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Governor J.B. Pritzker unveiled his plan called “Restore Illinois” today, under which different regions of the State can move to open businesses and schools and return to more normalcy if they meet certain thresholds.

Dr. Ngozi Ezike, the Director of the Illinois Department of Public Health, announced that 176 people in Illinois lost their lives to the COVID-19 virus in the last 24 hours, the highest daily toll so far.

Measures to Open the Illinois Economy

One measure being used to determine if the economy is ready to open is whether the number of COVID-19 infections and/or the number of hospitalizations has peaked and has shown a downward trajectory for 14 consecutive days. In the last 10 days, Gov. Pritzker has seemed to put his focus on the trend in hospitalizations.

Gov. Pritzker has also repeatedly said that other measures include whether testing, tracing and treatment are in place. In addition, he says it is critical that an adequate amount of Personal Protection Equipment (PPEs, e.g., face masks, gowns, etc.) be available.

Below are data showing the trends in infections, hospitalizations, and testing.

The Number of Infections and Hospitalizations

Evanston: The number of Evanston residents who have tested positive for COVID-19 increased by 6 cases today, May 5, for a total of 397 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 11 Evanstonians have died due to COVID-19.    

Chicago, Cook County and Illinois: For Chicago, the number of confirmed COVID-19 cases grew from 25,866 yesterday to 26,606 today; the cases in Cook County grew from 43,776 yesterday to 45,223 today; and the number of cases in Illinois grew from 63,840 yesterday to  65,962 today. The trend is shown in the first chart in the chart box.

Dr. Ezike said t there were 2,122 new confirmed cases reported in the last 24 hours in Illinois. The trend of new cases is shown in the second chart in the chart box.

The number of deaths in Illinois due to COVID-19 increased by 176 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 2,838.

Hospitalizations in Illinois: Gov. Pritzker reported the number of hospitalizations due to COVID-19 in Illinois was 4,780, up from 4,493 yesterday, but down from 4,953 on April 30 and 5,063 on April 29. The number of COVID-19 patients occupying ICU beds was 1,266  today, up from 1,214 yesterday, but down from 1,290 last week.  Today, 780 people are on ventilators.  

Gov. Pritzker has said the number of hospitalizations is a key factor that he would consider in deciding whether to open the economy. He said he wanted to see that number peak and then decline for 14 successive days.

The State’s hospitals have capacity to handle the numbers of patients reported above. As of May 4, there were 10,950 hospital beds open, 941 ICU beds open, and 2,354 ventilators available.

Adequacy of Testing

There are two measures to assess the adequacy of testing discussed by researchers: 1) the number of tests given in relation to the population; and 2) the percentage of people who test positive for COVID-19.

The Number of Tests in Illinois

Both Gov. Pritzker and Dr. Ezike have repeatedly said testing is critical to opening up the economy and to do so in a manner that protects the health and safety of the people. More than a month ago, Gov. Pritzker established a goal to give 10,000 tests per day. Last week, the State surpassed that goal, but both he and Dr. Ezike say that more testing is needed. They have not yet set a new goal. 

In the first five days of April, there was an average of 5,152 COVID-19 tests administered in Illinois each day. In the five days between April 30 and May 4, there was an average of 15,294 COVID-19 tests administered in Illinois each day. On May 5, the number of tests reported in the prior 24-hour period was 13,139 tests.

The number of COVID-19 tests administered in Illinoi on a daily basis has gone up substantially.

Some researchers say that on a nationwide basis the minimum number of COVID-19 tests to safely open the economy is 500,000 per day, which would require about 150 tests for every 100,000 people.*

For Illinois to meet that target, it would need to give about 19,500 tests per day. Gov. Pritzker said yesterday that the State needs to “vastly increase” its testing.

Some researchers put the number of tests needed at more than ten times that amount.**

The Percent-Positive Test Rate

There are many undiagnosed cases of COVID-19 because there has been limited testing capacity. Both Gov. Pritzker and Dr. Ezike have acknowledged that that confirmed number of COVID -19 cases reported daily by IDPH grossly understates the actual number of COVID-19 cases, because it does not capture people who have shown mild symptoms or who are asymptomatic and have not qualified for testing.

