This article monitors the revised criteria being used by School District 65 in determining whether to open its schools for in-person learning on Nov. 16. It continues to monitor new COVID-19 cases and other risk factors for Evanston and for the State. 1/

New COVID-19 Cases in Evanston and Other Risk Factors

New cases and deaths of Evanstonians: There were 4 new confirmed COVID-19 cases of Evanston residents today. The average number of new cases per day in the last seven days is 4.7.  There has been a total of 1,177 cases of Evanston residents, 70 of which are active. 2/

The 7-day test positive rate (the percentage who tested positive over a 7-day period) for Evanston today is 1.2%.

The above chart shows the trend of COVID-19 cases of Evanstonians using data reported by the City.

The total number of Evanstonians who have died due to the virus remains at 73; there have been 2 deaths since July 11.

According to data provided by IDPH on Oct. 2, about 75% of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities.

All Northwestern University students, staff and faculty who reside in Evanston are included in the numbers reported above, Ike C. Ogbo, Director of Evanston’s Health & Human Services Department, told the RoundTable. He said the City is not considering breaking out the data for any Evanston institution, including Northwestern University, for privacy reasons.

Northwestern University posted data on its website reporting that between Sept. 28 and Oct. 4, there were 17 new confirmed COVID-19 cases of students, staff and faculty based on Northwestern Medicine testing data. This data includes students, staff and faculty who reside out of Evanston and those who attend the NU’s Chicago campus. The RoundTable has asked NU how many of the students who tested positive lived in Evanston; NU has not responded. The test positive rate for NU students, staff and faculty is 0.38%.

Criteria Being Used by School District 65

On Sept. 25, Superintendent Devon Horton said School District 65 will be monitoring four of IDPH’s Risk Metrics and IDPH’s Metrics for School Determination of Community Spread in deciding whether to open the District’s schools for in-person learning on Nov. 16.

The metrics all relate to how Region 10 (Suburban Cook County) is doing in managing and suppressing the pandemic.  They are discussed below.

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 seven 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.

On Oct. 5 there were 105 new COVID-19 cases per 100,000 people in Suburban Cook County, well above the target of 50 cases. The first chart in the chart box shows the trend. 3/

To meet this criterion, the total number of new COVID cases in a 7-day period in Suburban Cook County must decline to about 1,330 new cases. In the 7 days preceding Oct. 6, there were 2,597 new cases.

Second, a Test Positivity Rate of 5% or Less. IDPH’s target is that there be a test positivity rate of 5% or less in Suburban Cook County.

While the World Health Organization and Johns Hopkins say that the test-positive rate should be below 5% before opening an economy, the Harvard Global Health Institute (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. 3, was 4.8%. In the prior two days it was 4.9% and 5.2%.. The second chart in the chart box shows the trend in the 7-day positivity rates.

The 1-day test positivity rate on Oct. 3 was 4.8%.

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.

Each bar in the third chart in the chart box shows the total number of new COVID-19 cases in the 7-day period preceding the date provided at the bottom of each bar. For example, the bar above the date Oct. 6 shows there were 2,597 new cases in Suburban Cook County in the period Sept. 30-Oct. 6.

The bar above the date Sept. 29 shows there were 2,367 new cases in Suburban Cook County in the period Sept. 23-29.

Between the two 7-day periods the number of cases increased by 203 cases, or by 9.7%.

Fourth, New COVID-19 Cases of Youth in a Week. This criterion also looks at the trend of new cases, but for youth, which IDPH defines to be anyone under 20 years old. The RoundTable will report on this criterion when it compiles sufficient data.

Fifth, Hospital Admissions and Surge Capacity. This criterion is a risk factor monitored by IDPH, but it is not one of the criteria being monitored by District 65.

The data show that there were a total of 20 hospital admissions due to COVID-19 in Suburban Cook County on June 26, (the day the State moved to phase 4 of the Restore Illinois Plan). The number was 25 on Oct. 3, the most recent date for which data is available. The increase in negligible.

IDPH reported that as of Oct. 5, Suburban Cook County has a surplus capacity of 28% of medical/surgical beds and 35% of ICU beds. IDPH’s target is 20% surplus capacity, so the target is met. The amount of the surplus capacity, though, has been trending downward because hospitals are using more beds for non-Covid-19 cases.

