Evanston had an additional 10 confirmed cases of COVID-19 in the last 24 hours, and four more Evanstonians lost their lives to the virus. On a Statewide basis, however, there has been a steady downward trend in the number of new cases.

After discussing the latest COVID-19 statistics, this article takes a look at the guidelines applicable to summer day camps in Phase 3. All four regions of the State are still on track to move on Friday to Phase 3 of Governor J. B. Pritzker’s Restore Illinois Plan.

Criteria to Move to Phase 3

To move to Phase 3, the Northeast Region, in which Evanston lies, 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. Ngozi Ezike, Director of Illinois Department of Public Health. 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 10 cases today, May 27, for a total of 688 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

In the last 24 hours, four more Evanstonians died due to COVID-19, bringing the total to 34. This was the highest number of deaths of Evanstonians due to the virus in a 24-hour period.

Cases and deaths in Cook County and Illinois: There were 702 new cases of COVID-19 in Cook County in the last 24 hours, and 1,111 in the State. There has been a steady downward trend since May 24, when there were 2,508 new cases. 

Since May 1, there have been 37,998 new confirmed cases of COVID-19 in Cook County and 61,448 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 176,000, all of whom may 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 160 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 5,083.

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 54.4% in the Northeast Region since May 1. This is on track to meet the criteria.
  • The Northeast Region has available 26.9% of its medical/surgical beds, 29.9% of its ICU beds, and 66.1% 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 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 has been administering in the last six weeks, the average per day between May 23 and 27 is 22,368, 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 to look 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 14.3%, down 4.8 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.

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.” 

IDPH has not posted information on its website to show if the Northeast Region or any other region is meeting this criteria. It appears that this criterion is being ignored in deciding whether a region may move to phase 3.

On a Statewide basis, Gov. Pritzker said on May 18, “Only about 29% of our known cases are engaged in a tracing process.”

Guidelines for Day Camps in Phase 3

On Sunday, May 24, Gov. Pritzker announced industry-specific guidelines governing the re-opening of businesses in Phase 3 of the Restore Illinois plan. The new guidelines are posted on the website of the Illinois Department of Commerce and Economic Opportunity (DCEO) and are available here.

https://www2.illinois.gov/dceo/pages/restoreILP3.aspx

The RoundTable previously summarized the guidelines applicable to retail stores, daycare centers, and outdoor eating and drinking at restaurants and bars. The guidelines applicable to summer day camps are summarized below.

The guidelines apply to “recreational youth programs such as sports camps, recreational camps, educational camps, and religious day camps.” Overnight camps are not allowed.

Screening

The day camp should make temperature checks available for employees and should screen employees for COVID-19 symptoms before they start work each day and also at mid-day.

If practical, employees should take participants’ temperatures before they are admitted to the camp; they should ask participants if they are have any COVID-19 symptoms. Any participant with symptoms should not attend the camp until certain conditions are met.

If an employee or participant contracts COVID-19, that person should remain isolated at home for a minimum of 10 days after symptom onset. 

Face Coverings 

Employees should wear face coverings over their nose and mouth when within six feet of others (cloth masks preferred).

A best practice is that participants wear a face covering over their nose and mouth at all times except when eating or playing a musical instrument, or when outside and able to maintain a safe social distance (with certain exceptions). 

Social Distancing

A social distance of at least six feet should be maintained between non-household individuals unless participating in activities permitted under Phase 3 guidelines.

Facilities and Limits on Groups

Day camps should emphasize outdoor, socially distant activities as much as possible

For indoor facilities, there is a maximum occupancy of 50% of the facility’s capacity.

The day camp coordinator should maintain group sizes of 10 participants or fewer. If social distancing is not feasible, groups should be limited to people within the same household or activity should be suspended. If practical, the day camp coordinator should maintain a ratio of two adults per group. If not practical, the day camp coordinator may assign one floater employee per every two groups.

Multiple groups are permitted at the same time as long as 1) the facilities allow for social distancing of participants and employees, 2) 30 feet of distancing is maintained between groups, and 3) areas for each group are clearly marked to discourage interaction between groups.

Groups should be static, with no mixing of employees or participants between groups for the duration of the day camp. An exception may be made if there is a floater employee per every two groups.

As best practices: 1) participants from the same household should be within the same group; 2) if indoors, the day camp coordinator should designate a room or space for each participant group to use for the duration of the day camp; 3) participants/employees should wear colors corresponding with their group to make social distancing easier to manage/enforce; 4) the day camp should display visual markers six feet apart to encourage social distancing in practical areas; and 5) if practical, the camp coordinator should eliminate common touchpoints (e.g., propping doors/using touchless door pulls).

The guidelines also provide requirements for sanitation, disinfecting, limits on sharing, and bus transportation.

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Footnotes

*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.”

Link: https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-21-COVID19-Report-23.pdf

**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

***Gov. 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