Iowa is entering year 4 of the COVID-19 pandemic. Where are we at and what's changed?

On Wednesday, Iowa marked the third anniversary of the first COVID-19 cases reported in the state.

Since then, virtually everybody has been affected by the disease in some way. The Iowa Department of Health and Human Services reports that nearly a million people have contracted COVID-19 — likely an undercount, since it does not include at-home tests — and more than 1 in 300 Iowans have died from the disease.

Even as fatigue over the pandemic has pushed COVID-19 to the background, the virus continues to affect Iowans. The state health department has reported more than 1,200 COVID-19 deaths in the past year, and continues to regularly report more than 1,000 new cases per week.

As Iowa enters year four of COVID-19, here's where the pandemic stands.

Data becomes more scarce, less meaningful

About a year ago, the Iowa health department adjusted its COVID-19 reporting schedule from daily to weekly updates.

Now, even those weekly updates are winding down. Beginning April 1, clinical labs will no longer be required to report the results of COVID-19 tests to the state, and the state will stop publishing weekly COVID-19-specific updates.

Instead, COVID-19 data will be incorporated into the health department's standard weekly respiratory virus surveillance reports.

The new system will not count every COVID-19 case in the state, but it will still meet the standards the health department sets for similar viruses.

Even before the change, the state was not capturing every COVID-19 case, since most at-home tests were not included in the weekly updates. Other Iowans who had the disease may have had few or no symptoms and opted not to get tested.

This means that while case counts remain somewhat effective at indicating broad week-to-week trends, they're much less meaningful compared to historical data. A week with 2,000 new reported cases in 2023 likely looks different than a week with 2,000 new reported cases in 2020.

In 2022, the state also stopped reporting data on people hospitalized with COVID-19 in Iowa, directing Iowans instead to the U.S. Department of Health and Human Services. But in February, that department also shut down its hospital utilization reporting page, leaving the U.S. Centers for Disease Control and Prevention as arguably the best resource for obtaining COVID-19 hospitalization data.

Hospitalization data is typically a better indicator of the pandemic's ups and downs than raw case counts.

Beyond the flaws in case reporting noted above, hospitalization data is typically more complete and consistent — though there can still be missing data — and it also describes the severity of cases in a way that the mere quantity cannot.

As seen in the winters of 2020 and 2021, the pandemic is at its most dangerous when hospital resources are stretched thin treating many severe cases.

In the week ending March 4, Iowa averaged 133 patients hospitalized with COVID-19. That's roughly in line with typical counts for 2023 so far.

The CDC did, however, report just three patients requiring intensive care for COVID-19 complications, which would be among the lowest throughout the pandemic.

Omicron subvariants remain dominant

The omicron variant of the coronavirus, which emerged toward the end of 2021, just completed its 13th consecutive month making up more than 99% of new positive tests in Iowa.

It shows no signs of going away, and most recent mutations to the virus have come from subvariants of the omicron strain.

Last year, subvariants such as BA.4 and BA.5 took over. So far this year, it's the XBB.1.5 subvariant, which has quickly become the dominant strain in the U.S., making up nearly 90% of new cases in the week ending March 4.

Iowa, which typically lags a few weeks behind the rest of the country's general trends, has nearly caught up. In the region including Iowa, Kansas, Missouri and Nebraska, XBB.1.5 was responsible for about seven out of every eight new cases.

While the XBB.1.5 variant is significantly more contagious than previous strains, current COVID-19 vaccines are still effective against it, the CDC says. Newer bivalent doses — which protect against multiple forms of the virus — provide additional protection.

More:XBB.1.5 is more contagious than Omicron—these products can help prevent infection

While the COVID-19 vaccines may not totally prevent you from contracting the disease, they significantly reduce the risk of severe disease and death.

That protection does fade over time, which is why a recent study by Yale University and the University of North Carolina at Charlotte suggests most people receive annual COVID-19 boosters.

Iowa's vaccination efforts have stalled

Despite those recommendations, nearly 40% of the state remains totally unvaccinated.

According to the state health department's most recent figures, as of early February, 60% of Iowans are fully vaccinated — having received both doses of a two-dose sequence, or one dose of a single-dose sequence. A further 4% have received one dose of a two-dose sequence, but not the second.

That's roughly similar to where Iowa stood one year ago. Less than 90,000 people became fully vaccinated over the 12 months preceding that most recent update, or less than 3% of the state. Less than half of Iowans under the age of 20 — and just 15% of those under 10 — are fully vaccinated, despite being eligible for more than a year.

Most Iowans haven't gotten a bivalent dose, either. Of the Iowans who are fully vaccinated, 30% have received a bivalent dose — or just 18% of the state's total population. (The CDC authorized bivalent boosters in October 2022.)

UIHC ends mask requirements

UI Health Care, among the last to still require face masks, announced on Monday that face masks would become optional for most employees, patients and visitors on March 8.

Face masks will still be required for anyone with symptoms of a respiratory virus and employees who are not vaccinated. Areas such as operating rooms that had already required face masks before the pandemic will still require them.

In general, UIHC suggests still wearing masks in crowded spaces or public transportation, if you had a high risk of exposure to the coronavirus, or if you or your close contacts are immunocompromised, among other situations.

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

This article originally appeared on Des Moines Register: COVID-19 in Iowa: The state of the pandemic entering year 4