PANDEMIC

PANDEMIC. An outbreak is “a sudden rise in the incidence of a disease” and typically is confined to a localized area or a specific group of people. If an outbreak become 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 is the Black Death, a plague which spread across Asia and Europe in the middle of the 14th century.

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

On March 16, 2020 the following announcement was made:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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. (9)

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

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

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

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. (12)

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. (13)

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. (14) 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. (15)

Officials of the DUBUQUE COMMUNITY SCHOOL DISTRICT and local partner organizations organized by March 24th to offer free grab-and-go meal services to families who could reach one of the distribution points. These included AUDUBON ELEMENTARY SCHOOL, BOYS' AND GIRLS' CLUB OF GREATER DUBUQUE, COMISKEY PARK, CONVIVIUM URBAN FARMSTEAD. DUBUQUE DREAM CENTER, STEPHEN HEMPSTEAD HIGH SCHOOL]], HOOVER ELEMENTARY SCHOOL, LINCOLN ELEMENTARY SCHOOL, MARSHALL ELEMENTARY SCHOOL, PRESCOTT ELEMENTARY SCHOOL, Terrace Heights, and Resources Unite. (16)

News of shortages of medical masks led some local companies like DUBUQUE MATTRESS COMPANY to begin making them. Manufactured of polyester cotton blend, the masks included a filter similar to one used in a furnace. Mid concerns of whether the masks provided adequate protection. According to the CDC website, masks of this type were only used with COVID-19 patients as a last resort. MERCYONE DUBUQUE MEDICAL CENTER posted that it would no accept any of the masks until further notice. Neither the City of Dubuque nor Dubuque County Public Health Incident Management had any requests for the masks. Local businesses and individuals were asked to donate N95 masks, gowns and face shields. (17)

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. (18)

Although he preferred the action be taken by the governor, Mayor Buol announced on March 26, 2020 his consideration of issuing 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. (19)

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%. (20)

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. (21)

City officials on March 27th warned that the estimated lost revenue, estimated at $2.5 million, could complete delete the city's cash reserves. The result could be delayed hirings, canceled city projects, and a reconsideration of tax rates and fee increases for the beginning fiscal year. There was a 24% increase in virus cases on March 26th bringing the total to 179 including six in Dubuque County. This led to the announcement by Governor Kim Reynolds of additional business closings such as furniture and clothing stores and non-essential dental procedures and surgeries. The proposed vote on a new FIVE FLAGS CIVIC CENTER was postponed indefinitely. (22)

Directions explained for controlling traffic in a grocery store.

Blue-tape arrows as traffic directors.

Further efforts to prevent the spread of disease at HyVee.

As of Thursday, March 26th there were 82,000 confirmed cases of coronavirus in the United States--the most in the world. Local grocery stores, convenience stores and pharmacies remained open while adjusting to huge changes in demand. Initially shelves of toilet paper were left bare as customers hoarded it. At a Walgreens, four cases brought in overnight were sold in three hours. Hand sanitizers became so scarce that Hartig Drug began making it up in 4-gallon batches. It was not enough to stock the shelves, but could be used by employees and customers in the store. "Sneeze shields" were installed at HyVee between the cashiers and customers. Food shortages were not reported although more cooking at home resulted in increased demand for flour. (23) 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. (24)

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 FINLEY HOSPITAL (THE) 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. (25) 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." (26)

---

Source:

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

2. Personal observations of the author

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

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

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

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

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

8. Des Moines Register

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

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

11. Carnegie-Stout Public Library website "FAQ"

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

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

14. KWWL News

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

16. Ibid. p. 1A

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

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

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

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

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

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

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

24. Personal observations

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

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