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Encyclopedia Dubuque

www.encyclopediadubuque.org

"Encyclopedia Dubuque is the online authority for all things Dubuque, written by the people who know the city best.”
Marshall Cohen—researcher and producer, CNN

Affiliated with the Local History Network of the State Historical Society of Iowa, and the Iowa Museum Association.




PANDEMIC

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Nasal swabs with a test kit provided results quickly allowing individuals to have another indication of their health.

PANDEMIC. An outbreak has been defined as “a sudden rise in the incidence of a disease” typically 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 in history 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.

                Photos and Pictures from 1918
                Courtesy: Wayne Collins
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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 Dubuque County response to the health crisis was coordinated by the Dubuque County Public Health Incident Management Team (IMT). This included staff from the Dubuque County Heath Department, City of Dubuque Health Services Department, DUBUQUE VISITING NURSE ASSOCIATION, and Dubuque County Emergency Management Agency. This agency worked in cooperation with the Iowa Department of Public Health with guidance from the U. S. Centers for Disease Control and Prevention and the Dubuque County Health Care Preparedness Coalition. The IMT beginning in 2002 had compiled and developed plans and policies to create the Dubuque County Public Health Emergency Preparedness Plan to respond to a public health emergency. The plan had last been updated and approved by the Dubuque County Health Department in July 2019. For the COVID-19 pandemic, the IMT established daily meetings for planning and response; worked directly with sectors of the community including healthcare providers and schools; and led specific community-based committees related to testing and hospital functions. (2)

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. 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.

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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's 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. (3) 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. (4) After four more cases of the virus were discovered in Iowa, Governor Reynolds stated all schools should close for four weeks. (5) 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. (6)

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 had 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.” (7) 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 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. (8) Rapidly losing ground were attempts to trace the passage of the disease as it became "community spread" meaning people could not identify how or where they became infected. (9)

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.

Governor 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. (10) In the meantime, President Trump refused to wear a mask saying that he thought it didn't "look good" on him.

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 also led the rosary every Thursday. Further information could be obtained at DBQArch.org. (11) FIRST CONGREGATIONAL UNITED CHURCH OF CHRIST 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.us to 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. (12)

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. (13)

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. (14)

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. (15)

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. (16) 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. (17)

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 sites 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. (18)

News of mask shortages 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. 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 not 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. (19)

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. (20)

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. (21)

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%. (22)

The U. S. Centers for Disease Control and Prevention reported that more than 13% of those surveyed reported having started or increased substance abuse to cope with pandemic-related stress. The Well-Being Trust and The Robert Graham Center, a policy development division of the American Academy of Family Physicians, estimated that the pandemic could lead to an additional 75,000 deaths nationally--including 11,000 in Iowa, Illinois, and Wisconsin--from alcohol and drug misuse and suicide.

Closing the Dubuque Fellowship Club, a nonprofit organization helping people in recovery from drugs and/or alcohol abuse, the group's twelve-step meetings were converted on line to video-conferencing. This caused a slight decrease in attendance. Turning Point Treatment Center began conducting most appointments over the telephone or on Zoom. Due to "Zoom fatigue," telehealth group sessions were shorter. In assessing the effectiveness of telehealth sessions, researchers writing in the journal Current Psychiatry Reports found comparable outcomes of in-person service when considering clinical effectiveness, treatment adherence, and patient satisfaction.

In early June, the Dubuque Fellowship Club, which began opening in 1984, reopened using card tables spread apart. (23)

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. (24)

City officials on March 27th warned that the estimated lost revenue, estimated at $2.5 million, could completely 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. (25)

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 its own 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. (26)

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. (27)

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. (28) 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." (29)

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. (30)

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 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. (31)

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. (32)

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. (33)

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. (34)

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. (35)

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. (36)

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. (37) 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. (38)

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. (39)

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. (40) 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 
                         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. (41)

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. (42)

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. (43)

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. (44)

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. (45)

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. (46)

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. (47)

On April 11, 2020 there were 1,510 confirmed cases of the virus in Iowa with 32 in Dubuque County. (48)

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. (49)

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. (50)

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. (51) 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. (52)

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. (53)

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. (54)

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. (55)

In April, Flexsteel announced 58 additional layoffs with unknown affects on the agreements mentioned previously in this entry. (56)

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. (57) 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. (58)

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: (59)

                    a. $180,000 for temporary shelter, if needed, to 
                       quarantine homeless people or families doubled 
                       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. (60)

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 (61)

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. (62)

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. (63)

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. (64)

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. (65)

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. (66) 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." (67)

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. (68)

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. (69)

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. (70)

Telehealth appointments in Dubuque were virtually non-existent prior to the onset of the virus. In an implementation 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. (71)

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. (72)

On May 8th the figures were:

Dubuque County (confirmed cases 175) Deaths-4 (73)

                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. (74)

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. (75)

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. (76) 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. (77)

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. (78)

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." (79)

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. (80) 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. (81)

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. (82)

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. (83)

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. (84)

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. (85) 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. (86)

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. (87) 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. (88)

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. (89) On May 27th, the United States surpassed 100,000 deaths from the virus. (90)

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. (91)

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. (92)

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. (93)

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. (94)

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 water slides, 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. (95)

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. (96)

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. (97)

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. (98)

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. (99)

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. (100)

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. (101)

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% (102)

Dubuque registered eighteen new cases of the virus between June 23rd and 24th pushing the total to 478. (103) On Sunday, June 28th there were only two states in the nation not showing an increase in confirmed cases. (104)

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. (105)

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 HEALTH 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. (106)

There were 349 new, confirmed cases in Iowa from 1:00 a.m. Tuesday, June 29 to June 30, 2020 bringing the state's total number of cases to 29,290. Five additional deaths were also reported resulting in the state's death toll rising to 717. (107)

The lack of state guidelines for reopening school in the fall left district administrators frustrated and worried as the number of cases continued to increase in the first week of July. Western Dubuque Community School District Superintendent Rick Colpitts informed the county Board of Supervisors of his plans on June 30th. With a team of administrators, teachers, parents and school board members a plan had been developed for reopening school for six weeks. His concern was finding the supervisors had placed a "school guidance" work session on their agenda. Expressing support for plans being drawn by each district, Supervisor Dave Baker stated his belief that state guidelines "seemed pretty loose, to put it mildly." (108)

Dubuque school leaders announced on July 2nd that it was likely that wearing masks would be required of staff and students in the fall. Altered schedules and classroom setups would allow for more distancing. Plans were also developed to require students to attend class virtually or to offer a mix of in-person and virtual learning if needed depending upon the spread of the virus. Each household would be assigned an "A" or "B" day in which the students would attend in-person with virtual classes on the alternate day. Students would have the option of attending an online learning program if their families did not feel comfortable sending them to school. Students would be required to attend classes if they were required to switch to a fully virtual format. Staff would be expected to check their temperatures before each day of teaching and families would be expected to check their children's temperatures. (109)

Business Insider provided a national study using multiple topics profiling which American cities would fare best after the end of the pandemic. Dubuque was ranked #16 behind the study's leaders--Springfield, Illinois; Jefferson City, Missouri; and Fargo, North Dakota. The study found that nearly one-third of the respondents were considering moving to less densely populated communities. Dubuque was one of five Iowa cities on the list which included thirty cities. (110)

Dubuque County confirmed 27 new COVID-19 cases in the 24-hour span of 5:00 p.m. June 29 through 5:00 p.m. Wednesday, July 1st. According to public health and government officials, the majority of the new cases did not result from the tests given those in the county jail or long-term care facilities. (111) In the 24-hour period from July 1st to July 2nd, the county recorded 70 additional cases bringing the county's total to 606. No additional deaths were recorded. (112)

Consideration of having a referendum/vote on a $74.3 million renovation to the FIVE FLAGS CIVIC CENTER was tabled until January 18, 2022. At least 60% of the voters would be needed to support the measure for it to pass. (113)

The eight new cases from Sunday to Monday came out of 108 new completed tests--a 7.4% positivity rate. The county's former rate had been 58%. With no new deaths, the county's total remained at 22. The number of recoveries increased by 17, so the number of "active" cases in the county decreased. (114) Hospitals in Florida and Texas approached capacity. Confirmed cases were on the rise in 41 of the 50 states plus the District of Columbia and the percentage of tests coming back position increased in 39 states. (115)

Support groups adapted to help members. The Dubuque non-profit The S.O.U.R.C.E. (Service-Center Offering Understanding, Recovery, Community, and Encouragement) provided space for area Narcotics Anonymous and Alcoholics Anonymous had to close in the early months of the pandemic. Members were then directed to meet through video chat. The Dubuque chapter of the National Alliance on Mental Illness (NAMI) offered one support group for people with mental health struggles and their family members in the early days of the pandemic. As time passed, the organization began a twice-monthly online peer support group with plans for a family-support group with an online event in July. Video offerings if some cases did not give enough personal contact. This was handled through members meeting in backyards or setting up chair outside the S.O.U.R.C.E. building to greet people needing conversation. By July, the doors of the building began to be reopened and some people returned for meetings. It was expected that online resources, however, would be continued. (116)

The county's recorded number of confirmed cases rose to 891 on July 10, 2020. The new results of 59 new cases came from 473 tests--a 12.5% positivity rate which was more than double the county's overall positivity rate of 6%. The number of deaths remained at 22. The number of people who had recovered declined at 22 resulting in the county's "active" cases to increase by 81 in one day. Statewide, the number of cases between July 9th and 10th increased by 764 with three additional deaths bringing the total to 743. (117)

Between 5:00 p.m. July 15 and 16, Dubuque County reported 64 cases of the virus for a county total of 1,103. In the same period, the county recorded 703 new test results with a positivity rate of 6.7%. Dubuque County as of July 16th had 23 deaths. (118)

The reaction to the virus in Iowa would be incomplete if not considered in relation to its attention on a national level. On January 22, 2020 the president stated, "We have it (virus) totally under control. One person coming in from China. It's going to be fine." (119) On February 29, 2020 President Trump, during a campaign rally in Charleston, South Carolina, accused the Democrats of "politicizing" the virus as "their new hoax." (120) In an oft repeated remark, on and after February 25, 2020 Trump assured the nation that we were "very close to a vaccine." On February 27 he made his first, but not only comment that "One day, it's like a miracle, it will disappear." (121) On April 23 during a press briefing in the White House he wondered aloud if "injecting disinfectant could get rid of it or whether ultra violet light applied inside the body would kill the virus."

One of the most attacked statements made by President Trump was: (May 14, 2020)

               "Don’t forget, we have more cases than anybody in the world. 
               But why? We do more testing,” Trump said following a tour 
               of a medical supply distributor in Allentown, Pennsylvania. 
               “When you test, you have a case. When you test, you find 
               something is wrong with people. If we didn’t do any testing, 
               we would have very few cases.”

While the U.S. had conducted the most tests, testing per capita ― a much more meaningful determiner as a measure of success ― lagged behind several other countries, including Russia, Italy, Germany, Spain and Canada. Experts continued to emphasize that widespread testing and contact were the cornerstones of a successful strategy against the further spread of the virus. Rep. Don Beyer used Twitter to relay the following statistics: (122)

                The United States has: 
                       - 4% of the global population
                       - 32% of global COVID-19 cases
                       - 28% of global COVID-19 deaths

On June 20th as the United States death toll reached 113,000, he told his supporters at a rally in Tulsa, Oklahoma (while the state was registering higher numbers of new cases than all but Florida, Texas, and Arizona) that he had done a "phenomenal job" leading the country through the pandemic.

The Tulsa rally might be seen as a turning point in Trump's re-election campaign. Plans in Tulsa to offer a second speech to overflow crowds unable to get into the convention center were scrubbed when no overflow crowd appeared and television recorded scores of empty seats inside. Announcements that members of the security team and even the girl friend of Donald Trump Jr. testing positive for the virus made the news. Plans to hold another rally in New Hampshire were curtailed due to "bad weather." The Republican convention had been moved from North Carolina to Florida after the governor of North Carolina indicated restrictions based on virus concerns. Ironically, Florida then became the site of an upsurge in confirmed cases of the virus and deaths. Suggestions of holding the convention outside were halted on July 21st, when the president announced the traditional convention would be scrapped.

On July 19th, the president was interviewed by Chris Wallace of Fox News. President Trump admitted that 'everybody makes mistakes' but that he 'would be right eventually.' "It's going to disappear and I will be right," the president stated repeating the statement made in February. (123)

The July 21st press conference by the president marked several important events. Early press conferences dealing with the virus were attended by members the coronavirus task force who stood behind the president. At first several members spoke. This was quickly reduced to the two doctors on the committee. President Trump held the July 21st conference without the presence of any members of his coronavirus task force--even the vice-president. Strained relations between Dr. Anthony Fauci, considered the nation's top epidemologist, and the president had been known for months with meetings between the two becoming few and Dr. Fauci being blocked from making public comments in the United States. Although never rejecting the president's statements made at press conferences, Dr. Fauci had often repeated warnings which seemed to undercut points the president had made. It was on July 21st that the president announced that news of the virus was likely to get worse before it improved.

In mid-March, the health crisis began to significantly impact the United States. In response, the Dubuque County Supervisors began to appropriate more than what they thought would be sufficient with the result that nearly $2.4 million was approved to COVID-19 spending. At the end of the 2020 fiscal year, $1.4 million was spent. The largest amount, $400,000, went to the COMMUNITY FOUNDATION OF GREATER DUBUQUE Greater Dubuque Disaster Recovery Fund for COVID-19. This was distributed through area non-profits especially those serving low-income and at-risk residents. (124)

Despite findings that adolescents transferred COVID-19 just as easily as adults and the closing of the Republican National Convention, President Trump repeatedly supported the opening of all public schools for students in the fall. Consideration had even been given to tying federal monies to public schools to there being direct instruction.

On July 20, 2020 the Dubuque County Public Health Incident Team reported that the governor's office had directed Epic Health and Wellness to not take more than 100 COVID-19 test samples per day. The clinic was only to be open from 6:00 a.m.-7:00 a.m. Monday through Thursday. The site had been processing up to 550 Samples daily and regularly had long lines. Local officials had received no notification of the impending action. A spokesperson for the governor stated that the changes were "to align their process with other sites across the state." In response to Democratic lawmakers charges that the governor was attempting to limit testing to keep case counts down, the state responded by make 2,000 new test kits available to other clinics in the area. (125)

Nationwide, the number of people afflicted with the virus reached 4 million on July 24, 2020. On the same day, the Iowa governor's office lifted the cap on testing at Epic Health and Wellness. With the resumed hours, the center could only serve those with prior appointments. (126) From July 23 to July 24 there were 26 additional cases of COVID-19 in Dubuque bringing the total to 1,316. There were no additional deaths so the total remain at 26. (127) Beginning July 26, 2020 masks would be required for people older than two who wished to visit the CARNEGIE-STOUT PUBLIC LIBRARY. (128)

On July 29, 2020 the following statistics were related to Covid-19 in Iowa. (129)

                        Positive Cases
                        Polk County. . . . . . .  9.19 thousand
                        Woodbury County. . . . .  3.87 thousand
                        Black Hawk County. . . .  2.90 thousand
                        Linn County. . . . . . .  1.89 thousand
                        Johnson County . . . . .  1.80 thousand
                        Dallas County  . . . . .  1.69 thousand
                        Scott County . . . . . .  1.50 thousand
                        Dubuque County . . . . .  1.40 thousand
                        Marshall County  . . . .  1.33 thousand
                        Pottawattamie County . .  1.08 thousand
                        Positive Cases by Age Group
                        0-17 (Child). . . .  6%
                       18-40 (Adult). . . . 48%
                       41-60 (Middle Age. . 30%
                       61-80 (Older Adults. 12%
                       Over 80 (Elderly). .  4%
                       Positive Cases by Sex
                       Male . . . . . . . . 50%
                       Female . . . . . . . 49%

Against this backdrop, national statistics on the same date indicated:

                        1. COVID-19 was killing a Texan every 6 minutes, 16 seconds
                        2. The United States was nearing 150,000 deaths from the
                           virus.

On July 28, President Trump held another press briefing on the virus. He wondered aloud how Dr. Fauci, the nation's expert on infectious disease, could have a better publicity rating than he had---and then placed the blame on his (Trump's personality). He then returned to praise the drug hydroxychloroquine, an anti-malarial and autoimmune prescription drug that has shown effectiveness against viral infections in-vitro. It's one of a large number of drugs that can affect the electrical activity in the heart in a way that could make people susceptible to developing potentially very dangerous abnormalities of the heart rhythm that could be fatal. A substantial study published in late May concluded that both hydroxychloroquine and chloroquine were associated with higher mortality among COVID-19 patients. And while a few small studies showed improvements when tested with humans, experts questioned the reliability of those studies' methods. Large observational studies found no evidence of benefit and perhaps some evidence of harm. The World Health Organization halted its sizable randomized-trial use of hydroxychloroquine for COVID-19 patients. (130)

During the evening of July 29th, several messages by President Trump posted on Twitter, a frequently used social media by the president, were taken down when it was judged their content was not supported by facts.

COVID-19 as of July 30, 2020:

                   1. The nation learned that the economic shutdown 
                      had led to the most devastating three-month collapse 
                      on record and wiped away nearly five years of growth. (131)
                   2. President Trump delivered a news conference filled with 
                      falsehoods about the coronavirus. (“Young people are almost 
                      immune to this disease,” he said.)
                   3. The United States had 4,506,161 confirmed cases of COVID-19,
                      58,176 more than the day before.
                   4. The number of deaths in the United States, which still after
                      after months had to national plan to deal with the virus,
                      reached 153,302. 

