The number of new COVID-19 cases per 100,000 people in Suburban Cook County has more than doubled in the last three weeks. The number per week is now 208, while the State’s target is 50. The trend is shown in the above chart. This is one metric being used by School Districts 65 and 202 in deciding whether to open their schools for in-person learning.
Comments of Dr. Ezike and Governor Pritzker
At today’s press briefing, Dr. Ngozi Ezike, Director of the Illinois Department of Public Health, gave an emotional statement on the toll of the pandemic.
“I understand the mental, the social, and the emotional toll that this pandemic continues to have on people,” Dr. Exike said. “It’s not just because I’m asking people, it’s because I’m feeling it and living it myself. I don’t get to live in some COVID free bubble, exempt from all the pain and the tragedy of this pandemic. So I understand how pandemic fatigue is striking everyone. It’s real.
”People are tired of not seeing their families. They’re tired of postponing the weddings, and the other life celebrations. Trying to work from home while also trying to manage kids’ learning remotely is a challenge. Not being able to visit your loved ones in long-term care and nursing homes, not being able to gather with groups of friends for a night out in your favorite restaurants is getting to be a lot to bear. The way we work, the way we live, the way we play has all changed. And the harsh reality is that the sacrifices we’ve made and that we continue to make do not have a future expiration date.
“And I know that that’s difficult. This new virus has caused this horrible situation.
“And although people want to refute the number of cases, we are seeing the number of people with COVID-19 continue to increase. We are seeing the number of individuals in the hospital because of COVID-19 increase. We are seeing the number of lives lost continue to increase. And if you’re tired of hearing it from me, please just ask one of your local physicians in the area. They will tell you what they are seeing in their hospitals.
“Since yesterday, we lost an additional 31 lives for a total of 9,418 deaths,” said Dr. Ezike. “These are people who started with us in 2020 and won’t be with us at the Thanksgiving table.”
Both Dr. Ezike and Gov. Pritzker again encouraged people to wear masks and socially distance.
“If you’re talking about COVID fatigue from having to keep wearing a mask,” said Dr. Ezike, “think about the COVID fatigue for healthcare workers, respiratory therapists, who are going to have to go through this whole episode again, of trying to fight for people’s lives because we couldn’t figure out how to control this virus by doing some of the simple measures that have been prescribed.
“I feel for those health care workers, the respiratory therapists, the nurses, the nurses, assistants, all these people who work with the public on a regular basis. You cannot work from home as a bus driver, right? So these people have to go to work every day as the disease is increasing throughout the State. And they’re the ones that will be dying. And so putting our people through this again, it’s unfortunate. And I’m desperate to find the message that will work. I’m looking for someone to tell me what the message is so that we can do what it takes to turn this around.
“The virus has caused this and instead of pitting one group against another, we need to get that and fight against the virus. We have some tools to do that. We don’t have a cure yet. We don’t have the vaccine yet. But we have a mask. And we’re asking people to use it. And I don’t know what else we can say.”
Gov. Pritzker said, “We’re just asking people, please wear your mask. It is the most respectful thing you can do to help the businesses in your area stay open and help our schools get more kids in the classroom, and make sure that our economy keeps going. Just wear a mask. We are getting through this because eventually there will be an effective treatment or a vaccine. We can see some of the development that is happening. I think it will be early next year. I hope. I don’t know. But we’ve got to be able to survive until then. We’ve got to keep everybody safe, and particularly people who are most vulnerable to the virus.”
New COVID-19 Cases in Evanston and Other Risk Factors
There were 10 new confirmed COVID-19 cases of Evanston residents today. The average number of new cases per day in the last seven days is 9.3. There has been a total of 1,337 cases of Evanston residents, 160 of which are active. The accompanying chart shows the recent trend.
The test positivity rate over the last 7 days is 1.6%.
The total number of Evanstonians who have died due to the virus is 74. There have been 3 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. 18 and Oct. 22 (the latest period for which data is available) there were 39 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 0.57%. 
