The State reported 1,773 cases today. Gov. Pritzker announced new restrictions in Region 4, just east of St. Louis. When asked about in-person learning in the schools, Gov. Pritzker said, “[E]very day, we’re watching very closely, trying to monitor, we’re listening to the local public health officials to try to determine what the right thing to do is.”
CDC reported today that there were 41,893 new COVID-19 cases in the nation and 654 additional deaths.
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.*
On Aug. 18, Gov. JB Pritzker announced that new restrictions had been imposed in Region 4, just east of St. Louis, because the positivity rate in that Region exceeded 8.0% for three days in a row. The new restrictions include closing bars, restaurants, and casinos at 11 p.m., limiting the seating and the places where people could gather in each of those businesses, and limiting meetings and social gatherings to the lesser of 25 people or 25% of overall capacity of a room. More stringent restrictions may be imposed if the positivity rate does not come down in 14 days, said IDPH in a prepared statement.
In making the announcement, Gov. Pritzker said, “Now is the time to start wearing a mask to maximize the chance that children can have in-person learning this fall. Maintain six feet of physical distance to keep the small business owners dining rooms open, and retail stores in business. Each of us has a role to play in the future of this region’s health and economy.”
When asked if it is was appropriate for schools in the region to be offering in-person learning in light of the virus, Gov. Pritzker said, “I think we’re watching closely is the answer. I think you’ve seen that the positivity rates so far among kids have been somewhat lower. We’ve also seen that kids tend not to contract – again it’s not universal, some kids do get sick – but many of them don’t. And so we’re watching very closely. And I won’t hesitate to take action if I need to.
“But we want school districts to do what they need to do, based upon the guidance that we put out from the State Board of Education. And most school districts are following that. They are, in fact, insisting on masks, making sure there’s social distancing, not having too many people in a room, and so on.
“We want kids to be able to get in-person learning if they can, if it’s safe. And we believe that it is. But again, you have to have all the mitigations in place to make sure that it is.”
Today, IDPH also released a map for residents highlighting which states are the highest risk for travelors. Locations with an average daily case rate of 15 or more cases per 100,000 residents are marked as an increased risk. As of today, Idaho, Nevada, North Dakota, California, Texas, Oklahoma, Kansas, Missouri, Iowa, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, Georgia, South Carolina and Florida are included.
“Travel may increase the chance of becoming infected and spreading COVID-19,” IDPH Director Dr. Ngozi Ezike said in a prepared statement. “While staying home is the best way to protect yourself and others from COVID-19, we know that it may not be possible to avoid all travel. We encourage people who are traveling, whether for work or otherwise, to check out the map before making plans.”
New Cases in Evanston, Suburban Cook County, Chicago and Illinois
New cases and deaths of Evanstonians: There were 2 new confirmed COVID-19 cases of Evanston residents today, 10 yesterday and 2 on Saturday.** There have been a total of 940 cases of Evanston residents, 49 of which are active.
In the last seven days, the City has reported an average of 4.8 new cases per day, compared to 5.4 new cases per day in the prior 7-day period. The above chart shows the trend of COVID-19 cases of Evanstonians using data reported by the City.
In the last 42 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 Aug. 14, about 75% of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities. Data provided by the City indicates that between July 14 and Aug. 12, there were only 3 confirmed cases of COVID-19 of residents of long-term care facilities.
New Cases in Suburban Cook County, Chicago and Illinois: IDPH reported there were 367 new COVID-19 cases in Suburban Cook County today, and 293 in Chicago.
In the State there were 1,773 new cases today. The number of new cases per day in the last seven days has been 1,539, 1645, 1834, 2,261, 828, 1562, and 1,773 today. The average per day in the prior seven days is 1,779.
For purposes of comparison, the average of new cases per day over the seven days ending on May 8 was 2,638, which is one of the highest in the State. One of the lowest was 602 cases for the seven days ending June 19.
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 12 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 7,765.
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). The number declined to 15 on July 30, and it was 18 on Aug. 14, 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 at least 20% surplus capacity of both medical/surgical beds and ICU beds.