According to the newest federal report for Dubuque County bars and gyms should be closed, restaurants should restrict indoor dining and promote outdoor dining, and face masks should be required in all businesses. The county and state were designated "red zones" which meant there were more than 100 new cases per 1,000 population in the past week and in which the positivity rate topped 10% during that time. The state was also considered a "red zone." Recommendations included promoting social distancing, wearing masks, testing the staff of long-term-care facilities weekly and requiring meat-packing plants and other workplaces to ensure social distancing, the wearing of masks, and regular testing of employees. (132)

The Telegraph Herald on August 3, 2020 announced that Dubuque County surpassed 1,500 infections. To give an indication of the dire nature, the paper printed the following (as of August 2nd): (133)

   County                 Confirmed           Deaths         Recovered               Tested
   IOWA
   Clayton . . . . . . . .   97   . . . . . . .  3   . . . .    71   . . . . . . .    2,114
   Delaware. . . . . . . .   90   . . . . . . .  1   . . . .    73   . . . . . . .    2,065
   Dubuque . . . . . . . .1,519   . . . . . . . 29   . . . .   727   . . . . . . .   19,569
   Jackson . . . . . . . .  138   . . . . . . .  1   . . . .    37   . . . . . . .    2,536
   Jones . . . . . . . . .  122   . . . . . . .  1   . . . .    68   . . . . . . .    2,407
   ILLINOIS
   Jo Daviess  . . . . . .  112   . . . . . . .  1   . . . .    82   . . . . . . .    2,789
   WISCONSIN
   Crawford    . . . . . .   62   . . . . . . . . 0  . . . .    51   . . . . . . .    3,297
   Grant . . . . . . . . .  328   . . . . . . .  14  . . . .   248   . . . . . . .    8,941
   Iowa  . . . . . . . . .   63   . . . . . . .   0  . . . .    57   . . . . . . .    3,439 
   LaFayette . . . . . . .  111   . . . . . . .   0  . . . .    87   . . . . . . .    2,276 

On August 10th the United States officially had recorded 5 million virus cases--at the time by far the highest number of any country in the world. (134)

Beginning Monday, August 10th the City of Dubuque was scheduled to begin enforcement of a city-wide mandate for people to wear face coverings in public places and in places where maintaining a six-foot distance between people was impossible. This would effect schools. The action of the city council was in line with public health and infectious-disease experts who were in nearly unanimous agreement that face coverings were effective in slowing down the spread of coronavirus. Governor Reynolds had encouraged the wearing of masks, but had not issued an order forcing it stating that mandates were ineffective and often not enforced. The governor's office also stated that her emergency management authority preempted local mandates. City officials and the Iowa League of Cities argued that cities could "institute a face-covering requirement, a capacity limit or both" through the Home Rule Amendment to the Iowa Constitution of 1968. Dubuque was following Muscatine, Iowa City and Johnson County in issuing face covering requirements. Violations would be processed like traffic tickets with a $10 fine increasing to $15 after 30 days of non-payment. Stores had the right to set rules on their own--a practice which had led several local stores including Menards to require face coverings. Customers who argued could be charged with trespassing if the police were called. Police officers were encouraged to gain compliance through conversation. (135)

There were exceptions. Although masks covering the nose and mouth were required for everyone three years of age or older, those with breathing difficulties, on oxygen therapy, or unable to remove a face covering without assistance were excepted. Anyone directed by a medical, legal or behavioral health professional directed not to wear face coverings were also excepted. Students involved in co-curricular activities according to Iowa High School Athletic Association rules for wearing face coverings along with police, firefighters and emergency medical personnel were also excepted although they were encouraged to wear a mask if possible. Masks were not required if alone of with members of their households. Those involved in moderate or high intensity exercise were also exempt. (136)

Concern about the safety of students and teachers led to a petition signed by 1,400 residents being submitted to the board of education in August. Among the signers were 165 current district employees or about 7% of the total. The petition was first circulated before the board of education chose to move the opening of school back to August 24th. A total of fifty-nine teachers would offer virtual instruction to students in the coming year. The option was made to teachers with health needs and concerns. At the elementary level, teachers had to be recruited to fill the teaching need. The hybrid learning model allowed the district to space students out at schools and the local mandate on wearing face coverings provided protection to students and staff according to the superintendent. (137)

How accurate were the statistics being reported by the state and national governments. In July the federal government announced that all statistics dealing with COVID-19 were no longer to be reported to the Center for Disease Control. The State of Iowa announced the same month that state statistics were to be reported to the state and then the headquarters of the testing service in Utah before they would be released locally. In August the following statement was released:

                       It doesn't make sense for school districts and, frankly, 
                       newspapers to constantly calculate something and expect
                       to get the exact same result as our website.
                          Pat Garrett, spokesman for Iowa Gov. Kim Reynolds

On August 12, 2020 Iowa Department of Public Health spokesperson Amy McCoy explained that the state determined its 14-day positivity rates by taking the "daily percentage of individuals positive" over the course of two weeks and dividing that total by 14. This approach would weigh each day equally even though the number of people tested on these days varied. On Friday, August 14th the department officials announced that the manner in which the positivity rate was determined was by taking the total of individual positive cases from 14 days divided by the sum total of total individuals tested over 14 days. An analysis by the Telegraph Herald between the two days found that as many as one-quarter of the new virus cases reported by Dubuque County in a two-week period had not been factored into the 14-day positivity rate posted on the state website. (138) On August 14th, CNN announced that reporting discrepancies nationwide were expected to result in the nationwide deaths of COVID-19 being neared 200,000 rather than the 163,000 reported.

Dubuque County registered five additional cases of COVID-19 between 5:00 p.m. Saturday and 5:00 p.m. Sunday, August 17th. This was the lowest single-day total for a twenty-four hour period since June 29. It immediately followed a 24-hour period with 45 cases--the highest period since July 16th. The new numbers brought the confirmed cases in Dubuque County to 1,797. The number of deaths was 31, those recovered totaled 1,202, and a total of 21,877 tests administered. (139)

Who knew the state's publicized COVID-19 figures were inaccurate and when they knew it was again brought to view on August 22nd. Dr. Caitlin Pedati, the state epidemiologist, says she became aware in late July of a problem in Iowa's disease surveillance reporting system that backdated thousands of new test results. Nonetheless, Gov. Kim Reynolds on August 6th released 14-day county positivity rates on the state's coronavirus website that she said would help school officials and parents decide how to proceed with the upcoming school year. Despite learning of the system errors, state officials did not mention them in public and continued to post new figures on the state's website as reliable indicators. (140) On August 22nd, Reynolds also maintained that she had been unaware of the flaws in the computation until just the previous week. The state announced Wednesday that because of the backdating problem, the positivity rates had been erroneous for two weeks. (141)

Using the state's own figures, the state's positivity rates for Dubuque County were consistently lower than the rates calculated by investigators/writers for the Telegraph Herald: (142)

                Date             State's Positivity Rates          Telegraph Herald's Positivity Rates
              August 16th. . . . . . .  10.6%. . . . . . . . . . . . . . . . . . .12%
              August 15th. . . . . . .  10.7%. . . . . . . . . . . . . . . . . . .13.2%
              August 14th. . . . . . .  10.8%. . . . . . . . . . . . . . . . . . .13.3%
              August 13th. . . . . . .  10.4%. . . . . . . . . . . . . . . . . . .13.9%
              August 12th. . . . . . .  10.5%. . . . . . . . . . . . . . . . . . .14.2%
              August 11th. . . . . . .  10.4%. . . . . . . . . . . . . . . . . . .14.0%
              August 10th. . . . . . .  10.5%. . . . . . . . . . . . . . . . . . .13.8%
              August  9th. . . . . . .  11.0%. . . . . . . . . . . . . . . . . . .14.1%
              August  8th. . . . . . .  10.9%. . . . . . . . . . . . . . . . . . .14.5%
              August  7th. . . . . . .  11.0%. . . . . . . . . . . . . . . . . . .14.3%
              August  6th. . . . . . .  12.0%. . . . . . . . . . . . . . . . . . .15.0%
              August  5th. . . . . . .  11.1%. . . . . . . . . . . . . . . . . . .15.0%
              August  4th. . . . . . .  10.8%. . . . . . . . . . . . . . . . . . .14.0%
              August  3rd. . . . . . .  10.9%. . . . . . . . . . . . . . . . . . .13.9%
              August  2nd. . . . . . .  10.6%. . . . . . . . . . . . . . . . . . .14.2%
              August  1st. . . . . . .  10.4%. . . . . . . . . . . . . . . . . . .13.0%

Over a seven-day period beginning on August 14th and number of confirmed positive cases in Dubuque County increased by 124. On its website, however, state officials indicated only 82 cases--a 34% decrease from the total number. State officials claimed that the difference was due to review and validating the case information. If true, according to the newspaper, this meant that the number not counted drove down the positivity rate initially or until they were finally validated and added---if ever. A 14-day period that ended on August 21st involved 234 new confirmed cases and 2,360 new tests in Dubuque County. Using state totals and Telegraph Herald calculations, this equated to a positivity rate of 9.9%. State officials, however, reported a positivity rate of 6.9%. (143)

As August came to an end, analysis by the Telegraph Herald staff indicated that 22% of the new confirmed cases of COVID-19 in Dubuque County were not being included in the 14-day positivity rate issued on August 27, 2020. The 14-day period was the first two-week stretch in which the newspaper staff checked the state's coronavirus figures consistently at midnight. This disproved state official claims that the TH's county-specific positivity rate calculations--which were always higher than those released by the state--were skewed by the hours in which the results were being checked. The inconsistent new-case totals were:

                Date                     TH                State
              August 13. . . . . . . . . 22 . . . . . . . .  36
              August 14. . . . . . . . . 16 . . . . . . . .  14
              August 15. . . . . . . . . 33 . . . . . . . .   6
              August 16. . . . . . . . .  4 . . . . . . . .   2
              August 17. . . . . . . . . 18 . . . . . . . .   2
              August 18. . . . . . . . .  5 . . . . . . . .  17
              August 19. . . . . . . . . 26 . . . . . . . .  16
              August 20. . . . . . . . . 19 . . . . . . . .  13
              August 21. . . . . . . . .  4 . . . . . . . .  11
              August 22. . . . . . . . .  9 . . . . . . . .   5
              August 23. . . . . . . . . 22 . . . . . . . .   3
              August 24. . . . . . . . .  4 . . . . . . . .  12
              August 25. . . . . . . . . 13 . . . . . . . .   9
              August 26. . . . . . . . . 18 . . . . . . . .   1

The changing state protocols used by state officials concerned Dr. Bobby Koneru, the medical liaison for Dubuque County on COVID-19. "Until there is a reliable, consistent way of calculating the data, I will not be 100% confident in what I am seeing in the state numbers." (144)

In view of Iowa having the highest rate of COVID-19 cases per capita in the United States, the White House coronavirus task force issued the last week of August new recommendations for Iowa which had seen its number of cases increase 77.4% from the previous week. The recommendations included mandating face masks and closing bars in the state's largest cities to slow the spread of COVID-19. The report also said gyms should be closed or limited to 25% of capacity and social gatherings should be limited to 25 or fewer people in 17 metro areas and 48 counties. (145)

Health officials confirmed 1,552 new COVID-19 cases in Iowa from 5:00 p.m. August 26th to 5:00 p.m. August 27th. There were 32 new cases confirmed in Dubuque County resulting the the county's total climbing to 1,964. Deaths remained at 36. With 32 new cases,, the county's positivity rate was 12.6%. (146)

Though anyone could be at risk for severe illness, those who were hardest hit seemed to be men, older people, and people with multiple health conditions like heart disease, diabetes, and obesity. In the United States and United Kingdom, studies found that minority groups, particularly African American and Latino people, had more severe disease. Scientists investigated factors that made people more susceptible, including environmental, genetic, gender, hormone, and even gut microbiome differences.

Medical professionals found that their patients experienced a range of "recoveries." The term "recovery" had different definitions around the globe. In the United States, the CDC considered patients recovered 3 days after fevers and other symptoms end, along with a negative repeat test for the virus. Given shortages of testing, the CDC updated its recommendations to extend self-isolation from 7 days to 10 days after symptoms first appear to lower the risk of infecting others in situations where testing was not available. In China, the definition of recovery was more strict, with the extra requirements for lung imaging tests that show improvement in inflammation and two consecutive negative tests for the virus in the respiratory tract at least 24 hours apart.

Recovery time and symptoms varied by person, but people who had it often described feeling like a mild cold is coming on before being hit with a fever, a dry cough, and shortness of breath. However, others were asymptomatic or experienced other symptoms, such as diarrhea, fatigue, a sore throat, a runny nose, and a headache.

Although the recovery time varied, reports showed it was a slow-moving illness that could take between two to six weeks to recover from, depending on how the body responded and the severity of illness. Experts found that it can take about a week of symptoms to know whether an infected person would end up in the hospital and worsen or start to get better.

Doctors observed a growing list of related health impacts beyond just respiratory problems, including the digestive system, heart, kidneys, liver, brain, nerves, skin, and blood vessels. For people with severe and critical disease, dangerous immune system and blood clotting responses could cause damage throughout the body and might result in long-term health effects. Kidney damage could require long-term dialysis. Strokes and blood clots might lead to disability and scarred lungs might result in permanently decreased lung function. Treatment itself -- whether it is time on a ventilator, in the intensive care unit, or certain drug therapies -- could also cause lasting harm.

Researchers found that people with mild disease could have abnormal lab or imaging findings, even if they never progressed to a more severe disease. According to one study, 47% of people who had only a mild disease and 61% with a moderate disease had abnormal liver function tests, indicating injury to the liver, during their illness. Another small study found that 50% of people who did not have symptoms had abnormal findings on imaging tests showing damage in the lungs, even without lung symptoms.

Doctors learned that even otherwise healthy young children who may have had only a mild disease or one without symptoms can, weeks after, have a condition similar to Kawasaki disease, called pediatric inflammatory multisystem syndrome (PIMS). This condition may be due to a delayed immune system response that inflames multiple organ systems, including blood vessels, and can lead to severe complications. While most children recover from Kawasaki disease, it can cause long-term heart damage, and doctors still don’t know what effects this new syndrome will have.

In situations where people did require hospitalization, recovery was possible. In a large study in the United Kingdom, more than 49% of patients recovered and left the hospital. One study in New York found that about 45% of severely ill people were able to leave the hospital. Though there were many limitations to these studies, they pointed to the need to develop care plans for survivors outside the hospital. Each institution developed their own policy because there was little data about what was needed to monitor for long-term effects. In general, after a patient was discharged, teams of providers followed up by telephone to ensure that people’s symptoms continue to improve. Patients are also brought in to follow up on lab test results that were abnormal in the hospital, like kidney and liver tests. (147)

Mental health was one of the biggest concerns. Being on more medication affected a patient’s sleep-wake cycle. It could slow down their gastrointestinal tract so they do not tolerate nutrition as well and get poor nutrition. Many of these patients end up having PTSD [post-traumatic stress disorder] and impaired concentration afterwards. (148) Patients recovering after hospitalization, or those at home with milder cases of COVID-19, sought care for anxiety, stress, and fear. Things that enhance a sense of safety, calming, social connectedness, self-reliance, and hope and optimism were considered essential. Doctors were stunned by the altruistic requests from the recovered patients. They are eager to help other patients and to further research by donating their blood products. (149)

One of the discoveries of the pandemic was that severely affected patients could be treated with plasma from past patients who had recovered from the disease. The concept behind the treatment was that recovered patients had the antibodies their system made to fight the virus. Infusing that plasma, the liquid portion of the blood, into a patient fighting the disease boosted the recipient's system. The use of plasma was begun in 1918 and was again implemented with H1N1. Dubuque hospitals joined more than 2,700 sites around the nation in a federal expanded access program managed by the Mayo Clinic. Participating sites had increased access to the plasma in exchange for reporting information about patient recovery.

Timing was important. The use of plasma donated by former COVID-19 patients was recommended only for those going to be hospitalized--the more severe cases. The plasma also seemed to work best when the patients were just getting worse. When the patient's body began making its own antibodies, the treatment had less impact. The best candidates for donating plasma were those who had been the sickest. Those interested in donating could apply through the MISSISSIPPI VALLEY REGIONAL BLOOD CENTER or directly through their health care provider. (150)

As the pandemic entered September, continued needs were identified. The NATIONAL MISSISSIPPI RIVER MUSEUM AND AQUARIUM, closed to the public in March, and other members of the Association of Zoos and Aquariums petitioned Congress for financial aid. Between March and May, the museum had lost an estimated 30% of its expected revenue. The 2,000 animals in the collections needed care and feeding and the museum's 50,000 items in its historic collections needed a constant temperature and humidity. Although the museum was able to reopen, attendance remained at about 50% of what would normally have been seen. Although the museum received federal Paycheck Protection Program Funding, allowing it to retain full-time staff for eight weeks, the program ended and furloughs had to begin. Maintenance programs were pushed in 2021. (151)

Day-care facilities, facilities which offered needed help for parent/parents working from home, adapted new learning styles. NOAH'S ARK CHILD DEVELOPMENT CENTER implemented "pods" with one teacher and several children of the same age. The students did not mix with those in other "pods" so children were only exposed to a limited set of people during the time they were "in school." Children in Little Explorers & Virtual Learning Center established "pandemic pods" like those of Noah's Ark. Children wore face masks until they were in their own pod. (152)

As of August 22nd, COVID-19 statistics were the following: (153)

   County                 Confirmed           Deaths         Recovered              Tested
   IOWA
   Clayton . . . . . . . .  151   . . . . . . .  3   . . . .    104   . . . . . . .    2,540
   Delaware. . . . . . . .  161   . . . . . . .  2   . . . .    126   . . . . . . .    2,767
   Dubuque . . . . . . . .1,898   . . . . . . . 35   . . . .  1,346   . . . . . . .   22,951
   Jackson . . . . . . . .  179   . . . . . . .  1   . . . .    124   . . . . . . .    2,951
   Jones . . . . . . . . .  147   . . . . . . .  2   . . . .    107   . . . . . . .    2,847

On August 26th members of the Dubuque County Board of Health voted unanimously to support a mask mandate to limit the spread of the virus. The mandate applied to the entire county outside the city of Dubuque which already had a mask ruling in place. The issue would then go to the Dubuque County Board of Supervisors for their approval. The mandate would require face coverings in interior places and businesses as well as in places outside if they were unable to maintain six feet of distance. Businesses would be prohibited from serving those without masks when they entered the premises. Exceptions were made for medical reasons. (154)

As the school year began, working parents were often faced with child care. Another of many unique methods of aiding students when they were not in school was piloted by the Gronen Company. The real estate development and restoration company provided a 'guidance center' and hired two tutors, both retired teachers, to assist an estimated ten students from first to twelfth grade whose parents were employees of the company. (155)

