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The number of Evanston residents who have tested positive for COVID-19 increased by 22 cases today, for a total of 579 cases.

The Northeast Region is only about 10 days away from moving to Phase 3 of Governor J. B. Pritzker’s Restore Illinois plan.

While the region may meet the criteria of the plan, it appears that the amount of testing falls short of the benchmarks used by some researchers. And, on a Statewide basis, contact tracing is being done on only 29% of the COVID-19 cases. 

Evanston, along with the rest of Cook County and eight other counties, is in the Northeast Region.

The Restore Illinois Plan

To move to Phase 3, the Northeast Region must meet benchmarks relating to hospitalizations, testing, and tracing.

The Number of Infections and Hospitalizations

One metric being used to determine if a region may move to phase 3 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 at least 14%.

While the criterion focuses 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, said Dr. Ngozi Ezike, the 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 22 cases today, for a total of 579 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 20 Evanstonians have died due to COVID-19. IDPH reports that 16 residents or staff of long-term care facilities in Evanston have lost their lives due to the virus.

New cases and deaths in Cook County and Illinois: Today, there were 1,472 new confirmed cases of COVID-19 in Cook County and 2,294 in the State. The trend, which has wide variations from day to day, is shown in the smaller chart above.

Since May 1, there have been 23,382 new confirmed cases of COVID-19 in Cook County and 37,457 new confirmed cases in Illinois.

Dr. Ezike said the high number of cases is due to more tests being administered in the State. She added that there are far, far more people who have COVID-19 in the State than have tested positive, because the amount of testing has been limited.

The number of deaths in Illinois due to COVID-19 increased by 57 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 4,234.

Hospital Admissions/Capacity in the Northeast Region

IDPH posts summary information showing how the Northeast Region is doing in terms of meeting the criteria to move to Phase 3. The data shows that as of May 18

  • Hospital admissions have declined by 31.1% in the Northeast Region since May 1. This is on track to meet the criteria.
  • The Northeast Region has 17.3% of its medical/surgical beds, 19.0% of its ICU beds, and 61.7% of its ventilators available. This is on track to meet the minimum capacity of 14%.
  • The test positive rate, using a 7-day rolling average, is 17.9%, which is slightly below the maximum of 20% stated in the plan.

IDPH does not report data showing whether any region is meeting or on track to meeting the criterion for tracing.

Gov. Pritzker said, though, that the Northeast Region is on track to meeting the criteria to move to Phase 3 at the end of this month.

Adequacy of Testing

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.”

The plan does not state how IDPH will determine if a Region is meeting this criteria. 

The Number of Tests in Illinois

In a May 7 study, the Harvard Global Health Institute (HGHI) estimated that Illinois needed to be administering 64,167 tests a day in order to safely open the economy.*

When asked about this number on May 7, Gov. Pritzker said, “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.”**

While the State has almost quadrupled the number of tests it is administering in the last six weeks, the average per day between May 14 and 19, is 20,674, still far short of the target of 64,167 set by HGHI.

The Percent Positive Test Rate

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. According to the World Health Organization and some researchers, a test-positive rate greater than 10% likely reflects that there is an inadequate amount of testing. ***

In the Restore Illinois plan, one criterion to move from Phase 2 to Phase 3 is that a region have a test-positive rate below 20%. In determining whether this criterion is met, IDPH says it will use a seven-day rolling average for the last 14 days.

As of May 15, IDPH reported that the test positive rate for the Northeast Region was 17.9%, down 5.3 percentage points in the last 14 days.

While the Northeast Region meets the criteria of the Restore Illinois Plan, it is still significantly higher than the maximum threshold recommended by WHO and some researchers.

Contact Tracing

The Restore Illinois plan provides that a Region must meet the criteria for contact tracing to move from Phase 2 to Phase 3. The requirement stated in the plan is “Begin contact tracing and monitoring within 24 hours of diagnosis.” 

There is no requirement that contact tracing begin for a certain percentage of the patients diagnosed with COVID-19.

In contrast, to move from Phase 3 to Phase 4, the requirement is “Begin contact tracing and monitoring within 24 hours of diagnosis for more than 90% of cases in the region.”

IDPH has not posted information on its website to show if the Northeast Region is meeting these criteria.

On May 18, Gov. Pritzker gave a simple explanation of the contact-tracing process.

“When someone tests positive for COVID -19, a contact-tracer will interview them to learn about their recent contacts with family, friends, co-workers, commuters, classmates and others And if their exposure to any of the those people in the last 48 hours was significant, those individuals would be notified and told only that they had been exposed to someone who has the virus, no names given.

“The contacts are then provided with education, information and support to understand their risk and what they should do to separate themselves from those who are not exposed and how to monitor themselves for illness, and the possibility that they could spread the infection to others – even if they themselves don’t feel ill. In fact, they are encouraged to stay home, to maintain social distance from others until 14 days after their last exposure, in case they also become ill.

“Another option,” he said, “is simply to get tested.”

The Governor stressed the importance of contact-tracing. “The process truly does reduce the number of infections, and, if done at scale, it can be a very effective weapon against COVID-19.”

He added, “Knowing if you’ve been exposed to someone with COVID-19 gives everyday Illinoisans the ability to keep their families and co-workers and friends safe by helping them seek testing or self-isolate, and it helps us to build a public health system that truly supports them if their exposure leads to actual infection.”

He provided information indicating that tracing still has a long way to go. He said, “Only about 29% of our known cases are engaged in a tracing process. That’s a number we want to push as high as possible, to the industry standard of over 60%.”

In fact, as noted above, the Restore Illinois plan calls for the percentage to reach 90% to advance to Phase 4.

To ramp up the tracing, Gov. Pritzker said the State is building a tech-based approach that innovates and scales up an existing system. “Ensuring that this is a locally driven effort, we’re scaling within our local health departments and providing a statewide technology infrastructure to ensure coordinated operation.”

One feature of the plan is to provide an App to COVID-positive patients and their contacts that will allow them to get services they need and provide local health departments an easy way to connect patients and their contacts with the latest information.

IDPH is also working with Partners in Health, an organization known for building strong community-based health systems in the world. Partners in Health is behind what has become known as the “Massachusetts Model” for what scaling up a contact tracing operation looks like; and Partners in Health staff can advise IDPH on Illinois’ program design and how best to tailor it to all of Illinois’ communities.

Local health departments will hire people needed to conduct the contact-tracing, and IDPH will provide funding of new hires through federal funding available under the CARES ACT.

Dr. Wayne Dufus, the Acting Chief Epidemiologist for the State, said on May 1 that he estimated that about 3,800 people would need to be hired to do the contact-tracing.

At the briefing on May 18, he outlined some metrics to use in assessing whether the contact-tracing program was succeeding. These include the time elapsed between the diagnosis of a person with COVID-19 and the time they were interviewed; the number of contacts identified; the percentage of contacts who were notified and provided information within 24 hours; the percentage of contacts who subsequently tested positive for COVID-19.

…………………………….

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

**Governor Pritzker explained, “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.”

*** See above article by Ashish Jha, MD, MPH. On May 15, Gov. Pritzker said, “Overall, the positivity rate can be an indication of how wide spread COVID-19 infections are among our population. We all want the positivity rate to come down which would indicate a declining number of people getting sick from the virus.”