One measure used by researchers is to assess whether the amount of testing is adequate is to look at the percent of people who test positive on COVID-19 tests. The World Health Organization suggests that a test-positive rate should be between 3% and 12%. A test-positive rate greater than 10% likely reflects that there is an inadequate amount of testing and that it should be increased to cast a wider net.***

In the first five days of April, there was an average positive test rate of 20.4%. Between April 30 and May 4, the average positive test rate was 17.6%.

On May 5, the test positive rate was 16.1%.  The trend is shown in the third chart in the chart box.

Illinois’s test positive rate is still above 10%.

The Rate of Infection

Another measure that shows how the spread of the virus is being contained is how many people, on average, are being infected by a single person. Gov. Pritzker said the rate of infection was 3.5 at the time the Stay-at-Home order was entered. It is 1.2 today on a Statewide basis, he said. The goal is to have the rate of infection below 1.0.

The ‘Restore Illinois’ Plan

At his daily briefing today, May 5, Gov. J.B. Pritzker announced a plan called “Restore Illinois” to reopen businesses, education, and recreational activities in the State in phases.

Under the plan, the State is divided into four regions, and different regions may move forward in the phases more quickly than other regions, depending on whether they are meeting the criteria to move from one phase to the next.

Evanston is included in the Northeast region of the State, which includes Chicago and nine counties, including the collar counties. The Northeast region has been hit hardest by the COVID-19 virus, and it may lag behind the three other regions in returning to normalcy. 

“We have to figure out how to live with COVID-19 until it can be vanquished and to do so in a way that best supports our residents’ health and our healthcare systems, and saves the most lives,” said Gov. Pritzker. “Restore Illinois is a public health plan to safely reintroduce the parts of our lives that have been put on hold in our fight against COVID-19. This is also a data-driven plan that operates on a region-by-region basis, a recognition that reality on the ground looks different in different areas of our State.”

He said the plan is a data-driven approach based on science. He said the State entered Phase 1 in early March when he entered an order closing the schools and the Stay-at-Home order. The State entered into Phase 2 on May 1, when modifications to the Stay-at-Home order went into effect. The earliest any region may enter Phase 3 is May 29.

What Can Be Done Under Each Phase

These are the five phases described in the plan.

Phase 1 – Rapid Spread: This phase began in early March, said Gov. Pritzker, and he entered an order closing schools and a strict stay at home order, under which only essential businesses remained open, and social distancing guidelines were put in place. Every region in the State has experienced this phase once already and could return to it if mitigation efforts are unsuccessful.

Phase 2 – Flattening: Gov. Pritzker said all regions of the State moved to Phase 2 on May 1, when the Stay-at-Home order was modified. In this phase, non-essential retail stores may reopen for curb-side pickup and delivery. Illinoisans are directed to wear a face covering when outside the home, and they can begin to participate in outdoor activities, such as golf, boating and fishing while practicing social distancing and subject to IDPH guidelines. 

Phase 3 – Recovery: In this phase, manufacturing, offices, retail stores, barbershops and salons may reopen to the public, subject to limits on capacity and other safety precautions. Health and fitness clubs may offer outdoor classes and one-on-one personal training, subject to IDPH guidance. The region’s State parks may open. Limited childcare and summer programs may operate with IDPH guidance.

All gatherings limited to 10 or fewer people are allowed.

Face coverings and social distancing are the norm.

Telework wherever possible is strongly encouraged. “Even as businesses reopen, businesses should do everything in their power to provide remote accommodation for older and COVID vulnerable employees,” said the Governor. 

Phase 4 – Revitalization:

“We have named phase four ‘revitalization,’ because it is in this phase that everyone in Illinois will be rebuilding what school and work will look like for a while, until we reach the other side of this pandemic,” said Gov. Pritzker.

Restaurants and bars, spas, cinemas, theatres, retail, and health and fitness clubs may reopen, within new capacity limits and IDPH approved safety guidance.

Schools, summer and fall programs, childcare and higher education may open within safety guidance; travel may resume; and all outdoor recreation programs would be allowed.

