In the last five days, the State averaged 21,727 tests for COVID-19 per day, almost five times the level tested six weeks ago. For the first time, the positive test rate for COVID-19 on a State-wide basis dropped below 10%, a key marker used by some researchers to measure the adequacy of testing.

The Restore Illinois Plan

In the Restore Illinois plan, the State is already in Phase 2 of the five-phase plan. There are four regions of the State, and each region may move through the remaining phases at its own pace, depending on when they meet the criteria to do so. Evanston, along with the rest of Cook County and eight other counties, is in the Northeast Region.

To move to phases 3 and 4, a region must meet benchmarks relating to hospitalizations, testing, and tracing.

The Number of Infections and Hospitalizations

One metric being used to determine if a region may move to Phase 3 and then to Phase 4 is that there be no overall increase in hospital admissions for 28 days, and that hospitals in the region have an unused bed capacity of at least 14%.

 While the criteria focus on the number of hospitalizations, rather than new COVID-19 cases, the number of new cases is still important, because about 30% of the people who test positive for COVID-19 are hospitalized, said Dr. Ngozi Ezike, the Director of the Illinois Department of Public Health.

The data below show new COVID-19 cases in Evanston, Cook County and Illinois, and the number of hospital admissions in the Northeast Region.

New COVID-19 Cases

New cases and deaths of Evanstonians: The number of Evanston residents who have tested positive for COVID-19 increased by 6 cases today, for a total of 538 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 18 Evanstonians have died due to COVID-19. Of the persons who lost their lives due to the virus, at least 13 were residents or staff of long-term care facilities in Evanston.

New cases and deaths in Cook County and Illinois: Today, there were 1,448 new confirmed cases of COVID-19 in Cook County and 2,432 in the State. The trend, which has wide variations from day to day, is shown in the smaller chart above.

Since May 1, there have been 23,382 new confirmed cases of COVID-19 in Cook County and 37,457 new confirmed cases in Illinois.

Dr. Ezike said the high number of cases is due to more tests being administered in the State. She added that there are far, far more people who have COVID-19 in the State than have tested positive, because the amount of testing has been limited.

The number of deaths in Illinois due to COVID-19 increased by 130 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 4,058.

Hospital Admissions/Capacity in the Northeast Region

IDPH has begun to post summary information showing how the Northeast Region is doing in terms of meeting the criteria to move to Phase 3. The data shows that as of May 15:

  • Hospital admissions have declined by 25.2% in the Northeast Region since May 1. This is on track to meet the criteria.
  • The Northeast Region has 17.2% of its medical/surgical beds, 18.4% of its ICU beds, and 63.1% of its ventilators available. This is on track to meet the minimum capacity of 14%
  • The test-positive rate, using a 7-day rolling average, is 19.4%, which is slightly below the maximum of 20%.

IDPH does not report data showing whether any region is meeting or on track to meeting the criterion for tracing.

Gov. Pritzker said, though, that the Northeast Region is on track to meeting the criteria to move to Phase 3 at the end of the month.

Adequacy of Testing

In his remarks on May 15, Governor J. B. Pritzker once again focused on testing and its importance to safely open the economy.

The Restore Illinois plan does not set a goal in terms of the number of tests that must be given in a region to advance to less restrictive phases. Rather, to move from Phase 2 to Phase 3, a region must have testing available “for all patients, health care workers, first responders, people with underlying conditions, and residents and staff in congregate living facilities.” To move from Phase 3 to Phase 4, testing must be “available in region regardless of symptoms or risk factors.”

The plan does not state how IDPH will determine if a Region is meeting these criteria. When asked today what the definition of adequate testing was, Gov. Pritzker gave a general response: “We want it widely available,” and he added, “We’re making a lot of progress.”

On a Statewide basis, Gov. Pritzker said testing has been expanded to include the following groups: all front-line workers and essential workers, including workers in grocery stores, pharmacies, restaurants, gas stations, public utilities, factories, childcare, eldercare and sanitation; all health care workers; all nursing home residents and staff; all first responders; all correction officers; all people with a compromised immune system or chronic condition; anyone with COVID-like symptoms; and anyone that has had contact with a confirmed COVID-19 case, whether or not they have symptoms.

“We now have 251 public testing sites across the State that offer free testing,” said Gov. Pritzker, and the State is running seven drive-through testing sites with plans to add four more in the next few days.

While he did not provide specific data for each region, he said he thought each region was on track to meet the criteria of adequate testing to move to Phase 3 at the end of this month.

