Oct. 15: Eighteen New COVID-19 Cases of Evanstonians, 4,015 New Cases for the State
The number of new confirmed COVID-19 cases reported for Illinois today was the highest number reported in the entire pandemic (not counting Sept. 4, which reported a catch up for the prior three days). While there 67,086 new tests today, the test positivity rate for the day went up to 6.0 %.
Governor J.B. Pritzker said yesterday that the State was moving in a “concerning direction.” He noted that the test positivity rate had increased by a full percentage point in the last week and that hospital admissions had increased.
“I have one simple message for everyone in areas with rising positivity,” said the Governor. “Mask Up. Just do that one simple thing, and it will make a tremendous difference in keeping infections down.”
New COVID-19 Cases in Evanston and Other Risk Factors
There were 18 new confirmed COVID-19 cases of Evanston residents today. The average number of new cases per day in the last seven days is 8.6. There has been a total of 1,250 cases of Evanston residents, 126 of which are active. The above chart shows the recent trend.
The total number of Evanstonians who have died due to the virus remains at 73; there have been 2 deaths since July 11.
All Northwestern University students, staff and faculty who reside in Evanston are included in the numbers reported above. Northwestern University posted data on its website reporting that between Oct. 8 and Oct. 14 (the latest period for which data is available) there were 12 new confirmed COVID-19 cases of students, staff and faculty, which includes those who live outside of Evanston. The test positive rate for NU students, staff and faculty is 0.23%. [1}
Criteria Being Used by School Districts 65 and 202
On Sept. 25, Superintendent Devon Horton said School District 65 will be monitoring four of IDPH’s Risk Metrics and IDPH’s Metrics for School Determination of Community Spread in deciding whether to open the District’s schools for in-person learning on Nov. 16.
On Oct. 12, Superintendent Eric Witherspoon said ETHS would be looking at essentially the same metrics.
The metrics all relate to how Region 10 (Suburban Cook County) is doing in managing and suppressing the pandemic. They are discussed below.
First, New Cases per 100,000 Population. IDPH’s target is that there be fewer than 50 new COVID-19 cases per 100,000 people in Suburban Cook County in a 7-day period. This criterion measures the level of contagion in Suburban Cook County and whether it is at a level that can be contained and suppressed.
On Oct. 15 there were 155 new COVID-19 cases per 100,000 people in Suburban Cook County, well above the target of 50 cases. This is an increase of 60% since Oct. 1. The above chart shows the trend. 
To meet this criterion, the total number of new COVID cases in a 7-day period in Suburban Cook County must decline to about 1,330 new cases. In the 7 days preceding Oct. 15, there were 3,834 new cases.
Second, a Test Positivity Rate. The World Health Organization and Johns Hopkins say that the test-positive rate should be below 5% before opening an economy. IDPH’s target is 5%, and District 65 appears to be using 5% as its target.
The Harvard Global Health Institute (HGHI) and a research/policy collaborative say that a test positive rate of 3% or below is a key indicator of progress towards suppression level testing.  ETHS appears to be using 3% as its target.
If a community’s test positivity rate is high, it suggests that the community is not testing enough and not locating people who have milder or asymptomatic cases and who may be spreading the virus.
The 7-day test positivity rate of Suburban Cook County as of Oct. 12, was 6.2%. In the prior six days, it was 5.0%, 5.3%, 5.2%, 5.5%, 5.6%, and 5.9%. The first chart in the chart box shows the trend in the 7-day positivity rates.
The 1-day test positivity rate on Oct. 12 was 8.3%.
Third, New COVID-19 Cases in a Week. This criterion looks at the trend, and whether the number of COVID-19 cases is increasing in Suburban Cook County or decreasing. The target is that the total number of new cases in the most recent 7-day period in Suburban Cook County should be decreasing or stable compared to the total number of cases in the prior 7-day period.
Each bar in the second chart in the chart box shows the total number of new COVID-19 cases in the 7-day period preceding the date provided at the bottom of each bar. For example, the bar above the date Oct. 15 shows there were 3,834 new cases in Suburban Cook County in the period Oct. 9 – Oct. 15.
The bar above the date Oct. 8 shows there were 2,928 new cases in Suburban Cook County in the period Oct. 2 – Oct. 8.
