals who were qualified by way of the online assessment. The testing done on May 6-8 was a "standalone" program of Dubuque County not associated with Test Iowa or the state strike teams. The Iowa Department of Public Health, however, paid for the testing. Estimates ranged from a 48-to-72 hour wait for the test results. (73)

As of May 11, 2020 the United States recorded over 80,000 deaths, an increase of 8,757 due to COVID-19 and stood as the nation with the highest number of deaths. Iowa recorded 12,373 an increase, of 414; and Dubuque County had 197, an increase of 6. Locally it was announced that efforts to revitalize Central Avenue would likely be put on hold as the city prepared for a projected $16.3 million financial loss this fiscal year and next. City council members would be asked on May 18 to cancel or defer $12.3 million in spending budgeted in the current fiscal year ending June 30th. (74) Dubuque's homeless shelters had not experienced an increase in demand. Fears, however, were that this would change dramatically when Governor Reynolds' moratorium on evictions and home foreclosures expired on May 28th. (75)

By May, 2020 it was discovered that one of the groups hardest hit numerically by the virus was the MARSHALLESE. While Asia or Pacific Island immigrants made up only 2.8% of Iowa's population they accounted for 8.8% of confirmed COVID-19 cases statewide. Local public health officials could not legally confirm or deny reports of an outsized outbreak among the Marshallese. Dr. Heather Kruse, medical director of CRESCENT COMMUNITY HEALTH CENTER, said a possible cause for increased susceptibility in this group was the prevalence of chronic health conditions including diabetes and hypertension. A barrier to better health was that those eligible for Medicaid based on income were ineligible because of their immigration status. To offer some remedy to the situation Dr. Mark James established a GoFundMe account to with a listed goal of $1 million. The COMMUNITY FOUNDATION OF GREATER DUBUQUE also established a fund focused on health service to Dubuque's Marshallese community. (76)

UNITYPOINT HEALTH-FINLEY HOSPITAL officials announced on May 11, 2020 that testing of COVID-19 asymptomatic patients admitted to its hospitals had begun. The testing applied to "admissions and transfers of all ages who have not been tested for COVID-19 in the prior 48 to 72 hours. Testing was done with a nasal swab with the waiting time for screening results of inpatients showing no symptoms being from 12 to 72 hours. The testing was done to "protect health care workers and prevent further spread of COVID-19 in our communities." (77)

On May 13th, Dubuque County officials announced six additional conformed cases of COVID-19 resulting in the total number to 203. Dubuque Specialty Care, the only long-term care facility in Dubuque County confirmed to have a COVID-19 outbreak (defined as three cases), remained static at 18. (78) By May 19th, however, this number had soared to 40 residents and 9 employees. The state website for the first time on May 19th listed the number of people diagnosed with the virus in long-term care facilities who had recovered. The state report indicated 10 such cases at Dubuque Specialty Care. State records and the website for Care Initiatives, the parent company of the Dubuque facility, indicated three other Care Initiatives facilities in which outbreaks had occurred. (79)

Following the lead of other states, Iowa began a slow re-opening of business. FARMERS' MARKET was scheduled to be opened on May 16th. Everyone including vendors and customers was to wear a mask and no food would be available for on-site consumption. Vendors were required to wear gloves. Those over 65 years of age with a compromised immune system was asked to pre-order and to work with a vendor for contactless pickup or delivery. Market entrances were restricted to 10th and Iowa and 13th and Iowa. A capacity crowd would be established based on the number of vendors. Those attending the market were asked to come alone and to wash their hands once they arrived. Browsing time was to be limited. (80)

On May 18, 2020 the city council voted unanimously to cancel or defer $12.3 million in spending from the budget in anticipation of the financial fallout from the pandemic. This would be accomplished by savings from completed or canceled projects and reductions in department operating budgets. (81)

Governor Reynolds announced on May 20th that theaters, museums, and pools could resume operations on May 22nd. In Dubuque, bars and other establishments serving alcohol that had been limited to carryout and delivery service would be permitted to reopen their indoor and outdoor spaces on May 28th. Like restaurants, these business would be limited to 50% capacity. (82)

