Evanston had 8 new confirmed cases of COVID-19 today, the fourth day into Phase 4 of the Restore Illinois Plan. The State had 724 cases.

Illinois is containing the virus much better than the nation as a whole. Today CDC reported there were 35,664 new COVID-19 cases in the nation. On a nationwide basis, the average number of new COVID-19 cases in the last seven days is 39,802 per day, compared to an average of 21,596 in the first seven days of June, or a 84% increase.

New COVID-19 Cases in Evanston, Cook County and Illinois

Each region of Illinois moved to Phase 4 of the Restore Illinois plan on June 26, which opens up more businesses and activities, subject to guidelines approved by the Illinois Department of Public Health. Under the plan, a Region may be moved back into Phase 3 based on the following factors:

  • A sustained rise in the COVID-19 test positivity rate
  • A sustained increase in hospital admissions for COVID-19 like illness
  • A reduction in hospital capacity threatening surge capabilities
  • A significant outbreak in the region that threatens the health of the region

This article presents data, as of June 30, relevant to these factors and to the ability of the State to conduct adequate testing and contact tracing.

Governor JB Pritzker said last week he will not hesitate to move Illinois back to phase 3, or to reinstate certain restrictions, if there is a surge in infections.

New Cases in Evanston, Cook County and Illinois

The data below show the number of new confirmed COVID-19 cases in Evanston, Cook County, and Illinois. The number of new cases is important because about 30% of the people who have COVID-19 are hospitalized, said Dr. Ngozi Ezike, Director of Illinois Department of Public Health. In addition, people who have COVID-19 are infectious and may spread the disease.*

New cases and deaths of Evanstonians: There were 8 new confirmed COVID-19 cases of Evanston residents today, June 30. The total number of confirmed COVID-19 cases of Evanstonians is now 793. Of those, 33 are active.

Over the last seven days, the City reported an average of 2.6 new COVID-19 cases per day. For the seven days prior, there was an average of 2.6 new cases per day. The trend is shown in the above chart. 

No Evanstonian lost their life to COVID-19 in the last three days. The total number of Evanstonians who have died due to the virus is 69.

According to data provided by IDPH on June 26, 51 residents or staff of long-term care facilities in Evanston have died due to COVID-19. Thus, 73 % of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities. Two facilities account for 37 of the deaths.

New Cases and Deaths in Cook County and Illinois: There were 414 new cases of COVID-19 in Cook County in the last 24 hours, and 724 in the State.

The number of new cases in the State is still much lower than the 3,137 new cases reported on May 1, and the 1,622 reported on May 29, the day the State moved into Phase 3.

Between June 26 and June 30, the average number of new COVID-19 cases per day in Cook County was 376, and in the State, it was 750. The trend is shown in the smaller chart above.

The number of deaths in Illinois due to COVID-19 increased by 23 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 6,923.

Hospital Admissions and Surge Capacity in the Northeast Region

One metric that will be used to determine whether a region will be moved back to Phase 3 is whether there is a “sustained increase” in hospitalizations for COVID-19 illnesses.

Another metric is whether there is a reduction in hospital capacity to care for patients with COVID-19 illnesses. There is no set criterion to assess what constitutes adequate capacity, but IDPH said 14% surplus bed capacity would be adequate for a Region to move to Phase 4.

IDPH reports that in the last 28 days, hospitalizations in the Northeast Region declined by 73%. IDPH does not report the number of hospitalizations in the Region, but there is a downward trend in the last 28 days.

The Northeast Region has available 33% of its medical/surgical beds, 44% of its ICU beds, and 74% of its ventilators. This easily meets a minimum surplus capacity of 14%.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,238 on June 1, and 1,498 on June 26 (the date the State moved to Phase 4 of the Restore Illinois plan). As of midnight on June 29, the number of hospitalizations was 1,560 The second chart in the chart box shows the trend in hospitalizations since June 1.

Adequacy of Testing

Widespread testing is essential to controlling the spread of the COVID-19 virus and to open an economy safely.

     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. **

IDPH reported that the test-positive rate for the Northeast Region as of June 30 was 4%, down 1 percentage point in the last 14 days.

The Northeast Region meets the rate recommended by WHO.    

On a Statewide basis, the test positivity rate on June 30 was 2.3%. The average for the last five days was also 2.6%.

       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. On the same day, Gov. Pritzker said, “I think we’re going to need many more tests than that.”***

While the number of COVID-19 tests that the State has administered has increased five-fold since the beginning of April, the average number of tests per day between June 26 and June 30 is 28,448, still far short of the target of 64,167 set by HGHI.

On June 30, there were 31,069 tests.

Contact Tracing

Widespread contact tracing is also essential to controlling the spread of the COVID-19 virus and to open an economy safely. The adequacy of contact tracing is not listed as a factor in deciding whether to move a Region back to Phase 3. But if contact tracing is not adequate, the impact may be an increase in new COVID-19 cases and hospitalizations.

In its criteria to move from Phase 3 to Phase 4, the Restore Illinois plan provided, “Begin contact tracing and monitoring within 24 hours of diagnosis for more than 90% of cases in region.” Dr. Ezike said this is an “internal goal.”

There is no data indicating that the State is anywhere near this goal. On a Statewide basis, Gov. Pritzker said on May 29 that contact tracing was only being done on about 30% of the known cases, far short of the 90% goal.

On June 23, Gov. Pritzker said he was not in a positon to provide metrics regarding the amount of contact tracing being done.

On June 25, the Governor’s Office said in a prepared statement that the State “continues to build up its statewide contact tracing capacities, increasing the ranks of contact tracers by 20% since June 1 for a total of over 550 active contact tracers across the State. 250 new tracers will join their ranks in the coming weeks as Illinois continues to scale up operations, including using new technology to multiply the State’s effectiveness in its contact tracing efforts.”  

Cook County has received about $41 million in grant funding from IDPH to rapidly scale-up its COVID-19 contact tracing program in suburban Cook County. The County recently said it would not have contact tracing fully in place until the fall.

When Can Regions Move to Phase 5?

Phase 5 is the last phase of the Restore Illinois Plan. A region may move to Phase 5 if there is a vaccine, effective and widely available treatment, or the elimination of new cases over a sustained period of time through herd immunity or other factors.

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Footnotes

* IDPH reports only the number of COVID-19 cases which have been confirmed through a test. The number does not include people who are infected, but who have not been tested, which may include people who are asymptomatic or who have minor symptoms. Any person who is infected, whether symptomatic or asymptomatic, may spread the disease. On June 25, the Director of CDC said that the center’s best estimate is that for every case that is reported there are actually 10 other infections.

** 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

***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/

And link to accompanying article: https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing

On June 23, the RoundTable asked Dr. Jha by email if he had updated his estimates of needed tests, and if his May 7 estimate of about 64,000 tests per day for Illinois was still a reasonable estimate. The RoundTable has not yet received a response.