On September 6th the Telegraph Herald reported 262 new confirmed cases in Dubuque County and 2,340 in the previous two weeks. The positivity rate calculated by the Telegraph Herald stood at 11.2% while the state's figure, following the practice of not counting recent confirmed cases until all data was received, was 8.3%. The state reached a total of 80,300 confirmed cases with fifteen additional deaths bring that total to 1,168. (156)

Despite a recommendation from the Dubuque County Board of Health to issue a countywide mask mandate, the Dubuque County Board of Supervisors voted 2-1 against such a measure at its meeting on September 8, 2020. The mayor of Epworth asked that rural communities be allowed to determine for themselves whether wearing masks was necessary. The mayor of Peosta claimed there was an absence of compelling data to support a mandate. The mayor of Sageville reminded the supervisors of the Iowa Attorney General who believed mandates were beyond local government authority. (157) On the day of their meeting, the Telegraph Herald announced that Dubuque County had recorded 112 new tests in the 24-hour period ending Tuesday making the county's positivity rate 27.7% for that period. The county's positivity rate on that day over the previous 14 days was 12.8% (or 9.4% using the state's method of not counting cases in which all information had not been received). (158)

On September 19, 2020 the United States officially exceeded 200,000 deaths due to the virus--doubling the number from the previous four months. (159)

Despite the 560 signatures on the UnMask DBQ petition, the Dubuque City Council on September 22, 2020 did not change its collective agreement that the mandate for Dubuque residents to wear masks under certain circumstances. In a unanimous vote, the council voted to receive and file the petition against the mandate passed in early August. The U.S. Centers for Disease Control and Prevention and the World Health Organization advocated for wearing masks as a means of reducing the spread of COVID-19. (160) Iowa was one state which did not have a state mandate in place. On September 25th the state registered 1,086 new cases, 1,128 recoveries, and 4 more deaths. (161)

On September 24, 2020 the confirmed number of new Covid-19 cases was 128 for a 24-hour period. The number was the highest in 24-hours since the newspaper began recording figures for that period of time on May 19th. Almost 81 new cases per day were recorded for the the county in the week ending on September 24th--double the previous week. According to the newspaper's recording system the county's positivity rate for the fourteen day period was 27.9%. Because the state did not count recent cases until all the data was received, such as the date of birth of the person being tested, it reported the positivity rate as being 16.6%. (162)

On Tuesday, September 22, 2020 the Dubuque County Public Health Incident Management Team reported data on age-group incidence of Covid-19. Their reported indicated: (163)

                         10 years and younger  . . . . 4%
                         11-14 year olds . . . . . . . 2%   
                         15-18 year olds . . . . . . . 8%
                         19-24 year olds . . . . . . .22%
                         25-29 year olds . . . . . . . 9%
                         30-34 year olds . . . . . . 5-7%
                         35-40 year olds . . . . . . 5-7%
                         45-49 year olds . . . . . . 5-7%
                         50-54 year olds . . . . . . 5-7%
                         55-59 year olds . . . . . . 5-7%
                         60-64 year olds . . . . . . 5-7%
                         65 years and older. . . . .  12%

On October 3, 2020 following a week in which a party was held in the White House Rose Garden to introduce his choice to fill a position on the Supreme Court, President Trump was taken by helicopter to Walter Reed Hospital. News that he had contracted COVID-19 preceded the announcement within days that twelve of those who had sat rather close together at the event had also tested positive. The president was treated with a series of experimental medications unavailable to the general public. Ignoring the quarantine, he chose to have two Secret Service agents drive him around in his hermetically sealed automobile to wave at fans near the hospital. He returned to the White House on Sunday, landed by helicopter on the White House lawn and climbed the outside stairs to the Truman Balcony. Again ignoring quarantine measures for those having the disease, he removed his mask, walked into a room of unmasked people in the White House and filmed a short political commercial encouraging Americans 'not to let the virus dominate their lives.' Medical information about the president's health (lung scans, date of his last negative test etc.) were not released by the administration.

On Wednesday, Governor Reynolds repeated the president's remark not to let the 'virus dominate' our lives as Dubuque County's positivity rate over the preceding two weeks climbed to 25.9% based on the Telegraph Herald's method of calculation. The state also recorded 444 people being treated for the virus in hospitals--a record number for the state since the beginning of the pandemic. (164) Iowa's death toll increased by 15 to 1,415. Dubuque County's death toll rose to 47. While stressing that younger healthy people often do not get seriously ill, state data indicated that 8,024 children under 17 had tested positive as well as more than 4,200 educators. (165)

For the week ending October 10th, the State of Iowa saw the hospitalizations for the virus reach a record high (461). The region including Dubuque, Clayton, Delaware, and Jones counties also established a record of 111 patients. Dubuque County was again listed as a "red zone" by the White House Coronavirus Task Force meaning that new cases were above the 100 per 100,000 population and positivity rates were higher than 10% in the past week. The report dated Sunday, October 4, stated that Dubuque County had the third-highest number of cases over the preceding three weeks among Iowa counties. (166)

It was reported on October 13, 2020 that Dubuque County's death toll had reached 49. With 865 new confirmed cases and 3,090 new tests during the past two weeks, the county's 14-day positivity rate was 28% using the Telegraph Herald's method of calculation. Iowa's statewide confirmed caseload increased by 510 during the previous 24-hour period to surpass 100,000. Iowa's death toll increased by 13 to 1,473. (167)

In the week ended October 17th, Iowa saw daily reports of new COVID-19 cases exceed 1,000 with hospitals reporting dwindling lack of space. Despite this, Governor Reynolds refused to change her approach leaving Iowa as one of the few states without a mask mandate while requiring at least 50% of school children to be in attendance. Increasing confirmed cases was occurring in 40 of the fifty states, while President Trump continued to schedule rallies despite medical requests to end them. Health officials were especially concerned with the cooling weather forcing more people indoors where the chances of spreading the disease increased.

At 5:00 p.m. October 16th the county's death toll had reached 52. There were 84 additional cases of the virus reported in the twenty-four hours between Thursday at 5:00 p.m. and Friday at the same time. (168)

In October, 2020 national and local labor activists charged that the Occupational Safety and Health Administration was failing to enforce federal labor laws. With more than 9,000 employee complaints related to COVID-19 through October 1, the agency had opened investigations into less than 200. The analysis was completed by the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO). Local labor officials contended that the agency had been underfunded and understaffed for a long time.

Help for businesses in Dubuque County came from the Safe to Work Initiative led by the GREATER DUBUQUE DEVELOPMENT CORPORATION and the Northeast Iowa Community College. The program helped employers share strategies and stay current on changing regulations. Officials with GDDC described the Initiative as helping employers organize their workforce, organize their workspace, monitor that workspace and react appropriately if a positive COVID-19 test occurred. The advice came through guidance from the Iowa Department of Health and Centers for Disease Control and Prevention. As new information became available, it was distributed by newsletters, a comprehensive online booklet, and webinars featuring guest speakers. (169)

In its Fall 2020 City Focus magazine, the City of Dubuque addressed the impact of the pandemic on communities of color. The following is the article in its entirety:

     As state and cities across the U.S. are tracking the impact of COVID-19, studies are revealing that communities
     of color are disproportionately impacted by COVID-19. People of color get sick and die of COVID-19 at rates higher
     than Whites and higher than their share of the population.
     On Aug. 18, the CDC released data showing that Blacks, Latinos, and American Indians/Alaskan Natives are
     experiencing hospitalizations at rates 4.5 to 5.5 times higher than non-Hispanic whites. Hispanics and Native
     Americans are dying about 1.5 times the rate of White people. Black Americans are dying at 2.4 times the rate of
     Whites.
     Communities of color are at increased risk of serious illness related to COVID-19 due to higher rates of underlying
     health conditions such as hypertension, diabetes, asthma, and upper respiratory conditions.  These health disparities
     exist in large part because of more regular exposure to environmental hazards and limited access to healthcare.
                 Structural Racism: A history a current pattern of policies and actions from
                 social institutions, such as government organizations, schools, banks, non-
                 profits, and courts of law, that disproportionately perpetuate negative treat-
                 ment toward a group of people based on their race.  Institutional racism leads
                 to inequality in opportunity and inequity of life outcomes.
      A lack of financial resources resulting from years of structural racism affects health through a variety of path-
      ways, including reduced access to employment, housing, and education; increased environmental exposures; trauma
      from chronic exposure to discrimination; and increased participation in unhealthy behaviors as coping mechanisms.
      In addition, people facing these risk factors are less likely to have insurance to pay for COVID-19 testing and are
      more likely to avoid using the health care system because of high costs.
      People of color are also disproportionately impacted by the economic consequences of the COVID-19 pandemic.   Nearly
      a quarter of Black and Latinx people are employed in service industries compared to 16% of White people, putting them
      at increased risk of job loss and loss of income.
      Because the average net worth of White families is 10 times higher than that of Black families, they generally lack
      the savings and wealth to absorb unanticipated events such as job loss or emergency medical expenses. Similarly,
      communities of color are disproportionately rent-burdened and at more risk of being evicted during the COVID-19
      pandemic.
      Racial disparities in health, income, and housing has exacerbated the toll of COVID-19 on communities of color. Long
      standing, systematic conditions are putting Blacks, Latinos, and American Indians/Alaskan Natives at risk of the most
      severe outcomes of the pandemic.
      The City of Dubuque recognizes the struggles of all of our residents during this difficult time and as we recover we
      will continue to be mindful of the unique experiences of the communities that we serve. (170)

Dubuque County registered its highest one day count of people (33) hospitalized with COVID-19 on Wednesday, October 21, 2020. Given the fact, the Dubuque County Board of Health members voted unanimously to send a letter to the County Board of Supervisors indicating their intention of writing a new resolution for a countywide mask mandate. Dubuque's two hospitals issued a joint statement that they were experiencing the highest levels of COVID-19 related hospitalizations since the start of the pandemic, but that they had not reached capacity. They agreed that action had to be taken to lower the transmission rate. (171) Dubuque County's deaths from the virus reached 54, the seventh highest in the state. Statewide there were 4,205 new cases reported on Wednesday bringing the total in the state to 182,687 with 1,681 deaths. (172)

In 2020 the PANDEMIC led the DUBUQUE RACING ASSOCIATION board of directors to approve directing nearly $600,000 to local organizations impacted by the virus. The funds would have usually been directed to the DRA endowment fund. The relocation of the money was contingent on approval of the City of Dubuque which owned Q CASINO RESORT AND HOTEL. If approved the DRA would work with DIAMOND JO CASINO, United Way of Dubuque Area Tri-States, and the COMMUNITY FOUNDATION OF GREATER DUBUQUE to determine the distribution. In May 2019, the DRAC awarded $1.1 million to 129 local non-profits. In the spring of 2020, the DRA announced that there would be a delay in allocations as the casinos faced the impacts of the pandemic. (173)

On October 22, 2020 the Dubuque County recorder urged county residents to stay away from county buildings due to a COVID-19 "outbreak among staff and strongly criticized other department heads. John Murphy reported the staff in "a minimum of three (unnamed) departments" had confirmed cases of the COVID-19 virus in the past week. John reported:

                     these departments work closely together, and their department head does not require
                     their staff to wear masks, yet they are still working with the public on a daily
                     basis. For co-workers that were in close contact, it appears that isolating/
                     quarantine is essentially on a voluntary basis, thus exposing other county employees
                     and the public to COVID-19.

Murphy criticized the unnamed department heads or elected officials for being "lackadaisical about positive tests in their departments, who needs to isolate/quarantine and the use of masks.

                     I'm notifying the public because the county refuses too lead, and this allows the
                     public to make the decision for themselves. I apologize to the public on behalf of
                     Dubuque County for our inability to act. Hopefully, we an get all three county
                     supervisors on the same page, protecting public safety....I wouldn't want my
                     friends or family in the building right now, and I feel obligated to express that
                     to the public. (174)

Following the second presidential debate on Thursday which included President Trump stating that we had "turned the corner on the disease" came the weekend figures for Iowa. On Saturday, October 24, 2020 the number of confirmed cases of COVID-19 in Dubuque County exceeded 5,000 after 20 new cases were reported. At 5:00 p.m. Saturday, Dubuque County ranked 7th in the state in most completed COVID-19 tests (35,440), most people diagnosed with the virus who have recovered (3,293), and most related deaths (57). Dubuque County had the ninth-highest cases per capita (5,252 per 100,000 residents). Only Woodbury County had a higher per-capita rate. (175).

In early August, the Dubuque city council had approved a mask mandate. Later in the month, the Dubuque County Board of Health recommended a measure similar to the city's only to see it rejected by the supervisors. In October, the county's health board was expected to propose a similar recommendation. Between August and October the number of COVID-19 cases in the county had risen from 1,919 to 5,210. On October 27, 2020 the Telegraph Herald confirmed that the mask mandate for the county still faced opposition and that the two supervisors who had voted against it before remained unconvinced it was a good idea. (176)

Misinformation about COVID-19 was traceable to many sources in 2020. Much of it began with President Trump. Although advised early (as proven by his tape recorded interviews with Bob Woodward in March) that the disease was dangerous, the president chose to downplay it to the press. At one meeting he claimed that it would just "go away." At a press conference months later while still discounting its importance, the president suggested (though he claimed it was a joke) that perhaps people could inject disinfectants into their bodies to rid themselves of the virus or use ultra-violet light. With his family members and other surrogates on the campaign trail, the message remained that concern was over blown despite the rising numbers of deaths. Toward July the idea of "herd immunity" was suggested by his medical advisor, Dr. Atlas (a radiologist and not an epidemiologist). In this theory as soon as 60% of the population had contracted the disease there would be protection. This theory was widely criticized while great efforts were made to develop a vaccine. On October 30th while campaigning, President Trump claimed without citing any facts that the numbers of deaths were being inflated by doctors and other health care providers because "COVID-19 deaths" brought in more money to the hospitals. He continued to hold rallies, even in states with high numbers of confirmed cases, despite appeals of local health providers not to come. Television footage of these rallies identified few people wearing masks and no attempt to practice social distancing.

One claim made by the administration and those who did not believe in any vaccinations was that INFLUENZA was at least if not more dangerous than COVID-19. Based on information from the Iowa Department of Public Health, there were 89 flu deaths in Iowa from October 2018 to September 2019. There were 103 flu deaths from October 2019 to September 2020. As of October 19, 2020 the State of Iowa had 1,682 COVID-19 deaths since March. There were 57 related COVID-19 deaths in Dubuque County with 23 more in Clayton, Delaware, Jackson and Jones counties. Those 80 death were equal to 78% of the flu deaths deaths from October 2019 to September 2020. (177)

The Telegraph Herald reported on October 31, 2020 that 133 new cases had been reported in the last 24 hours. This brought the total to 5,609. The number of people tested grew by 239 in that same period bringing the total to 36,601. The number of deaths remained at 58. (178) The number of confirmed cases in the United States surpassed 9 million.

Readers of the Telegraph Herald on November 5th were met with headlines that local COVID-19 numbers were "soaring." Iowa remained among the "red" states in terms of high virus numbers with the fifth highest positivity rate in the nation. Dubuque and surrounding counties had some of the highest positivity rates in the state. Jackson County stood at 26.2%, Clayton and Delaware had rates of 25.9% and 24.7% respectively, and Dubuque County recorded 19.7%. On November 4, 2020 there were 2,135 active cases in Dubuque County. Two weeks prior to this, there were 1,642 active and two weeks before that there were 1,458. It was anticipated that if the increase remained on track, Dubuque County would add an additional 6,000 COVID-19 cases (reaching 12,000) by Christmas. The growth of the number of cases came at a time when mitigation measures were often less stringent than in the spring. In addition the State of Iowa made changes in assessment. Instead of focusing on the overall testing figures to understand how many new tests had been conducted in a period of time, the state changed to "individuals tested" which made comparisons more difficult. Those living with someone who had tested positive were asked to quarantine assuming they too had the virus instead of getting tested. This lessened the number of people who might actually be positive. (179)

In a week in which President claimed victory before most absentee votes had been counted, the United States witnessed three consecutive days in which newly confirmed COVID-19 cases set records of over 1,000. On November 7th, Iowa recorded an additional 4,249 cases with fourteen deaths and 1,151 more recoveries. There were 8,649 new tests given for a total of 1,021858 tests being given in the states. Dubuque County had 171 new positive cases between 10:00 a.m. Friday to 10:00 a.m. Saturday. There was a total of 67 deaths. The 14 day positivity-rate for the county was 21.7. (180)

In the presidential election, not all states had been declared one week after the election and a recount was already underway in Georgia. President-elect Biden had 307 electoral votes easily eclipsing the 270 needed to be named president. Despite this, President Trump broke with tradition and denied the incoming administration officials copies of the daily briefing needed for national defense and other documents including the plan, if one existed, for distributing the COVID-19 vaccine. Remaining in their position of not attempting to contain the virus, Vice President Pence and his family planned a Florida vacation. The president, while playing golf, had dozens of lawsuits filed contending wide-spread voter fraud. By November 12, many GOP leaders, however, were admitting little substance lay on the suits as no proof was being shown. The Washington Post called the election official from each state who repeated no fraud had been found. Senate Republicans and Democrats were stalled $2 trillion apart in stimulus package proposals with Democrats claiming the unemployed needed as much as they had received earlier in the year. Senate Republicans did find time to approve more conservative judges.