On May 22, 2020 the announcement was made that Leisure Services' adult summer sports programs had been canceled. Organizers of the leagues were unable to guarantee the safety of participants and staff from virus infection given the near impossibility of maintaining social distancing. (83) On May 23rd, Dubuque County had recorded 307 confirmed cases (an increase of 7), 16 deaths, 145 recovered, and 4,115 residents tested. The Dubuque County Public Health Incident Management Team coordinated additional targeted testing during the week. DUBUQUE VISITING NURSE ASSOCIATION members collected test samples from approximately 575 individuals at the VNA and 300 samples from local congregate living facilities. (84)

Days at home led many Dubuque residents to resume old renovation projects or begin new activities. This resulted in a surge of garbage delivered to the DUBUQUE METROPOLITAN LANDFILL. Residential trash disposal increased by 8.6% compared to the previous year. Lines of thirty-cars were reported. (85) As of Sunday, May 24th, Dubuque County officials reported 319 confirmed cases (an increase of 10), 16 deaths, 146 recovered, and 4,425 people tested. (86)

Governor Reynolds announced on May 26, 2020 that casinos, bowling alleys and playgrounds would be allowed to reopen on June 1, 2020. Restrictions continued that stated these sites would be limited to 50% of their capacity to comply with state social distancing, hygiene, and public health requirements. She also lifted a moratorium on evictions and foreclosures and allowed gatherings of more than ten people to resume. The continued reopening occurred as COVID-19 deaths in Iowa increased to 478 including a one-day record of 26 announced on Saturday. Iowa's 17,703 cases placed it at the position of 12th highest per capita in the nation. (87) On May 27th, the United States surpassed 100,000 deaths from the virus. (88)

By Saturday, May 30th, Dubuque County had 345 confirmed cases of the virus making the county the 14th highest in the state. The number of deaths remained at 18 and 173 people recovered from the disease. Dubuque Specialty Care remained the only long-term care facility in the county which reported more than three confirmed cases. (89)

School district leaders, faced with the possibility of a second wave of the virus in the winter and aware many students were ill-equipped for distance learning, announced on June 6th the purchase of nearly 2,000 laptops and tablets. The $571,000 purchase was to ensure that every student from prekindergarten through 12th grade would receive a device if schools were again to be closed. In that instance, every pre-kindergartener through first grade students would receive a tablet. Second through fifth graders would receive laptops. Sixth through twelfth grade student already had sufficient laptops. If students were able to attend school in the fall, the technology would be used in the classroom. (90)

A virtual meeting of the Dubuque Human Rights Commission on June 8th dealt with recent protests following the killing of George Floyd on May 25th by a Minneapolis, Minnesota police officer. Commission chairman Anthony Allen who was also the president of the Dubuque chapter of the NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE (N.A.A.C.P.) expressed his pride in the nature of the local protests in peaceful marches and demonstrations. He also called for attention to the potential of the pandemic to worsen issues related to education, housing, and employment. The weakened economy and increased unemployment could result in higher numbers of evictions. (91)

Unsuspected victims of the pandemic in 2020 could prove to be the students' favorite winter experience--snow days when school was cancelled or "heat" days when temperatures soar. Equipping schools and students with sufficient technology in the case schools might be closed again in the fall of 2020-2021 led to the consideration that schools could remain "open" in the case of snow. Students supplied with computers could work at home as they did during the virus. Implementing such change would require changed in state law. (92)

Hopes that at least one major summer activity could be salvaged were dashed on June 15th when the city council voted 6-1 to keep the municipal pools closed for the remainder of the year. State officials had announced pools could reopen if social distancing, increased hygiene practices, and other health measures were followed. City officials stated that if the pools did open, attendance would have been limited to 150 people at a time at Flora Pool and 100 at a time at Sutton. In normal conditions, attendance at the two pools combined could exceed 1,800. Equipment including waterslides, high dives, lockers and play equipment would also have been closed. Lounge chairs and picnic tables would have been removed. It was considered impossible to enforce social distancing. (93)

The impact of the pandemic caused Boyd Gambling Corporation, the parent company of DIAMOND JO CASINO to announce in mid-June that between 25% to 60% of the employees at the casino would be laid off during July. Based on employment figures of 450 workers, this indicated between 112 to 270 employees could be permanently laid off. Correspondence with the city indicated 292 could be affected. The current furlough for those not laid off was expected to last longer that six months from the date it began. (94)

One service seeing a major increase in business was offered by the DUBUQUE REGIONAL HUMANE SOCIETY. Pet adoptions soared nationwide since March and continue strong into June. The prospects of being home for a long period of time was considered one the major reasons for the increase in adopting pets. Being home offered time to train a pet into a routine. Many people also found a pet to be an emotional support. The Dubuque facility also followed the nation-wide practice of moving many animals into foster homes prior to their adoption, a practice being considered by some agencies to become permanent after the health issue subsided. (95)