Suburban Cook County: 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. 23 there were 208 new COVID-19 cases per 100,000 people in Suburban Cook County in a 7-day period, well above the target of 50 cases. This is an increase from 91 on 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. 22, there were 5,133 new cases.
Public health experts convened by Harvard’s Global Health Institute (HGHI) and Edmond J. Safra Center say that a region with more than 169 cases per 100,000 people in a week is in a red zone having “accelerated spread.” 
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.
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. 19, was 7.3%. In the prior seven days, it was 6.2%, 6.5%, 6.8%, 6.8%, 7.1%, 7.2%, and 7.2% The accompanying chart in the chart box shows the trend in the 7-day positivity rates.
The 1-day test positivity rate on Oct. 19 was 8.1%.
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.
The data shows that there were 5,133 new COVID-19 cases in Suburban Cook County in the 7-day period Oct. 17 – Oct. 23.
There were 4,193 new cases in Suburban Cook County in the prior 7-day period Oct. 10 – Oct. 16.
Between the two 7-day periods the number of cases increased by 940 cases, or by 22%.
The accompanying chart in the chart box shows the trend.
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 42 on Oct. 20, the most recent date for which data is available.
IDPH reported that as of Oct. 23, Suburban Cook County has a surplus capacity of 23% of medical/surgical beds and 29% 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 3,874 new cases reported today. The number of new cases reported per day in the last seven days has been 4554, 3629, 4,245, 3,113, 3,714, 4,342, and 3,874 new cases today.
The current 7-day average of new cases per day is 3,982, which is the second 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 two weeks. One of the lowest was 596 cases for the seven days ending June 16.
The trends for the State are shown in the accompanying chart in the chart box.
The number of deaths in Illinois due to COVID-19 increased by 31 in the last 24 hours. This brings the total number of deaths due to COVID-19 in Illinois to 9,418.
Hospitalizations: On a Statewide basis, the number of hospitalizations due to COVID-19 was 2,498 as of midnight on Oct. 22. This is up from 1,596 on Sept. 1. The accompanying chart in the chart box shows the trend.
For purposes of comparison, the highest number of hospitalizations due to COVID-19 was 4,868 on May 6.
The number of patients using ICU beds is 515, up from 347 on Sept. 1.
Test Positive Rate: On a Statewide basis, the 7-day test positive rate today is 5.8%, which is an increase from a low of 2.2% on July 8. 
The one day rate is 6.1%.
Number of Tests: The average number of tests per day in the last seven days is 71,434. This is substantially higher than HGHI’s mitigation level testing target of 19,116 per day, and it is slightly higher than HGHI’s suppression level testing target of 68,211 per day. .
The number of new tests reported today was 80,973. Starting Oct. 15, IDPH began including antigen tests in its tally of COVID-19 tests.  Gov. Pritzker said on Oct. 20 that the percentage or antigen tests in Illinois was very small, about 1% or 2%. With the plan to administer 3 million antigen tests before the end of this year, this will change.
Delays in Getting Test Results: Public health experts convened by HGHI and Edmond J. Safra Center say test results should be obtained within 24 hours.
Gov. Pritzker said on Oct. 23 that the turn around time for many tests administered at State run testing sites is two or three 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.
The new antigen tests being distributed by IDPH can generate results in 15 minutes.
Contact Tracing: Widespread contact tracing is also essential to control the spread of the COVID-19 virus.
IDPH does not report the percentage of cases for which contact tracing begins within 24 hours.
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.
 On July 1, a network of research, policy and public health experts convened by Harvard’s Global Health Institute and Edmond J. Safra Center published a Key Metrics for COVID Suppression framework that provides guidance to policy makers and the public on how to target and suppress COVID-19 more effectively across the nation. The targets for new Covid-19 cases per 100,000 people are as follows (these are converted from cases per day to cases per week): a) less than one 7 cases: “on track for containment;” b) 7 to 63 cases: “community spread,” rigorous test and trace program advised; c) 70 to 168 cases: “accelerated spread,” stay-at-home orders and/or rigorous test and trace programs advised; and d) 169+: tipping point,” stay-at-home orders necessary.
3/ 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.
4/ 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
5/ 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.
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.