Around the first week of November, Dubuque hospitals began administering monoclonal antibody infusions to COVID-19 patients with less severe symptoms. This was the first opportunity physicians had been able to recommend medicine-based treatment for non-hospitalized patients. Recipients were those who had mild or moderate COVID-19 symptoms who were at high risk of later needing to be hospitalized. (181)

On November 11th, local health officials announced that without an immediate turn-around in community spread of COVID-19 an already critical situation inside local hospitals could turn "catastrophic." A total of 7,000 total cases had been reported with an average of 126 new confirmed cases daily over the previous two weeks. A spokesperson for Grand River Medical Group said he had never seen multiple patients, very sick patients, needing to stay in the emergency room for long periods because there were not enough beds or staff available. On November 10th the Iowa Department o Public Health announced there were 43 Dubuque County residents with COVID-19 who were hospitalized with 1,190 statewide--an increase of 230 people, or 24%, over 24 hours previously. There were 210 COVID-19 patients in ICUs statewide. While hospitals usually could reach out to other facilities in the state for help, the same situation in Dubuque existed elsewhere. Asking for help from the community, hospital officials asked local residents to wear masks, practice social distancing, and to limit trips outside their homes. (182)

Responding to the dire statistics, Governor Reynolds announced new restrictions. Social gatherings of 25 or more people indoors and 100 or more outdoors were prohibited unless everyone older than 2 wore face coverings and was socially distanced. The restriction continued of six feet or more distance between people in bars and restaurants and limiting groups to eight people unless they all belonged to the same family. The new rules did not apply to school districts which had the choice of moving to online learning. Face masks were also required in all establishments providing personal services including tattoo parlors, barbershops and salons. When asked why she didn't impose a mask requirement on smaller groups she replied,"It's a place to start, and it's progress from where we were." Attendance at indoor sporting events was limited to two spectators per participant. (183) In her announcement, she required that all youth and high school sporting events must be limited to 25 people indoor events and 100 people for outdoor events unless all spectators over the age of 2 are wearing face masks at all times unless eating or drinking. At the time of her press conference, 88 of the state's 99 counties were above the 15% rolling 14-day positivity rate which allowed schools to apply for a waiver to conduct all classes online. Between November 4th and November 11th, the state had reported more than 21,000 new cases over the last week with an average state-wide positivity rate of 19%. (184)

Dubuque County had the most long-term care centers with active COVID-19 outbreaks in the state as of November 14, 2010. There was a total of 150 cases among the five centers. (186) As of the same date, COVID-19 related deaths rose by 4 to equal 77. The county's 14-day positivity rate climbed to 24.4%. (186)

                        If Iowans don't buy into this, we lose. Businesses will
                        close once again, more schools will be forced to go online,
                        and our health care system will fail."
A map of the spread of the pandemic across the United States as of November, 18 2020. Photo courtesy: CNN

With those words, Iowa Governor Kim Reynolds announced a three-week state-wide mask-wearing mandate would go to into effect November 19th. Following months of disparaging wearing masks as a "feel good" measure, Reynolds' announcement came just after the Dubuque County Board of Supervisors finally passed a county-wide mask mandate. Both came within days of Iowa exceeding 2,000 deaths from the virus and the nation surpassing 11 million cases of the disease. Reynolds' mandate would require all people above the age of 2 to wear face coverings, limit social gatherings to no more than fifteen people indoors or thirty outdoors, and force bars and restaurants to limit their hours of operation to be between 6:00 a.m. and 10:00 p.m. (187)

Despite pleas from most medical professionals not to be involved in large gatherings, many Americans were expected to gather in semi-traditional numbers for Thanksgiving. In anticipation of this in Dubuque and with numbers of college students returning home for the holiday, the Dubuque Community School District announced on November 20, 2020 new plans. As a precaution, all classes would be held remotely for one week after Thanksgiving. (188) On the same day, it was announced that Dubuque County had 159 additional cases of COVID-19 between 5:00 p.m. Wednesday and 5:00 p.m. Thursday and the county's positivity rate was 23.2%. Dubuque County's deaths rose to 88--the fifth highest in Iowa. On November 1, there had been only 59 deaths. (189)

Some good news was announced on December 9th when Dubuque hospitals began administering monoclonal antibody infusions to COVID-19 patients with less severe symptoms. This was the first opportunity to recommend medicine-based treatment for non-hospitalized patients. Recipients were those who had mild or moderate COVID-19 symptoms who were at high risk of later needing to be hospitalized. The goal was to reduce the number of cases that might need to be hospitalized.

Nationally, the daily COVID-19 death toll on November 21, 2020 exceeded 254,000 with the daily average running over 1,300 deaths. This placed the United States with the dubious distinction of having more deaths from the virus than any other country. (190) Despite this, President Trump refused to share whatever plans his administration had for distributing two newly announced vaccines--one from Pfizer and the other from Moderna. In one of the starkest reports, El Paso County, Texas was offering jobs for morgue workers capable of lifting bodies weighing 175 or more. (191) Morgues in many places in the southern United States along with their hospitals were overcrowded. Refrigerated trucks were being used for temporary morgues. Propaganda prior to the election that the pandemic was just a hoax to sway the election against Trump led to those later hospitalized to refuse believing they had the disease. (192)

On November 24, 2020, the day on which the United States recorded its first occurrence of the nation suffering over 2,000 deaths from COVID-19, President Trump called a hurried news conference. He announced the Dow Jones Industrial average had topped 30,000 which he called a "sacred number," and then left the room without answering questions. It was to the reporter covering the news conference, "the strangest thing he had ever witnessed at the White House." (193)

The November 28th issue of the Telegraph Herald listed Dubuque County with 9,103 confirmed cases (30 new), 91 deaths, 5,694 recovered and 43,725. Medical officials waited for the effects of holiday travel during Thanksgiving on the number of new cases. Included in the county figures were those from nursing homes. Luther Manor Communities had 83 cases (an increase of one), Manor Care Health Services had 15, Dubuque Specialty Care had 7, Hawkeye Care Center had 5, and Bethany Home had four. (194)

With news already bleak, on December 1, 2020 Dubuque County reported its first virus reinfection. The resident of SUNNYCREST MANOR had completed their ten days of isolation and reached their 28 days when they could be considered clinically recovered by the Iowa Department of Public Health. Like all residents and staff at the facility, the person had been tested weekly and had been found to be negative. The federal Centers for Disease Control and Prevention reported that infected people could shed virus for up to three months after first showing symptoms. (195)

NBC News reported on December 4th that one American was dying every thirty seconds from COVID-19. On December 6th the same news service reported that the virus had become the single largest cause of death in the United States. In the same week, President Trump recorded a 45 minute television segment focusing totally on what he called the fraud that had led to his loss of the presidential election. This came as the meeting of the Electoral College loomed and followed another week where his legal efforts to overturn several states voter record had been rejected by supreme courts in those states. His attorney Rudi Guliani continued, however, to hold what the Lt. Governor of Pennsylvania called "snake handling sessions at the Ramada" where allegations of voter fraud were followed by findings that the reports lacked verification. On December 5th, President Trump flew to Valdosta, Georgia allegedly to campaign for two Republicans in a runoff election. Instead, the 90 minute rally at which the only sign was a "Welcome to Georgia, President Donald J. Trump" was devoted to further charges by the president of voter fraud. Georgia, for the record, had three recounts and the state's election officer, a Republican, had deemed the election free of corruption. For this, the election official and the governor who refused to throw out the votes and have the legislature choose the state's electors, received death threats. At the rally where no effort was made to enforce social distancing and few masks were seen, the two candidates were introduced and one comment was made by the president about wearing masks.

In Iowa, civil rights and labor organizations charged that the Iowa Occupational Safety and Health Administration officials had not investigated complaints about employers failing to protect workers from COVID-19. Of the 148 COVID-19-related complaints filed with the state administration as of October 4th only five had resulted in an inspection. Iowa OSHA officials responded that they had procedures to determine which cases to investigate. The complaint stated that the OSHA operations manual stated that all complaints classified as "formal" be inspected. This did not occur for 3 of the 36 closed complaints statewide. (196)

Dubuque County confirmed the its death total had reached 100 as of December 5th. Records indicated that the county rated 5th in the number of active cases while ranking 6th in total population. The most cases over the past seven days had been in the 18-29-year olds (24%). The county's 14-day positivity rate dipped to 14.4%. (197)

The week of December 7th was filled with a flurry of contradictions. On December 10th, the United States had witnessed its third consecutive day of COVID-19 related deaths exceeding 3,000 and a map of the United States being almost entirely being considered a "red" zone. Pfizer's virus vaccine received an endorsement from an advisory panel which meant early distribution. The medical profession warned, however, that until at least 70% of the nation's population was vaccinated little hope of stemming the disease existed. Wearing masks and social distancing was still recommended. In Washington, D.C. the president responded by ignoring health warnings from authorities and hosted two galas at the White House and promised he would yet win the election weeks after recounts suggested this was not possible. The attorney general of Texas, indicted for bribery, was joined by seven Republican attorneys general, in filing a brief with the United States Supreme Court charging voter fraud in Wisconsin, Michigan, Georgia, and Pennsylvania. The plaintiffs asked that the votes of these states not be counted. The plaintiffs were joined by 105 members of the United States House of Representatives who filed amicus briefs in support of the filing. Ironically, the Supreme Court the same week had thrown out a suit asking that Pennsylvania's votes be rejected. In Iowa, the state altered its method of counting COVID-19 deaths during the preceding three days resulting in a spike of "new" casualties, although the numbers reflected deaths which had occurred months earlier.

Following a Thursday meeting of the federal vaccine board, health departments announced on December 12, 2020 announced COVID-19 vaccine distributions were ready to start to hospitals and nursing homes. Iowa, Wisconsin and Illinois officials all announced that the first to receive the vaccine would be health are providers through hospitals and the staff and residents of long-term care facilities. Dubuque County's COVID-19 Incident Command Team placed an order for 1,950 doses of the vaccine with priority given to providers working directly with patients at MERCYONE DUBUQUE MEDICAL CENTER and UNITYPOINT HEALTH-FINLEY HOSPITAL. Area nursing homes partnered with Walgreens, a national pharmacy chain, to administer the vaccine. Education campaigns were designed to give staff and patients grounds for an informed decision as to whether to receive the vaccine. In what would be the largest vaccination campaign in the nation's history, patience was urged for everyone. There was also a strong recommendation to continue wearing masks, avoiding groups, and social distancing. (198)

On December 14th, the United States surpassed 300,000 deaths from COVID-19. Photo courtesy: CNN

The beginning of the vaccination program did not mean the number of deaths would decline. Nationally the number of fatalities continued to exceed 3,000 daily with estimates that the number would increase. As on Friday, December 11th, Dubuque County had 9,889 confirmed cases (increase of 61); 123 deaths; 7,769 recovered; and 1,997 active (a decrease of 100). (199)

A new headline appeared in the Telegraph Herald on December 16, 2020. For the second consecutive week, the number of newly confirmed and active COVID-19 cases declined. Officials had worried about Thanksgiving which traditionally involved gathering with lots of people outside the household. A surge in numbers had been expected. Beginning on the morning of November 16 to the morning of November 23, Dubuque County confirmed 819 new cases. Between November 23 to 30, the number declined to 559 and from November 30 to December another decline to 419 was recorded. As of December 14th that number had dropped again to 343 new cases. From November 23 when the county recorded 3,400 active cases, the active cases fell to 1,748. Health officials attributed the improvement to the public following public health information. Mitigating the positive news was the fact that the number of active positive cases declining was due in part to the number of people dying. On November 23rd this number was 90 while on December 15th this had increased to 126. The amount of testing has also decreased. (200)

COVID-19 is caused by SARS-CoV-2 which since between January through December 20, 2020 infected more than 17,000,000 in the United States and was linked to at least 315,000 deaths. Through December 16th county records indicated 143 residents of Dubuque County had died. This number exceeded the figure reported by the Iowa Department of Public Health by 12 deaths, a fact officials could not explain. On December 20, 2020 it was announced that these investigations had led to a terrible conclusion. The first COVID-19 related death in Iowa was that of Kathy Davis of Dubuque who died on March 24th. Kathy and her husband Chuck had taken a vacation in March to New Zealand to celebrate her retirement after thirty years as a counselor at Northeast Iowa Community College. Their trip was shortened as the number of COVID-19 cases increased and they returned home. (201)

On December 20, 2020 the organization responsible for Dubuque County-funded rent, utilities, and burial assistance was nearly out of money. Originally allocated $128,000 for the fiscal year running through June 30th, Resources Unite saw increases in requests for funds for rent and utility assistance from those impacted by the virus. Executive Director Josh Jasper proposed to the Dubuque County Board of Supervisors another $130,000 to complete the year--doubling his original estimate. (202)

President Trump made little comment, in his Christmas message, about the thousands of daily COVID-19 deaths taking place in the United States. After little involvement in negotiations over a bill to extend payments to the unemployed, he suddenly stated that the $600 worked out in Congress was not enough and demanded that payments be $2,000. He then left Washington, D.C. for his club in Mar-a Lago, Florida leaving relief for the unemployed in a shambles and a bill to fund the government unsigned. As of December 22nd, Dubuque County had recorded 135 deaths since records had begun. The county's fourteen day positivity rate as of December 21st had fallen to 9.8%. (203)

In Dubuque County the first doses of COVID-19 vaccine began arriving for health care workers and public health officials. The Iowa Department of Public Health indicated there were 4,857 people in this category in Dubuque County. More shipments were to arrive regularly with most arriving on Monday. The Pfizer vaccine shipment of 1,950 doses arrived first followed by 400 doses of the Moderna vaccine. Individuals receiving vaccines had to receive the same kind for it to be effective. (204)

In giving priorities to groups, the Iowa Department of Public Health drafted an unofficial list of groups to be prioritized next. These included: (205)

                      1. residents of residential dare facilities, assisted-living
                         programs and elder group homes, as well as independent-
                         living facility residents older than 65,
                      2. emergency and law enforcement personnel,
                      3. food-packaging an distribution workers,
                      4. teachers, school staff an child care providers
                      5. adults with high-risk, pre-existing medical conditions

Covid-19 cases on Friday, hours after the country ushered in 2021 and left behind its deadliest month of the pandemic. The nation also has set a Covid-19 hospitalization record for four straight days. Some leaders warn the worst is still ahead. More than 125,370 coronavirus patients were in United States' hospitals Thursday, the fourth consecutive day that number set a record for the pandemic, COVID Tracking Project data indicated. (206)

On January 2, 2021, Iowa reported its total confirmed cases since the beginning had risen to 284,377. The total remained at 3,946. Dubuque County's total was 10,709 with 139 deaths. Population centers in the United States reported much different news with Los Angeles hospitals reporting emergency rooms were filled. The United States surpasses 350,000 deaths. (207)

The State of Iowa reported that COVID-19 cases in Dubuque County dropped 62% in December compared to one month earlier, yet nearly 40% of the people tested were still found to have the virus. A worrying figure, however, was that the number of people tested for the virus fell 52% from 7,351 to 3,528. The number of testing sites had not declined other than being closed on the holidays. (208) In the United States, the number of deaths in one day exceeded 4,000 on January 6, 2021 only to be surpassed on January 7th.

As the United States exceeded 400,000 deaths from the virus, Dubuque County officials were wrestling, as was most of the United States, with the rollout of the vaccines. On January 18th there had only been 1,040 Dubuque County residents who had received the required two doses of the vaccine. There were 3,182 residents who had received their first dose. The 800 doses the county was to receive the following week were only for the second shot. The status of the request for another 800 doses for those to receive their first vaccine had not been confirmed. People receiving the vaccination were still only with the 1A category of health care personnel and residents and staff in long-term care facilities. (209)

Between 5:00 p.m. January 25th and 5:00 p.m. January 26th Dubuque County added 29 COVID-19 positive cases with the county's 14 day positivity rate remaining at 10%. As of Tuesday, Dubuque County had 11,673 confirmed cases; 159 deaths; 10,433 recovered; and 1,081 active cases. The state's death toll was 4,492. (210)

Interest locally remained high for the second round of the Paycheck Protection Program of the federal government. Funds issued by the federal government to financial institutions like banks and credit unions with processed applications and dispersed funds. The second round allowed applications from companies not receiving funding last year and companies that had already received a "first draw" loan and spent the amount on authorized uses. Companies seeking a second round of funding had to have no more than 300 employees and be able to demonstrate a 25% reduction in gross receipts between comparable quarters in 2019 an 2020. Companies receiving funds had to maintain employee and compensation levels. (211)

On January 30, 2021 the Dubuque Community School District officials announced it would move students to full-time, in-person classes by February 15th. This followed Governor Reynolds signing a bill requiring public and accredited nonpublic schools statewide to offer completely in-person instruction to parents who ask for it. The law did not prohibit schools from continuing part in-person and part online learning. Health officials cited growing evidence that children were not the main cause of community spread and that transmission in schools was low if mask-wearing, social distancing, and contact tracing were in effect. (212)

In the City of Dubuque an incentive plan to encourage staff to receive the COVID-19 vaccine was proposed. The plan would provide city staff with a $100 incentive in the form of gift certificate from a local restaurant of the employee's choice, a $100 gift certificate from a local not-for-profit organization or a $100 donation in the name of the staff member to a not-for-profit organization. (213)

As nearly a year of the pandemic was coming to a close in January 2021, the economic cost of the virus to the city was still known as revenue estimates changed and costs continued to rise. As revenues from parking fees, hotel and motel taxes, and gaming fees declined the city spent $470,919 on transit operations and protective equipment, $350,031 on sheltering to isolate potential cases, $75,305 for remote work telecommunications,and $52,101 on building disinfection. For fiscal year 2020, the city lost nearly $2.1 million including $675,982 in parking fees and fines and $185,096 in hotel and motel tax. Projections for losses in 2021 made in January were $2.7 million.

