Iowa records 6,000 COVID-19 deaths. That pain is 'just the tip of the iceberg.'

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Originally published May 14, 2021.

There's a video Ashlee Birmes treasures.

It shows her mom pulling up to Birmes' home in Le Mars. It shows Birmes' 2-year-old son beside himself with joy — his arms and legs pump giddily as he lets loose a torrent of "Hi, Nana. I love you, Nana. Hi, Nana." As soon as the car door opens, the toddler darts inside to shower more love on his grandma.

"That's how it was every time he would see her," Birmes, 25, said.

Over the past month, she's been trying to ease the little one into a new world, one where his grandmother no longer visits. Staci Ann Birmes, 50, died in her home on April 8 after a months-long bout with the lingering effects of COVID-19.

For Birmes and the friends and families of 6,000 other Iowans, there will be no return to pre-pandemic normal.

Staci Birmes, who also had fibromyalgia, first became sick with the disease in November, during the worst spike Iowa experienced. Ashlee Birmes said the initial bout was like a case of bronchitis. A later scan revealed her lungs to be a mass of scar tissue, Ashlee Birmes said. Her mother would turn blue from lack of oxygen just from walking through the house.

It was only around her grandson that Staci Birmes found the energy to act as if nothing was wrong.

'This pandemic was real': By the numbers

Since Iowa's first casualty of the pandemic on March 24, 2020, an average of 14 Iowans have died daily from the disease. In 13-and-a-half months, COVID-19 killed more Iowans than eight of 2017's top 10 causes of death combined. At the pandemic's peak in Iowa, in November and December, nearly 46 Iowans died daily from it on average.

The state's count of deaths from the illness reached 6,000 midday on  Saturday.

"I hope this is evidence enough to whoever may continue having doubts that this pandemic was real," said Dr. Jorge Salinas, the lead epidemiologist at the University of Iowa Hospital and Clinics. "It has impacted the lives of Americans and the lives of humans on Earth tremendously.

"Six thousand deaths is very tragic, but it's just the tip of the iceberg," he continued. "For every dead person, there are tens of people who have been hospitalized. Tens of thousands of people have been hospitalized, required mechanical ventilation, required so many medical treatments to survive, just in Iowa, in America."

There have been enough positive tests in Iowa — more than 398,000 — for nearly one in every eight Iowans. People sick with COVID have spent a collective 158,975 days in Iowa hospitals, and the health care system was nearly overwhelmed in the fall. (Iowa Department of Public Health reports daily totals of positive tests and people in hospitals, not the total number of individuals who have tested positive or been hospitalized.)

Older people faced the most dire outcomes from COVID-19. People 80 or older accounted for 58% of the deaths. The disease killed 2,335 Iowans who resided in nursing homes, nearly 40% of the total death toll, despite nursing home residents making up less than 1% of the state's total population.

Nursing home residents and staff were also among the first groups of Iowans eligible to receive the vaccine. Outbreaks at nursing homes have since nearly disappeared.

Iowa and the nation are not in the same spot as they were just a handful of months ago, government and health officials say.

'Every day, things get better and better as people get more vaccines'

Iowa Gov. Kim Reynolds, citing vaccination rates and declining viral activity on Wednesday, declared it time for Iowans "to lean further into normal."

"There's no reason for us to continue to fear COVID-19 any longer," Reynolds said. "We know how to manage it, and that individuals can be trusted to make decisions that will keep us on a path forward. I believe that Iowans are ready to live our lives normally again, and I think we've earned it."

About 59% of adult Iowans have received at least one dose of a COVID-19 vaccine, according to the U.S. Centers for Disease and Control. About 39% of the state's total population, including young people who are not eligible for the vaccines, have been fully vaccinated.

Shortly after Reynolds' remarks, federal regulators approved the Pfizer vaccine for people as young as 12. On Thursday, new CDC guidance allowed for fully vaccinated people to not wear face coverings except in limited cases.

"All in all, America and Iowa are in a better position every week, and every day things get better and better as people get more vaccines," Salinas said, adding that he believes it's appropriate to begin relaxing public health measures.

He likened the COVID-19 vaccines to the Eiffel Tower or Great Wall of China on the scale of magnitude and reverence of the achievement. The scientists responsible for them should win the Nobel Prize, Salinas said.

"Everything next to it, no matter how beautiful or important, is dwarfed by the vaccine," Salinas said.

Even so, he expects the true end of the pandemic to be a while in coming. People will still wear masks in his hospital during routine interactions; it's not clear how often people may need additional boosters of the vaccine; and there are enough people who outright refuse the vaccine that he expects occasional, relatively small-scale, outbreaks to continue.

Pandemic thinking will be a condition people will need to get used to living with, he said.

Ashlee Birmes and her family treated the pandemic seriously, she said. They wore masks when out in public. She lined up for a vaccine as quickly as she could.

But she's not acting like the pandemic is over. Her son can't be vaccinated yet, and she — and others in the community, she added — need to step up and protect people who aren't eligible or otherwise can't be vaccinated, she said.

"My son is young, and he may not get it as bad as some adult, but you never know," Birmes, who is also pregnant with her second child, said. "It just scares me. I know I have that extra layer of protection, and I can wear a mask, but to get a 2-year-old to wear a mask and stay close to you is extremely hard."

'Took our last parent that we had'

Salinas likens the pandemic to a war, or life under a dictatorship, in the scale of societal trauma that the virus wrecks. Some of the traumas will be stark, like recovering from job loss or grieving the death of a loved one. Others, such as emotional traumas of a year of abnormal, anxious, isolated life, will have subtle and unexpected ripples, he said.

The lingering effects will also be unequal — just like how the pandemic affected lower income Iowans, people living in communal housing, and people who couldn't work from home the worst.

He called for a retrospective report detailing Iowa's response to the pandemic, with an emphasis on what could be improved upon for future health crises.

"We can try to, in a refractory way, go back to the way things were, but you just can't," Salinas said. "Things are going to have to be different, and we're going to have to acknowledge the pain and magnitude of events like this. If you decide not to do that, it's going to be harder to overcome these situations."

The way Iowa and the nation recover from the pandemic will be the result of policy and political choices, Salinas said.

Pandemics don't operate in vacuums, siloed away from the rest of life. They interrupt, and build on and compound struggles faced by institutions, social systems and people.

For Ashlee Birmes, the pandemic did not just cost her a parent. She lost her father six years prior; in effect, COVID sheared an entire generation from her family.

"It is sad that this pandemic took the last parent I had living. The last living grandparent on my side my children would have gotten to know and enjoy," she said in a text message.

"Now," she said in an interview, "it's just done."