At the briefing today, May 29, Governor J. B. Pritzker confirmed that all four regions of the State moved into Phase 3 of the Restore Illinois plan. He said thousands of small businesses are opening up, including restaurants and bars for outdoor dining, retail stores, childcare services, service counters, personal care services, some health and fitness centers, youth sports, offices, manufacturers, outdoor recreation, and State parks. People may gather in groups of 10 or fewer.

A press release issued last Sunday said 700,000 residents of Illinois were expected to return to work in Phase 3. 

“Today I’ll be signing a new executive order that reflects the changes under Phase 3 of Restore Illinois,” said the Governor. “This brings to an end the Stay-at-Home order executive order. The success of the last phase is evidenced by the decline of the positivity rate [the positive test rate], the declining hospitalizations, the declining ICU bed uses and the declining number of deaths. As we end that phase, it’s important to take note that the people of Illinois have taken this seriously and that has made all the difference.

“The new executive order, called the Community Recovery Order, reflects our new, more open reality, but for public health purposes, it still requires limits of groups of 10 or fewer for all groups and continuing other mitigation practices, such as maintaining social distances and wearing a face covering in public by all who are able.” 

Gov. Pritzker said that, given the state of the economy, “I’ll also be extending our ban on residential evictions, the moratorium on utility shutoffs and suspension on repossession of vehicles. We will also continue offering the ability to conduct marriages and notarization remotely, as well as the suspension of many in-person licensing and training requirements for the time being, to ensure that workers can keep their professional credentials active.

“The path to this point has been tremendously difficult, no doubt,” said the Governor. “We have lost over 5,000 of our fellow Illinoisans to this virus. It’s a harrowing number. And it’s just over a few months. Many of our residents have lost someone they love – a family member, a friend – to this virus. I have, too. If you’re someone who doesn’t know a single person who has died because of COVID-19 or been hospitalized because of COVID-19, that doesn’t mean that pain isn’t real for another mother, another child, another friend. I hope you will take at least a moment to grieve for their loss.

“As we take our next step forward, and especially as we begin to safely reopen meaningful swaths of our economy, we have to continue to look out for each other. Our number-one priority must be the health and safety of workers and families, and all of our state’s residents.”

Both the Governor and Dr. Ngozi Ezike, the Director of the Illinois Department of Public Health, urged people to maintain social distancing and to wear face coverings, saying the pandemic is not over.

Restrictions on Places of Worship Now Eliminated

The new executive order is expected to eliminate all restrictions on places of worship, including a limitation that gatherings at places of worship be limited to 10 persons. Yesterday, IDPH filed guidelines applicable to places of worship, but the guidelines are only recommendations, and not mandatory.

Yesterday, the State filed with the U.S. Supreme Court its response opposing an emergency petition to enjoin the Governor from restricting gatherings for religious services. The State’s response said the Stay-at-Home order, which contained the restrictions on gatherings for church services, expires by its own term on May 29, and that after that date religious gatherings will no longer be subject to mandatory restrictions. The State argued that the emergency petition was moot. 

(Update: On May 29, the Supreme Court issued an order denying the churches’  request for relief, citing the changes that became effective on May 29. The denial was without prejudice.)

All Four Regions Will Move to Phase 3

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 13 cases today, May 29, for a total of 710 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

In the last 24 hours, three more Evanstonians died due to COVID-19, bringing the total to 41. Eleven Evanstonians have lost their lives to the virus in the last 72 hours.

Cases and deaths in Cook County and Illinois: There were 960 new cases of COVID-19 in Cook County in the last 24 hours, and 1,622 in the State.

Since May 1, there have been 39,743 new confirmed cases of COVID-19 in Cook County and 64,597 new confirmed cases in Illinois.*

The number of deaths in Illinois due to COVID-19 increased by 86 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 5,270.

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 hospital admissions declined by 55.4% in the Northeast Region since May 1.

The Northeast Region has available 28.4% of its medical/surgical beds, 32.3% of its ICU beds, and 67.8% of its ventilators. This easily met the minimum capacity of 14%.

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.”

IDPH did not evaluate whether that standard was met.

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 25 and 29 is 20,768, 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 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 criteria of the Restore Illinois Plan, it is almost three times the rate recommended by WHO.

Contact Tracing

The Restore Illinois plan provides as one criterion to move from Phase 2 to Phase 3 that a Region, “begin contact tracing and monitoring within 24 hours of diagnosis.”

IDPH has not monitored whether any region met this criteria. On May 28, Dr. Ezike said this is only an internal goal, not a requirement to move to Phase 3.

On a Statewide basis, Gov. Pritzker said today that tracing is only being done on about 30% of the known cases.

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Footnotes

* IDPH reports only the number of COVID-19 cases that have been confirmed through a test. The number does not include infected people 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.”

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

***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 that “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