State and federal relief have been important. This included:

                       $3.6 million in federal assistance as part of the Coronavirus Aid,
                       Relief, and Economic Security Act;
                       $1.4 million from the State of Iowa;
                       $647,301 in federal Community Development Block Grant
                       coronavirus funds

Cost saving measures taken by the city included a hiring freeze on vacant positions and frozen travel budgets. Each city department was directed to develop budget reduction plans ranging from 10% to 30%. (214)

Iowa ranked 47th in the nation in getting vaccine "into the arms" of Iowans and despite warnings of medical experts on the national level to beware of dropping safety measures, Iowa Governor Kim Reynolds announced the lifting of Iowa mask rules and limits and businesses and social gatherings in time for the annual Super Bowl. The news reached national networks on February 6th amid reports that "Covid Kim" text messages showing irritation/anger were reported. The relaxation of safety measures came after it was announced that a more infectious variant of coronavirus had been found in Iowa. (215) It was on February 5th that the announcement was made that Iowa had now exceeded 5,000 deaths from the virus. Dubuque County's death total was 181 while the active number of cases declined to 922 from 964. The confirmed cases in the county rose 27 to a total of 11,926. (216)

In the already challenging field of finding foster families, the pandemic placed additional concerns. Nationally there were 400,000 children in need of placement. Concerns of economic disruption and infection, visitation, court hearings and schooling forced human service workers to re-imagine new solutions. The effect of the pandemic, however, has been made difficult to determine because of changes in funding. States have had new federal regulations which restricted the use of federal funds. Rather than pay for foster care placements, states were required to begin services to prevent such placements. Removal of children from families in eastern Iowa began decreasing since July 2018 and continued through the pandemic. The number of children placed in foster care declined from 951 to 873. (217)

Dubuque County's Covid-19 Incident Management Team announced on February 3, 2021 their proposed vaccine point-of-distribution and administrative site at the former YOUNKERS department store at KENNEDY MALL. The Board of Supervisors had approved the lease agreement for the site which stated it was a no-cost space rental and $10,000 for utilities over five months. At its meeting on February 3rd the additional costs to run the site were outlined. Including security, signage, and various staff these costs totaled $126,815 for five months. Team officials noted that Dubuque County had still not received most of the 2,650 dosages of vaccine it had been promised for the week. The county had received 700 Moderna doses but not the 1,950 Pfizer doses. Based on census data, the county had 20,854 residents who qualified for the vaccine; 300 first responders; 17,819 residents over 65; 2,385 k-12 school staff, and over 350 child care workers. (218)

At their meeting on February 8th, Dubuque County Supervisors voted to extend their requirement to wear face coverings despite the governor's recent decision to rescind the state mandate. (219) On February 9th it was announced that Governor Reynolds' decision to lift the mask mandate had been made without input from public health officials in her own administration. The state was last in the nation in distributing vaccines and fifth from the last in the nation in administrating vaccines. (220)

On February 22, 2021 the United States officially exceeded 500,000 deaths from COVID-19. This figure was greater than all the United States casualties in WORLD WAR I, WORLD WAR II, and the [VIETNAM WAR]]. (221) Despite this, the United States was still registering 2,000 deaths per day which was a continuing decrease but over 60,000 new cases being reported. (222) On February 20, 2021 Dubuque County reported 191 deaths since the start of record keeping with 12,202 confirmed cases, 11,404 recovered, and 1,748 active cases. The State of Iowa had begun a change in the way it reported COVID-19 information on its website. This caused massive shifts in the number of confirmed cases at the state level and to positivity rates at both the state and county levels. The state began showing total related to the individual tests, rather than individuals tested. Prior to the change, if a person had been tested four times during the pandemic, the state reported only the individual's last test and result. Now all four tests and their results were counted. The number of confirmed cases soared, although the number of people likely changed very little. The addition of thousands of negative tests served to greatly reduce to-date and 14-day positivity rates. Dubuque County, for example, went from 6.4% to 3.1%. (223)

During the week beginning on February 21, 2021 the Iowa Department of Public Health is expected to send 2,340 doses of the vaccine to Dubuque County. One these 654 units were scheduled for UNITYPOINT HEALTH-FINLEY HOSPITAL with 300 for residents 65 and older and 354 for employees of Hormel, the first front-line workers to be scheduled. Hartig pharmacies were to receive 600 for individuals with disabilities and those in assisted living--all 65 and older. MEDICAL ASSOCIATES CLINIC PC (THE) were scheduled for 498 units and 198 to Grand River Medical Group, both for 65 and older patients. MERCYONE DUBUQUE MEDICAL CENTER would receive 198 doses for the area's religious communities with 192 doses reserved for the DUBUQUE VISITING NURSE ASSOCIATION to give to any school or child care workers left after the last two weeks. (224)

In February, nearly a year after the beginning the pandemic, Governor Reynolds and her staff were still "looking at solutions" for getting the vaccine to people without a primary care physician. For Dubuque County residents over the age of 65, the county announced a hot line (563-587-4950). Callers could leave their information on a recording and would be contacted when a vaccination appointment was available. State officials, however, were unsure how to proceed. The suggestion that calling 2-1-1 was met the realization that the system would have to be enhanced to handle the number of calls. The 2-1-1 system, announced on February 11, was a free information and referral system linking residents to service programs. Reynolds also suggested eligible Iowans contact their regional Area Agency on Aging. As the Telegraph Herald Editorial Board wrote:

                         So for the 65-and-older crowd who aren't in long-term-care facilities
                         and haven't heard from a health care provider, getting a vaccine
                         appointment has been coming down to 1) fast internet, 2) some degree
                         of technological savvy, and 3) a while lot of luck. (225)

The first week of March proved to be a watershed in the battle to provide vaccinations. Following weeks of being told that most Iowans had to wait for vaccines to be available, it appeared something of a logjam had been broken. As a 71-year-old Iowan, I was assured that my doctor's staff would call when one of the three vaccines was available. I also signed up to be on two lists associated with local hospitals and monitored a Walgreen's app to which I would have to respond if appointments were available. I refused the opportunity to drive to Scott County believing their vaccine should go to them, although friends had driven to Wisconsin where your residence did not seem to matter. I ended up declining an opportunity to go to a local hospital, because they would not schedule my wife.

On March 2nd, my wife and I received a note on Facebook messenger that appointments were available through MercyOne at the community center in Peosta for Dubuque County residents. Within five minutes, both of us had scheduled appointments and we both received confirmations by email. Note that this information came through a friend of my wife and not through any of the sources to which I had joined.

The following day, we received a phone call asking if we had scheduled an appointment. I thanked the person for called, but said we were on a schedule. The following morning, the Walgreen's app also indicated that appointments were available. The number of people vaccinated in Iowa increased dramatically over the week. We were given the Pfizer vaccine which meant two shots (as with the Moderna vaccine). Iowa's governor was given the Johnson and Johnson vaccine which needed only one shot. All claimed being able to greatly reduce the possibility of being hospitalized or dying of the disease. Johnson and Johnson had the least ability of protecting a person from getting the illness. On March 4th it was announced that Iowans 64 years of age and older who had disabilities would be able to be vaccinated. (226)

During the second week of March, 2021, an estimated two million Americans were vaccinated with either the first and only, first, or second shot depending upon the brand used. In Iowa about 18.1% of the state's population had received at least one dose while 590,000 were fully vaccinated which was 10.2%. In Dubuque County 21,799 had at least one dose (an increase of 2,154) or 22.4% of the county population with 10,420 fully vaccinated (an increase of 807) or 10.7% of the population. As of Saturday, March 6th the positivity rate in Dubuque County was 4% which compared with 2.7% in Jones County, .8% in Clayton County, and 2.9% in Jackson County. (227)

On March 8, 2021 Iowa officials announced that Iowans sixteen years of age and older with high-risk health conditions were eligible for the vaccine. (228)

As of Monday, March 15, 2021 reports indicated that 74,147 residents in a 10-county Telegraph Herald coverage area had at least one dose of the COVID-19 vaccine. This was 24.5% of the area's population. There were 14,618 Dubuque County residents fully vaccinated equaling. 15%. As of the same time, 413,218 Iowans had been fully vaccinated. The death figure remained at 6,536 statewide. Dubuque County's 14-day positivity rate was 2.2%. (229) Nationwide, the number of vaccinations over the weekend on March 13th and 14th topped three million Americans each day. Death rates continued at about 1,500 Americans daily. (230)

Good and bad news was received on March 18, 2021. Governor Reynolds indicated that all Iowa residents would be eligible for coronavirus vaccinations on April 5th as long as supply projections were met. Hours later local public health officials announced that the first case of COVID-19 variant B.1.1.7 had been found in Dubuque County. Researchers believed that the variant could be spread more easily than the original strain, but that current COVOD-19 vaccines would likely protect against the new strain. Local officials stressed the need to maintain the current mitigation strategies including distancing, masks and avoiding large gatherings. (231)

As of March 20, 2021 Iowa health officials had not yet reported what were called "break-through" cases. This occurrence first appeared in late January and gradually spread into the West, Midwest and South. These were post-vaccination infections in people more than two weeks after they received their final COVID-19 shot. According to health officials, the number of these cases would continue to grow, but there was no cause for alarm.

Breakthrough infections are an entirely expected part of any vaccination process. They are what keep vaccines from reaching 100 percent efficacy in trials and are proof that no inoculation is a perfect preventative. By March, 2021 the ones found after COVID-19 vaccination seemed to be "unextraordinary."

A small percentage of vaccinated people have gone on to test positive for the coronavirus. The post-shot sicknesses documented seemed to be mostly mild, supporting the idea that inoculations are powerful weapons against serious disease, hospitalization, and death. Coronavirus infections were expected continue to occur, even as more people were inoculated. The goal of vaccination was not eradication, but a condition in which humans and viruses coexist, with the risk of disease at a tolerable low level.

When breakthrough cases arose, it was not always clear why. The three vaccines used in the United States were all designed around the original coronavirus virus and seemed to be a bit less effective against some newer versions of the virus. Although variants did not make current vaccines obsolete, the more variants there were, the more concern for breakthrough cases. The circumstances of exposure to any version of the coronavirus also made a difference. If vaccinated people spent time with groups of unvaccinated people in places where the virus was common, that raised their chance of getting sick.

The degree of defense caused by an infection or a vaccine differed from person to person. Some people might have underlying conditions that limited their immune system’s response to vaccination; others might simply produce fewer or less potent antibodies and T (thymus) cells that could stop a coronavirus infection.

An ideal response to vaccination would create an arsenal of immune molecules and cells that could immediately stop the virus, leaving no time for symptoms to appear. When that "front line of fighters" was relatively sparse the pathogen rushed to copy itself, and the immune system recruited more defenders. The longer this continued, the more likely the disease was to occur.

In some ways, the shots’ amazing success in trials—where breakthrough cases were also observed, hid the inevitability of post-vaccination infections in more natural settings. Breakthrough cases include asymptomatic infections. This is different from the criteria used the judge the original vaccines. In clinical trials, the three vaccines cleared for emergency use in the United States were evaluated for their ability to prevent symptomatic cases of COVID-19, which they each did to a remarkably high extent. The Moderna and Pfizer-BioNTech vaccines reduced, on a population scale, the risk of disease by about 95 percent; Johnson & Johnson’s registered 72 percent among Americans.

Efficacy, a figure specific to clinical trials, does not always translate perfectly to the real world, where there is immense variability in how, when, where, by whom, and to whom shots are administered. The vaccine’s performance under these conditions is tracked by a separate measure, called effectiveness. Studies rigorously examining vaccine effectiveness are challenging, but early data suggested that the Pfizer-BioNTech and Moderna shots were living up to their initial reports. A team at the CDC began tracking breakthroughs as well as any patterns related to where, or in whom, these infections occurred. Details like those helped experts figure out why post-vaccination infections happen, and how they might be stopped. If post-vaccination infections climb to unexpectedly high rates, backup plans would to quickly begin. Some shot recipients might get second or third shots to bolster their immune response; others might be administered a tweaked vaccine to account for a new viral variant.

The more people vaccinated, the more breakthrough cases will occur, in absolute numbers. The rate at which they appeared was also expected decline, as rising levels of population immunity reduced the paths that the virus needed to travel. People with low responses to vaccines—as well as those who chose not to get their shots—still received protection from the many millions in whom the shots did work. (232)

As reports of increasing cases nationally were heard in Iowa, the virus cases fell as the vaccination program continued to expand. As of March 22, 2021, Iowa reported only 230 new cases in the twenty-four hour period which increased the state's total to 345,938 The death toll remained at 5,675. As of 5:00 p.m. Monday there had been 499,348 Iowa fully vaccinated, an increase of 3,730 from Sunday. Dubuque County had 17,294 residents fully vaccinated, an increase of 35 from the previous day. (233) Dubuque County Supervisors were expected to vote during the last week of March on whether to approve a drive-through COVID-19 vaccination site in the PORT OF DUBUQUE. (234)

On Friday, March 20, CDC officials admitted alarm at the 7% rise of COVID-19 cases in the United States. Among the concerns were spring break activities in southern states witnessing an absence of masks or social distancing. Eager to resume business activity after the passage of national stimulus checks to millions of people, governors removed restrictions in place. Pfizer announced vaccination trials for children as more states opened up eligibility. (235)

In Dubuque County, clinics established at the elementary school in Peosta and Kennedy Mall processed those receiving their first or second shots without problem. While times had been scheduled to arrive, those receiving their vaccination found they could enter early and be finished after a fifteen minute rest period.

As of Saturday, March 27th, a total of 556,498 Iowans had been fully vaccinated--an increase of 23,305 from Friday according to state reports. The number of residents who tested positive for COVID-19 grew by 483 in the twenty-four hour period which increased the state's total to 349,179. Two additional related deaths were reported bringing Iowa's total to 5,718. (236)

COVID-19 had a tremendous economic nationally. To address some of these economic concerns, the American Rescue Plan Act, a $1.9 trillion stimulus bill was passed, without any Republican support in the House or Senate, by the United States Congress. An estimated $350 billion in the plan was to be distributed to every state, city, and county government in the nation with each receiving an allotment based on population and economic factors. The National League of Cities estimated that the City of Dubuque would receive $27.4 million which Dubuque County would receive $18.9 million. Half of the amount was to be received by May with the remainder coming within the next twelve months. Unknown in March was how the money could be spent. Regulations were still being written by the United States Department of the Treasury.

The bill did provide a broad outline of how the money could be spent. These included replacing lost revenue from the pandemic; providing assistance for local households and businesses; investing in water, sewer or broadband infrastructure; and providing premium pay for essential workers. (237)

Governor Reynolds implored Iowans to receive their vaccinations. The U. S. Census Bureau had recently indicated that 45.5% of nearly 1.5 million Iowans who had not yet been vaccinated would get their shot when they became eligible. This left an estimated 800,000 Iowans, roughly 36% of the total adult population, unwilling to commit to the program. Iowa was expected to receive nearly 161,000 doses the first week of April, the largest weekly supply to date. (238)

Her hopes of ramping up the vaccinations, however, was hampered the same day with reports Johnson & Johnson (J & J), a company which was to play a major role in supplying vaccinations had to discard 15 million doses. The company, identified by its "one and go" single vaccine, found that its vaccine made by Emergent Biosolutions in its Baltimore, Maryland factory did not meet quality standards. The Food and Drug Administration had inspected Emergent since 2017 and in 2020 had cited the company for poorly trained employees, cracked vials, and handling contamination around one of its facilities. (239) On Thursday, April 1st, the Iowa Department of Public Health reported that the spoiled doses would not affect the supply headed for Iowa the first week on April, but could impact the supply further on in the spring. (240)

Iowa's changing methodologies for reporting virus cases caused it for several days in April to be shown as a blank spot on the United States map of virus reports. In April nothing had changed. On April 3nd there were 549 new, confirmed cases from 10:00 a.m. Friday to Saturday according to the state's dashboard, bringing the state's total number to 352,811. The state's website reported that of the 352,811 people who reported positive, 334,471 had recovered. This was 465 more recoveries than what the state reported Friday. There were 200 residents of the state hospitalized with 44 in the ICU and 20 on ventilators. Governor Reynolds signed a new public health disaster proclamation that extended regulatory relief for an additional 30 days to those on the front lines of COVID-19 recovery. (241)

By May 15, 2021 many U.S. states and cities had a growing surplus of Covid-19 vaccines. In some cases this indicated that a large percentage of the population had been vaccinated. In the nation, 37% of the people have had at least one shot. In some states, however, those administering vaccine met with stiff pockets of resistance use before Johnson & Johnson shelved millions of shots until federal health officials’ investigated rare cases of blood clots. Disparities within a state like Iowa existed, leading those living in eastern Iowa being willing to travel to western portions of the state where appointments were open. (242)

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On April 17th the word surpassed three million deaths from COVID-19 according to John Hopkins University data with the United States accountable for 18%--the highest country share. It took an estimated 8.5 months after the first fatality in China for there to be one million deaths and just 3.5 months to reach the second. The passage of the 3 million mark on April 17th dealt a blow to hopes that increasing vaccinations might signal an end to the disease which has rapidly developed variants. Actual mortality figures were undoubtedly low due to unreliable reporting which only seemed likely to deteriorate as the disease struck poorer and poorer countries.

Numbers of deaths numbers in the United States and parts of Europe have slowed due to the presence of vaccination efforts. An estimated 40% of the COVID-19 vaccines through April 17th had been administered to people in countries accounting for just 11% of the world's population. Less wealthy parts of the world which struggled to get vaccines witnessed their absolute numbers increase. Within the last one million deaths worldwide, Mexico saw its portion grow by 9.5%. (243)

Reporting on COVID-19 in Dubuque County on April 17th showed that there were seventeen new cases reported in the last twenty-four hours, 31% of the county had been fully vaccinated, 45.5% had received at least one dose, and that Dubuque County had a positivity rate of 5.4% over a fourteen-day period while the state average was 4.6% There had been 202 deaths from the virus with 12,341 recovered and 584 active cases. (244)

On Monday, April 19th President Biden announced that there was enough vaccine in the nation for everyone from the age of sixteen to adults. Resistance to the vaccine continued with the daughter of former President Trump being criticized for encouraging vaccination after getting her shot and Brett Baer, a correspondent on Fox News, a predominantly Republican news station, for announcing that he too had been vaccinated. On April 21st Governor Reynolds remarked that several predominately Iowa counties were showing resistance to the vaccination by not making appointments. Indications were later made that these counties were largely dominated by Republican voters.

President Biden announced on April 21st that the United States had reached his upwardly revised goal of 2,000,000 vaccinations in 100 days. In Dubuque County, walk-in clinics established in Dubuque and Dyersville were being used to test the interest of people going forward in getting a vaccination. It had become more difficult in filling appointments. On the first day, 74 people came to the clinic in Dubuque and 38 had visited the one in Dyersville. As of April 19th, 57% of residents in Dubuque County aged 16 years and older had received at least one COVID-19 shot. While this was the sixth-highest vaccination rate in Iowa, it was below the 70%-90% of the population needing to be vaccinated to achieve herd immunity.

The beginning of the vaccination program had given priority to certain demographics. Beginning April 5th, all Iowans qualified to receive the vaccine. Starting April 19th, all Americans qualified. In addition to the site in the former Younker's department store at Kennedy Mall, a drive-through, no appointment clinic in the parking garage of the Grand River Center in Dubuque was scheduled for April 24 to run from noon to 7:00 p.m. (245)

The politicalization of the virus continued. Starting with President Trump's initial remarks that the disease would simply "go away", Republican response moved to doing little while work on a vaccine proceeded under a Trump proposal called "Warp Speed." One of the president's last medical advisors, with no experience in immunology or epidemics, suggested just letting the virus spread until enough people had it that "herd immunity" would be achieved. Republican campaign stops were marked with no concern for crowds even after medical professionals urged social distancing. Masks were seldom seen and although the president looked as through he was speaking among his supporters, camera views indicated he was well beyond the three feet recommended distance. After his hospitalization for the virus and receiving cutting-edge treatments available to few, President Trump removed his mask and entered the White House to a meeting. He commented that wearing a mask, "Did not make me look good." Candidate for President Biden spoke to groups via Zoom or in open air venues with social distancing practices. Thousands of people crowded the Dubuque airport during the run-up to the election to see President Trump.

