November was Iowa's deadliest month of the coronavirus pandemic: Over 600 Iowans died of COVID-19

Nick Coltrain Tim Webber
Des Moines Register

The novel coronavirus reaped a toll of more than 600 Iowans in the month of November, the deadliest month since the pandemic reached the state in March.

As of noon Monday, the Iowa Department of Public Health reported 611 deaths from COVID-19 in November alone. That was more than a quarter of the 2,403 reported fatalities so far. COVID-19 is the disease caused by the virus.

November also saw more than double the October records for COVID-19 hospitalizations and positive tests for the virus.

"(November) was worse than the spring, for sure," Dr. Jorge Salinas, an epidemiologist with the University of Iowa Hospitals and Clinics, said in an interview. "The spring surges were primarily associated with large outbreaks in certain industries, such as meat processing plants, and affected ethnic minorities disproportionately. This surge was different in a sense that it was more democratic. It impacted all age groups, all demographics, all classes..."

More than 96,000 Iowans tested positive for the novel coronavirus in November. That’s 3% of Iowans, or 1 out of every 33. More new cases were identified in November than in the first seven months of the pandemic combined.

It often takes two or three days, but sometimes up to a week, for new cases to be added to the Iowa Department of Public Health’s online dashboard. That means when the tallying is complete, it is possible that 100,000 Iowans will have tested positive for the virus in November alone.

The record number of new confirmed cases comes even as two holidays, Veterans Day and Thanksgiving, temporarily shuttered Test Iowa sites.

Over the course of the month, about 5,000 Iowans were hospitalized due to COVID-19, up from about 2,400 in October. That sharp influx of cases pushed the number of Iowans concurrently hospitalized with COVID-19 to 1,527 on Nov. 17, a record that made hospital officials worry for their ability to keep up with the needs.

More:Jammed Des Moines hospitals could see COVID-19 cases double by Thanksgiving, expert warns

Since then, the number of hospitalized Iowans has gradually begun to decline, but more than 1,000 are still hospitalized due to the disease. Before November, the number of concurrently hospitalized Iowans had never exceeded 700.

And the record number of COVID-19 hospitalizations also ushered in a record number of COVID-19 deaths, far outpacing the previous high of 388 deaths in October. The 611 November deaths work out to a mournful average of one more person dying from COVID-19 every 70 minutes.

Three times in November, IDPH reported more than 40 deaths from COVID-19 complications in a single day, including 47 on Nov. 24. Before November, the daily high was 30.

COVID-19 is particularly deadly to older people, and nursing home residents account for more than 1,000 of Iowa's fatalities from the disease.

Brent Willett, president and CEO of the Iowa Health Care Association, said nursing homes are testing residents and staff at multiple times the rates seen early in the pandemic as supply chains have opened up.

Nursing homes have seen a drop in the mortality rate among residents who contract the virus, from about 28% to about 17%, though it doesn't lessen the pain of the loss, he said. If people want to protect nursing home residents, they need to follow public health guidelines of mask wearing, social distancing, hand washing and staying home if sick, he said.

"I certainly can't predict what the numbers are going to look like in December, but I think if we collectively keep up the level of vigilance we seem to have discovered in late November, we'll certainly be headed in the right direction," Willett said.

Iowa doctor 'cautiously optimistic,' but warns state not 'out of the woods' 

On the Tuesday before Thanksgiving, Iowa Gov. Kim Reynolds highlighted "positive signs" in Iowa's coronavirus data, citing dips in confirmed infection rates. Salinas, the University of Iowa Hospitals and Clinics epidemiologist, was likewise heartened by the figures.

More:Gov. Kim Reynolds sees 'positive signs' in state's latest coronavirus data, urges Iowans to remain vigilant

Iowans appear more conscientious and aware of public health measures to stop the spread of the virus, such as mask wearing, avoiding large gatherings, hand washing, staying home if sick and maintaining social distance, he said.

Salinas said he didn't want to make any predictions for December, but noted Iowa and other Midwest states have seen their peaks recede. A lowered peak doesn't automatically mean infections will continue to decline, and Iowa could see cases plateau at a very high level.

"If we plateau at 2,000 new cases a day, that's still very problematic because that's still more than 10,000 cases per week," he said.

In October, his hospital was able to predict that it needed to implement its "surge plan" for new patients because a certain number of those who were infected would be sick enough to require hospitalization, Salinas said. The hospital has no plans to ease up on those measures, designed to increase capacity for people who need hospitalization, for another 10 days as officials watch the numbers.

Salinas likened November to sprinting the final 5 miles of a marathon after health care workers already have run for more than 20 miles.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned Sunday on ABC's "This Week" that the nation could see a "surge upon a surge" in new cases if people didn't follow public health guidelines.

Dr. David Williams, the chief clinical officer for UnityPoint Health, said Fauci's words were warranted, and underscored the need for Iowans to follow public health guidelines. Williams said he was "cautiously optimistic — and I would emphasize the word cautiously in that statement" about the state of the pandemic in Iowa.

Hospitalizations of COVID-19 patients at UnityPoint have declined in recent weeks, from a high of about 600 people in mid-November to about 500 now, he said. That's a hopeful sign, but the decline is still more than double the number of people the hospital system was treating in mid-October, Williams said.

UnityPoint is seeing lower positivity rates in its testing, too, but that doesn't mean the virus will fade automatically, Williams said. The figures can spike right back up if Iowans become lax with their precautions, he said.

While a vaccine appears likely to be approved in the next few weeks, and mass distribution may be possible by next spring, Iowa is "not out of the woods," he warned. More people tend to need hospitalization during winter months, even without COVID-19 upending daily life, and he doesn't expect that to be different in a world dominated by the pandemic.

"We're looking forward to the vaccine, but we're also looking at a really difficult next couple of months," Williams said.

Tim Webber is a data visualization specialist for the Register. Reach him at, 515-284-8532, and on Twitter at @HelloTimWebber.

Nick Coltrain is a politics and data reporter for the Register. Reach him at or at 515-284-8361.