The COVID-19 pandemic was confirmed to have reached the U.S. state of Iowa in March 2020. The first known cases were three individuals who had traveled on a cruise in Egypt before returning home to Johnson County on March 3. Initially, case clusters were focused at meatpacking plants and congregate care facilities. By late October, community spread had become a concern, and some areas of the state had reported over 20% test positivity. A headline stated that "Iowa hospitals fear overwhelming patient surge if coronavirus cases continue to climb."