After the vaccines were introduced, an announcement was made that President Trump and his family had received the shots. There was no formal announcement of this, however, from the White House and the former president never encouraged anyone to receive the vaccination.

Beginning the third week of April, 43 of Iowa's 99 counties declined further shipments of vaccine because of a decrease in demand. On April 21st, 2021 Governor Reynolds was asked about an Associated Press-NORC Center for Public Affairs Research poll from late March indicating that 36% of Republicans said they probably or definitely would not get vaccinated compared with 12% of Democrats. Governor Reynolds responded,"That's your poll" and went on to cite the Kaiser Family Foundation research that age was a factor in resistance to the vaccination with the highest incidence between 18 to 39." As governor, she repeatedly warned people to be proactive in stopping the spread, but adamantly opposed mandatory restrictions and quickly reopened businesses. (246)

Despite her citing Kaiser Family Foundation research in this instance, further reading would have found that the foundation found consistent reluctance among Republicans to be vaccinated. In March, "about three in ten Republicans (29%) and a similar share of white adults identifying themselves as Evangelical Christians (28%) said they would definitely not get the vaccine. The foundation study also found that 5% of Democrats and 9% of independents would no agree to be vaccinated." (247)

Locally, city staff indicated that Flora and Sutton swimming pools would open for business on June 1st, the first time they had been open to the public since last spring. There would be some limitations. (248)

As on Saturday, April 24 there were 13,227 confirmed cases of COVID-19 in Dubuque County--an increase of 5. There were 205 deaths--an increase of 1 and a total of 126 active cases--a decrease of 1. Dubuque County had 46,110 cases of residents having at least one dose of vaccine (47.4% of the county) and 35,321 residents being fully vaccinated--an increase of 1,286 (36.3% of the county. (249)

The Telegraph Herald of May 12, 2021 announced no additional Covid-related deaths from Monday to Tuesday. Three additional Dubuque County residents were confirmed to have the disease. As of Tuesday, 125,706 residents in a ten-county coverage area had been fully vaccinated--51.6% of the area's population of those 16 and older. As of Tuesday, Dubuque County had a positivity rate of 1.9%. Within Iowa, 49% of the state's residents had been fully vaccinated. (250) On Wednesday, the CDC announced that it was authorizing the availability of the vaccine to those 12 years of age and older.

Walk-in appointments for vaccinations began falling in early May. In response, Dubuque County health officials turned to more mobile clinics and targeted events occurring in the county. Vaccines were, therefore, offered at the Dubuque Farmers' Market, the Dubuque County Fairgrounds, and at the Food Truck at Washington Square. Some of the county's semi-permanent sites were closed beginning with the Grand River Center which had been opened in early April. (251)

Officials with the CDC announced on May 14, 2021 that persons fully vaccinated no longer had to wear masks or practice social distancing with other people who were fully vaccinated. By a 2-1 vote the Dubuque County Supervisors on May 14, 2021 repealed the mask mandate. This change only impacted Dubuque County and not the City of Dubuque in which a decision still had to be made. (252)

City Council members on May 19th voted unanimously to end the mandate requiring anyone older than 2 to wear face masks while in public to lessen the chances of spreading COVID-19. The ordinance had been in place in the city since August. (253) As of May 25, 2021 Dubuque County's Covid record stood since at 13,430 confirmed cases; 209 deaths; 13,049 recovered; and 172 active. (254)

Bad information shared on social media was being blamed for 37% of SUNNYCREST MANOR staff remaining unvaccinated in early June, 2021. The condition continued to result in testing requirements and visitation restrictions. Centers for Medicare and Medicaid Services required long-term-care facilities to test all residents and staff for COVID-19 once every three to seven days for two weeks following a positive test of either an employee or a resident. While visitors could visit residents outdoors at any time, a positive test barred visitors from coming into the rooms or common areas of the units for two weeks. Making matters even worse, the U. S. Department of Health and Human Services began requiring nursing homes to report on staff and resident vaccination rates--an action which could affect facilities' ratings and perhaps funding. One inducement to get people vaccinated being suggested was to lift restrictions on those who had received their shots. (255)

Dubuque public school administration announced in June, 2021 the addition of thirteen new "Core+" teaching positions to help students catch up on skills lost during the pandemic. The teacher, one in each elementary school, would work with students in small groups and offer tutoring to meet academic standards. Funds to pay for the new staff were made available through nearly $20 million from three federal relief packages enacted during the pandemic. The Core+ teacher positions were created as two-year positions based on the availability of federal funds. (256)

As of June 25, 2021 61.6% of Dubuque County was fully vaccinated. That figure was the highest among Clayton, Delaware, Jackson and Jones counties. (257) On July 2, 2021 the figure stood at 62.2%--still the highest among the previously named counties, but less than the target set by President Biden of 70% by July 4th. (258)

On July 18, 2021 the stock market plunged over 700 points (its worst day since October). Many analysts credit this drop to the fact that Covid-19's delta variant was seen as the cause for hospitalizations and deaths from the disease increase in every state. The country reported an average of 532,287 new cases daily over the past week, according to a Wall Street Journal analysis of Johns Hopkins data. This was more than double the seven-day average 10 days previously. The Dalta variant, dominant in the United States, was estimated to be 40%-80% more infectious than the original virus. Existing vaccines were effective against the variant although none were 100% effective. In response public health officials in parts of Nevada and Calfornia were reinstating indoor mask recommendations. (259)

Photo courtesy: Axios

Early in the summer of 2021, the U.S. seemed to have COVID-19 under a degree of control. But by July, the Delta variant was sweeping through the country. “Breakthrough infections” — people who have contracted the virus even after being vaccinated — received a lot of attention as cases increased. It became clear that those infections were not the man factor of the new surge in cases, and that vaccinated people were much safer than unvaccinated people.

The CDC reported in the second week of July that 97% of people hospitalized for COVID-19 infections were unvaccinated. More than 160 million Americans were fully vaccinated. Of those 160 million people, only 3,733 subsequently were hospitalized for a severe COVID-19 infection, according to the CDC’s most recent update, and 791 had died from the virus.

Clinical trials indicated that both the Pfizer and Moderna vaccines were 94-95% effective at preventing serious illness and death. There were still people in the other 5-6%. That did not mean the vaccines did not work; those cases are noteworthy precisely because they are rare. Real-world evidence consistently indicated that the vaccines continued to offer strong protection against the Delta variant. (260)

Concern about the low number of people vaccinated, the Dubuque County Board of Supervisors considered and then rejected 5-0 with one abstaining a proposed $10,000 lottery drawing as an incentive for COVID-19 vaccinations. The Dubuque COVID-19 Incident Management Team had proposed but not endorsed four lottery drawings of $10,000 each, in two groups. (261)

In July with the annual change of leadership, the GREATER DUBUQUE DEVELOPMENT CORPORATION found reasons to believe the economic recovery from the COVID-19 pandemic was strong. These were the achievements of two of the four broad goals in the five-year campaign "Greater Dubuque 2022" which concluded in June. Dubuque County's median household income surpassed the goal of $60,000 to reach $63,130. Construction spending exceeded the goal of $800 million to reach $813,975,796. The goals of growth in the county's labor force from 59,800 to 64,000 and population from 95,500 to 100,000 were missed. (262)

Any optimism, however, was tempered by the alarming rise in the Delta variant of COVID-19 which appeared to be gaining strength across Iowa, according to test results from the Iowa State Hygienic Laboratory.

In each of the past two weeks prior to July 1, the delta variant accounted for more than half of positive coronavirus tests from Iowa that included variants of the virus according to the Iowa Department of Public Health. The variant, first discovered in India, was confirmed to have arrived in Iowa on May 4. The situation added urgency to vaccination campaigns, and renewed suggestions that mask mandates could return to some public places. (263) The new form of the virus had a viral load estimated to be 1,000 times higher than other strains, making it easier to infect people, even outside, in areas with low vaccination rates. Within ten days the number of counties in Iowa which reported having COVID-19 under control dropped from 30 to 13. (264)

On August 2, 2021 United States health officials announced that the nation had reached the goal of 70% of the vaccine-eligible population having at least one shot. The goal had originally been announced by President Biden for July 4th. Areas which had been recently designated "hot spots" for the Delta variant were seen increasing their number of vaccinations. (265)

On August 8, the United States was averaging 100,000 new COVID-19 cases daily--the highest in six months according to Johns Hopkins University. Because it can take days or weeks for some cases to lead to hospitalization to death, doctors are foreseeing a repeat of scenes from 2020. The director of the U.S. Centers for Disease Control and Prevention. Americans who had previously had the disease should not assume they did not a shot. A CDC study published on August 6, 2021 suggested that people who got the disease in 2020 and did not get vaccinated were ore than twice as likely to be reinfected as those who also had the disease but who were then fully vaccinated. In August of the country was not fully vaccinated including children under 12 who were not eligible but who were still vulnerable to COVID. As of August 3 there were 192 children with COVID-10 admitted everyday to hospitals. That was a 45.7% increase from the previous week in patients ages 0-17. (266)

By August 8th, the State of Iowa provided was updating COVID-19 figures only once per week on Wednesday. As of August 4, 2021 the State reported that 382,401 residents had COVID-19, an increase of 3,570 from the previous week. Ten additional deaths were reported increasing the total to 6,193. Despite repeated efforts to get Iowa residents totally vaccinated, only 59% met the criteria. (267)

With the opening of public schools quickly approaching, a group of Iowa mothers with young school-age children held a rally outside the Iowa Capitol on August 11, 2021. They were protesting a law passed in May and signed by Governor Reynolds that prohibited school boards and other local officials from mandating the wearing of masks. The issue had been a high-stakes political issue between Republicans who said mask wearing was a personal freedom and liberty issue while Democrats claimed there was scientific evidence that wearing masks helped stop the spread of the virus. Arkansas Republican governor Asa Hutchison had recently called the GOP-majority legislature back into session to review the mask mandate it had approved in April. In Florida, the Republican governor had to "walk-back" his decision to deny mandates when several large school districts simply defied him and said masks in school would be worn. Governor Reynold's statement that "I trust Iowans to do the right think and make the decisions as to what's best for themselves and their families" led to condemnation by those who felt she was avoiding her responsibility to lead for the benefit of everyone. (268)

For the remainder of 2021, the Dubuque County COVID-19 Incident Management Team announced in early August that it would focus on personalized outreach and targeted vaccine clinics. As on August 3, 2021 67% of Dubuque County residents 12 and older had begun or finished their vaccination series. While below the targeted 70% nationally, Dubuque County had the fourth highest vaccination rate among counties in Iowa. Instead of going to mass clinics like the one offered at Kennedy Mall, the vaccination sites had moved to routine visits to personal physicians. Drug store and health care providers offered walk-in options. The Incident Team is beginning to analyze age, race, ethnicity and ZIP code data and working with the Dubuque County Equity Immersion Committee to identify groups of people in need. The Incident Team also planned to use letters and testimonials from county medical personnel and community leaders to stress the importance of getting vaccinated. Flyers were also to be distributed featuring current testing and vaccination opportunities and bars, restaurants, child care facilities and schools. Knowing the status of the number of cases in the county was made more difficult when the Iowa Department of Health ended its Test Iowa program and began reporting update on COVID-19 only once per week. (269)

On August 14, 2021 the Dubuque County COVID-19 Incident Management Team revealed over the past week that positive cases are on the rise in the county, with the great majority caused by the delta variant. This, coupled with an only slowly increasing vaccination rate and uncertainty in data accuracy, has troubled the Dubuque County Board of Health enough to approve local contact tracing staff and take bold actions. Between August 4 and Wednesday, Aug. 11, 93 Dubuque County residents tested positive for COVID-19. The week before that — from July 28 to Aug. 4 — 43 new county residents tested positive. The week prior — between July 21 and July 28 — 32 new county residents tested positive. According to the data, the delta variant arrived in Dubuque County in June, representing just over 22% of the 80 positive cases reported that month. By July, the delta variant made up more than 86% of the 108 cases that month.

To help the county get a better idea of transmission in Dubuque County, the Board of Health approved hiring a full-time contact tracer for the Visiting Nurse Association — the county’s contracted public health arm — to resume calling those who test positive. The position will cost $52,000 through the end of the fiscal year ending June 30, 2022. VNA Director Stacy Killian said that CRESCENT COMMUNITY HEALTH CENTER offered to cover $25,000 of the cost with money the center had received from the federal government. (270)

While commending the Dubuque County Board of Health, the Dubuque County Board of Supervisors chose not to require vaccinations of county government staff or recommend that local employers require COVID-19 vaccinations among staff and the wearing of masks by customers. The Board of Health had unanimously made the recommendations at the urging of the Dubuque County COVID-19 Incident Management Team made up of public health and emergency staff from Dubuque County and the City of Dubuque. "Your (Board of Health's) recommendations should stand on their own as well-reasoned," said county Supervisor Ann McDonough. "Our role is different and somewhat constrained." She was referencing the governor's ban on local governments from mandating masks or vaccinations among their residents." (271)

By August, 2021 such states as Iowa, Florida, and Texas blocked mask mandates. Florida's governor had gone so far as withhold some state funding from school districts that had gone ahead and implemented mandates to wear masks. Republican leaders claimed that parents should be able to decide for their own children whether to wear masks. Some pediatricians and legal experts have reminded policy makers that parental rights had never been unlimited citing requirements that children receive certain vaccinations before entering school. A poll from the Associated Press and the NORC Center for Public Affairs Research found that 6 in 10 Americans wanted students and teachers to be required to wear face masks while in school. The same poll found that only 3 in 10 Republicans favored mask requirements, compared with 8 in 10 Democrats. (272)

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According to "Worldometer), Iowa (population 3,155,070)on September 2, 2021 stood 31st in the nation in the total number of COVID-19 cases in the United States (441,889). There had been 6,307 deaths. While there were 40,703,674 cases, there had also been 31,265,847 individuals considered "recovered" (including those who were termed "long-haulers" because they continued to have recurring difficulties including memory). The state with the fewest cases, Vermont, also had the most people vaccinated. (273)

Near the beginning of August, 2021, considerations were first voiced for encouraging those who had received their first regimen of vaccines (Pfitzer and Moderna--two shorts/Johnson and Johnson--one shot) to get a "booster. A date of September 20th to begin these boosters was released by the White House only to be challenged on September 3rd with suggestions that only FDA approved Pfitzer would be eligible to be used. (274) The other two vaccines were still only CDC approved on an emergency basis.

Despite the fact that President Trump had been rushed to the hospital with COVID-19 and then received a regimen of drugs unavailable to the general public to restore his health, he immediately returned to his previous message of distain for medical advice. Upon returning to the White House by helicopter, he immediately removed his mask and entered a room full of people. He and his wife were later given the vaccine just before leaving the White House after the election. Only late in July, 2021 did he formally suggest at a rally that people get vaccinated. For this suggestion, he received jeers from some of those in attendance.

The disconnect President Trump had instigated between science and the general public soon after the virus was discovered had grown through the months of disinformation from social media. Among the conspiracy theories circulating was that the "vaccine" actually contained materials that could be used to track people by the governmenrt. Joe Rogan, host of “The Joe Rogan Experience,” the most popular podcast on Spotify, had an estimated 11 million listeners per episode--four times as many people as prime-time cable hosts. On the April 23 episode of his popular podcast, host Joe Rogan said, “If you’re, like, 21 years old, and you say to me, ‘Should I get vaccinated?’ I’ll go ‘No.’ (275) "If you're a healthy person, and you're exercising all the time, and you're young, and you're eating well, like, I don't think you need to worry about this," Rogan said. (276) After an outcry, Rogan said he is not “an anti-vaxx person” and “I’m not a doctor, I’m a … moron,” cautioning listeners that his show is meant to entertain and not to provide medical advice. (277) It appeared in September, however, that some of the ideas popular on social media were still in his consideration. He admitted before entering a hospital after a diagnosis of COVID-19 that he had used invermectin, a horse dewormer drug, which had received widespread publicity. (278)

Misinformation on social media was spread by such groups as America’s Frontline Doctors, a conservative group of physicians that included members with ties to the January 6 Capitol riot, which charged patients $90 to be connected with a doctor who would prescribe discredited COVID treatments, including ivermectin and hydroxychloroquine. Children’s Health Defense, the anti-vaccine group founded by Robert F. Kennedy, Jr., promoted ivermectin, as have other anti-vaccine influencers, including life coach Preston Smiles (225,000 followers on Instagram) and former federal prosecutor and QAnon believer Sidney Powell (129,700 followers on Telegram). Conservative media personalities pivoted from hydroxychloroquine to ivermectin as did the conservative talk radio host Phil Valentine, who died of COVID-19 at the first of September. (279)

As of September 7, 2021, 79.4% of Iowan hospitalized with Covid-19 were unvaccinated as were 88% of COVID-19 in intensive care units throughout the state. As of September 8th, a total of 416,794 Iowa residents had COVID-19, an increase of 8,9404 from the previous week. Thirty ore related deaths were reported increasing the total of 6,337. As of the same date the CDC reported that 1,651,894 Iowans had been fully vaccinated, 61.7% of the state's residents at least 12 years of age. The CDC continued to rank Dubuque County as "high"--the highest rating for transmission of the virus. (280)

As businesses struggled to resume something close to normal activity, volunteer organizations saw their membership drop. Some which had counted on retired people for help found the need to reach-out to younger individuals for help. The number of volunteers at the Retired and Senior Volunteer Program fell from 285 before the pandemic to 150. The American Cancer Society Discovery Shop which resells donated clothing and home decorations saw their number of volunteers drop by half forcing the shop to close on Mondays. Other volunteer agencies rethought their philosophy. DuRide only limited rides for seniors to medical visits. In February, 2020 DuRide offered 1,040 rides. One month later the number was 57. It since added low-contact services like food deliveries. (281)

CNN reported on September 15, 2021 another milestone in the story of COVID-19. As of the night of September 14th, the United States with a population of 331.4 million people had the deadly distinction of 1 in every 500 Americans dying of the virus since the nation's first reported infection. The country averaged more than 152,300 new cases each day of the preceding week. This was more than 13 times what is was on June 22nd. The United States averaged 1,805 new COVID-19 deaths daily over the same week-much higher than the low average of the year (218) established on July 5th. With only 54% of the population fully vaccinated, the rate of people beginning vaccinations each dropped 4% from the previous week and 28% from the previous months according to the CDC. (282)

In September, with school open, the number of cases of COVID-19 was rising including those in children too young to be vaccinated. The Dubuque County COVID-19 Management Team announced that in the week ending on September 15 there were 2142 new positive cases among county residents. This brought the tot to 667 active cases in the county a number which had risen from 193 since August 11th. Of the new cases 23% were among residents 17 and younger. That matched the 18 to 29 age group as the two highest.

