Over the weekend, new COVID-19 cases continued to mount, test positivity rates continued to rise, and hospitalizations have jumped.  So far, the new restrictions imposed by Governor JB Pritzker in the past few weeks have not slowed the spread of the virus.

At a briefing today, Gov. Pritzker was asked if he was considering imposing a new stay-at-home order and taking the State back to phase three of the Restore Illinois Plan. He said it can take two weeks before the new restrictions he recently imposed would have the desired effect.

He added, “We’re not currently looking at a stay-at-home order. I mean, obviously, that’s something that lurks in the background. You know, if we believe that these tiered mitigations ultimately are ineffective, if people choose not to wear masks, and if the spread of the virus continues to go unabated – kind of community spread – we would obviously have to consider, you know, more significant mitigations.”

In the past few months, the Governor has expressed a clear preference to target Regions where new cases and positivity rates are on the rise, and to target activities or businesses where the virus appears to be spreading.

The new restrictions have focused on indoor service at bars and restaurants, and on gatherings of more than 25 people. Some bars and restaurants have challenged the new restrictions in courts, and some are defying the order. Enforcing the order appears difficult.

Once again, the Governor asked everyone to wear a mask, and keep socially distant. “If we did that,” he said, “I promise you we can bring these positivity rates down all across the State, particularly in the rural areas, which are being most terribly affected.”

EVANSTON: 8 New COVID-19 Cases Today

There were 8 new confirmed COVID-19 cases of Evanston residents today. On Saturday there were 29 cases and on Sunday there were 19. The average number of new cases per day in the last seven days is 16. There has been a total of 1,516 cases of Evanston residents, 338 of which are active. The above chart shows the recent trend.

In the last 7 days, there were a total of 112 new COVID-19 cases of Evanstonians. That equates to about 149 new cases per 100,000 people in the 7-day period. The State’s 7-day target is 50 per 100,000.

While the number is almost three times the State’s target, Evanston is doing much better than the rest of the State.

The test positivity rate over the last 7 days is still relatively low at 2.8%.

The total number of Evanstonians who have died due to the virus remains at 75. There have been 4 deaths since July 11.

The Impact of NU on Evanston’s Increase in Cases

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. If NU students, staff or faculty live outside Evanston, they are not included. [1]

Northwestern University has posted data on its website reporting that between Oct. 26 and Nov. 1 (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 0.8%.

SUBURBAN COOK COUNTY, CHICAGO AND ILLINOIS 

Several key metrics used by IDPH to measure the spread of COVID-19 are the trend of new cases, the number of new cases per 100,000 population, and the test positivity rate.  Another key metric is the number of hospitalizations due to COVID-19 and hospitals’ capacity to care for a surge of new patients.

First, New Cases There were 1,165 new COVID-19 cases in Suburban Cook County today and 1,473 in Chicago.

 In the State there were 6,222 new cases reported today. The current 7-day average of new cases per day in the State is 6,367, which sets yet 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.

The trends of new cases in Suburban Cook County, Chicago and the State are shown in charts in the chart box.

Second, 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]

In the 7-days ending Nov. 2, the number of new cases per 100,000 people were as follows for the regions indicated:

·       Suburban Cook County: 351

·       Chicago: 357

·       Illinois: 351

Each is about seven times IDPH’s target. An accompanying chart  illustrates the difference. [3]

Third, a Test Positivity Rate. IDPH’s target is that the test positivity rate be 5% or less, although some experts say it should be 3% or less.  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. [4]

The most recent 7-day test positivity rates are as follows:

·       Suburban Cook County: 10.1% (as of Oct. 30)

·       Chicago: 9.7% (as of Oct. 30)

·       Illinois: 9.7% (as of Nov. 2

Each is about double IDPH’s target. A chart in the chart box shows the trend.

Fourth, Hospital Admissions and Surge Capacity. The 7-day average of new hospitalizations due to COVID-19 in Suburban Cook County and Chicago, combined, was 126 on Oct. 30 (the most recent day for which data is available). The numbers are up from 54 on Sept. 1.

IDPH reported that as of Oct. 30, Suburban Cook County has a surplus capacity of 23% of medical/surgical beds and 28% of ICU beds; and Chicago has a surplus capacity of 24% of medical/surgical beds and 29% ICU beds. IDPH’s target is 20% surplus capacity, so the target is met.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,371 as of midnight on Nov. 1. This is up from 1,596 on Sept. 1. A chart in the chart box shows the trend. Hospitalizations have more than doubled in the last two months.

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 722, up from 347 on Sept. 1.

Number of Tests: The average number of tests per day in the last seven days is 78,605. This is higher than HGHI’s mitigation level testing target, but about one-third the amount needed to meet HGHI’s suppression level testing target.  [5].

The number of new tests reported today was 68,118. Starting Oct. 15, IDPH began including antigen tests in its tally of COVID-19 tests. [6] The plan is 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.

Illinois Department of Public Health Director Dr. Ngozi Ezike said on Oct. 29 that, as the number of new cases surges, contact tracers are “being stretched very thin, even as we bring the new contact tracers onboard.” She encouraged people to cooperate with contact tracers.

Gov. Pritzker said on Nov. 2 that the State may not be able to increase the number or contact tracers unless the federal government provides funding to do so.

IDPH does not report the percentage of cases for which contact tracing begins within 24 hours.

…………………………….

FOOTNOTES

1/ Northwestern University Covid-19 Cases. Ike C. Ogbo, Director of Evanston’s Health & Human Services Department, told the RoundTable that the COVID-19 cases reported by the City include cases of 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/ Number of Cases per 100,000 Population. 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 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.  The article is available here: https://globalepidemics.org/key-metrics-for-covid-suppression/

IDPH provides these categories and ratings: 1) “minimal” – less than 50 cases per 100,000 in a week; 2) “moderate” – between 50 and 100 cases per week; and 3) more than 100 cases per 100,000 in a week.

3/ Calculations. The RoundTable calculated the number of cases per 100,000 using case data provided by IDPH and assuming that the population of Suburban Cook County is 2.469 million, that the population of Chicago is 2.710 million, and that the population of Illinois is 12.671 million.

4/ The Test Positivity Rate. 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 (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.”

While stating the test positivity target is 5% or less, IDPH provides these categories and ratings: 1) “Minimal” – test positivity rate is equal to or less than 5%: 2) “Moderate” – test positivity rate is between 5% and 8%; and 3) “Substantial” – test positivity rate is over 8%.

5/ How Much Testing Should be Done.  The Harvard Global Health Institute posted a paper showing testing targets as of October 1, 2020. The targets for Illinois are 438 tests per 100,000 people to meet the “mitigation” target and 1,602 tests per day to meet the “suppression” target. The paper says that Illinois 7 day average of testing is 564 tests per day. Link to paper: https://globalepidemics.org/october-1-testing-targets/

Mitigation Level Testing: In an earlier paper, 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.”

Link to HGHI’s report: https://globalepidemics.org/july-6-2020-state-testing-targets/

6/ Antigen Tests. 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/  Saliva-based Tests. 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