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The Illinois Department of Public Health (IDPH) is now presenting data that allows the four regions of the State to monitor how they are doing in terms of meeting some of the criteria to move from Phase 2 to Phase 3, as defined in the Restore Illinois plan. Evanston is included in the same region as Chicago, and a number of surrounding counties in the Northeast region of the State.
Governor J.B. Pritzker reported that more than one million unemployment claims have been filed in Illinois in the last nine weeks. The toll on families has been devastating.
Metrics for Restore Illinois
In the Restore Illinois plan laid out by Gov. Pritzker on Monday, the State is already in Phase 2 of the five-phase plan. There are four regions of the State, and each region may move through the remaining phases at its own pace.
One metric being used to determine if a region may move from Phase 2 to Phase 3 and from Phase 3 to Phase 4 is that there be no overall increase in hospital admissions for 28 days, and that hospitals in the region have an unused bed capacity of 14%. While these criteria focus on the number of hospitalizations, rather than new COVID-19 cases, the number of new cases is still important, because about 30% of the people who test positive for COVID-19 are hospitalized.
Another criterion is whether the percentage of people who test positive on a COVID-19 test is less than 20% of the people tested. Two other criteria determine whether testing is adequate, and whether tracing is adequate.
Below are data showing trends in new COVID-19 cases, hospitalizations, and testing. Where data is available for the Northeast region, it is provided.
The Number of Infections and Hospitalizations
Evanston: The number of Evanston residents who have tested positive for COVID-19 increased by 27 cases today, May 7, for a total of 436 cases, according to information provided by the City of Evanston. The trend is shown in the above chart.
To date, a total of 12 Evanstonians have died due to COVID-19.
Chicago, Cook County and Illinois: For Chicago, the number of confirmed COVID-19 cases grew from 27,440 yesterday to 28,441 today; the cases in Cook County grew from 46,689 yesterday to 48,341 today; and the number of cases in Illinois grew from 68,232 yesterday to 70,873 today. The trend is shown in the first chart in the chart box.
IDPH Director Dr. Ngozi Ezike said that there were 2,641 new confirmed cases in Illinois in the last 24 hours. 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 137 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 3,111.
Hospital Admissions in the Northeast Region: IDPH reports that hospital admissions in the Northeast region were 260 on May 1; 266 on May 2; 240 on May 3; and 269 on May 4.
In the Northeast region, 19% of the medical/surgical beds were available; 20% of its ICU beds were available, and 62% of ventilators were available.
Adequacy of Testing
Researchers often use two measures to assess the adequacy of testing for COVID-19: 1) the number of tests given in relation to the population; and 2) the percentage of people who test positive on COVID-19 tests.
The Number of Tests in Illinois
Both Gov. Pritzker and Dr. Ezike, have repeatedly said that testing is critical to opening up the economy and doing so in a manner that protects the health and safety of the people.
The Restore Illinois plan does not set a goal in terms of the number of tests that must be given. Rather, to move from Phase 2 to Phase 3, a region must have testing available “for all patients, health care workers, first responders, people with underlying conditions, and residents and staff in congregate living facilities.” To move from Phase 3 to Phase 4, testing must be “available in region regardless of symptoms or risk factors.”
The plan does not state how it will be determined if these criteria are being met.
When asked about a new study out of Harvard University that set a target for Illinois of 64,000 tests a day, Gov. Pritzker said there was a challenge to increasing the number of tests due to the lack of supplies needed to administer the tests, and the lack of coordination from the federal government.
He added, “I don’t think 64,000 is adequate for the State of Illinois. I think we’re going to need many more tests than that. We want people to be safe when they go to work. We want people to be safe when they go to school. People want to be safe in all their activities, and they want to know that others have been tested around them.” He said it was important “nobody is without an opportunity to get a test.”*
In the last five days the number of tests administered per day was about 15,750.
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 have are asymptomatic and who 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 Restore Illinois plan, the criterion to move from Phase 2 to Phase 3 and from Phase 3 to Phase 4 is whether a region has a test-positive rate below 20%. That threshold is double what some researchers say should be the maximum.
In the Northeast region, the test-positive rate was 24.05% on May1; 23.87% on May 2; 21.58% on May 3; 23.52% on May 4; 20.96% on May 5; and 21.93% on May 6.
One Million Unemployed
During his daily briefing session today, May 7, Gov. Pritzker gave an update on the unprecedented number of unemployment claims filed in Illinois.
He said an “unprecedented number of Illinoisans have lost their jobs because of the spread of COVID-19. The devastation this pandemic has reaped on our economy, that of the United States and the world is mind-boggling.
“Businesses large and small have shuttered; families have had their saving wiped out; workers who have worked every day of their adult life have found themselves on unemployment for the first time ever.”
He said that in the month between the beginning of March and April 4, the Illinois Department of Employment Security saw more initial claims filed than in all 12 months of 2019.
Between April 4 and May 2, that number nearly doubled, he said.
“As of today, IDES has now processed more than one million initial unemployment claims, just since March 1,” said the Governor.
In the first four months of 2020, Illinois paid more than $2 billion in claims. That is $500 million more than what was paid out in all of 2019.
“The pain and devastation of people who lost their jobs is heart breaking,” he said. In addition to the suffering due to deaths, hospitalizations, and sickness, “the financial toll on the people of Illinois has been breathtaking and is unprecedented.”
He acknowledged that the computer system used by IDES was not equipped to handle the massive number of claims. He said the system was designed in the aftermath of the Great Recession with the idea that nothing could ever be worse than the Great Recession. He said the unemployment claims filed in the last few months surpassed that era several times over.
He acknowledged there were many delays in processing claims, but said after revamping the computer system, bringing many people out of retirement and hiring many new people to process the claims, “IDES is now paying claims in a timely manner to 99.9% of clean claims.”
He added that about 75% of these claimants receive their first payment within two weeks of filing.
Illinois was one of the first states to initiate an additional $600 per week federally funded benefit between March 29 and July 25, which is available under the federal CAREs Act. In addition, IDES was also quick to allow an additional 13 weeks of federally funded unemployment benefits for those who run through their first 26 weeks of eligibility.
On Monday, IDES will be ready to process claims for 1099 workers, including independent contractors, sole proprietors, and many others who do not qualify for traditional unemployment.
*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.