Since August 16th, 11% of the total positive COVID-19 cases had been in residents 11 years of age or younger and were not able to be vaccinated. At the same time in 2020, the same age group accounted for 4%. As of September 10th, only 36.6% of county residents between the ages of 12 to 15 had been fully vaccinated. Residents aged 16 to 17 were 44.3 % vaccinated while 40.5% of those 18 and 19 were fully vaccinated. Those aged 20 to 29 were 45.2 % vaccinated. A federal court had recently barred Iowa's new state law banning masks. No data was reported from the Iowa Department of Health on breakout cases where those vaccinated had been later found to be positive. The State of Iowa continued to only report once weekly. (283)

While struggling to get approximately 23% of the American population to have at least one shot of vaccine, the CDC announced that as of September 25, 2021 elderly Americans, those with compromised immune systems, and those whose jobs left them at risk of infection could get a booster shot. The third shot would have to be at least six months following the last vaccination. The first booster shots would only be available to those who had received the Pfizer vaccine. For those who had received the Moderna or Johnson & Johnson vaccines a decision was still to be made with the possibility of mixing the vaccines as an option. (284)

Following the approval of Iowa Department of Education officials, the Dubuque Community School District began offering at-home COVID-19 tests to families as an option for students showing COVID-19 symptoms. Provided by the Test Iowa program at no cost to the district, the kits were given to families who might not have health insurance or a primary care provider or even transportation to a source of the tests. The saliva-based test taken at home was to be mailed to the State Hygienic Laboratory in a prepaid envelope. If a positive result was found, usually within three to five days, local health officials would be notified and follow ups would be scheduled with the family. (285)

The beginning of October brought the news that the United States had passed another milestone by registering over 700,000 deaths from COVID-19. The news, however, was somewhat tempered by the reports that vast parts of the nation which had been suffering increasing numbers of deaths were now seeing a decline. While Pfizer was offering a booster vaccine, Moderna and Johnson & Johnson were anticipating being able to begin offering theirs within a week.

On October 8, 2021 the Dubuque Community School District reported 35 cases of COVID-19 among students with six cases among staff. This was a decline among students by 17. (286) On October 11, 2021 the Dubuque Community School Board on a vote of 5-2 approved a policy that no mandate to wear masks would be made for a school until it had a 3% virus positivity rate. (287)

As of Saturday, October 30th, 2021 the Centers for Disease Control and Prevention rated the level of community gransmission as "high"--the highest rating--in all 10 local counties; IOWA--Clayton, Delaware, Dubuque, Jackson, Jones; ILLINOIS--Jo Daviess; WISCONSIN--Crawford, Grant, Iowa and Lafayette. Dubuque County, Iowa (69%) ranked third among those counties in terms of fully vaccinated people. (288)

By October, 2021 a strange phenomena accelerated potentially by the pandemic was well-recognized across the nation. While the jobless rate fell in Dubuque County to 2.9% in September (down from 4.6% in the same month last year), area businesses could not find workers. Unemployment in Dubuque County was lower than the national rate (4.8%) and Iowa's (4.0%). Iowa Governor Reynolds announced that the state would double the number of weekly work searches required for people to receive unemployment benefits starting early in 2022. This approach, according to economists, of reducing unemployment benefits or making them harder to receive, has consistently failed. Rick DICKINSON, president and CEO of the GREATER DUBUQUE DEVELOPMENT CORPORATION, reported that the "reduction of federal benefits for the unemployed that took place in Iowa in June resulted in little or no impact on the available workforce."

A county's labor force is 'the number of county residents who are either working or receiving unemployment benefits.' The labor force in September, 2019 was 57,800. In September, 2021 the figure stood at 54,800---a reduction of 3,000 people. This suggests that the reduction in workers over the past two years was not caused primarily by individuals taking unemployment benefits, it was the result of people choosing to leave the workforce. Some two-income homes had one person decide to stop working and stay home. After staying home, the decision was made that that not trying to find or paying childcare was better. Many individuals at or near the typical retirement age decided to "call it quits" early. (289)

With schools in session and the number of COVID-19 bases trending upwards, Dubuque County officials returned to the topic of testing in October. Knowing the exact numbers of those tested was uncertain as the popularity of over-the-counter tests had risen. Officials were informed that an average of 250 county residents were being tested daily with over 6,000 residents receiving tests in October and more than 1,600 receiving antigen tests. Those testing positive for COVID-19 on PCR tests equaled 18.6% while only 5.2% received positive results on the antigen tests. Health officials claimed this was probably due to a lower sensitivity and therefore accuracy of the antigen tests. (290)

There were 7,643 new COVID-19 cases from Wednesday, October 27 to Wednesday, November 3, according to the state’s dashboard, bringing the state’s total number of cases to 491,052--an average of 1,091 new cases per day over the last 7 days, up 9% from new cases reported the previous week. The 491,052 people who have tested positive, 455,885 had recovered--9,829 new recoveries compared to last week.

The state reported 104 new deaths from COVID-19 over the past week, with a death toll of 7,069. One hundred and seventeen new deaths were reported in the previous week. (291)

On November 17, 2021 the state reported it had surpassed 500,000 total COVID-19 cases. There were 9,234 new COVID-19 cases from Wednesday, November 10 to Wednesday, November 17, according to the state’s dashboard, bringing the state’s total number of cases to 508,513--an average of 1,319 new cases per day over the last 7 days. The number of new cases was up 12% from new cases reported last week. The state’s website reported that of the 508,513 people who had tested positive, 472,324 had recovered. This is 6,775 new recoveries compared to last week.

The state confirmed 102 new deaths from COVID-19 over the past week, with a death toll of 7,268. Ninety-seven deaths were reported in the week prior. Subtracting the number of recoveries (472,324) and the number of deaths (7,268) from the total number of cases (508,513) showed there were currently---2,357 more active cases than what was reported last Wednesday.

There were 99 patients hospitalized in Iowa within the last 24 hours and the total number of hospitalizations was 544 (up from 524 the previous week). Of those, 123 are in the ICU (up from 113 last week), and 57 are on ventilators (up from 52 last week). People who are not fully vaccinated accounted for 76.1% of COVID-19 hospitalizations in the state, and 78.9% of COVID-19 patients in the ICU.

As of Wednesday afternoon, according to the state’s COVID-19 vaccine dashboard, 14,154 more vaccine doses were administered to Iowans last week for a total of 3,329,988 doses administered to Iowa residents. 6,744 more Iowans completed their vaccine series in the last week for a total of 1,744,988, which is 62.8% of Iowans 12 and older.

Percentage by county of eastern Iowa residents age 12 and older who have been fully vaccinated (according to IDPH data on the Iowa dashboard): (292)

Allamakee County: 53.2%

Benton County: 61.6%

Bremer County: 64.1%

Black Hawk County: 63.9%

Buchanan County: 59.4%

Butler County: 62.4%

Cedar County: 63.2%

Chickasaw County: 59.3%

Clayton County: 50.2%

Delaware County: 58.8%

Dubuque County: 67.8%

Fayette County: 58.3%

Grundy County: 67.0%

Iowa County: 68.1%

Johnson County: 73.3%

Jones County: 62.1%

Keokuk County: 49.8%

Linn County: 70.0%

Tama County: 66.1%

Winneshiek County: 64.3%

Washington County: 61.3%

Thanksgiving 2021 meant those who were vaccinated up to three times some reason to feel they might be safe to join with family members in large groups. It also brought a new term, "pandemic exhaustion," into the vocabulary amid the realization that virus cases were again soaring. In November, 2021 there were more deaths from the virus than there were in 2020 before the vaccinations. This was generally accepted to be true because of the new strains of the virus which spread more rapidly.

Nasal swabs in a test kits provided people in minutes with another indication on their health.

On October 6th, 2021 there were 249 confirmed cases of COVID-19 reported in Dubuque County. By November 24th this had risen to 691--five consecutive weeks of increase at a rate of about 100 per day. As of November 24th, 75% of people with COVID-19 who were hospitalized statewide were not fully vaccinated. The number rose to 86% when considering COVID-19 patients in ICUs. MERCYONE DUBUQUE MEDICAL CENTER and UNITYPOINT HEALTH-FINLEY HOSPITAL on November 24th reported a total of 41 patients compared to 35 the previous week and 31 the week previous to that. Health officials urged those attending family get-togethers to move some the activities outside and to self-assess themselves in the morning prior to thanksgiving. If they felt ill at all, they should not attend such gatherings. (293) Self-assessments could take a step further by using test kits as shown in the picture.

On November 26th, Americans awoke to news that the stock market had plunged 800 points on the news of a new variant believed to have originated in South Africa but detected in Belgium. Dozens of countries restricted travel to and from southern Africa amid concerns that it could be more contagious than previous strains and render Covid-19 vaccines less effective.

Belgian authorities said Friday that one case of the variant had been recorded in the country. The person had traveled from abroad, was unvaccinated and had not been infected with Covid-19 previously.

Experts from the World Health Organization used the labeled B.1.1.529—a “variant of concern.” The WHO used this label for virus strains that had proven to be more contagious, lead to more serious illness or decreased the effectiveness of public-health measures, tests, treatments or vaccines. (294) By the end of November 26, 2021 the new variant had been named "Omicron." (295)




See: CONVIVIUM URBAN FARMSTEAD


---

Source:

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

2. "Incident Management Team Coordinating Countywide Response," CityFocus, Fall, 2020, p. 14

3. Personal observations of the author

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

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

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

7. 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/

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

9. Des Moines Register

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

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

12. Carnegie-Stout Public Library website "FAQ"

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

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

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

16. KWWL News

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

18. Ibid. p. 1A

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

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

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

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

23. Goldstein, Bennet, "Regrouping," Telegraph Herald, August 30, 2020, p. 1A

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

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

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

27. Personal observations

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

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

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

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

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

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

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

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

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

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

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

39. Barton, "Dubuque Commission Creates..."

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

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

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

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

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

45. Ibid., p. 5A

46. Ibid.

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

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

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

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

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

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

53. Ibid., p. 2A

54. Ibid.

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

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

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

58. Barton, "Dubuque Commission Creates...

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

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

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

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

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

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

65. 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

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

67. Lyon, Randolph

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

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

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

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

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

73. City of Dubuque website

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

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

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

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

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

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

80. "6 New Dubuque County COVID-19 Cases," Telegraph Herald, May 13, 2020, p. 3A

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

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

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

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

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

86. "2 New COVID-19 Deaths in Dubuque County," Telegraph Herald, May 23, 2020, p. 3A

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

88. "10 New COVID-19 Cases in Dubuque County," Telegraph Herald, May 25, 2020, p. 3A

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

90. NBC News

91. "4 More COVID-19 Cases Found in Dubuque County," Telegraph Herald, May 31, 2020, p. 3A

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

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

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

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

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

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

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

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

100. CNN News

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

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

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

104. CNN News, June 28, 2020

105. 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

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

107. "Coronavirus," KWWL online.

108. Fisher, Benjamin, "Leaders Ask for Guidance on Reopening Area Schools," Telegraph Herald, June 30, 2020, p. 1A

109. Hinga, Allie, "School District Lay Out Fall Plans," Telegraph Herald, July 2, 2020, p. 1A

110. Montgomery, Jeff, "Dubuque High on Post-Pandemic List," Telegraph Herald, July 1, 2020, p. 1A

111. Fisher, Benjamin, "County Virus Cases Jump by 27," Telegraph Herald, July 2, 2020, p. 1A

112. "Tri-State Counties See New Virus Cases," Telegraph Herald, July 3, 2020, p. 3A

113. Barton, Thomas J., "Van Milligen: Table Vote on Five Flags Until 2022," Telegraph Herald, July 3, 2020, p. 1A

114. "County Hits 700 Total with 8 More COVID-19 Cases," Telegraph Herald, July 7, 2020, p. 3A

115. Lincoln, Adrianna Gomex and Lisa Marie Pane, "Hospitals Nearing Capacity as Miami Closes Restaurants," Associated Press, July 7, 2020, (Telegraph Herald) p. 6A

116. Hinga, Allie, "Support Groups Adapt to Help Members Through Pandemic," Telegraph Herald, July 5, 2020, p. 3A

117. "59 More Dubuque County COVID Cases," Telegraph Herald, July 1, 2020, p. 3A

118. "Dubuque County Adds 64 COVID Cases," Telegraph Herald, July 17, 2020, p. 3A

119. Garcia, Catherine, "New Lincoln Project Ad presents Brutal Timeline of Trump's Coronavirus Response," https://news.yahoo.com/lincoln-project-ad-presents-brutal-042611927.html

120. "Trump Calls Coronavirus DemocratsNew Hoax,'" NBC News Online: https://www.nbcnews.com/politics/donald-trump/trump-calls-coronavirus-democrats-new-hoax-n1145721

121. Garcia

122. Ibid.

123. Perrett, Connor, "Trump Admitted to Mistakes in Coronavirus Response But Doubled Down on His Predication that the Virus is 'Going to Disappear,' says He 'will be Right Eventually,' Online: https://news.yahoo.com/trump-admitted-mistakes-coronavirus-response-144735385.html

124. Fisher, Benjamin, "County Reports $1.5 Million in Pandemic Expenditures," Telegraph Herald, July 23, 2020, p. 1A

125. Foley, Ryan J., "Reynolds Aide Linke Quality Concerns to Changes at Dubuque Testing Site," Telegraph Herald, July 23, 2020, p. 3A

126. Barton, Thomas J. and Benjamin Fisher,"Reynolds Lifting Cap at Dubuque Testing Site," Telegraph Herald, July 25, 2020, p. 1A

127. "26 Additional Virus Cases in Dubuque County," Telegraph Herald, July 25, 2020, p. 3A

128. "Masks to be Required in Dubuque Public Library," Telegraph Herald, July 25, 2020, p. 3A

129. "COVID-19 in Iowa," Online: https://coronavirus.iowa.gov/#CurrentStatus

130. "Hydroxychloroquine, What it is, and What it Does to your Body," Business Insider, Online: https://news.yahoo.com/hydroxychloroquine-does-body-183000326.html

131. "A Collapse That Wiped Out 5 Years of Growth, With No Bounce in Sight," New York Times, Online: https://www.nytimes.com/2020/07/30/business/economy/q2-gdp-coronavirus-economy.html?auth=login-email&login=email

132. Barton, Thomas J. "County, State Deemed 'Red Zones,'" Telegraph Herald, July 31, 2020, p. 1A

133. "Dubuque County Surpasses 1,500 Infections," Telegraph Herald, August 3, 2020, p. 3A

134. Winfield, Nicole and Lisa Marie Pane, "U.S. Tops 5 Million Virus Cases," Telegraph Herald, August 10, 2020, p. 4C

135. Barton, Thomas J. "Council: Mask Up, Dubuque," Telegraph Herald, August 7, 2020, p. 1A

136. Barton, Thomas J. "What the Mask Mandate Means for You," Telegraph Herald, August 8, 2020, p. 1A

137. Hinga, Allie, "Petition Seeks Fully Virtual School Start," Telegraph Herald, August 13, 2020, p. 1A

138. Montgomery, Jeff, "State Offers New Explanation of Virus Data," Telegraph Herald, August 14, 2020, p. 1A

139. "County Sees Lowest New Case Total Since June," Telegraph Herald, August 17, 2020, p. 3A

140. Montgomery, Jeff, "State's COVID-19 Data Inconsistencies Remain," Telegraph Herald, August 21, 2020, p. 1A

141. "Iowa Medical Director was Aware for Weeks of COVID Data Flaw," KWWL News. Online: https://kwwl.com/2020/08/20/iowa-medical-director-was-aware-for-weeks-of-covid-data-flaw-2/

142. Montgomery, Jeff, "Error Leads State to Report Lower Virus Positivity Rates," Telegraph Herald, August 18, 2020, p. 1A

143. Kass, Dustin, "Inside Look at How TH Found Ongoing Flaws with Iowa's COVID-19 Data," Telegraph Herald, August 23, 2020, p. 1A

144. Montgomery, Jeff, "Virus Tallies Differ," Telegraph Herald, August 28, 2020, p. 1A

145. "Record Daily Number of New COVID-19 Cases in Iowa," Telegraph Herald, August 28, 2020, p. 3A

146. "White House Task Force Recommends Iowa Issue M Mandate, Close Bars," KWWL News. Online: https://kwwl.com/2020/08/21/white-house-task-force-recommends-iowa-issue-mask-mandate-close-bars/

147. Klein, Betsy, "Iowa Has the Highest Rate of Covid-19 Cases in the U. S.," CNN News, Online: September 2, 2020

148. Graham, Judith, "What Recovery From COVID-19 Looks Like," Scientific American, Online: https://www.scientificamerican.com/article/what-recovery-from-covid-19-looks-like/

149. Pathak, Neha MD, "Life After COVID-19: The Road to Recovery," WebMD, Online: https://www.webmd.com/lung/news/20200513/complications-on-the-road-to-recovery-after-covid

150. Fisher, Benjamin, "Plasma Treatment Common in Dubuque," Telegraph Herald, August 16, 2020, p. 1A

151. Kelsey, Elizabeth, "River Museum Seeks Funding From Congress," Telegraph Herald, August 10, 2020, p. 5A

152. Mehl, Annie, "Child Care Centers Adapt as School Year Approaches," Telegraph Herald, August 10, 2020, p. 1A

153. "20 Cases, 1 Death Add to Dubuque County Toll," Telegraph Herald, August 23, 2020, p. 3A

