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In their daily briefing today, Governor J. B. Pritzker and Dr. Ngozi Ezike, the Director of the Illinois Department of Public Health, each pointed to some positive trends in the COVID-19 pandemic in Illinois, leading Gov. Pritzker to say that the State seems to be coming down from the peak. Both, however, emphasized the pandemic is not over and that it is essential that everyone maintain social distancing, wear a face-covering and adhere to other aspects of the Restore Illinois Plan.
The Governor reiterated that all four regions of the State are on track to move to Phase 3 of the Restore Illinois Plan this coming Friday.
Criteria to Move to Phase 3
To move to Phase 3, the Northeast Region must meet benchmarks relating to hospitalizations, testing, and tracing.
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 Restore Illinois 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, said Dr. Ezike. In addition, people may be infectious even if they are not hospitalized.
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 on May 23, 11 cases on May 24; 13 on May 25; and 12 today, for a total of 678 cases, according to information provided by the City of Evanston. The trend is shown in the above chart.
To date, a total of 30 Evanstonians have died due to COVID-19.
New cases and deaths in Cook County and Illinois: In Cook County, there were 1,468 new cases on May 23; 1,593 on May 24; 1,083 on May 25; and 722 today.
In the State, there were 2,352 new cases in Illinois on May 23; 2,508 on May 24; 1,713 on May 25; and 1,178 today.
Dr. Ezike said the lower number of cases in the last few days was due to the three-day weekend. The trend in cases for Cook County and Illinois is shown in the smaller chart above.
Since May 1, there have been 37,296 new confirmed cases of COVID-19 in Cook County and 60,270 new confirmed cases in Illinois.
IDPH reports only the number of COVID-19 cases that have been confirmed through a test. The number does not include people infected who have not been tested, which may include people who are asymptomatic or who have minor symptoms. Dr. Ezike has said on multiple occasions that the number of confirmed cases is far lower than the number of people who have been infected by COVID-19.
On May 21, a study was published by the Imperial College in London, which has published a number of studies on the pandemic. Its latest study estimates that the total number of infectious people in Illinois as of May 17 is 167,000, who may all have the potential to spread the disease. The study says that the high number of infectious people “underscores the importance of testing and case based isolation as a means to control transmission.”*
The number of deaths in Illinois due to COVID-19 increased by 39 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 4,923.
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 26:
- Hospital admissions have declined by 54.2% in the Northeast Region since May 1. This is on track to meet the criteria.
- The Northeast Region has available 26% of its medical/surgical beds, 28.9% of its ICU beds, and 65.6% of its ventilators. This is on track to meet the minimum capacity of 14%.
- The test-positive rate, using a seven-day rolling average, is 14.5%, which is 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 criteria for tracing.
Gov. Pritzker said, though, that the Northeast Region is on track to meeting all 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 criterion.
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 has been administering in the last six weeks, the average per day between May 22 and 26 is 22,955, still far short of the target of 64,167 set by HGHI.
The Percent Test-Positive Rate
One measure used by researchers to assess whether the amount of testing is adequate is looking at the percent of people who test positive on COVID-19 tests. The World Health Organization recently said on May 15 that the test-positive rate should be below 5% before opening an economy. A higher test-positive rate 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.
IDPH reported today that the test-positive rate for the Northeast Region was 14.5%, down 3.8 percentage points in the last 14 days.
While the Northeast Region meets the criteria of the Restore Illinois Plan, it is still higher than the maximum threshold recommended by WHO and some researchers.
The Restore Illinois plan provides that a Region must meet the criterion 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.”
IDPH has not posted information on its website to show if the Northeast Region of any other region is meeting this criterion.
On a Statewide basis, Gov. Pritzker said on May 18, “Only about 29% of our known cases are engaged in a tracing process.”
Moving Off the Peak
Dr. Ezike and Gov. Pritzker each pointed to some positive trends on May 26.
Dr. Ezike reported that during the week of May 16 there were 780 deaths due to COVID-19. She added, though, that it was the first week since the pandemic began that there were fewer deaths than in the previous week. “I am hopeful that this fact is the beginning of a downward trend,” she said.
Gov. Pritzker said that the seven-day average for the test-positive rate for the State was 9.2% today, the first day it dropped below 10%. In early May, WHO said the maximum test positive rate should be 10%, but it has since moved the benchmark to a maximum of 5%.
Gov. Pritzker added that hospitalizations related to COVID-19 had been holding steady a couple of weeks ago, but they have now dropped to a six-week low with nearly 1,200 fewer beds in use for COVID-19 patients. He said the availability of hospital beds and ICU beds was above 30% for both.
“The fact that we’ve seen these numbers trend in a good direction even after we opened things up in Phase 2 demonstrates the importance of every-day action. One of the biggest mitigation measures, which was put in place the same moment we opened things up, was requiring face- coverings. Take note that, along with social distancing, face-coverings can make all the difference in protecting each other and it appears to be working. Since we implemented that change, we saw all the numbers that had already stabilized then begin to fall.”
In response to a question, the Governor said, “We seem to have come off the peak.”
On Sunday, May 24, Gov. Pritzker announced the industry-specific guidelines governing the re-opening of businesses in Phase 3 of the Restore Illinois plan. There are separate sets of guidelines and tool kits for manufacturing, offices, retail stores, service centers, youth and sports, health and fitness centers, personal care service, outdoor recreation, day camps, and restaurants and bars (outdoor dining and drinking). Click here for an article about the guidelines with a focus on the minimum requirements and the best practices that are encouraged for retail stores.
Phase 3 of Restore Illinois is expected to bring approximately 700,000 Illinoisans back to the workplace, a key step towards getting the Illinois economy back on track – with an estimated 20%, or $150 billion in annual GDP, of the overall economy returned to operations, said the Governor.
*The Imperial College, London, published “Report 23: State-level tracking of COVID-19 in the United States” on May 21, 2020. One part of the study estimates the number of infectious individuals in every state in the U.S., including Illinois as of May 17, which includes people who have not been tested for COVID-19 and who may be asymptomatic. As of May 17, the report estimates that there are 176,000 infectious individuals in Illinois, with a potential range of a low of 54,000 to a high of 395,000.
The report says, “Despite new infections being in a steep decline in the United States, the number of people still infectious, and therefore able to sustain onward transmission, can still be large. This discrepancy underscores the importance of testing and case based isolation as a means to control transmission.”
**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 each day 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.”
**** On May 26, Johns Hopkins University & Medicine Coronavirus Resource Center said on its website that “the World Health Organization (WHO) advised governments [on May 15] that before reopening, rates of positivity in testing (i.e., out of all tests conducted, how many came back positive for COVID-19) should remain at 5% or lower for at least 14 days.”
Johns Hopkins explains, “The rate of positivity is an important indicator because it can provide insights into whether a community is conducting enough testing to find cases. If a community’s positivity is high, it suggests that that community may largely be testing the sickest patients and possibly missing milder or asymptomatic cases. A lower positivity may indicate that a community is including in its testing patients with milder or no symptoms.” Link: https://coronavirus.jhu.edu/testing/testing-positivity