On June 16th, Dubuque County reported three new cases bringing the number up to 387--the 15th highest in the state. There was an additional death bringing the total to 22--the eighth highest in the state. (96)

Despite the assertion by President Trump that he had advised his administration to "slow down" the amount of testing so ensure the number of confirmed cases would decline, Governor Reynolds announced on June 18th that a Test Iowa Clinic would be opened in Dubuque. To be located at Epic Health and Wellness at 1075 Cedar Cross Road, the center's staff would collect samples free of charge from Monday through Thursday from 8:00 a.m. to 5:00 p.m. and 8:00 a.m. until 1:00 p.m. Friday the following week. As of June 18th there were 397 confirmed cases of COVID-19 in Dubuque County--the 15th highest total in the state.

People interested in being tested would fill out an assessment at testiowa.com to receive an identification number. They would then all the clinic and schedule an appointment. Upon arrival at the clinic, people would remain in their vehicles to receive a nasal swab from a clinic staff member. The State of Iowa provided all supplies for the tests. (97)

At a political rally in Arizona during the third week of June, 2020 President Trump declared that the virus was "going away." Such a statement seemed strange given the sharp increase in cases in Florida, Texas, Oklahoma and Arizona. His closing of thirteen COVID-19 testing stations including six in Texas the same week seemed more in line with his statement that he had told administrators to "slow down testing" claiming that the identification of new cases only made the news worse. (98)

In Dubuque, six additional cases of the virus were confirm between Tuesday, June 23rd and Wednesday June 24th bringing the total to 460 cases. The increase was a dramatic drop from the 35 new cases in the reported previous 24 hours. VNA nurses reported an increase in the number of young adults affected by the disease. Statewide, Iowa reported an additional 341 cases between Tuesday and Wednesday. (99)

During the third week of June, the State of Iowa announced that the COVID-19 virus had caused unemployment in Dubuque County to soar to 12.2% in May. This was compared to May of 2019 when the unemployment figure was 2.1% (100)

Dubuque registered eighteen new cases of the virus between June 23rd and 24th pushing the total to 478. (101) On Sunday, June 28th there were only two states in the nation not showing an increase in confirmed cases. (102)

In an announcement that made national news, Iowa education officials released guidelines on June 25th that allowed schools to reopen to normal activities as of July 1 without requiring that students and teachers undergo health checks, wear face coverings or observe social distancing in schools. Jean Hessburg, a spokeswoman for the Iowa State Education Association, the state’s teacher’s union, said the plan didn't comply with the U.S. Centers for Disease Control and Prevention guidelines for public places. ISEA President Mike Beranek released a statement urging school districts to create their own guidelines mandating face coverings, physical distancing and other safety protocols. The union represents more than 50,000 teachers and other education professionals. The Iowa Department of Education made no public announcement on the guidelines, and Gov. Kim Reynolds made no mention of it at a news conference she held earlier in the day. (103)

Federal and state financial relief spelled the difference between closing or being able to exist for many businesses. An example was the ABC Learning Early Childhood Center in Dubuque. The early childhood facility witnessed its attendance plunge from as many as 135 children per day to no more than 10 including 2 of the owner's children. Across the county, 60% of the child care programs temporarily closed with the distinct possibility of not reopening. Fortunately the Dubuque program received a federal forgivable loan and a $25,000 small business grant from the federal government. In Dubuque, more than 160 small businesses received more than $2.75 million in state grants.

Federal relief also proved critical for local hospitals which were faced with dramatic declines in patient volumes as the focus shifted from elective procedures to dealing with the virus. Many residents chose cancel visits which resulted in steep declines in hospital and health care system revenues. All this occurred as the unexpected costs of COVID-19 testing and the purchase of additional protective equipment drove costs up. In Dubuque County, the hospitals received nearly $9 million. CRESCENT COMMUNITY HREALTH CENTER received an estimated $950,000 in COVID-19 awards from the U. S. Department of Health and Human Services.

