Governor JB. Pritzker announced today the Chicago will be subject to Tier 1 restrictions beginning on Friday, Oct. 30. The restrictions were imposed “due to a sustained increase in its positivity rate as well as a sustained increase in COVID-related hospitalizations for more than seven of the past ten days,” said Gov. Pritzker.

Yesterday, Tier 1 restrictions were imposed in Suburban Cook County for the same reasons.

“Region 11 [Chicago] is now averaging more than twice as many COVID-related hospital admissions per day as it was a month ago, with a positivity rate that has almost doubled since the beginning of October,” said Gov. Pritzker. “So, starting on Friday the City, too, will begin operating under our resurgence metrics, with a closure of indoor restaurant and bar service and a restrained gathering cap limit of 25 people. We can’t ignore what is happening around us – because without action, this could look worse than anything we saw in the spring.”

“When the first several regions started implementing mitigation measures, it was because the 7-day rolling test positivity was above 8% for three consecutive days,” said IDPH Director Dr. Ngozi Ezike.  “What we are starting to see now, first with Suburban Cook County, and now with Chicago, is that mitigation measures are needed because COVID-19 hospital admissions are going up alongside increases in test positivity. Based on current trends, we soon could face reduced hospital bed availability and overwhelming our health care systems.

“Please, for our health care workers, yourself, and your community, keep distance between you and others, wash your hands, and always wear a mask when around people.”

 

New COVID-19 Cases in Evanston and Other Risk Factors

There were 8 new confirmed COVID-19 cases of Evanston residents today. The average number of new cases per day in the last seven days is 14.1. There has been a total of 1,412 cases of Evanston residents, 235 of which are active. The above chart shows the recent trend.

In the last 7 days, there were a total of 99 new COVID-19 cases of Evanstonians. That equates to about 132 new cases per 100,000 people in the 7-day period. The State’s 7-day target is 50 per 100,000.

The test positivity rate over the last 7 days is still relatively low at 2.6%.

The total number of Evanstonians who have died due to the virus remains at 74. There have been 3 deaths since July 11.

The Impact of NU on Evanston’s Increase

All Northwestern University (NU) students, staff and faculty who live in Evanston and who  test positive for COVID-19 are included in the case numbers reported above. [1]

In the last week there has been a dramatic increase in COVID-19 cases of Northwestern students, faculty and staff. Northwestern University posted data on its website reporting that between Oct. 19 and Oct. 25 (the latest period for which data is available) there were 49 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 0.92%.

Suburban Cook County: Criteria Being Used by School Districts 65 and 202

School Districts 65 and 202 are using IDPH’s Risk Metrics and IDPH’s Metrics for School Determination of Community Spread in deciding whether to open their schools.

The metrics all relate to how Region 10 (Suburban Cook County) is doing in managing and suppressing the pandemic. Superintendent Devon Horton said the District will decide by Oct. 30 whether or not to open the schools for in-person learning on Nov. 16.

At this point, the trends look bad.

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. [2]

On Oct. 27 there were 236 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 first chart in the chart box shows the trend.

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.” [3]

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. 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. [4]

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. 24 was 8.0%. On October 1, it was 5.2%. A chart in the chart box shows the trend.

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 5,834 new COVID-19 cases in Suburban Cook County in the 7-day period Oct. 21 – Oct. 27.

There were 4,871 new cases in Suburban Cook County in the prior 7-day period Oct. 14 – Oct. 20.

Between the two 7-day periods the number of cases increased by 963 cases, or by 20%. IDPH deems an increase of 20% or more as “substantial.”

A chart in the chart box shows the trend.

Fourth, Hospital Admissions and Surge Capacity.

There were a total of 54 new hospital admissions for suspected COVID-19 in Suburban Cook County on Oct. 24, the most recent date for which data is available. The number is up from 24 on Sept. 1.

IDPH reported that as of Oct. 26, Suburban Cook County has a surplus capacity of 27% of medical/surgical beds and 33% 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.

New Cases, Positivity Rate, and Hospitalizations in the State

New Cases: In the State there were 4,000 new cases reported today. The number of new cases reported per day in the last seven days has been 3,714, 4,342, 3,874, 6161, 4,026, 4,729, and 4,000 new cases today.

The current 7-day average of new cases per day is 4,585, which sets another record for 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 several weeks. One of the lowest was 596 cases for the seven days ending June 16.

The trends for the State are shown in the fourth chart in the chart box.

The number of deaths in Illinois due to COVID-19 increased by 46 in the last 24 hours. This brings the total number of deaths due to COVID-19 in Illinois to 9,568. 

Hospitalizations: On a Statewide basis, the number of hospitalizations due to COVID-19 was 2,758 as of midnight on Oct. 26. This is up from 1,596 on Sept. 1. The fifth 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.

While the number of cases has increased by about 75% since the peak in May, hospitalizations are down about 55% from the peak in May. One explanation for this is that a much higher percentage of young people are contracting the virus than in May. Another possibility is that hospitalizations lag behind new cases.

The number of patients using ICU beds is 595, up from 347 on Sept. 1.

Test Positive Rate: On a Statewide basis, the 7-day test positive rate today is 6.4%, which is an increase from a low of 2.2% on July 8. [4]

Number of Tests: The average number of tests per day in the last seven days is 72,139. 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. [4].

The number of new tests reported today was 57,264. Starting Oct. 15, IDPH began including antigen tests in its tally of COVID-19 tests. [5] The plan to administer 3 million antigen tests before the end of this year.

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. [6]  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.

…………………………….

Footnotes

1/ Ike C. Ogbo, Director of Evanston’s Health & Human Services Department, told the RoundTable that the COVID-19 cases reported by the City include faculty, staff and students attending Northwestern University who live in Evanston. The RoundTable asked the City in an FOIA Request to provide the number of NU students who tested positive for COVID-19 and who live in Evanston. The City refused to provide the data. On Oct. 26, the RoundTable appealed the City’s decision to the Public Access Counselor of the Attorney General’s Office.

The RoundTable has asked Northwestern University on two occasions to provide information breaking out the number of new COVID-19 cases of its faculty, staff and students by residency in Evanston. NU did not respond to either request.

 [2] 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.

Link:  https://evanstonroundtable.com/Content/City-News/City-News/Article/Illinois-rapid-saliva-test-for-COVID-19-now-operating-under-FDA-Emergency-Use-Authorization/15/26/18440