More than 780 Iowans have tested positive for COVID-19 since the first case was announced in the state on March 8. Fourteen people have died, including a Dubuque County resident.

Those numbers are dwarfed by the totals from Illinois — more than 10,000 cases and 243 deaths — and Wisconsin — more than 2,100 cases and 56 deaths.

But health experts believe the worst is yet to come.

A model created by researchers at the University of Washington — and being referenced by groups including Iowa’s Legislative Services Agency — projects that Iowa, Wisconsin and Illinois remain weeks away from experiencing the peak of their COVID-19 outbreaks.

And when they do, the number of intensive-care-unit beds needed in each state will far exceed their respective current capacities, according to the projections. Additionally, Iowa is projected to have a shortfall in total hospital beds compared to the anticipated need.

In the Dubuque area, public health officials and health care leaders — including Grand River Medical Group, Medical Associates Clinic and Health Plans, MercyOne Dubuque and UnityPoint Health-Finley Hospital — are working closely to prepare for the coming peak while continuing to push measures that could delay or reduce it.

Mary Rose Corrigan is the public health specialist for the City of Dubuque and a spokeswoman for the Dubuque County Public Health Team. She said this isn’t the first time these local entities have collaborated, but COVID-19 has introduced a new sense of urgency.

“We have been working together for a long time, but it is really kicking into action now,” she said. “We have something real to deal with and react to.”

THE PROJECTIONS

On Monday, Dubuque County Public Health Executive Director Patrice Lambert told the Telegraph Herald after a press conference that state officials predict that cities across Iowa could expect a peak in COVID-19 cases in about two weeks.

As of Saturday, the University of Washington projections, which update regularly, predicted Iowa’s “peak resource use” would occur on May 1. That means it is the day when the “estimates predict the greatest need for hospital beds, ICU beds, ventilators and other related hospital resources,” according to the University of Washington.

The projections estimate that more than 45 Iowans per day will die from COVID-19 during a week-and-a-half stretch around that time.

According to the study, COVID-19 patients in Iowa will require 4,655 hospital beds on May 1, exceeding the 4,297 beds available statewide.

The shortage is far more worrisome for ICU beds, with more than 700 needed and an estimated 250 in the state.

As of Saturday, more than 60% of the people with confirmed COVID-19 in Iowa have not required any hospitalization, according to state data.

The peak resource date for Illinois is estimated at April 20. The projections show that the state has enough hospital beds to accommodate COVID-19 patients at that time, but it only has about two-thirds of the needed ICU beds — a shortage of about 500.

Wisconsin’s peak is expected at April 27. Like Illinois, the state is expected to have enough total hospital beds at that time, but not enough ICU beds. The projections estimate Wisconsin will be short about 200 of the latter beds.

LOCAL PREPARATIONS

The coronavirus causes only mild or moderate symptoms, such as fever and cough, for most people. As a result, many of those people are never tested.

As of Saturday, 24 cases of COVID-19 had been confirmed in Dubuque County. That was the ninth-highest total among the state’s counties, but it pales in comparison to the three highest: Linn County, 139 cases; Polk County, 109; and Johnson, 96.

Justin Hafner, CEO of Grand River Medical Group, recently told the Telegraph Herald that each of Dubuque’s four largest health care organizations — Grand River, Medical Associates, Mercy and Finley — have dealt directly with confirmed COVID-19 patients already.

The expectation of a looming COVID-19 surge has captured the attention of area health directors and hospital leaders, who are working to create “surge plans” that address the potential for increasing patient volumes.

Officials have been reluctant to discuss local hospital bed capacities, citing a variety of options at their disposal that could increase that number. The Harvard Global Health Institute recently estimated that the Dubuque metro area had about 520 hospital beds, about 20 of which were ICU beds.

But local hospital leaders, including MercyOne Dubuque President Kay Takes, noted that recent actions freed up more space.

“Since they have eliminated non-essential surgeries and procedures, they are at a low census right now,” Corrigan added. “That allows them to take certain spaces and repurpose them.”

She also noted that area hospitals have expressed a mutual willingness to transfer patients from one facility to another when needed. Dubuque hospital officials also have been in contact with other area facilities, including hospitals in Grant County, Wis.; and Jo Daviess County, Ill.

Other relatively simple measures — such as putting two beds in a room typically reserved for one — can further enhance capacity.

For smaller hospitals, ramping things up can be more difficult.

Jeff Kindrai, director and health officer for the Grant County (Wis.) Health Department, noted that multiple hospitals in the region provide limited services and rarely keep patients who require ventilators.

“Often, when a person needs that level of care, they are shipped out to another facility,” he said.

Kindrai said employees at many smaller hospitals are being trained to use ventilators from the strategic national stockpile.

RUSH TO PREPARE

Preparing for the peak isn’t just about securing the necessary beds and equipment for patients.

Jaime Collins, director of marketing and communications at Southwest Health in Platteville, Wis., believes that acquiring protective equipment for front-line workers is critical.

“We need to make sure we have a strong, viable health care workforce,” she said. “That is priority No. 1.”

Collins said Southwest Health has sought to acquire additional masks and face shields from donors and manufacturing companies.

“We are confident with the levels we have now, but we have to look at these things continuously,” Collins said. “No one knows for sure where this is going.”

Corrigan said local hospitals can request additional personal protective equipment by contacting the county’s emergency management agency, which then passes it along to the state. She said local hospitals recently requested extra facemasks, but have adequate supplies of other PPEs.

Testing has been a persistent problem throughout the U.S., with limited supplies hindering efforts to confirm active cases, trace their recent contacts and stop the virus’ spread.

Corrigan said tests still are difficult to acquire locally.

“Not everyone that wants a test can get one,” she acknowledged. “Your health care provider will make the determination on whether you need a test.”

STAYING VIGILANT

Amid all the talk of peak dates and surge planning, local health experts still believe the most important action is also the easiest one.

Social distancing — staying at least 6 feet away from others — and staying home if possible remain critical.

“When we reach our peak and how big it is, is dependent on how well people cooperate with our ‘Safer At Home’ order,” Kindrai said, referring to Wisconsin’s statewide order.

Corrigan said adhering to such guidelines requires discipline.

Trips to grocery stores should be viewed as a way to gather necessities and not as “a way to get out of the house,” for example, she said.

“We are starting to see more cases so we are trying to get as much information as we can out to the public about how important it is to stay at home,” wrote Sandra Schleicher, public health administrator in Jo Daviess County, in an email to the TH.

While the local COVID-19 numbers are well below hot spots elsewhere in Iowa, Illinois and Wisconsin, as well as across the country, Dubuque County’s Lambert stressed that the battle is far from over — and residents must understand the stakes are high.

“Nobody should ever let their guard down,” she said. “This is such a fluid epidemic. Everything can change in the matter of a day.”