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Updating Vaccines

Yesterday, the U.S. Food and Drug Administration issued guidances for the development of vaccines to address variants of the COVID-19 virus.  

“The FDA is committed to identifying efficient ways to modify medical products that either are in the pipeline or have been authorized for emergency use to address emerging variants,” said Acting FDA Commissioner Janet Woodcock, M.D. “We know the country is eager to return to a new normal and the emergence of the virus variants raises new concerns about the performance of these products. By issuing these guidances, we want the American public to know that we are using every tool in our toolbox to fight this pandemic, including pivoting as the virus adapts. We need to arm health care providers with the best available diagnostics, therapeutics and vaccines to fight this virus. We remain committed to getting these life-saving products to the frontlines.”

Under the testing proposed by the FDA, the developer of an updated vaccine would not need to go through a full clinical trial. Instead, it could administer an adapted vaccine  to a group of volunteers, and then the developer would take blood samples from the volunteers and test how the samples produce an immune response to the COVID-19 variants in a laboratory. The FDA would compare that response to the response prompted by the original vaccines.

Dr. Woodcock did not say what would trigger the need for updated vaccines.

The FDA said in a prepared statement that it will be continuously monitoring the situation and updating its plans as more information becomes available. “The FDA urges Americans to continue to get tested, get their vaccines to prevent COVID-19 and follow important health measures—wash your hands, wear a mask and maintain social distance.”

Risk of Community Spread

Both the CDC and IDPH recommend that communities assess the risk that COVID-19 will spread using two measures: 1) the total number of new COVID-19 cases per 100,000 people in the community (e.g., county) in the past seven days; and 2) the percentage of tests for COVID-19 that were returned positive in the last 7 days. [1, 2 and 3]

For total cases in the last 7 days per 100,000 people, IDPH uses a target of 50 cases. CDC says between 10 and 49 cases represents a “moderate” risk of transmission.

For test positivity in the last 7 days, IDPH uses a target of 5%. CDC says between 5% and 7.9% represents a “moderate” risk of transmission.

Two of the charts in the above chart box track these two measures for Evanston, Suburban Cook County, Chicago and the State. [4] The third chart shows the trend of new cases in the State.

Evanston – COVID

There were 7 new confirmed COVID-19 cases of Evanston residents today, up from 4 yesterday.

The average number of new cases per day in the last seven days is 7.9, down from the seven-day average of 12 on Feb. 16. For purposes of comparison, on Oct. 12, the seven-day average was 5.6.

There has been a total of 3,844 COVID-19 cases of Evanston residents during the pandemic, 211 of which are active.  

In the last seven days, there was a total of 55 new COVID-19 cases of Evanstonians. That equates to about 73 new cases per 100,000 people in the seven-day period.

The case positivity rate over the last seven days is 2.8%, up from 2.7% yesterday. These test positivity rates are a significant increase compared to the rates in the last 30 plus days. The increases may be due in part to the relatively low number of tests administered to Northwestern University students in the latest seven-day period for which it reported data, and NU’s relatively high test positivity rate of 5.95% during that period.

Today, the City reported a total of 186 tests, with an average of 285 tests per day in the last seven days. On Feb. 16, the average number of tests per day in the prior seven days was 1,250.

No Evanstonian died due to COVID-19 in the last 24 hours. The number of deaths due to COVID-19 remains at 110.   

Impact of Northwestern University. Northwestern University has posted data on its website reporting that between Feb. 15 and Feb. 21 there were 30 new confirmed COVID-19 cases of faculty, staff, and students. The number includes those who live outside of Evanston. The City claims it does not know how many of these cases are people who live in Evanston. [5]

Illinois – COVID

 In the State, there were 1,665 new COVID-19 cases reported today, up from 1,246 yesterday.

Statewide, the average number of new cases per day in the last seven days is 1,771, up from 1,725 yesterday.  The seven-day average one week ago, on Feb. 16, was 1,915, so today’s number is a decrease of 8%.  

Today’s seven-day average is down from an all-time high of 12,380 on Nov. 17. An accompanying chart shows the trend.

In the seven days ending Feb. 23, the number of new cases per 100,000 people in the State was 98, down from 

106 one week ago.

The seven-day case positivity rate for the State today is 2.8% and the test positivity rate is 3.0%.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 1,488 as of midnight on Feb. 22. This is down from an all-time high of 6,171 on Nov. 23.

The number of patients using ICU beds is 361, down from 1,195 on Dec. 1. The number of patients on ventilators is 172, down from 724 on Dec. 1.

On a Statewide basis, there were 27 deaths due to COVID-19 in the last 24 hours, which brings the total to 20,330.

For the last seven days, the numbers of deaths in the State are 24, 72, 63, 42, 35, 34, and 27 today. The seven-day average is 42.

Vaccinations in the State

A total of 2,752,885 doses of vaccine have been delivered to providers in Illinois, including Chicago and long-term care facilities.  IDPH is currently reporting that a total of 2,254,982 doses of vaccines have been administered.

FOOTNOTES 

1/ On Feb. 12, the CDC issued a “K-12 School Operational Strategy.” As part of that strategy, the report says, “CDC recommends the use of two measures of community burden to determine the level of risk of transmission: 1) the total number of new cases per 100,000 persons in the past 7 days; and 2) the percentage of nucleic acid amplification tests (NAATs), including RT-PCR tests that are positive during the last 7 days. The two measures of community burden should be used to assess the incidence and spread of SARS-CoV-2 in the surrounding community (e.g., county) and not in the schools themselves.” The CDC provides a chart to assess whether the risk of transmission is low, moderate, substantial, or high. The CDC recommends different types of mitigations depending on the risk level. If the two indicators suggest different levels of risk, the mitigations recommended in the higher level of risk should be implemented, says CDC. The table below, reprinted from CDC’s report, provides CDC’s Indicators and Thresholds for Community Transmission of COVID-219.

 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” – 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/ The Test Positivity Rate. In addition, 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.”  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.”

IDPH says 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%.

4/ Calculations. The RoundTable calculates 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.

5/ 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. On Nov. 13, the City filed a response claiming it does not have any records showing the number of NU students who tested positive for COVID-19 and who live in Evanston.

The RoundTable has asked Northwestern University on several 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.