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As the number of identified coronavirus cases in Iowa continues to grow daily, key questions have emerged: How many Iowans will contract the virus? How many will die because of it? And can the state's hospital system handle what's coming?

Data projections are beginning to offer clues.

"It is going to get worse before it gets better," said Dr. Hans House from the University of Iowa Hospitals and Clinics, who is among the medical professionals privately reviewing various models about COVID-19, the respiratory disease caused by the virus.

A projection is a forecast that uses current conditions. If those conditions change — for instance, if Iowa officials implement more or fewer social distancing measures in response to the virus, or if Iowans follow or flout the rules already established to stop its spread — so does the forecast.

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Gov. Kim Reynolds on Wednesday said she and her staff review data daily to inform their decisions on mandatory and nonmandatory mitigation efforts in the state.

A research center at the University of Washington estimates, as of Wednesday, that 1,367 Iowans will die by Aug. 4 of COVID-19.

The data, by the Institution for Health Metrics and Evaluation, indicates that from April 30 to May 3, a peak of 45 Iowans will die daily because of coronavirus. The analysis shows the state's hospital system running out of beds, including intensive care beds, around the same time.

But those numbers could shift based on whether more stringent social distancing measures are adopted and followed over time.

► MORE: The latest on the coronavirus outbreak in Iowa

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The Washington state researchers made their estimates assuming that Iowa has no state-mandated mitigation orders in place and that "nonessential services" remain open. That doesn’t exactly fit what Reynolds has ordered, which includes a mix of state-mandated closures, such as for restaurants and bars, while other services that might be considered nonessential continue to operate.

The data further assumes that states like Iowa without state-mandated mitigation orders will enact them within seven days of the model’s latest update.

"If not, the number of deaths and burden on their hospital systems will likely be higher than the model predicts," according to the website.

Not calculated in that data: Reynolds' order that certain businesses close for the next several weeks and her recommendation that schools close. She has also limited gatherings to 10 people or fewer, and asked businesses to let employees work from home when possible.

"Some of the modeling that's out there right now ... does not take those assumptions into account," Reynolds said Wednesday.

Those efforts are also one of the reasons Reynolds has, so far, not ordered Iowans to stay in their homes except for essential work or travel. She has argued that Iowa is under the "equivalent" of such orders.

Iowa is now among a minority of states without a mandatory stay-at-home order.

► MORE: Updated COVID-19 maps and charts track cases and data in Iowa and across the U.S.

Iowa doctor sees growing cases in the state, but also hopeful signs

House, an emergency physician at UIHC, predicts a steady increase in COVID-19 cases in the state for the next several weeks.

House is making his assumptions based on modeling by Gregory Wong, a researcher at Pennsylvania State University.

Weeks ago, the model predicted 486 cases of COVID-19 in Iowa by March 31, a figure that was just below the actual total of 497. House is going public with his assumptions because it's been at least two weeks since the state has implemented social distancing measures.

The model he is using predicts more than 18,000 COVID-19 cases total in Iowa by April 19 and more than 57,000 by April 25.

While the Penn State model has matched the state's coronavirus cases so far, it shows only exponential growth of COVID-19 cases in Iowa. It does not include a peak in cases or projections on deaths. House emphasized those factors limit the data.

He believes there will be a peak in cases in Iowa sometime around the third week of April, but the figures could change if Iowans practice — or disregard — social distancing recommendations.

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The Iowa Department of Public Health in recent days has estimated that Iowa will see a "first peak" of COVID-19 cases in the next two to three weeks. The department has not released more specific information to the public about its metrics.

On Sunday, department spokeswoman Amy McCoy told the Des Moines Register that the estimate is based on a combination of data points.

"We look at the number of cases, the rate of cases in a population, the time frame over which cases have been identified, the vulnerable populations in areas where cases occur, as well as evaluate the lessons learned in other states and countries around the globe," McCoy said in an email. "We also consider the public health mitigation strategies we have put in place which include things like social distancing — staying 6 feet apart and avoiding group activities."

House noted that while cases are expected to increase in the weeks ahead, he sees some promising signs. On Wednesday, state public health officials announced 52 new cases. While such a jump is still high, it is a slight decease from the Pennsylvania State model's predictions.

House said he is now looking for consecutive days of a decline in cases, which could indicate a peak soon. But the numbers will continue to depend on mitigation strategies that must be in place for some time.

"Maybe we're making a difference," he said. "We'll see."

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.

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