New Cases, Positivity Rate, and Hospitalizations in the State

New Cases: In the State there were 1,617 new cases reported today. The number of new cases reported per day in the last seven days has been 2,273, 2,166, 2,206, 2442, 1,453, 1,853, and 1617 today. The current 7-day average of new cases per day is 2,001.   

For purposes of comparison, the average of new cases per day over the seven days ending on May 1 was 2,565, which is one of the highest in the State. 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 32 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 8,836.

Hospitalizations: On a Statewide basis, the highest number of hospitalizations due to COVID-19 was 4,868 on May 6, and it dropped to 1,498 on June 26. As of midnight on Oct. 4, the number of hospitalizations in Illinois was 1,673, an increase of 175 since June 26.

So far, increases in the number of new cases has not resulted in a significant surge of hospital admissions or of total hospitalizations.

Test Positive Rate: On a Statewide basis, the 7-day test positive rate today is 3.4%, 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 58,313. This is substantially higher than HGHI’s mitigation level testing target of 19,116 per day, but still less than its suppression level testing target of 68,211 per day. 4/.

Delays in Getting Test Results: Another critical factor is how long it takes to get COVID-19 test results.  An Aug. 3 report published by a group of universities concludes that the optimal time to get test results is the same day, or within 1 to 2 days. 5/

IDPH does not report the median time it takes to get test results, but it has published some guidance indicating that the typical time is 2 to 3 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.

Contact Tracing: Widespread contact tracing is also essential to control the spread of the COVID-19 virus and to open an economy safely.

There is no data disclosing the percentage of COVID-19 cases that are contact traced and how quickly the tracing starts.

When Can Regions Move to Phase 5?

Phase 5 is the last phase of the Restore Illinois Plan. A region may move to Phase 5 if there is a vaccine, effective and widely available treatment, or the elimination of new cases over a sustained period of time through herd immunity or other factors.

Dr. Anthony Fauci said on Sept.11, that he expects a vaccine will become available by the beginning of 2021, but that it will likely take until the end of 2021 to vaccinate more than 50% of the population. He said it will likely be well into 2021 or towards the end of 2021 before the country will get back to some degree of normalcy. 

Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, told a Senate committee on Sept. 16 that most Americans would not likely be vaccinated before the summer or fall of 2021. He urged people to use facemasks, which he said are “the most important, powerful public health tool we have.”

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Footnotes

1/ Under a July 15 Action Plan to Combat a Resurgence of COVID-19 in Illinois, the State has been divided into 11 regions, and the Governor and the Illinois Department of Public Health will determine if additional mitigations are appropriate in a region, on an individualized basis. Suburban Cook County is a region for purposes of the plan.

Under the Action Plan to Mitigate a Resurgence of COVID-19 announced on July 15, additional restrictions may be imposed in a region if there is:

  • A sustained rise in the 7-day rolling average of the test positivity rate ( for 7 days out of a 10 day period) and one of the following:
    • A sustained increase in hospital admissions for a Covid-19 like illness, or
    • A reduction in hospital capacity threatening surge capabilities (ICU capacity or medical/surgical beds under 20%) OR
  • Three consecutive days averaging greater than or equal to an 8% positivity rate.

 

2/  IDPH reports only the number of COVID-19 cases which have been confirmed through a test. The number does not include people who are infected, but who have not been tested, which may include people who are asymptomatic or who have minor symptoms. Any person who is infected, whether symptomatic or asymptomatic, may spread the disease.

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/  A report, “Tracking COVID-19 in the United States: From Information Catastrophe to Empowered Communities” published by Resolve to Save Lives on July 21, says, “If test results are delayed beyond one or two days, they become much less useful, as those who are infected will have passed the period of peak infectivity and will neither be able to be rapidly isolated (unless all who are tested are isolated until result return), nor warn exposed contacts so that they can quarantine before they become infectious.” Dr. Thomas R. Frieden, the former director of the CDC, runs Resolve to Save Lives. Link to the study: https://preventepidemics.org/wp-content/uploads/2020/07/Tracking-COVID-19-in-the-United-States-Report.pdf

 

6/  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