Despite stories like those mentioned, concern existed as to whether federal monies were going to areas intended and if or when more monies would be appropriated. Democrats in the U.S. House of Representatives were investigating whether Paycheck Protection Program funds favored large rather than small businesses. The $2 trillion stimulus bill passed in March provided $150 billion to local, state and tribal governments but only provided direct assistance to 31 of the largest cities in the nation--none of which were in Iowa. Faced with no further support from the Iowa Legislature before it adjourned in June, local Dubuque department heads drew up scenarios to cut up to 30% or more of their budgets for the fiscal year starting July 1st. (104)

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Source:

1. Pandemic Influenza Preparedness and Response: A WHO Guidance Document, Geneva: World Health Organization, 2009, p. 13

2. Personal observations of the author

3. Hinga, Allie, "Pandemic Impacts Spread Locally," Telegraph Herald, March 14, 2020, p. 1A

4. Des Moines Register, "Reynolds: All Iowa Schools Should Close," Telegraph Herald, March 16, 2020, p. 1A

5. Walsh, Nick Paton, "U.S., UK Coronavirus Strategies Shifted Following UK Epidemiologists Ominous Report," CNN, March 17, 2020

6. Garret, Laurie, "Trump Has Sabotaged America’s Coronavirus Response," Voice, January 31, 2020, Online: https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

7. Hassan, Carma, "Vermont is Changing the Way it Reports Cases," CNN, March 17, 2020

8. Des Moines Register

9. Barton, Thomas J. "Iowa Adds Restrictions," Telegraph Herald, March 18, 2020, p. 1A

10. Kruse, John, "Dubuque Archdiocese: No Masses Starting Thursday," Telegraph Herald, March 17, 2020, p. 3A

11. Carnegie-Stout Public Library website "FAQ"

12. Barton, Thomas J. "Dubuque Commission Creates Plan for Pandemic Relief Funding," Telegraph Herald, April 22, 2020, p. 5A

13. Montgomery, Jeff, "Local Companies Get Serious About Remote Working," Telegraph Herald, March 18, 2020, p. 1A

14. Barton, Thomas J., "Commission Seeks Virus Funds," Telegraph Herald, March 20, 2020, p. 1A

15. KWWL News

16. Hinga, Allie, "School Keeping Children Fed," Telegraph Herald, March 24, 2020, p. 2A

17. Ibid. p. 1A

18. Mehl, Annie, "Hospitals Stop Accepting Handmade Masks as Donors Continue to Sew," Telegraph Herald, March 24, 2020, p. 3A

19. Hogstrom, Erik, "Possibly 200 Local Virus Cases," Telegraph Herald, March 23, 2020.

20. Barton, Thomas and Benjamin Fisher, "Buol Mulls Shelter in Place," Telegraph Herald, March 26, 2020, p. 1

21. Goldstein, Bennet, "Social Distancing Has Complications for Mental Health," Telegraph Herald, March 26, 2020, p. 1

22. Montgomery, Jeff, "Help Line Available for Small Business," Telegraph Herald, March 26, 2020, p. 3A

23. Barton, Thomas J., "City Budget Could Take $2.5 Million Hit," Telegraph Herald, March 27, 2020, p. 1A

24. Montgomery, Jeff, "Area Businesses Overcoming Disruptions in Demand, Supply," Telegraph Herald, March 27, 2020, p. 1A

25. Personal observations

26. Fisher, Benjamin, "Would Local Hospitals Have Enough Beds?" Telegraph Herald, March 28, 2020, p. 1A

27. Hinga, Allie, "Unprecedented, Improbable End for Area Students," Telegraph Herald, March 29, 2020, p. 1A

28. Hinga, Allie, "Offiials Try to Boost Census Participation," Telegraph Herald, March 29, 2020, p. 7A

29. Fisher, Benjamin, "Local Health Leaders Expect Virus Cases to Peak in Two Weeks," Telegraph Herald, March 31, 2020, p. 1A

30. Montgomery, Jeff, "John Deere Implements Temporary Shutdown," Telegraph Herald, March 31, 2020, p. 1A

31. Goldstein, Bennet, "Shelters Work Doggedly to Find Homes for Animals," Telegraph Herald, March 31, 2020, p. 1A

32. Barton, Thomas J. "Jails Work to Lower Inmate Counts," Telegraph Herald, April 2, 2020, p. 1A

33. Montgomery, Jeff, "U. S. Downturn Lands at Dubuque Airport," Telegraph Herald, April 4, 2020, p. 1A

34. Hinga, Allie, "Local Districts Mull Online Learning Options During Iowa's Extended School Shutdown," Telegraph Herald, April 4, 2020, p. 1A