The Number of Tests in Illinois

In a May 7 study, the Harvard Global Health Institute (HGHI) estimated that Illinois needed to be administering 64,167 tests a day in order to safely open the economy.*

When asked about this number on May 7, Gov. Pritzker said, “I don’t think 64,000 is adequate for the State of Illinois. I think we’re going to need many more tests than that.”**

The State has significantly increased its testing capacity. In the first five days of April, there was an average of 5,152 tests per day. The average per day between May 11 and 15 is 21,727.

Using a 7-day average, Illinois is now testing 4.7% of its population per month.

While the amount of testing has dramatically increased, it falls far short of the target of 64,167 set by HGHI.

The Percent Positive Test Rate

One measure used by researchers to assess whether the amount of testing is adequate is to look at the percent of people who test positive on COVID-19 tests. The World Health Organization suggests that a test-positive rate should be between 3% and 12%. A test-positive rate greater than 10% likely reflects that there is an inadequate amount of testing and that it should be increased to cast a wider net.***

“Overall, the positivity rate can be an indication of how wide spread COVID-19 infections are among our population,” Gov. Pritzker said today. “We all want the positivity rate to come down, which would indicate a declining number of people getting sick from the virus.”

In the Restore Illinois plan, one criterion to move from Phase 2 to Phase 3 and from Phase 3 to Phase 4 is that a region have a test-positive rate below 20%. In determining whether this criterion is met, IDPH says it will use a seven-day rolling average for the last 14 days.

The 20% threshold is double what some researchers say should be the maximum.

As of May 15, IDPH reported that the test positive rate for the Northeast Region was 19.4%, down 3.7 percentage points in the last 14 days.

On a Statewide level, the positivity rate over the last 24 hours is 9.2%, Gov. Pritzker said. This appears to be the first time the rate dropped below 10%, the maximum rate suggested by some researchers.

Gov. Pritzker added that the State-wide seven-day average of the positivity rate is 12%, and the 14-day average is 14%.

He said the 14-day average is likely “a better indicator of the true infection rate among the general public than when testing was far more limited.”

The Need for Testing

“Testing of course is enormously beneficial to Illinoisans on an individual level,” said the Gov. Pritzker. “Having the ability to know whether you currently have the virus provides a small comfort in a world with so many unknowns. More tests also means more surveillance so we can respond to outbreaks that are taking place. But just as importantly, testing is instrumental in our ability to reopen the economy while controlling the spread of the virus. That’s what it takes to keep the public safe while getting our people back to work and into the world.”

 Dr. Ezike said in a prepared statement, “Not everyone with COVID-19 has symptoms. Without greater testing, it is difficult to know who is infected with this virus. This could mean a person who thinks they are healthy may unknowingly pass the virus to someone else, potentially with deadly consequences.

“I encourage residents in these areas to take advantage of this opportunity to get tested for free and to take action to help prevent further spread of the virus,” she said.

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Footnotes

*Ashish Jha, MD, MPH, the Faculty Director of the Harvard Global Health Institute (“HGHI), and two colleagues conclude in a May 7 report, “HGHI and NPR publish new state testing targets” that on a nationwide basis 900,000 tests for COVID-19 are needed by May 15 to open the economy. They also provide estimates of the tests each state should be ready to provide by May 15. For Illinois, they say that 64,167 tests a day are needed. Link to HGHI’s report: https://globalepidemics.org/2020/05/07/hghi-projected-tests-needed-may15/

HGHI’s report said it was publishing its results in partnership with NPR, and it provides a link to the article that published HGHI’s results in a little more detail. The article notes that other organizations have estimated that Illinois needs 44,898 tests per day (Los Alamos) and 96,342 tests per day (MIT). What the various models have in common is that they show that the number of COVID-19 tests currently being administered on a daily basis in Illinois is very low. Link to the article: https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing

A report, “Roadmap to Pandemic Resilience,” published by the Edmond J. Safra Center for Ethics at Harvard University, concludes that on a nationwide basis the nation needs to be doing 5 million tests per day by early June to deliver a safe social reopening. ” Link: https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20_0.pdf

**Governor Pritzker explained, “We want people to be safe when they go to work. We want people to be safe when they go to school. People want to be safe in all their activities and they want to know that others have been tested around them.” He said it was important “nobody is without an opportunity to get a test.”

*** See above article by Ashish Jha, MD, MPH.