Public-health experts predicted a tsunami of COVID-19 infections in Iowa this winter. Doctors and researchers told me in November that they expected thousands of Iowans to travel to visit family over Thanksgiving and Christmas. They worried that people would continue to pack into crowded bars and go maskless in public, and they thought that, by January, the state’s hospitals would be overrun with patients—by New Year’s, as many as 80 Iowans could be dying every day.
But Iowa, unlike other states, did not experience this post-holiday apocalypse. Iowa’s cases have actually been on a relatively consistent decline since just before Thanksgiving. So what happened?
The answer is not clear-cut, because the course of any pandemic is influenced by a complicated cocktail of factors. But one key reason could be that Iowans drastically changed their behavior just in the nick of time, experts told me when I spoke with them again this past week. “It’s the encouragement of masking plus the fear,” Eli Perencevich, an infectious-disease doctor at the University of Iowa Hospitals and Clinics, told me when I asked him about the missing surge. Christine Petersen, the director of the Center for Emerging Infectious Disease at the school’s College of Public Health, agreed. “For the first time in the last 10 months, we had an episode where public-health officials were screaming, and then the event didn’t happen,” she told me. “It means people listened to the prevention messages!”
In all likelihood, Iowans were simply scared into taking the virus more seriously. The experts I spoke with said they saw more people wearing masks in grocery stores and shopping centers as autumn turned to winter. Iowans stayed home more during the state’s fall surge than they had in September, and they remained there through December and early January, according to SafeGraph, a company that collects cellphone-location data. Road traffic decreased from October to November, and stayed steady, instead of increasing, through Christmas and New Year’s, Jeff Von Brown, a spokesperson for the Iowa Department of Transportation, told me. “It looks like people did heed advice” not to travel, he said. (Winter weather may have also played a role.)
Iowa experienced three distinct COVID-19 surges in 2020. The first was in the spring, when outbreaks in meat-processing plants sickened hundreds of workers, and the virus spread through nearby communities. The second surge arrived in late August, when students returned to campuses in Iowa’s college towns for the fall semester. The third spike was the biggest, with new daily cases more than quadrupling from early October to mid-November. This outbreak was different from the others: It burned through rural and urban communities alike, affecting people of all different age groups and backgrounds.
Until that point, Republican Governor Kim Reynolds had not issued a mask mandate for the state, calling for Iowans to assess the safety risks for themselves and respond accordingly. But on November 16, Reynolds gave in to pressure from public-health experts, announcing a partial statewide mask mandate, putting capacity limits on indoor gatherings, and ordering hospitals to postpone elective procedures. The state released a public-service announcement featuring Iowa celebrities like Tom Vilsack, Joe Biden’s nominee for agriculture secretary, and the former Olympic wrestler Dan Gable urging residents to wear a mask. And local hospitals ran TV ads begging Iowans to stop going out.
The same month, the health-care professionals I spoke with were skeptical that this late push would be enough to prevent a holiday spike. But it may have been: After peaking at more than 4,700 new COVID-19 cases per day in mid-November, Iowa’s daily case numbers began to drop, and kept falling in the weeks after Thanksgiving. While daily case numbers ticked up slightly from December 26 to January 9, by the end of January, they’d fallen below 1,000. The pandemic is still far from over in Iowa. Doctors are confirming about 900 new COVID-19 cases every day, on average, and the test-positivity rate in many counties is still high. More than 5,000 Iowans have died so far, and at least 60 percent of them died in the last three months. But the state was able to avoid a fourth surge that would have killed even more people.
Just as there are no atheists in foxholes, it would stand to reason that there are fewer anti-maskers in the middle of a major COVID-19 spike. That roughly matches how the public typically responds to communicable diseases, says Rachael Piltch-Loeb, a fellow at the Harvard T.H. Chan School of Public Health. The closer an outbreak gets to someone’s neighborhood, “the more likely someone is impacted by it, and the more likely it changes [the person’s] risk perception,” she told me. It was probably easier, during Iowa’s first two surges, for people who weren’t meat-packing workers or students to feel disconnected from the disease. But then Iowans read the warnings in news articles, heard the pleas of local health-care providers on TV, and saw their neighbors and loved ones become seriously ill. Those who perceive a higher risk to their personal safety will be much more likely to wear a mask or stay home.
Getting sick yourself can significantly change your risk calculus, too. Bo Schnurr, a 49-year-old investment adviser and high-school volleyball coach in Algona, never wore a mask last year, unless she was on the court coaching. Then, in October, she tested positive for COVID-19 and spent six days in the hospital. For weeks after she was discharged, Schnurr carried around a portable oxygen tank. Doctors say her lungs are still inflamed, and some days she still feels too tired and achy to get out of bed. Now Schnurr takes precautions, even if she may have immunity. “I’m still wearing a mask for the reason that I would never wish this on anybody,” she told me. Schnurr hopes that other Americans will choose to wear masks in public, but she says she understands why many still don’t. “Some people have to experience it on their own to actually change how they believe things,” she said.
Shifting pandemic politics likely played a role in Iowans’ perception of risk. People look to political leaders and other community figures with whom they share values to dictate how they should respond to crises. And when leaders in Iowa downplayed the virus in the middle of a contentious election year—suggesting that the COVID-19 death toll was artificially inflated, not masking up in public—many Iowans followed suit.
Ironically, though, Reynolds’s early inaction on the pandemic—when she largely kept the state open—may have helped her later decision to issue new restrictions seem more meaningful to residents, David Ropeik, a risk-communication consultant, told me. “The fact that she was hesitant at first made the fact that she was all in later more trustworthy”—and could have pushed some Iowans to take the virus more seriously, he said.
That seriousness served Iowa well this winter. But as the state’s daily case numbers stay stable—and the COVID-19 vaccines produce a new sense of security—Iowans could become complacent. Already, Reynolds has begun to loosen earlier pandemic restrictions, including lifting limits on crowd sizes at sporting events, and she signed legislation requiring public schools to offer a 100 percent in-person learning option by mid-February. The state’s vaccine rollout has been slower than anticipated. And just this week, health officials announced new cause for alarm: The U.K. variant—a much more contagious strain of the coronavirus—has made it to Iowa.