35. "City of Dubuque to Receive $650,000 Via Program Linked to Stimulus Bill," Telegraph Herald, April 4, 2020, p. 3A

36. "Dubuque Manufacturer Flexsteel Industries Lays Off 40 Employees for 3 Months," Telegraph Herald , April 4, 2020, p. 3A

37. Barton, "Dubuque Commission Creates..."

38. "New COVID-19 Cases Announced Saturday," Telegraph Herald, April 5, 2020, p. 2A

39. Fisher, Benjamin, "Local Nurse Group Drives COVID-19 Tracing," Telegraph Herald, April 5, 2020, p. 3A

40. Montgomery, Jeff, "Team Covering Mask Needs," Telegraph Herald, April 9, 2020, p. 1A

41. Mehl, Annie, "Iowa Grants Give Relief to Businesses," Telegraph Herald, April 11, 2020, p. 1A

42. Barton, Thomas J., "Up to the Challenge," Telegraph Herald, April 12, 2020, p. 1A

43. Ibid., p. 5A

44. Ibid.

45. Montgomery, Jeff, "Group to Provide $2M in Emergency Funding," Telegraph Herald, April 12, 2020, p. 7A

46. "Confirmed COVID-19 Cases by County," Telegraph Herald, April 12, 2020, p. 3A

47. Fisher, Benjamin, "Local Satellite Virus Testing Site Picked," Telegraph Herald, April 14, 2020, p. 1A

48. Gilligan, Amy, "Documenting History Through Trying Times," Telegraph Herald, April 14, 2020, p. 4A

49. "New Conformed COVID-19 Case in Dubuque County as Iowa's Single-Day Total Shatters Record," Telegraph Herald, April 20, 2020, p. 3A

50. Montgomery, Jeff, "Pandemic Spurs Drastic Changes in Just 1 Month," Telegraph Herald, April 19, 2020, p. 1A

51. Ibid., p. 2A

52. Ibid.

53. Jacobson, Ben, "Nursing Homes Enhance Safety," Telegraph Herald, April 19, 2020, p. 3A

54. "Flexsteel Officials Announce 58 Additional layoffs," Telegraph Herald, April 19, 2020, p.9A

55. "Dubuque County Sees 1,912 New Unemployment Claims; 7,800 Total in 4 Weeks," Telegraph Herald, April 17, 2020, p. 3A

56. Barton, "Dubuque Commission Creates...

57. Montgomery, Jeff, "UNI Report: Dubuque County Businesses Hit Hard," Telegraph Herald, April 22, 2020, p. 1A

58. "Reynolds Pinpoints Northeast Iowa," Telegraph Herald, April 17, 2020, p. 1A

59. "Schools Should Consider Early Start in the Fall," (editorial), Telegraph Herald, April 24, 2020, p. 4A

60. Barton, Thomas J. "COVID-19 Ransacks City Budget," Telegraph Herald, April 23, 2020, p. 1A

61. "Iowa Reports 648 New COVID-19 Cases," Telegraph Herald, April 26, 2020, p. 7A

62. Montgomery, Jeff, "77 Iowa Counties to Reopen May 1," Telegraph Herald, April 28, 2020, p. 1A

63. Gruber-Miller, Stephen and Kim Norvell, "Iowa Begins Easing Coronavirus Business Restrictions Starting Friday in 77 Counties with Low Cases," Des Moines Register, April 27, 2020, Online: https://www.msn.com/en-us/news/us/watch-gov-kim-reynolds-to-hold-monday-morning-briefing-on-coronavirus-at-11-30-a-m/ar-BB13gAnO

