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The Illinois Department of Public Health (IDPH) provided guidance today, containing eight pages of recommendations for places of worship to use in holding religious services. The guidance was posted on IDPH’s website after the Governor was given until 8 p.m. tonight to respond to an emergency petition filed by two churches seeking to enjoin him from enforcing his Stay-at-Home order against the churches.
Some Background and the New Guidance
On April 30, Governor J. B. Pritzker modified his Stay-at-Home order to include houses of worship in the list of essential services that people could leave their home to use. But a religious gathering was limited to a maximum of 10 people, and subject to social-distancing guidelines.
Since that time, the Governor has prevailed – on a preliminary basis – in several federal lawsuits brought by churches that allege that his orders violate the churches’ First Amendment right to freedom of religion. After the United States Circuit Court of Appeals for the Seventh Circuit denied the churches’ request for an emergency injunction, two churches filed an emergency petition asking that the U.S. Supreme Court to block Gov. Pritzker from enforcing his orders. Justice Brett Kavanaugh gave the Governor until 8 p.m. tonight, May 28, to respond to the churches’ petition.
At his daily briefing today, Gov. Pritzker did not directly comment on the petition pending before the Supreme Court, but said, “We will also be posting recommendations for houses of worship, providing more guidance for houses of worship in Phase 3. Having received many plans and ideas from responsible faith leaders, IDPH has reviewed many detailed proposals and has provided guidance, not mandatory restrictions, for all faith leaders to use in their efforts to ensure the health and safety of their congregants. This includes suggestions on capacity limits, new cleaning protocols, indoor gatherings of 10 persons or less, a reduction of activities like sharing food, and the safe conduct of outdoor congregating.
“The safest options remain remote and drive-in services, but for those that want to conduct in person activities, IDPH is offering best practices.”
The Governor emphasized, “We’re not providing restrictions. We’re simply providing the best recommendations that we can for keeping people safe. So we hope that the pastor will follow that guidance and those recommendations for his services, his or her services.”
IDPH’s guidance says, “[I]t is strongly recommended that places of worship continue to facilitate remote services, particularly for those who are vulnerable to COVID-19 including older adults and those with co-morbidities.
“Even with adherence to physical distancing, multiple different households convening in a congregational setting to worship carries a higher risk for widespread transmission of the virus that causes COVID-19, and may result in increased rates of infection, hospitalization, and death, especially among more vulnerable populations. In particular, the high risk associated with activities such as singing and group recitation can negate the risk-reducing behaviors such as six feet of physical distancing.
“Recognizing the centrality of worship in many people’s lives and the spiritual and emotional value of prayer, community, and faith, this guidance provides recommendations for places of worship that choose to resume or expand in-person activities and for those that do not.”
The guidance says the safest options are remote services (which can be streamed online, broadcast by radio, and/or conducted by telephone or dial-in), and drive-in services (which involve congregants driving to a common location and worshiping together from their household vehicle, while listening to either a remote service or one that is broadcast through speakers).
“For places of worship that choose to hold in-person activities, the safest course of action is to congregate outdoors and/or in small groups of less than 10 people,” says the guidance. In those settings, the guidance suggests that the six foot spatial distancing be used for groups of people who do not reside together, that congregants wear face coverings and refrain from singing and group recitation.
If gatherings cannot be limited to 10 people, the guidelines recommend that the place of worship set a capacity limit that allows for extensive social distancing (six feet or more) between congregants, and that attendance be limited to 25% of building capacity or a maximum of 100 attendees, whichever is lower.
The guidance contains many additional recommendations, including that congregants be screened for temperature and/or COVID-19 symptoms before entering the place of worship.
All Four Regions Will Move to Phase 3 Tomorrow
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 nine cases today, May 28, for a total of 697 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 38. Eight Evanstonians have lost their lives to the virus in the last 48 hours.
Cases and deaths in Cook County and Illinois: There were 785 new cases of COVID-19 in Cook County in the last 24 hours, and 1,527 in the State.
Since May 1, there have been 38,783 new confirmed cases of COVID-19 in Cook County and 62,975 new confirmed cases in Illinois.*
The number of deaths in Illinois due to COVID-19 increased by 104 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 5,186.
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 55.1% in the Northeast Region since May 1. This is on track to meet the criteria.
· The Northeast Region has available 27.9% of its medical/surgical beds, 31.4% of its ICU beds, and 67% of its ventilators. This is on track to meet the minimum capacity of 14%.
· The test-positive rate, using a 7-day rolling average, is 14.2%, 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 24 and 28 is 21,544, 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 14.2%, down 4.3 percentage points in the last 14 days.
While the Northeast Region meets the criterion 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 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 criteria 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.”
* IDPH reports only the number of COVID-19 cases which 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, 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