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Evanston had 3 new confirmed cases of COVID-19 today. The State had 1,187 new cases, ending a four-day downward trend. The State administered a record 38,161 COVID tests which may have been a factor in the increase.     

CDC reported today that there were 60,979 new COVID-19 cases in the nation on July 14. On a nationwide basis, the average number of new COVID-19 cases in the last seven days is 61,974 per day, compared to an average of 21,596 in the first seven days of June.

Governor Warns He Will Not Hesitate to Reimpose Restrictions

At a press conference today, July 15, Gov. J.B. Pritzker announced a plan to combat a resurgence of Covid-19 in Illinois. Under the plan, the State has been divided into 11 regions, and the Governor and the Illinois Department of Public Health will determine if additional mitigations are appropriate on a region by region basis. One of the regions is Chicago. A second is suburban Cook County.

”The epidemiologists and professionals at IDPH have determined that we need to take action in a region if we see a sustained rise in the [test] positivity rate, along with either a sustained increase in COVID-19 hospital admissions, or a reduction in hospital surge capacities,” said the Governor.

Action will also be deemed necessary if the average test positivity rate in a region exceeds 8% over a three day period.*

New Cases in Evanston, Suburban Cook County and Illinois

The data below show the number of new confirmed COVID-19 cases in Evanston, Cook County, and Illinois.**

New cases and deaths of Evanstonians: There were 3 new confirmed COVID-19 cases of Evanston residents today, increasing the total number of cases to 825, according to data reported by the City.

In the last seven days, the City has reported an average of 2.5 new cases per day. The above chart shows the trend of COVID-19 cases of Evanstonians using data reported by the City.

In the last 12 days, one Evanston resident has lost their life due to COVID-19, and that was on July 11. The total number of Evanstonians who have died due to the virus is 71.

According to data provided by IDPH on July 10, a total of 53 residents or staff of long-term care facilities in Evanston have died due to COVID-19. Thus, about 75% of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities. Two facilities account for 39 of the deaths.

New Cases in Suburban Cook County and Illinois: There were 202 new cases of COVID-19 in suburban Cook County in the last 24 hours. Beginning July 11, there were 241 new cases, then 161 cases, 151 cases, 118 cases, and then an increase to 202 today.

In the State there were 1,187 new cases today. Starting with July 10, there was a decline in new cases in the State from 1,317, to 1,195, to 954, to 883, to 707, and then an increase to 1,187 today.

The number of new cases in the State is still much lower than the 3,137 new cases reported on May 1, and lower than the 857 reported on June 26, the day the State moved into Phase 4.

Between July 11 and July 15, the average number of new COVID-19 cases per day in suburban Cook County was 175, and in the State, it was 987. The trends for the State are shown in the first chart in the above chart box.

The number of deaths in Illinois due to COVID-19 increased by 8 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 7,226.

Hospital Admissions and Surge Capacity

One metric that will be used to determine whether additional restrictions will be imposed in a region is whether there is a “sustained increase” in hospitalizations for COVID-19 illnesses in the region.

Another metric is whether there is a reduction in hospital capacity to care for patients with COVID-19 illnesses. The criteria say there should be 20% surplus capacity of both medical/surgical beds and ICU beds.

IDPH has not provided this data for suburban Cook County.

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 July 14, the number of hospitalizations in Illinois was 1,454, down 44 from June 26.

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. ***

Recently, the Harvard Global Health Institute (HGHI) published a paper saying that a research/policy collaborative agreed that a 3% test positive rate or below is a key indicator of progress towards suppression level testing.****

IDPH has not yet reported the test positivity rate for suburban Cook County.      

On a Statewide basis, the test positivity rate on July 15 was 3.1%. The average for the last five days was 2.5%.

       The Number of Tests in Illinois

In a recent paper, HGHI published two testing targets for each State: one for what it calls mitigation level testing, and second for suppression level testing. For Illinois, the mitigation level testing target is 19,116 tests per day. For suppression level testing the target is 68,211 tests per day.****

 While the number of COVID-19 tests that the State has administered has increased six-fold since the beginning of April, the average number of tests per day between July 11 and July 15 is 33,514. This is substantially higher that the mitigation level testing target, but less than 50% of the suppression level testing target.

