Again at his May 8 briefing, Governor J.B. Pritzker focused on testing for the COVID-19 virus, saying that extensive testing is essential to opening the economy in a manner that protects the health and safety of people in the State. On the positive side, the State for the first time administered more than 20,000 tests in a single day. Yet, this falls far short of the 64,167 tests a day that a Harvard team says is necessary – a number the Governor said yesterday that the State needs to exceed.

While testing is deemed essential, the Restore Illinois plan laid out by Gov. Pritzker on May 5 does not contain a target number of tests per day that must be met as part of its criteria. And the benchmark for the test positive rate is twice as high as the maximum number identified by some researchers.

Metrics for Restore Illinois

In the Restore Illinois plan, 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, depending on when the region meets the criteria to do so.

Evanston, along with the rest of Cook County and eight other counties, is in the Northeast Region. To move to Phases 3 and 4, a region must meet benchmarks relating to hospitalizations, testing, and tracing. The earliest any region may move to Phase 3 is May 29. And once a region moves to Phase 3, the earliest it can move to Phase 4 is 28 days from the date it moved into Phase 4.

The Number of Infections and Hospitalizations

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 on 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, said Dr. Ngozi Ezike, Director of the Illinois Department of Public Health.  

The data below show new COVID-19 cases in Evanston, Cook County, and Illinois, and the number of hospital admissions in the Northeast Region.

New COVID-19 Cases

The number of Evanston residents who have tested positive for COVID-19 increased by 8 cases today, May 8, 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 14 Evanstonians have died due to COVID-19.    

There were a total of 1,895 new confirmed cases in Cook County and 2,887 new confirmed cases in Illinois today. Since May 1, there have been 13,713 new confirmed cases in Cook County and 20,842 new confirmed cases in Illinois. The trend in new confirmed cases in Cook County and Illinois is shown in the first chart in the chart box.

The number of deaths in Illinois due to COVID-19 increased by  30 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 3,241.  

Hospital Admissions

There were 271 admissions related to COVID-19 to hospitals in the Northeast Region on May 5, the most recent day for which data is available. The number of hospital admissions on May 1, the earliest possible benchmark date, was 260. The trend is shown in the second chart in the chart box.

In the Northeast Region, the average percentage of medical/surgical beds available between May 1 and 7 was 19%; the average for ICU beds was 20%; and the average for ventilators was 62%.

 The benchmark criteria to move from Phase 2 to Phase 3 in the Restore Illinois plan is that 14% of medical/surgical beds, ICU beds, and ventilators be available.

Adequacy of Testing

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.

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

The Restore Illinois plan does not set a goal in terms of the number of tests that must be given in a region to advance to less restrictive phases. 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 determine if these criteria are being met.

In a May 7 study, the Harvard Global Health Institute (HGHI) estimated that Illinois needed to be administering 64,167 tests a day by May 15 in order to safely open the economy.* When asked about this number on May 7, Governor Pritzker said it was a challenge to increase 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 that “nobody is without an opportunity to get a test.”

In the last five days between May 2 and 7, the average number of tests administered per day In Illinois was 15,827. Today 20,671 tests were reported.

Both numbers fall far short of the target of 64,167 set by HGHI.  

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 the 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 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, one criterion to move from Phase 2 to Phase 3 and from Phase 3 to Phase 4 is that a region have 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 21.79% on May 7, the most recent data reported. The trend in the percent positive rates for the region is show in the third chart in the chart box.

The State’s Efforts to Expand Testing

In his daily briefing today, Gov. Pritzker gave a report on the progress made in ramping up the number of COVID-19 tests that the State administers per day. He said today was the first time the State exceeded giving more than 20,000 tests in a 24-hour period. .

“As of May 6, Illinois ranks second among the ten most populace states in the number of tests completed per capita in the last seven days,” said the Governor. “And, Illinois is fifth among all 50 states in total tests completed since the beginning of this pandemic.”

He said the State now has 244 public testing sites across the State, up from 177 on April 30, and 112 on April 24. He said in building out these sites, the State has made it a priority to partner directly with existing trusted organizations such as federally qualified health centers and other community health centers. He added that the State now owns seven drive-through sites, which are collectively taking more than 3,000 specimens per day. The State plans to add three more drive-through sites next week.

“Testing is fundamental to our ability to reopen the economy while controlling the spread of the virus,” said the Governor. ‘That’s what it takes to keep the public safe. The progress we’ve made on testing in the last two months, building a Statewide program from scratch to around 15,000 to 20,000 tests per day is tremendous.

“Even if we’re one of the best states in the nation on testing, we know it’s not enough to be where we need to be on a longer time frame. I’m committed to continuing our success on this front, because it is fundamental to our economic future and to keeping Illinois safe while COVID-19 is still out there.”

As noted above, a recent report by researchers with the Harvard Global Health Institute estimate that Illinois needs to be giving about 64,000 tests a day to safely open the economy. 

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Footnotes

*Ashish Jha, MD, MPH, the Faculty Director of the Harvard Global Health Institute (“HGHI), and two colleagues conclude in a May 7 report, “HGHI and NPR publish new state testing targets” that on a nationwide basis 900,000 tests for COVID-19 are needed by May 15 to open the economy. They also provide estimates of the tests each state should be ready to provide by May 15. For Illinois, they say that 64,167 tests a day are needed. Link to HGHI’s report: https://globalepidemics.org/2020/05/07/hghi-projected-tests-needed-may15/

HGHI’s report said it was publishing its results in partnership with NPR, and it provides a link to the article that published HGHI’s results in a little more detail. The article notes that other organizations have estimated that Illinois needs 44,898 tests per day (Los Alamos) and 96,342 tests per day (MIT). What the various models have in common is that they show that the number of COVID-19 tests currently being administered on a daily basis in Illinois is very low. Link to the article: https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing

A report, “Roadmap to Pandemic Resilience,” published by the Edmond J. Safra Center for Ethics at Harvard University, concludes that on a nationwide basis the nation needs to be doing 5 million tests per day by early June to deliver a safe social reopening. ” Link: https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20_0.pdf

** See above article by Ashish Jha, MD, MPH.