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Evanston had no new confirmed case of COVID-19 today. The State had 955 new cases.
CDC reported today that there were 57,772 new COVID-19 cases in the nation on July 20. On a nationwide basis, the average number of new COVID-19 cases in the last seven days is 66,240 per day, compared to an average of 21,596 in the first seven days of June. Cases have tripled since early June.
State’s Action Plan to Combat a Resurgence
Under a July 15 Action Plan to Combat a Resurgence of COVID-19 in Illinois, 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 in a region, on an individualized basis. Suburban Cook County is a region for purposes of the plan.
Key factors in determining whether to impose additional restrictions are whether the test positivity rate is increasing, whether hospital admissions are increasing, and whether hospitals’ capacity to care for a surge of patients is decreasing.*
New Cases in Evanston, Suburban Cook County, Chicago and Illinois
New cases and deaths of Evanstonians: There were no new confirmed COVID-19 cases of Evanston residents today. The total number of cases is 840, according to data reported by the City.**
In the last seven days, the City has reported an average of 2.6 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 18 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 17, 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, Chicago and Illinois: IDPH reported today there were 220 new cases of COVID-19 in Suburban Cook County and 192 in Chicago. This is the fourth day in a row where the new cases in Suburban Cook County exceeded those in Chicago.
In the State there were 955 new cases today. The average per day in the prior seven days is 1,170.
The number of new cases per day in the State is much lower than the average of 2,638 new cases per day in the seven day period ending May 8, but it is significantly higher than the average of 602 cases per day in the seven days ending June 19.
Dr. Ngozi Ezike, Director of the Illinois Department of Public Health, said on July 16, “Many of the new cases are of youth ages 10-19 and 20-29, who are seeing higher case rates now than ever before in this pandemic. The virus is now being spread by youth.”
She said everyone needs to wear masks, socially distance, and wash their hands. “We cannot control this situation without masking and distancing,” she said. “We cannot.”
The trends for suburban Cook County, Chicago and the State are shown in the first two charts in the above chart box.
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 7,324.
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 hospital admissions for COVID-19 illnesses in the region.
The data show that there were a total of 20 hospital admissions due to COVID-19 in Suburban Cook County on June 26, (the day the State moved to phase 4 of the Restore Illinois Plan) and the number has declined to 16 on July 18, the most recent date for which data is available.
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 reported today that as of July 21 Suburban Cook County has a surplus capacity of 31% of medical/surgical beds and 42% of ICU beds. The 20% threshold is met.
On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,238 on June 1, and 1,498 on June 26. As of midnight on July 20, the number of hospitalizations in Illinois was 1,466, down 32 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.
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.****
On June 26, the test positive rate for Suburban Cook County was 4.9%. On July 17 (the most recent date for which data is available), the test positive rate was 4.4%.
On a Statewide basis, the test positive rate on July 21 was 3.2%. The average for the last seven days was 3.2%.
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 seven-fold since the beginning of April, the average number of tests per day in the last seven days is 36,441. This is substantially higher than the mitigation level testing target, but significantly less than the suppression level testing target.
On July 21, there were 29,745 tests.
Another factor getting more attention recently is how long it takes to get the test results. A report, “Tracking COVID-19 in the United States: From Information Catastrophe to Empowered Communities” published by Resolve to Save Lives on July 21, says that a critical piece of information is the time it takes to get test results. “If test results are delayed beyond one or two days, they become much less useful, as those who are infected will have passed the period of peak infectivity and will neither be able to be rapidly isolated (unless all who are tested are isolated until result return), nor warn exposed contacts so that they can quarantine before they become infectious.”
The study recommends that all states should report diagnostic test median turnaround time (specimen collection to test report) each week. Currently, no state does that, says the study.
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.
* Under the Action 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.
**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 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/
*****Delays in getting the results on COVID-19 tests impacts the ability to contact trace in a timely fashion. On July19, Dr. Francis Collins, the Director of the National Institute of Health said speaking in regards to the nation as a whole, “The average test delay is too long. That really undercuts the value of the testing to find out who’s carrying the virus, and then quickly get them isolated so they don’t spread it around.”
It also delays the start of contact tracing and the efforts to advise people that they have been exposed to someone with COVID-19, so that they may self-isolate as well.
Illinois does not report the average length of time that test results are reported. In some cases the results are reported the same day or the next day. But IDPH says on its website (updated on June 30) that people who undergo COVID-19 testing will receive a call with test results “in 4-7 calendar days.” This suggests a relatively long delay in getting the test results.