Evanston had 1 new COVID-19 case both today and yesterday, after seeing an average of 5 new cases a day in the prior five days. One troubling statistic is that the test positivity rate in Suburban Cook County has crept up to 6.7%.
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. 1/
New Cases in Evanston, Suburban Cook County, Chicago and Illinois
New cases and deaths of Evanstonians: There was 1 new confirmed COVID-19 case of an Evanston resident today, 1 new case yesterday and 5 new cases on Saturday. There have been a total of 967 cases of Evanston residents, 51 of which are active. 2/
In the last seven days, the City has reported an average of about 3.9 new cases per day, compared to 4.6 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 49 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. 21, 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 21 and Aug. 19, there were a total 6 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 319 new COVID-19 cases in Suburban Cook County today, and 300 in Chicago.
In the State there were 1,612 new cases today. The number of new cases per day in the last seven days has been 1,740, 2,295, 1,832, 2,208, 2,356, 1,893, and then 1,612 cases today. The average per day in the prior seven days is 1,991.
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 State’s current 7-day average is more than three times the lowest 7-day average in mid-June.
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 8 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 7,888.
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 21 on Aug. 21, 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. 21, Suburban Cook County has a surplus capacity of 32% of medical/surgical beds and 38% of ICU beds. The surplus capacity for both medical/surgical and ICU beds is lower that it was a month ago, 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. 19, the number of hospitalizations in Illinois was 1,529, an increase of 31 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. 3/
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. 4/
Under the State’s Action Plan, additional restrictions may be imposed in a Region if the Region has a 7-day average test positivity rate of 8.0% or higher for three consecutive days.
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 6.7% on Aug. 21 (the most recent date for which data is available). The test positivity rate for Suburban Cook County has been trending upward. The fourth chart in the chart box shows the trend.
On a Statewide basis, the test positive rate today was 4.5%. The average for the last seven days is 4.2%, which is an increase from a low of 2.2% on July 8. After hovering around 3.8% in the last five days in July, the State’s seven-day test positivity rate has been trending upward.
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.4/
While the number of COVID-19 tests that the State has administered has increased nine-fold since the beginning of April, the average number of tests per day in the last seven days is 46,968. This is substantially higher than the mitigation level testing target, but significantly less than the suppression level testing target.
On Aug. 21, there were 36,158 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. 5/
An Aug. 3 report published by a group of universities concludes that the optimal time to get test results is the same day, or within 1 to 2 days. It found that the turnaround time in Illinois was 3 days in July. 6/
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.
A promising development reported on Aug. 19, is that a saliva test developed at the University of Illinois can produce results very fast “in many cases in 3 to 6 hours.” 7/
The technology for do-it-yourself tests, that provide results almost instantaneously, has been developed, but it is not yet approved by the FDA. 8/
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.
1/ 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.
2/ 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.
3/ 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
4/ 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
5/ 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
6/ 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.
7/ On Aug. 19, the University of Illinois received emergency use authorization from the Food and Drug Administration to run a saliva-based COVID-19 test. “The saliva test is less expensive, faster, and requires significantly less raw materials than traditional testing,” said Gov. JB Pritzker. “If ongoing research continues to yield positive results, this has potentially game changing implications for our State-wide testing complex as well as for testing on a national level, particularly for our high risk communities and settings.
“This type of scalable product would allow us to mass deploy testing, and better track and contain the spread of COVID-19. We’re already working to deploy this to more public universities across the State over the next weeks and months and exploring rolling this out to do testing potentially for K-12 schools and even more testing at our long-term care facilities,” said the Governor.
Dr. Martin Burke, who put the research team together that developed the test, said that in a trial run in July, they were able to get “very fast test results, in many cases in 3 to 6 hours,” which enabled them to rapidly isolate people who were infected with the virus and to contact trace. They were able to reduce the test positivity rate from 1.5% to 0.2% during the month, he said.
Dr. Burke said “speed is the key.” The test is “very well suited to scalability” and the cost is about $10 a test. He added that the University has capacity to administer 20,000 tests a day.
8/ Dr. Michael Mina, an Assistant Professor of Epidemiology at Harvard T. H. Chan School of Public Health, urges that a cheap, daily, do-it-yourself test be used to help stop the transmission of the virus. He said the paper-strip tests have already been developed, and they cost less than $1 per test. He proposes that consumers could test themselves every day or every other day, and if they tested positive they could self-isolate at the time they are most infectuous. He said this would provide a way to open more businesses and schools.
The FDA has held up approval of the test because the test is not as accurate as nasal-swab, lab-based tests. Dr. Mina says, however, that the purpose of the test is not to diagnose people for purposes of treatment, but rather to provide critical initial screening on a large scale. He says the tests are 85% accurate, and positive test results could be followed up by a visit to the doctor and a more accurate nasal swab test or, if illness weren’t that severe, by daily testing until a person is negative. https://news.harvard.edu/gazette/story/2020/08/cheap-daily-covid-tests-could-be-akin-to-vaccine/