IDPH reported that as of Aug. 17, Suburban Cook County has a surplus capacity of 32% of medical/surgical beds and 37% of ICU beds. The surplus capacity for both medical/surgical and ICU beds has been trending downward over the last month as hospitals in the region are likely using the beds for non-COVID patients. The 20% threshold, though, is still 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 Aug. 16, the number of hospitalizations in Illinois was 1,544, an increase of 46 since June 26. The third chart in the chart box shows the trend in hospitalizations.
So far, increases in the number of new cases has not resulted in a significant surge of hospital admissions or of total hospitalizations.
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, and that many infected people are not being tested.***
More recently, the Harvard Global Health Institute (HGHI) published a paper saying that a research/policy collaborative agreed that a test positive rate of 3% or below is a key indicator of progress towards suppression level testing.****
On June 28, the test positive rate for Suburban Cook County was 4.9%. On July 7 the test positivity rate dipped to 4.0%, but it increased to 6.0% on Aug. 14 (the most recent date for which data is available). The test positivity rate for Suburban Cook County has been trending upward.
On a Statewide basis, the test positive rate today was 4.6%. The average for the last seven days is 4.2%, which is an increase from a low of 2.2% on July 8. The State’s seven-day test positivity rate has been between 3.8% and 4.2% for about two weeks.
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 eight-fold since the beginning of April, the average number of tests per day in the last seven days is 42,305. This is substantially higher than the mitigation level testing target, but significantly less than the suppression level testing target.
On Aug. 17, there were 38,246 tests.
Delays in Getting Test Results
Another critical factor is how long it takes to get COVID-19 test results. A report published by Resolve to Save Lives on July 21 said it is important to get test results within one or two days so that a person infected can be quickly isolated, and so people who were in contact with the infected person can be informed that they might be infected and that they should isolate themselves. *****
An Aug. 3 report published by a group of universities concludes that the optimal time to get test results is the same day, or 1 to 2 days. It found that the turnaround time in Illinois was 3 days in July.******
IDPH does not report the median time it takes to report test results. In its new guidance posted for schools on Aug. 12, IDPH said the typical time to get test results from State labs is 2 to 3 days, and the time can increase if demand is high. IDPH did not report the time for private labs
Widespread contact tracing is also essential to control 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.
IDPH at one time had an internal goal of beginning contact tracing within 24 hours of diagnosis for more than 90% of cases in region.” There is no data indicating how close the State is toward meeting this goal.
On Aug. 17, Gov. Pritzker said the State has increased the number of contact tracers from about 500 to 1,900, and the hiring process is ongoing. He said Chicago and Cook County have been behind the rest of the State in terms of hiring contact tracers.
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.
A study published by the CDC on July 21 concluded that the number of people infected by COVID-19 in different regions of the country was between 2 and 13 times higher than the number of confirmed COVID-19 cases reported in those regions. The study did not cover Illinois. The study was based on antibody tests, which determines if a person has antibodies to the virus. If they have antibodies, it is assumed they were infected by the virus and recovered, perhaps with minor or no symptoms.
*** 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
***** 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, “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.” Dr. Thomas R. Frieden, the former director of the CDC, runs Resolve to Save Lives. Link to the study: https://preventepidemics.org/wp-content/uploads/2020/07/Tracking-COVID-19-in-the-United-States-Report.pdf
******An Aug. 3 report, “Failing the Test: Waiting Time for COVID Diagnostic Tests Across the U.S.” provided the results of a survey of 19,058 people in July who shared how long they had to wait for their COVID-19 test results. The report was prepared by the COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States, which is a joint project of Northeastern University, Harvard University, Rutgers University, and Northwestern University.
“Rapid turnaround of testing for COVID-19 infection is essential to containing the pandemic,” says the report. “Ideally, test results would be available the same day. Our findings indicate that the United States is not currently performing testing with nearly enough speed.”
For people tested in April the average wait time was 4.2 days; for people tested in July, the average wait time was 4.1 days.
The report said its key conclusions are: most (63%) people are not getting results within the 1-2 days that would be optimal to aid contact tracing; a substantial minority (21%) of individuals are receiving test results too late (5+ days) to be of any significant assistance in helping to control the spread of COVID-19; the testing challenges are national in scope, with most states reporting a median waiting time of 3 days or more; the waiting times are longer for African Americans (5 days) and Hispanic Americans (4.6 days) compared to white respondents.
The report found that the median time to get test results for people in Illinois was 3 days.