64. Barton, Thomas J. "City of Dubuque Employees in Unions Forgo Raises," Telegraph Herald, April 30, 2020, p. 3A

65. Lyon, Randolph

66. Montgomery, Jeff, "Experts: County Jobless Rate Near 21%," Telegraph Herald, May 1, 2020, p. 1A

67. Montgomery, Jeff, "Food Delivery Picks Up, Ride-Sharing Drops Off," Telegraph Herald, April 29, 2020, p. 1A

68. Barton, Thomas J. "Policing in a Pandemic," Telegraph Herald, April 29, 2020, p. 1A

69. Reese, Kayli, Local Officials Say Surge in Telehealth Likely to Last," Telegraph Herald, June 20, 2020, p. 5A

70. Hinga, Allie, "Local Colleges Deal with Financial Impact of Virus," Telegraph Herald, May 4, 2020, p. 1A

71. City of Dubuque website

72. Montgomery, Jeff, "Retail Stores to Reopen Today," Telegraph Herald, May 8, 2020, p. 1A

73. Fisher, Benjamin, "'Aggressive' Testing Plan Devised," Telegraph Herald, May 5, 2020, p. 1A

74. Barton, Thomas J. "Central Avenue Plans Could Take Back Seat," Telegraph Herald, May 11, 2020, p. 1A

75. Goldstein, Bennett, "Homeless Shelters Expect Surge," Telegraph Herald, May 11, 2020, p. 1A

76. Fisher, Benjamin, "Marshallese Hit Hard by COVID-19," Telegraph Herald, May 7, 2020, p. 1A

77. "Dubuque Hospital Expands COVID-19 Testing," News in Brief, Telegraph Herald, May 12, 2020, p. 3A

78. "6 New Dubuque County COVID-19 Cases," Telegraph Herald, May 13, 2020, p. 3A

79. Fisher, Benjamin, "Nursing Home Outbreak Swells to 49 Cases," Telegraph Herald, May 19, 2020, p. 1A

80. "Dubuque Farmers Market to Open Saturday," Telegraph Herald, May 15, 2020, p. 5A

81. Barton, Thomas J., "Council Amends Budget to Brace for Crisis Fallout," Telegraph Herald, May 19, 2020, p. 1A

82. Barton, Thomas J., "Reynolds Will Allow More Businesses to Reopen," Telegraph Herald, May 21, 2020, p. 1A

83. West, Brenden, "City Cancels Summer Leagues," Telegraph Herald, May 22, 2020, p. 1B

84. "2 New COVID-19 Deaths in Dubuque County," Telegraph Herald, May 23, 2020, p. 3A

85. Kruse, John, "Landfill Sees Surge in Garbage," Telegraph Herald, May 25, 2020, p. 1A

86. "10 New COVID-19 Cases in Dubuque County," Telegraph Herald, May 25, 2020, p. 3A

87. Goldstein, Bennet, "Reynolds Eases Limits on Businesses, Gatherings," Telegraph Herald, May 27, 2020, p. 12A

88. NBC News

89. "4 More COVID-19 Cases Found in Dubuque County," Telegraph Herald, May 31, 2020, p. 3A

90. Hinga, Allie, "Screen Play: School Officials Eye Nearly 2,000 Laptops, Tablets," Telegraph Herald, June 6, 2020, p. 1A

91. Montgomery, Jeff, "Human Rights Agency Pushes for Change," Telegraph Herald, June 9, 2020, p. 1A

92. Hinga, Allie, "Educators Rethink Technology," Telegraph Herald, June 15, 2020, p. 1A

93. Barton, Thomas J. "Hopes Dry Up for 2020 Dubuque Pool Season," Telegraph Herald, June 16, 2020, p. 1A

94. Montgomery, Jeff, "Diamond Jo Cutting Up to 270 Jobs," Telegraph Herald, June 16, 2020, p. 1A

95. Kelsey, Elizabeth, "Pandemic Prompts Shelter Shift," Telegraph Herald, June 16, 2020, p. 1A

96. "Dubuque County Reports COVID-19 Death, 3 New Cases," Telegraph Herald, June 16, 2020, p. 3A

97. Hinga, Allie, "Reynolds: Test Iowa Site Coming to Dubuque," Telegraph Herald, June 19, 2020, p. 1A

98. CNN News

99. "Dubuque County Appears to Have 193 'Active' Cases," Telegraph Herald, June 25, 2020, p. 3A

100. Montgomery, Jeff, "GDDC Shifts Focus From Housing," Telegraph Herald, June 24, 2020, p. 1A

101. "Dubuque Reports 18 New Virus Cases," Telegraph Herald, June 26, 2020, p. 3A

102. CNN News, June 28, 2020

103. Pitt, David, "Iowa School Reopening Plan Doesn't Require Masks, Distancing," US News and Reports, Online: https://www.usnews.com/news/best-states/iowa/articles/2020-06-25/iowa-school-reopening-plan-doesnt-require-masks-distancing

104. Barton, Thomas J. and Benjamin Fisher,"County's COVID-19 Funding Tops $200 Million," Telegraph Herald, June 28, 2020, p. 1A