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The seven-day average of new Covid-19 cases of Evanstonians is now at 5.4, with a test positive rate of 1.6%. The test-positivity rate for Suburban Cook County has continued to drop, ending at 5.2% on Sept. 15.
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. 1/
The Illinois Department of Public Health (IDPH) reported today that 24 counties in Illinois are considered to be at a warning level for novel coronavirus disease (COVID-19). A county enters a warning level when two or more COVID-19 risk indicators that measure the amount of COVID-19 increase.
Cook County is not among the counties at a warning level.
IDPH said in a prepared statement, “Although the reasons for counties reaching a warning level varies, some of the common factors for an increase in cases and outbreaks are associated with university and college parties as well as college sports teams, large gatherings and events, bars and clubs, weddings and funerals, long-term care facilities, correctional centers, manufacturing plants, schools, and cases among the community at large. General transmission of the virus in the community is also increasing.
“Public health officials are observing people not social distancing, gathering in large groups, and not using face coverings. Some communities lack access to convenient testing before people become symptomatic. In some counties, local law enforcement and states’ attorneys are not enforcing important mitigation measures like social distancing and the wearing of face coverings. Additionally, some people refuse to participate in contact tracing and are not providing information on close contacts or answering the phone.”
New Cases in Evanston, Suburban Cook County, Chicago and Illinois
New cases and deaths of Evanstonians: There were 3 new confirmed COVID-19 cases of Evanston residents today. The average number of new cases per day in the last seven days is 5.4. There has been a total of 1,078 cases of Evanston residents, 73 of which are active. 2/
All Northwestern University students and staff who reside in Evanston are included in the numbers reported above, Ike C. Ogbo, Director of Evanston’s Health & Human Services Department, told the RoundTable. He said the City is not considering breaking out the data for any Evanston institution, including Northwestern University, for privacy reasons.
The above chart shows the trend of COVID-19 cases of Evanstonians using data reported by the City.
The total number of Evanstonians who have died due to the virus is 73; there have been 2 deaths since July 11.
According to data provided by IDPH on Sept. 18, about 75% of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities.
Northwestern University posted data on its website today reporting that between Sept. 11 and Sept. 17, there were 24 confirmed COVID-19 cases of students (20), staff (2), and faculty (2) based on Northwestern Medicine testing data. This data may include students, staff and faculty who reside out of Evanston. On Sept. 17, the RoundTable asked NU how many of the students who tested positive lived in Evanston; NU has not responded. The test positive rate is 0.35%.
New Cases in Suburban Cook County, Chicago and Illinois: IDPH reported there were 318 new COVID-19 cases in Suburban Cook County today. In the last seven days, the average number of new cases is 284 per day.
A total of 269 new cases were reported in Chicago today. In the last seven days, the average number of new cases is 279 per day.
In the State there were 2,120 new cases reported today. The number of new cases reported per day in the last seven days has been 2,145, 1,462, 1,373, 1,466, 1,941, 2,050, and then 2,120 new cases today. The current 7-day average of new cases per day is 1,790.
For purposes of comparison, the average of new cases per day over the seven days ending on May 1 was 2,565, which is one of the highest in the State. One of the lowest was 596 cases for the seven days ending June 16.
The trends for Suburban Cook County, Chicago and the State are shown in the first two charts in the above chart box. (Due to a slowdown in data processing within IDPH systems, the 7-day trends are skewed because cases were understated on Sept. 1, 2 and 3, and then there was a catch up on Sept. 4).
The number of deaths in Illinois due to COVID-19 increased by 20 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 8,411.
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 was 20 on Sept. 15, 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 Sept. 18, Suburban Cook County has a surplus capacity of 29% of medical/surgical beds and 38% of ICU beds. The surplus capacity for both medical/surgical and ICU beds is significantly lower than it was on June 26, 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 highest number of hospitalizations due to COVID-19 was 4,868 on May 6, and it dropped to 1,498 on June 26. As of midnight on Sept. 17, the number of hospitalizations in Illinois was 1,481, a decrease of 17 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.
The World Health Organization said on May 15 that the test-positive rate should be below 5% before opening an economy. 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/
The 7-day test positive rate for Evanston today is 1.6%.
The 7-day test positive rate for Suburban Cook County was 5.2% on Sept. 15 (the most recent date for which data is available). This is a drop from 6.9% on Sept. 1. The fourth chart in the chart box shows the trend.
On a Statewide basis, the 7-day test positive rate today is 3.6%, which is an increase from a low of 2.2% on July 8.
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 ten-fold since the beginning of April, the average number of tests per day in the last seven days is 50,068. This is substantially higher than the mitigation level testing target, but still less than the suppression level testing target.
A significant number of the tests are now being administered to students and staff at the University of Illinois/Champaign. Reports indicate that the University is testing 44,000 students two times a week.
Delays in Getting Test Results
Another critical factor is how long it takes to get COVID-19 test results. 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. 6/
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/ Gov. Pritzker said on Sept. 9 that the plan is to expand this method of testing across the State, especially to other college campuses..
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.
There is no data disclosing the percentage of COVID-19 cases that are contact traced and how quickly the tracing starts.
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.
Dr. Anthony Fauci said on Sept.11, that he expects a vaccine will become available by the beginning of 2021, but that it will likely take until the end of 2021 to vaccinate more than 50% of the population. He said it will likely be well into 2021 or towards the end of 2021 before the country will get back to some degree of normalcy.
Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, told a Senate committee on Sept. 16 that most Americans would not likely be vaccinated before the summer or fall of 2021. He urged people to use facemasks, which he said are “the most important, powerful public health tool we have.”
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/
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/