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 The State reported today there were 97 deaths in the last 24 hours due to COVID-19, the largest number since early June. “Today we mark a terrible milestone for the State of Illinois,” said Governor JB Pritzker. “We have now surpassed 10,000 deaths of Illinoisans lost to Covid-19.

 “I cannot stress enough the severity of our situation,” continued Gov. Pritzker. “IDPH is looking at proposing further regional and statewide restrictions, because the rise in cases and hospitalizations is unsustainable.”

He summarized some statistics highlighting the magnitude and the speed of the spread of the virus. Today there were 9,935 new COVID-19 cases in the State, which blew through the prior record.

“We are seeing record numbers of new COVID-19 cases across the State. Our community transmission rates are at drastic levels. …  Our test positivity rate has climbed to 10.5%.

“The rate of growth in our positivity is far outpacing our growth in testing. In other words, the more we test, the more we’re finding people infected with the virus. That’s awful news.

“We have more than doubled the number of people in our hospital system with this disease in just about five weeks, with no sign of slowing.

“We continue to see rising numbers of severe cases trailing rising hospitalization rates, which, mind you, is already a sign of severity on its own. The number of COVID-19 patients in the ICU is up more than 100% since Oct. 1. … And since the beginning of October, the number of people fighting COVID-19 on a ventilator Statewide climbed from around 140 to more than 300.”

Gov. Pritzker warned that if there was not a change in behavior, the number of hospitalizations would surge much higher than they are now, and “in some areas of our State, that will mean that you’ll run out of hospital beds and nurses and doctors who can treat you. If the current trajectory continues, if our hospitals continue to fill up, if more and more people continue to lose their lives to this disease, we’re going to implement further Statewide mitigations, which nobody, and I mean nobody, wants.”

He said local leaders had to step up and enforce the mitigations that have recently been imposed, that high-risk industries had to follow the mitigations, that families had to put off gatherings or dinner parties, and people needed to wear masks. Absent that, he said, “we’re heading down a very dark, dark path toward where we were last spring.”

When asked what the mitigations would be, he said they could include anything in phase 2 or 3 of the Restore Illinois Plan or in the higher tiers of the current plan.

EVANSTON: 30 New COVID-19 Cases Today

There were 30 new confirmed COVID-19 cases of Evanston residents today, which is a new record for the City. The average number of new cases per day in the last seven days is 21.6. There has been a total of 1,588 cases of Evanston residents during the pandemic, 409 of which are active. The above chart shows the trend.

In the last 7 days, there was a total of 151 new COVID-19 cases of Evanstonians. That equates to about 196 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 four 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 3.7%.

There was one death of an Evanstonian due to COVID-19 in the last 24 hours, bringing the total to 76. There have been 5 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. 29 and Nov. 4 (the latest period for which data is available) there were 37 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 0.65%.

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 1,619 new COVID-19 cases in Suburban Cook County today and 2,182 in Chicago.

 In the State there were 9,935 new cases reported today, which blows through the State’s prior record of new cases in a day.

 Today, the 7-day average of new cases per day in the State is 7,433, which is 47% higher than the 7-day average one week ago. It 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 accompanying charts.

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 a geographic area in a 7-day period. This criterion measures the level of contagion in an area and whether it is at a level that can be contained and suppressed. [2]

In the 7-days ending Nov. 5, the number of new cases per 100,000 people were as follows for the areas indicated.

        Suburban Cook County:  406 (compared to 97 on Oct. 1 )

        Chicago:  417 (compared to 86 on Oct. 1)

        Illinois:  411 (compared to 111 on Oct. 1)

The new cases per day in each area has more than tripled since Oct. 1, and each is more than eight times IDPH’s target. An accompanying chart illustrates the increase. [3]

Third, a Test Positivity Rate. IDPH’s target is that the test positivity rate be 5% or less, although some leading 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:  11.1% (as of Nov. 1)

        Chicago:  10.5% (as of Nov. 1)

        Illinois:  10.5% (as of Nov. 4)

Each positivity rate is more than double IDPH’s target. An accompanying chart highlights the rates.

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 149 on Nov. 1 (the most recent day for which data is available). The number is up from 54 on Sept. 1.

IDPH reported that as of Nov. 4, Suburban Cook County has a surplus capacity of 25% 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 3,891 as of midnight on Nov. 4. 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 772, up from 347 on Sept. 1. Patients on ventilators is 343, up from 142 on Sept. 1.

Fifth: Number of Tests: The average number of tests per day in the last seven days is 82,090. This is higher than HGHI’s mitigation level testing target, but about 40% of the amount needed to meet HGHI’s suppression level testing target.  [5].

The number of new tests reported today was 86,015. [6] This includes antigen tests. [6]

Sixth: 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.

Seventh: Contact Tracing: Widespread contact tracing is also essential to control the spread of the COVID-19 virus.

IDPH Director Dr. Ngozi Ezike said on Oct. 29 that as the number of new cases surge, 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.

Deaths: There were 97 deaths Statewide in the last 24 hours, and a total of 10,030 deaths due to COVID-19 during the pandemic.

…………………………….

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) fewer 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” – fewer than 50 cases per 100,000 in a week; 2) “moderate” – between 50 and 100 cases per week; and 3) “substantial” more than 100 cases per 100,000 in a week.  In its Metrics for School Determination of Community Spread, IDPH says the “target” is 50 cases per week per 100,000 people.

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%. In its Metrics for School Determination of Community Spread, IDPH says the target is 5%.

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. The State’s plan is to administer 3 million antigen tests by the end of this year.

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