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Governor J.B. Pritzker said this afternoon that the latest modeling pushes the peak of the COVID-19 crisis from late April or mid-May to mid-June.

The Illinois Department of Public Health, though, reported the lowest number of new COVID-19 cases in three weeks.

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. The Northeast Region has 90.3% of the confirmed COVID-19 cases in the State.

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 3.

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 those criteria focus on the number of hospitalizations rather than new COVID-9 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

New cases and deaths of Evanstonians: The number of Evanston residents who have tested positive for COVID-19 increased by 11 cases today, May 11, for a total of 480 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 15 Evanstonians have died due to COVID-19. Of the persons who lost their lives due to the virus, 13 resided in long-term care facilities in Evanston.

The following long-term care facilities in Evanston had the number of COVID-19 cases and the deaths indicated since early March, according to data posted on the IDPH website:

  • Albany Care: 8 cases, 0 deaths
  • Alden Estates of Evanston: 5 cases, 1 death
  • Aperion Care Evanston: 29 cases; 1 death
  • Symphony of Evanston 15 cases, 1 death
  • The Grove of Evanston: 24 cases, 4 deaths
  • The Mather of Evanston: 4 cases, 0 deaths
  • The Merion: 12 cases, 0 deaths
  • Three Crowns Park: 34 cases; 6 deaths
  • Westminster Place: 12 cases, 0 deaths

New cases and deaths in Cook County and Illinois: There were relatively high numbers of new COVID-19 cases in Cook County and the State on May 8 and 9, but significant drops on May 10 and today. On Friday, Cook County reported 1,895 new cases, and the State reported 2,887 new cases. The number of new cases today was 726 in Cook County and 1,266 in the State. These were the lowest numbers in the last three weeks.

Since May 1, there have been 16,858 new confirmed cases in Cook County and 26,089 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 54 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 3,459.

Hospital Admissions/Capacity in the Northeast Region

There were 267 admissions related to COVID-19 to hospitals in the Northeast Region on May 8, the most recent day for which data is available. This was down from 307 on May 1, the earliest possible benchmark date for the Restore Illinois plan. Hospital admissions are trending down since May 1, as 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 8 was 18%; the average for ICU beds was 19%; and the average for ventilators was 62%.

 The benchmark criterion 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 “nobody is without an opportunity to get a test.”

Between May 6 and 10, the average number of tests administered per day In Illinois was 16,740. Today, the number was 12,441 tests.

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 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 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%. In determining whether this criterion is met, IDPH says it will use the average test-positive rate for the last 14 days.

The threshold is double what some researchers say should be the maximum.

In the Northeast Region, the test positive rate was 22.3% on May 8, the most recent data reported. The trend in the percent test-positive rates for the region is show in the third chart in the chart box.

Peak is Now Expected in Mid-June

“Everyone tracking our State’s data has likely seen that on a statewide basis we haven’t passed our peak yet,” said Gov. Pritzker this afternoon, May 11. “We have seen more stability in our numbers, but so far we are not seeing significant declines in key metrics like hospitalizations.

“Compared to the forecast that I shared with you on April 23, which predicted peaking between late April and early May, that time frame of plateauing near a peak has been expanded from mid-May into mid-June.”

He said the modeling is led by top researchers with the University of Illinois at Urbana/Champaign, Northwestern University School of Medicine, the University of Chicago, and the Illinois Department of Public Health.

“In many ways, this news is disheartening,” said Gov. Pritzker. “But what we’ve been able to do since early March is slow down the exponential rate of transmission. When we do that, it leads to a slower rate of infections over a longer period of time, giving our health care system the ability to treat those who have complications and giving our pharmaceutical researchers time to develop effective treatments and potentially a vaccine. Pushing the peak down, and therefore to a longer time frame, might not sound like good news to some, but I promise you, it is saving lives,” said Gov. Pritzker.

He added that the State has been able to reduce to spread of infections measured by an R-naught value. In early March, he said, the average infected person was spreading the virus to 3.6 additional people, and the data now shows that infected persons are spreading the virus, on average, to 1.0 persons. Once that number goes below 1.0 it “will be very good news for the people of the State of Illinois.”

He added that hospitals in each region now have adequate bed capacity and ventilators to serve the projected number of people who might need treatment in hospitals.

All four regions are on pace to meet all the metrics of Restore Illinois to advance to Phase 3 at the end of May, the Governor said, with the exception of the Northeast Region, which has a test positive rate in excess of 20%. He said there is ample time, though, to bring the rate under 20%.

He did not appear willing to lift additional restrictions before the end of May or to modify the restrictions provided in Phase 3 or Phase 4. He cautioned, though, “Lifting all of our mitigation at the end of May, would likely lead to a second wave of outbreak in every one of our four regions.”

…………………………….

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.