154. Fisher, Benjamin, "Health Board Passes Mask Mandate," Telegraph Herald, August 27, 2020, p. 1A

155. Mehl, Annie, "On-Site Tutors Leading a Hand to Gronen Employees' Children," Telegraph Herald, August 29, 2020, p. 1A

156. "30 New COVID-19 Cases in Dubuque County," Telegraph Herald, September 6, 2020, p. 3A

157. Fisher, Benjamin, "County Supervisors: No Mask Mandate," Telegraph Herald, September 9, 2020, p. 1A

158. "27.7% Positivity Rate in 24 Hours," Telegraph Herald, September 9, 2020, p. 3A

159. CNN News

160. Kruse, John, "UnMask DBQ Asks Council to Rescind Mandate," Telegraph Herald, September 22, 2020, p. 1A

161. KWWL news

162. Fisher, Benjamin, "Area Officials Release New Data Amid Spike in Virus," Telegraph Herald, September 25, 2020, p. 1A

163. Ibid.

164. Pitt, David (Associated Press),"Reynolds:"We Can't Let COVID-19 Dominate Our Lives," Telegraph Herald, October 8, 2020, p. 5C

165. "Dubuque Death Roll Rises to 47," Telegraph Herald, October 8, 2020, p. 3A

166. Hinga, Allie, "Covid-19 Hospitalization Numbers Soar," Telegraph Herald, October 10, 2020, p. 1A

167. "Dubuque County Death Toll Hits 49," Telegraph Herald, October 13, 2020, p. 3A

168. "Virus Claims Mire in Dubuque, Jo Daviess Counties," Telegraph Herald, October 17, 2020, p. 3A

169. Montgomery, Jeff, "OSHA Falls Short on COVID-19, Union Say," Telegraph Herald, October 18, 2020, p. 1A

170. "Pandemic Impact on Communities of Color," CityFocus, Fall 2020, p. 11

171. Mehl, Annie and Benjamin Fischer,"COVID-19 Hospitalizations Soar," Telegraph Herald, October 22, 2020, p. 1A

172. "Dubuque County Adds 2 Virus-linked Deaths," Telegraph Herald, October 22, 2020, p. 3A

173. "DRA Pledges $590,000 to COVID Relief," Telegraph Herald, October 21, 2020, p. 1A

174. "Dubuque County Recorder: Avoid County Buildings Due to COVID-19 'Outbreak,' Telegraph Herald, October 23, 2020, p. 3A

175. "Dubuque County Now Tops 5,000 COVID-19 Cases," Telegraph Herald, October 24, 2020, p. 3A

176. Fisher, Benjamin, "Mask Mandate Still Faces Opposition," Telegraph Herald, October 27, 2020, p. 1A

177. Fisher, Benjamin, "Experts: COVID-19 Deadlier than Flu," Telegraph Herald, October 29, 2020, p. 1A

178. "133 New Dubuque County Virus Cases," Telegraph Herald, October 31, 2020, p. 3A

179. Montgomery, Jeff, "Local COVID-19 Numbers Soaring," Telegraph Herald, November 5, 2020, p. 1A

180. "Coronavirus," KWWL News

181. Reese, Kayli, "City Hospitals Using New Virus Treatment," Telegraph Herald, December 9, 2020, p. 1A

182. Fisher, Benjamin, "Health Professionals Sound Alarm," Telegraph Herald, November 11, 2020, p. 1A

183. Fisher, Benjamin and John Kruse, "Iowa Issues New COVID-19 Guidelines," Telegraph Herald, November 11, 2020, p. 1A

184. O'Neill, Tim, "Iowa Gov. Mandates Masks for Spectators," Telegraph Herald, November 11, 2020, p. 1B

185. "Dubuque County Has Most Nursing Home Outbreaks in State," Telegraph Herald, November 14, 2020, p. 3A

186. "42 More COVID-19-Related Deaths in Tri-State Area," Telegraph Herald, November 14, 2020, p. 3A

187. "Iowa Gov. Kim Reynolds Issues Mask Mandate After Disparaging It as 'Feel Good Measure," NBC News Online, November 17, 2020

188. Hinga, Allie, "Dubuque Public Schools to Go Virtual Temporarily," Telegraph Herald, November 20, 2020, p. 1A

189. "159 New Cases in Dubuque County," Telegraph Herald, November 20, 2020, p. 3A

190. Crary, David, "Daily COVID-19 Deaths Spike As Toll Hits 254,000," Telegraph Herald, November 21, 2020

191. Ibid.

192. Rachel Maddow program, MSNBC, November 18, 2020

193. Personally witnessed by Randy Lyon while watching MSNBC News

194. "30 New Virus Cases in Dubuque County," Telegraph Herald, November 28, 2020, p. 3A

195. Fisher, Benjamin, "County Sees 1st Virus Reinfection," Telegraph Herald, December 1, 2020, p. 1A

196. Hinga, Allie, "ACLU Targets Iowa OSHA for COVID-19 Safety Reviews," Telegraph Herald, December 6, 2020, p. 1A

197. "Dubuque County Hits 100 COVID-19-Related Deaths," Telegraph Herald, December 6, 2020, p. 3A

198. "Fisher, Benjamin, "Officials Outline Vaccine Distributions," Telegraph Herald, December 12, 2000 p. 1A

199. "4 COVID-19-Related Death in the Area," Telegraph Herald, December 12, 2020, p. 3A

200. Fisher, Benjamin, "COVID-19 Numbers Declining," Telegraph Herald, December 16, 2020, p. 1A

201. Goldstein, Bennet, "'So Many Lives," Telegraph Herald, December 20, 2020, p. 1A

202. "Resources Unite Seeks More County Money," Telegraph Herald, December 20, 2020, p. 3A

203. "Area Endures 8 More Virus-Related Deaths," Telegraph Herald, December 23, 2020, p. 3A

204. Fischer, Benjamin, "County Plans Vaccine Priorities, Telegraph Herald, December 23, 2020, p. 1A

205. Ibid., p. 2A

206. Maxouris, Christina and Jason Hanna, "US Surpasses 20 million Covid-19 Cases as Experts Warn It'll Take Months for Vaccines to Turn the Tide," CNN Online, January 1, 2021

207. "48 New Dubuque County COVID-19 Cases," Telegraph Herald, January 4, 2021, p. 3A

208. Kruse, John, "County COVID-19 Cases Declining," Telegraph Herald, January 6, 2021, p. 1A

209. Fisher, Benjamin, "Vaccinations 'Very Slow," Telegraph Herald, January 20, 2021, p. 1A

210. "29 New Virus Cases in Dubuque County," Telegraph Herald, January 27, 2021, p. 2A

211. Montgomery, Jeff, "Demand High for 2nd Round of PPP Funding," Telegraph Herald, January 28, 2021, p. !A

212. Kruse, John, "Dubuque Schools Set Feb.15 for Full-Time Return," Telegraph Herald, January 30, 2021, p. 1

213. Kruse, John, "City Will Offer Staff $100 Incentive to Receive Vaccine," Telegraph Herald, January 30, 2021, p. 1

214. Kruse, John, "City Hopes For Additional Pandemic Funding," Telegraph Herald, January 24, 2021, p. 1A

215. Leys, Tony, "A More Infectious U.K. Variant of Coronavirus is Found in Iowa, Confirmed in Three Residents," Des Moines Register, February 1, 2021

216. "Iowa's Death Toll from Virus Exceeds 5,000," Telegraph Herald, February 5, 2021, p. 3A

217. Goldstein, Bennet, "Pandemic Puts Strain on Foster Care System," Telegraph Herald, February 5, 2021, p. 1

218. Fisher, Benjamin, "County Vaccination Hub Site Expected to Cost $127,000," Telegraph Herald, February 4, 2021, p. 2A

219. Fisher, Benjamin, "Supervisors: Extend Mask Mandate," Telegraph Herald, February 9, 2021, p. 1A

220. Fisher, Benjamin and the Associated Press, "Iowa Governor Lifts mask Mandate Without Input From Public Health," Telegraph Herald, February 9, 2021, p. 2A

221. "All in With Chris Hayes," MSNBC, February 22, 2021

222. "Rachel Maddow," MSNBC, February 23, 2021

223. "1 New COVID-19-Reated Death in Dubuque County," Telegraph Herald, February 20, 2021, p. 2A

224. Fisher, Benjamin, "County Officials Talk Vaccine Plans; Mandate Critics Voice Displeasure," Telegraph Herald, February 18, 2021, p. 2A

225. "Technology Gap Adds to Vaccine Woes for Older Iowans, (editorial), Telegraph Herald, February 21, 2021, p. 4A

226. Personal experience of Randy Lyon, author of this encyclopedia. March 4, 2021

227. "Dubuque County Reports 1 New COVID-19 Death," Telegraph Herald, March 7, 2021, p. 10A

228. KWWL News online

229. "Dubuque County Fully Vaccinates Another 101 Residents," Telegraph Herald, March 16, 2021, p. 2A

230. Rachel Maddow, MSNBC

231. Pitt, And David, "Reynolds: All Iowans Can Get Vaccine by April 5," Telegraph Herald, March 18, 2021, p. 1A

232. Wu, Katherine J. "Don't Be Surprised When Vaccinated People Get Infected," The Atlantic, May 19, 2021, Online

233. "Virus Cases Dwindle As Vaccines Ramp Up," Telegraph Herald, March 23, 2021, p. 2A

234. Fisher, Benjamin, "Vote Set on Drive-Through Vaccination," Telegraph Herald, March 23, 2021, p. 1A

235. MSNBC online news for March 20, 2021.

236. "Dubuque County Sees 19 New CONID-19 Cases," Telegraph Herald, March 28, 2021, p. 3A

237. Kruse, John, "Local Leaders Await Stimulus Funds, Rules for Spending," Telegraph Herald, March 28, 2021, p. 1

238. Pitt, David, "Reynolds Implores Iowans to Get Shots as Infections Rise," Telegraph Herald, April 2, 2021, p. 7B

239. Lardner, Richard, Jason Dearen, Linda A. Johnson (Associated Press), "Company Producing J & J Vaccine Had History of Quality Control Violations," Telegraph Herald, April 2, 2021, p. 13A

240 "Iowa Vaccine Supply Won't Be Affected by Spoiled Doses Next Week," kwwl.com

241. "Coronavirus," kwwl.com

242. Edney, Anna and Drew Armstrong, "Unused Vaccines Are Piling Up Across U. S. as Some Regions Resist, Bloomberg, Apr. 15, 2021, Online

243. Hong, Jinshan, Covid Claims 3 Million Lives as Burden Shifts to Poorer Nation," Bloomberg, April 17th, 2021 Online.

244. "Nearly 30% of 10-County Area Residents Fully Vaccinated," Telegraph Herald, April 17, 2021, p. 2A

245. Fisher, Benjamin, "Walk-in Vaccination Clinics Test Remaining Demand," Telegraph Herald, April 21, 2021, p. 1A

246. Pitt, David,"Reynolds Pushes Vaccine as Demand Lags in Areas," Telegraph Herald, April 22, 2021

247. Ibid.

248. Kruse, John, "Dubuque to Open Pools This Summer," Telegraph Herald, April 23, 2021, p. 1A

249. "2 More Local COVID-19-Related Deaths Reported," Telegraph Herald, April 25, 2021, p. 8A

250. "No Local Related Deaths, 3 Additional COVID-19 Cases in Dubuque County," Telegraph Herald, May 12, 2021, p. 2A

251. Fisher, Benjamin, "County Alters Vaccination Strategy," Telegraph Herald, May 13, 2021, p. 1A

252. Fisher, Benjamin, "Supervisors Repeat Mask Mandate," Telegraph Herald, May 15, 2021, p. 1A

253. Kruse, John, " Dubuque City Council Unanimously Votes to End Mask Mandate," May 19, 2021, TH ONline: https://www.telegraphherald.com/news/breaking/article_95b5a4ec-8fcf-5810-995a-5a9c9ee17c9e.html

254. "35 New Cases of COVID-19 in Area," Telegraph Herald, May 26, 2021, p. 2A

255. Fisher, Benjamin, "Vaccine Rates Lag in Care Facilities," Telegraph Herald, June 5, 2021, p. 1A

256. Hinga, Allie, "Dubuque to Add Teachers to Help Kids Catch Up," Telegraph Herald, June 20, 2021, p. 1A

257. "Dubuque County Reports 3 New COVID-19 Cases," Telegraph Herald, June 26, 2021, p. 5A

258. "More Than 148,000 Area Residents Fully Vaccinated," Telegraph Herald, July 2, 2021, p 5A

259. Calfas, Jennifer, "Delta Variant Helps Push Covid-19 Cases Higher in Every State," Wall Street Journal, July 19, 2021, Online.

260. Baker, Sam, "COVID Cases are Surging, and It's Not Because of "Breakthrough" Infections," Axios, July 22, 2021, Online.

261. Fisher, Benjamin. "Health Board Not in Favor of Vaccination Lottery Plan," Telegraph Herald, July 8, 2021, p. 1

262. Kelsey, Elizabeth, "Greater Dubuque Development Corporation Touts Local Success Amid Pandemic," Telegraph Herald, July 9, 2021, p. 6A

263. Leys, Tony and Nick Coltrain, " Highly Transmissible Delta Variant of Coronavirus is Gaining Strength in Iowa, State Lab Tests Suggest," Des Moines Register, July 1, 2021, Online

264. Weig, Nick, "Dramatic Rise in COVID-19 Cases in Iowa as Delta Variant "Seeking Out" Unvaccinated Areas," July 26, 2021, Online: https://cbs2iowa.com/news/local/dramatic-rise-in-covid-19-cases-in-iowa-as-delta-variant-seeking-out-unvaccinated-areas

265. "All in With Chris Hays," MSNBC television

266. Yan, Holly and Aya Elamroussi, "Hospitals in the South Are Running Out of Space or Staff," CNN Online.

267. "4 Area Counties at 'High Transmission," Telegraph Herald, August 8, 2021, p. 8A

268. Pitt, David (Associated Press), "Iowa Mothers Urge Reversal of State Mask Mandate Prohibition," Telegraph Herald, August 12, 2021, p. 7B

269. Fisher, Benjamin, "Dubuque County Tweaking Plans for COVID-19 Response," Telegraph Herald, August 4, 2021, p. 1A

270. Fisher, Benjamin, "Variant Cases on Rise in Dubuque County, Worrying Health Officials," Telegraph Herald, August 15, 2021, p. 1A

271. Fisher, Benjamin, "County 'Constrained' on Masks, Vaccines," Telegraph Herald, August 17, 2021, p. 1A

272. Associated Press, "Mask Debate Moves From School Boards to Courtrooms," (Telegraph Herald, August 29, 2021), p. 18A

273. Worldometer, "COVID Live Update," September 4, 2021, Online: https://www.worldometers.info/coronavirus/

274. "All in with Chris Hayes," MSNBC, September 3, 2021

275. Flynn, Kerry, "Joe Rogan Addresses His Controversial Anti-vaccine Comments," CNNBusiness, April 29, 2021, Online: https://www.cnn.com/2021/04/29/media/joe-rogan-clarifies-vaccine-comments/index.html

276. Ibid.

277. Flynn

278. CNNWire, "Joe Rogan Says He Has COVID-19, Has Taken Controversial Drug Ivermectin" September 2, 2021, Online: https://abc7chicago.com/joe-rogan-covid-ivermectin-19-monoclonal-antibodies/10992980/

279. Butler, Kiera, "The Real Reason People Are Treating Themselves With Horse Dewormer," Mother Jones, September 1, 2001. Online: https://www.motherjones.com/politics/2021/09/the-real-reason-people-are-treating-themselves-with-horse-dewormer/

280. "141 New Virus Cases in Dubuque County," Telegraph Herald, September 9, 2021, p. 5A

281. Garrett, Olivia, "Pandemic Continues to Impact Volunteer Numbers," Telegraph Herald, September 10, 2021, p. 1A

282. Holcombe, Madeline, "1 in Every 500 US Residents Have Died of COVID-19," CNN Online. September 15, 2021

283. Fisher, Benjamin, "Hospitalizations Concern Board of Health," Telegraph Herald, September 16, 2021, p. 1A

284. Neergaar, Lauran and Mike Strobbe, "U. S. Booster Shots Start, Even as Millions Remain Unprotected," (Associated Press), Telegraph Herald, September 25, 2021, p. 14A

285. Hinga, Allie, "Schools to Offer COVID-19 Test Kits," Telegraph Herald, October 7, 2021, p. 1A

286. "Dubuque's Hempstead Reports 24 COVID-19 Cases This Week," Telegraph Herald, October 9, 2021, p. 2A

287. Hinga, Allie, "School Board Sets Mask Threshold," Telegraph Herald, October 12, 2021, p. 1A

288. "No New COVID-19 Related Deaths in Tri-State Area," Telegraph Herald, October 31, 2021, p. 10A

289. Montgomery, Jeff, "Unemployment Reveals Complex Labor Shortage," Telegraph Herald, October 31, 2021, 1A

290. Fisher, Benjamin, "Supervisors Talk COVID-19 Testing," Telegraph Herald, November 2, 2021, p. 1A

291. Pierce, Andrew, "Iowa Coronavirus," KWWL, November, 3, 2021, Online: https://www.kwwl.com/coronavirus/nov-3-iowa-passes-7-000-covid-19-deaths/article_243b0660-3ce2-11ec-89f4-f7fd50ff53c3.html

292. Pearce, Andrew, "Nov. 17: Iowa Passes 500k Total COVID-19 Cases as Weekly Cases Rise," KWWL.com, November 17, 2021

293. Fisher, Benjamin, "Virus Cases Mounting," Telegraph Herald, November 25, 2021, p.1

294. Steinhauser, Gabriele, "New Coronavirus Variant Arrives in Europe, Sets Off Global Fears of Restrictions, Wall Street Journal, Online, November 26, 2021

295. McKenzie, David et al. "Omicron, A New Covid-19 Variant with High Number of Mutations, Sparks Travel Bans and Worries Ccientists," CNN Online November 26, 2021