Between the two 7-day periods the number of cases increased by 906 cases, or by 31%.
Fourth, New COVID-19 Cases of Youth in a Week. This criterion also looks at the trend of new cases, but for youth, which IDPH defines to be anyone under 20 years old. The RoundTable will report on this criterion when it compiles sufficient data.
Fifth, Hospital Admissions and Surge Capacity. This criterion is a risk factor monitored by IDPH, but it is not one of the criteria being monitored by Districts 65 or 202.
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 34 on Oct. 12, the most recent date for which data is available.
IDPH reported that as of Oct. 15, Suburban Cook County has a surplus capacity of 24% of medical/surgical beds and 31% of ICU beds. This is one of the lowest capacities in last two months. IDPH’s target is 20% surplus capacity, so the target is met. The amount of the surplus capacity has been trending downward because hospitals are using more beds for non-Covid-19 cases.
New Cases, Positivity Rate, and Hospitalizations in the State
New Cases: In the State there were 4,015 new cases reported today. The number of new cases reported per day in the last seven days has been 2,818, 2,905, 2,727, 2,742, 2851, 2862, and 4,015 new cases today.
Today’s total is the highest number of new cases during the entire pandemic.
The current 7-day average of new cases per day is 2,988 which is the highest 7-day average during the entire pandemic.
For purposes of comparison, the average of new cases per day over the seven days ending on May 1 was 2,565, which was the previous high for the State, until the increases in the last week. One of the lowest was 596 cases for the seven days ending June 16.
The trends for the State are shown in the third chart in the chart box.
The number of deaths in Illinois due to COVID-19 increased by 53 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 9,127.
Hospitalizations: On a Statewide basis, the number of hospitalizations due to COVID-19 was 1,932 as of midnight on Oct. 14.
For purposes of comparison the highest number of hospitalizations due to COVID-19 was 4,868 on May 6. On Sept. 7, the number of hospitalizations dropped to 1,484, but since then they have increased by 448 patients.
Test Positive Rate: On a Statewide basis, the 7-day test positive rate today is 4.9%, which is an increase from a low of 2.2% on July 8. 
The one day rate is 6.0%.
Number of Tests: The average number of tests per day in the last seven days is 60,747. This is substantially higher than HGHI’s mitigation level testing target of 19,116 per day, but still less than its suppression level testing target of 68,211 per day. .
The number of new tests reported today was 67,086. Starting today, IDPH began including antigen tests in its tally of COVID-19 tests. 
Delays in Getting Test Results: Another critical factor is how long it takes to get COVID-19 test results. 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. 
IDPH does not report the median time it takes to get test results, but it has published some guidance indicating that the typical time is 2 to 3 days.
A saliva test developed at the University of Illinois can produce results in 3 to 6 hours, and it is being used at U of I, Champaign.  Gov. Pritzker said the plan is to expand this method of testing across the State, especially to other college campuses.
Contact Tracing: 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.
1/ 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.
2/ Using data compiled from IDPH’s website, the RoundTable has computed the total number of new COVID-19 cases in Suburban Cook County for each 7-day period ending on days between Sept. 13 and Sept. 30. The RoundTable then computed the number of COVID cases per 100,000 people in Suburban Cook County using a population of 2,469,662.
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
The Harvard Global Health Institute posted a paper, “July 6, 2020/State Testing Targets,” in which it published 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
4/ The Illinois Department of Public Health announced on Oct. 15 that is including both molecular and antigen tests in the number of statewide total test performed in Illinois. “Previously, due to the limited number of antigen tests and limited information about antigen test accuracy, antigen tests were not included in the total number (which comprised less than 1% of total tests performed). Antigen tests, like BinaxNOW™, are now becoming more readily available, therefore, IDPH will include both molecular and antigen tests in its total number of tests starting October 15, 2020.
Dr. Michael Mina, assistant professor of epidemiology and assistant professor of immunology and infectious diseases at the Harvard T. H. Chan School of Public Health, said an antigen test detects if there is an antigen which is one of the proteins in the virus, while the PCR test looks for the RNA of the virus. He said the initial rapid antigen tests would largely only detect people during their window when they are likely to be transmitting 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/ 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.