On July 15, there were 38,161 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 impose additional restrictions in a Region.  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 how close the State is toward meeting 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 July 15, Gov. Pritzker said, “The State has also worked to expand its contact tracing operation, with approximately 1,450 contact tracers now working across Illinois. Over the next week, 26 local health departments will receive additional funding from the State, representing over $127 million of available grant funds for contact tracing. With these funds, local health departments will hire approximately 1,330 contact tracers over the next few months and significantly expand their contact tracing efforts.

“The State currently has about a third of the tracers it needs,” he said.

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

* Under the Plan to Mitigate a Resurgence of COVID-19 announced on July 15, additional restrictions may be imposed in a region if there is:

  • A sustained rise in the 7-day rolling average of the test positivity rate ( for 7 days out of a 10 day period) and one of the following:
    • A sustained increase in hospital admissions for a Covid-19 like illness, or
    • A reduction in hospital capacity threatening surge capabilities (ICU capacity or medical/surgical beds under 20%) OR
  • Three consecutive days averaging greater than or equal to an 8% positivity rate.

** 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.

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

****The Harvard Global Health Institute recently posted a paper, “July 6, 2020/State Testing Targets,” in which it published new state testing targets in collaboration with NPR and also explained “how we can  best use testing targets not as an ultimate goal but as a tool on the path to zero cases.” HGHI said, “And we have begun to work closely with the Safra Center for Ethics at Harvard and other researchers, public health and policy experts across the U.S. to align on key aspects of what we think is needed to get the nation back on track.

“Five months into this pandemic, what we need more than ever is still a robust testing, tracing and supported isolation infrastructure, combined with various measures of social distancing, mask wearing and hand washing. We have made some progress, but not nearly enough. Unsurprisingly, new daily cases are reaching record highs, and getting ahead of this virus seems all but impossible.”

HGHI published two targets for testing for each state: one for what it calls “mitigation” level of testing, and second for what it calls a “suppression” level of testing.

The targets for Illinois are 19,116 tests per day to meet a mitigation level of testing, and 68,211 tests a day to meet a suppression level of testing.

Mitigation Level Testing: HGHI says for mitigation level testing, “The focus is on reducing the spread of the virus through broad testing of symptomatic people, tracing and testing a recommended 10 contacts per new case and isolating positive contacts, and social distancing, mask wearing or stay-at-home orders as necessary. 

“There is a challenge with this approach: As states open up, mitigation level testing is often not sufficient to prevent new outbreaks.

“With strict social distancing orders in place, cases go down, but then spike back up again as a state loosens restrictions. It’s a rollercoaster of recurring outbreaks that creates great uncertainty, for example around reopening businesses, schools, and other vital parts of the economy.”

Suppression Level Testing: HGHI says, “Suppression level testing allows a state or community to quickly find and isolate new cases before they lead to a wider outbreak, with an aim of keeping new case levels at or near zero.

“This requires large, proactive testing — including regular testing of asymptomatic people in high-risk environments such as nursing homes, colleges, and parts of the service industry — paired with rapid contact tracing and supported isolation (TTSI), as well as other measures. Several states are working hard to build and maintain this type of response, including Massachusetts, New York and Connecticut.  

 “Suppression level TTSI programs reduce uncertainty and allow life to return to something closer to normal — but still include mask-wearing, social distancing, handwashing and other measures. It is easier to do when case counts are relatively low or on the decline.”

Test Positive Rate: HGHI says, “A network of research, policy, and public health organizations convened by Harvard and MIT called the TTSI Collaborative has agreed on a 3% test positive rate or below as a key indicator of progress towards suppression level testing. This targets broad and accessible testing for symptomatic and asymptomatic people. Out of the positive tests that do not come from hotspot testing, at least 80% should come from contact tracing.”

Link to HGHI’s report: https://globalepidemics.org/july-6-2020-state-testing-targets/

Link to NPR’s article: https://www.npr.org/sections/health-shots/2020/06/30/883703403/as-coronavirus-surges-how-much-testing-does-your-state-need-to-subdue-the-virus