Iowa to allow elective surgeries and farmers markets starting April 27

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DES MOINES — On April 24, Iowa Gov. Kim Reynolds signed a new proclamation continuing the State Public Health Emergency Declaration. The proclamation permits health care providers to begin the process of resuming some elective surgeries and procedures through a phased approach, permits farmers markets to begin limited operations with appropriate public health precautions, and provides other relief to Iowans affected by this disaster.

Nonessential Elective Surgeries

Pursuant to Iowa Code § 135.144(3), and in conjunction with the Iowa Department of Public Health, unless otherwise modified by subsequent proclamation or order of the Iowa Department of Public Health, I hereby order that effective at 5 a.m. on April 27, 2020, and continuing until this disaster proclamation expires:

  1. A hospital, outpatient surgery provider, or outpatient procedure provider may conduct in-patient surgeries and procedures that, if further delayed, will pose a significant risk to quality of life and any outpatient surgeries or procedures if the hospital or provider complies with the following requirements:

(1) A hospital or provider must have:

(a) Adequate inventories of personal protective equipment (PPE) and access to a reliable supply chain without relying on state or local government PPE stockpiles to support continued operations and respond to an unexpected surge in a timely manner; and

(b) A plan to conserve PPE consistent with guidance from the CDC and Iowa Department of Public Health;

(2) A hospital or provider must have a plan for timely COVID-19 testing of symptomatic patients and staff to rapidly mitigate potential clusters of infection and as otherwise clinically indicated. Providers must comply with any relevant guidance related to testing requirements for patients and staff issued by the Iowa Department of Public Health, the CDC, or a provider’s professional specialty society. For scheduled surgeries patients should have a negative COVID-19 test performed within 48 hours of surgery date. If a COVID-19 test is not available, a hospital or provider should consider alternative methods to determine the patient’s probability of COVID-19. If the patient has symptoms of fever, cough, or low oxygen saturation, then postponing the surgery is recommended.

(3) A hospital must continue to accept and treat COVID-19 patients and must not transfer COVID-19 patients to create capacity for elective procedures.

(4) A hospital must reserve at least 30 percent of intensive care unit (ICU) beds and 30 percent of medical/surgical beds for COVID-19 patients.

(5) A hospital or provider that begins conducting surgeries or procedures as authorized by this paragraph but is no longer able to satisfy all these requirements must cease conducting such surgeries or procedures except as authorized by paragraph B. All hospitals and providers shall have a plan in place to monitor compliance and a transition plan to reduce or suspend procedures and surgeries as necessary.

  1. Except as provided in paragraph A, all nonessential or elective surgeries and procedures that utilize PPE must not be conducted by any hospital, outpatient surgery provider, or outpatient procedure provider, whether public, private, or nonprofit.
  2. A nonessential surgery or procedure is one that can be delayed without undue risk to the current or future health of a patient, considering all appropriate factors including, but not limited to any: (1) threat to the patient’s life if the surgery or procedure is not performed; (2) threat of permanent dysfunction of an extremity or organ system; (3) risk of metastasis or progression of staging; and (4) risk of rapidly worsening to severe symptoms.
  3. Each hospital, outpatient surgery provider, and outpatient procedure provider shall limit all nonessential individuals in surgery and procedure suites and patient care areas where PPE is required. Only individuals essential to conducting the surgery or procedure shall be present in such areas.
  4. Each hospital, outpatient surgery provider, and outpatient procedure provider shall establish an internal governance structure to ensure that the principles outlined above are followed.

Farmers Markets

Pursuant to Iowa Code § 29C.6(6) and Iowa Code § 135.144(3), and in conjunction with the Iowa Department of Public Health, I hereby order that farmers markets, as defined in Iowa Code § 137F shall not be prohibited as a mass gathering under the Proclamations of Disaster Emergency issued on April 6, 2020, or April 16, 2020, but only to the extent that the farmers market complies with the following requirements:

  1. Farm Products and Food: The farmers market may only permit vendors who sell farm products or food. Vendors selling other goods or services are not permitted.
  2. Entertainment and Activities Prohibited: Musical performances, children’s activities, contests, or other entertainment or activities organized by the farmers market or vendors are prohibited.
  3. Common Seating Prohibited: Farmers markets must eliminate all common seating areas, picnic tables, or dining areas and shall prohibit vendors from having any seating for the public to congregate or eat food on the premises.
  4. Vendor Spacing: Farmers markets shall space all vendor booths or assigned parking areas so that there is six feet or more of empty space from the edge one vendor’s assigned areas to the neighboring vendor.
  5. Social distancing, hygiene, and public health measures: Farmers markets shall also implement reasonable measures under the circumstances of each market to ensure social distancing of vendors and customers, increased hygiene practices, and other public health measures to reduce the risk of transmission of COVID-19 at farmers markets consistent with guidance issued by the Iowa Department of Public Health, Iowa Department of Agriculture and Land Stewardship, Iowa Department of Inspections and Appeals, and Iowa State University Extension and Outreach.

Any other farmers market, festival, or community gathering of 10 or more people that does not comply with these requirements is prohibited. Customers of farmers markets are strongly encouraged to engage in social distancing, wear a mask or other protective face-covering if unable to maintain a distance of six feet from others, practice good hygiene practices, and attend the market alone without other family members.

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