Public gatherings in Phase 4 would be limited to 50 people. “This limit is subject to change up or down depending on what the science tells us at the time,” said the Governor.

Face coverings and social distancing will be the norm.

“It brings me no joy to say this, but based on what the experts tell us, and everything we know about this virus and how easily it spreads in a crowd, large conventions festivals and other major events will be on hold until we reach phase five,” said Gov. Pritzker.

Phase 5 – Illinois Restored: In this phase, the economy fully reopens with safety precautions continuing. Conventions, festivals and large events are permitted, and all businesses, schools, and places of recreation can open with new safety guidance and procedures in place reflecting the lessons learned during the COVID-19 pandemic.

The Criteria to Move from One Phase to the Next 

“IDPH will watch the identified health metrics closely to determine when regions have attained them, so each can move from phase two, to phases three and four,” said Gov. Pritzker. 

He laid out the criteria that must be met to move from Phase 2 to Phase 3. First, he said, a region must be at or under a 20% test positive rate and increase by no more than 10 percentage points over a 14-day period. Second, a region must have either not had an overall increase or must have maintained overall stability in hospital admissions for COVID-like illness in the last 28 days. Third, a region must maintain the availability of a surge threshold of 14% availability of ICU beds of medical and surgery beds and ventilators.

Because May 1 marked the beginning of phase two, that is the first day for the 14- and 28-day measurement periods to begin, meaning that the earliest that a region can move to Phase 3 is May 29, he said.

Several other criteria mentioned in the plan include that there be testing for COVID-19 for patients, health care workers and at-risk residents, and that the region begin contact tracing and monitoring within 24 hours of a diagnosis.

To move from Phase 3 to Phase 4, the plan says that the test-positive rate and the number of hospitalizations must decline and hospital capacity benchmarks must be met; that testing be available in the region regardless of symptoms or risk factors; and that contact tracing within 24 hours of diagnosis occur for more than 90% of cases.

There is a high threshold to move from phase four to phase five. “The only way that we can cross into phase five, with all the sectors of the economy running with completely normal operations is with a vaccine, or a widely available and highly effective treatment or with the elimination of any new cases over a sustained period of time,” said Gov. Pritzker.

IDPH will be tracking each of the four regions applying these metrics, and will make the data available data online every day. “Importantly, just as public health indicators will tell us when to move forward at any time. They could also signal that we need to move backward,” Gov. Pritzker said. 

Enforcement

“We don’t have the capacity or the desire to police the individual behavior of 12.7 million people,” said the Governor. “Enforcement comes in many forms. And our first and best option is to rely on Illinoisans working together to see each other through this pandemic. But we are also working with local law enforcement, and I’ve asked for their assistance to monitor for violations and consider taking actions when necessary, but that is not the option that anyone prefers.”

Gov. Pritzker said, “There is no modern-day precedent for this. We are quite literally writing the playbook as we go. The scientists learn more about this virus every day. And we can, we will, make our Restore Illinois plan, smarter, as we move forward. I’m not afraid to redesign the playbook if the rules change.”

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Footnotes

*Ashish Jha, MD, MPH, the Faculty Director of the Harvard Global Health Institute, and two colleagues conclude in an April 18 article “Why we need at least 500,000 tests per day to open the economy – and stay open,” that on a nationwide basis at least 500,000 tests a day are needed to succeed with the opening of the economy and to stay open. They add that number “is probably too low” and “we likely need many more.” Link: https://globalepidemics.org/2020/04/18/why-we-need-500000-tests-per-day-to-open-the-economy-and-stay-open/?referringSource=articleShare

 That is about triple the number being administered now, and it would require about 150 tests per day per 100,000 people.

** Other researchers put the number much higher. A report, “Roadmap to Pandemic Resilience,” published by the Edmond J. Safra Center for Ethics at Harvard University, recommends massive scale testing for COVID-19, together with supported isolation as the path to open up the nation’s economy. The report, updated on April 20, has 23 authors, with expertise in many different disciplines.

The Safra Center report says, “We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy.” Link: https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20_0.pdf

*** See article by Ashish Jha cited above.