The Northeast Region less than two weeks away from moving to Phase 3 of Governor J. B. Pritzker’s Restore Illinois plan. Restrictions will be loosened for many businesses and activities in Phase 3, but in virtually every case, the opening or loosening will be subject to guidance from the Illinois Department of Public Health, which is still forthcoming.

The Restore Illinois Plan

Under the Restore Illinois plan, the Northeast Region is on track to move from Phase 2 to Phase 3 in about 10 days, Gov. Pritzker reiterated today.  Evanston, along with the rest of Cook County and eight other counties, is in the Northeast Region.

If the region moves to Phase 3, certain restrictions currently in place will be loosened, but many restrictions will remain in place. Schools may still not be opened for in-class instruction; bars and restaurants will not be open, except for take-out; gatherings of more than 10 people will still be prohibited.

Face coverings in public will still be required, and social distancing will still be expected. Here is what the plan says:

Gatherings: All gatherings of 10 people or fewer are allowed with this limit, subject to change based on the latest data and guidance.

Travel: Travel should follow IDPH and CDC approved guidance.

Health Care: All health-care providers will be open with IDPH approved safety guidance.

Education and child care: Remote learning only will be permitted in Pre-K-12 schools and higher education; limited child-care and summer programs may open with IDPH approved safety guidance.

Outdoor recreation: State parks will be open; activities will be permitted in groups of 10 or fewer with social distancing.

 Manufacturing: Non-essential manufacturing that can safely operate with social distancing can reopen with IDPH approved safety guidance; Select industries can begin returning to workplaces with social distancing and sanitization practices in place.

“Non-essential” businesses: Employees of “non-essential” businesses are allowed to return to work with IDPH approved safety guidance depending upon risk level, tele-work is strongly encouraged wherever possible. Employers are encouraged to provide accommodations for COVID-19-vulnerable employees.

Bars and restaurants: These will be open for delivery, pickup, and drive-through only.

Personal care services and health clubs: Barbershops and salons may open with IDPH-approved safety guidance. Health and fitness clubs may provide outdoor classes (as long as people are practicing social distancing and have fewer  than 10 people) and one-on-one personal training with IDPH approved safety guidance is permitted.

Retail: Shops and stores may open with capacity limits and IDPH-approved safety guidance, including face coverings.

Virtually everything that may be opened in Phase 3 is subject to guidance from IDPH. When asked what the guidance was for certain areas, such as childcare and retail malls, Gov. Pritzker and Dr. Ngozi Ezike, Director of Illinois Department of Public Health, said the guidance would be coming in the next few days.

The Criteria to Move to Phase 3

To move to Phase 3, the Northeast 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 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. Ezike.

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 14 cases today, for a total of 593 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 22 Evanstonians have died due to COVID-19. IDPH reports that 16 residents or staff of long-term care facilities in Evanston have lost their lives due to the virus.

New cases and deaths in Cook County and Illinois: Today, there were 1,001 new confirmed cases of COVID-19 in Cook County and 1,545 in the State. The trend, which has wide variations from day to day, is shown in the top chart above.

Since May 1, there have been 28,168 new confirmed cases of COVID-19 in Cook County and 45,105 new confirmed cases in Illinois.

Dr. Ezike said the high number of cases is due to more tests being administered in the State.

The number of deaths in Illinois due to COVID-19 increased by 146 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 4,379.

Hospital Admissions/Capacity in the Northeast Region

IDPH posts 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 18:

  • Hospital admissions have declined by 41.8% in the Northeast Region since May 1. This is on track to meet the criteria.
  • The Northeast Region has 17.6% of its medical/surgical beds, 19.4% of its ICU beds, and 62.3% of its ventilators available. This is on track to meet the minimum capacity of 14%
  • The test-positive rate, using a seven-day rolling average, is 17.5%, which is slightly below the maximum of 20% stated in the plan.

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

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

Adequacy of Testing

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.”

The plan does not state how IDPH will determine if a Region is meeting this criteria. 

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.”**

While the State has almost quadrupled the number of tests it is administering in the last six weeks, the average per day between May 15 and 19 is 20,961, still far short of the target of 64,167 set by HGHI.

Gov. Pritzker said today that the State is administering more tests per person than any other state in the country.

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. According to the World Health Organization and some researchers, a test positive rate over 10% likely reflects that there is an inadequate amount of testing. ***

In the Restore Illinois plan, one criterion to move from Phase 2 to Phase 3 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.

As of May 15, IDPH reported that the test positive rate for the Northeast Region, was 17.9%, down 5.3 percentage points in the last 14 days.

The seven-day rolling average for the State is 14%,

While the Northeast Region meets the criteria of the Restore Illinois Plan, it is still significantly higher than the maximum threshold recommended by WHO and some researchers.

Contact Tracing

The Restore Illinois plan provides that a Region must meet the criteria for contact tracing to move from Phase 2 to Phase 3. The requirement stated in the plan is “Begin contact tracing and monitoring within 24 hours of diagnosis.” 

IDPH has not posted information on its website to show if the Northeast Region is meeting these criteria.

On a Statewide basis, Gov. Pritzker said yesterday, “Only about 29% of our known cases are engaged in a tracing process.”

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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. On May 15, Gov. Pritzker said, “Overall, the positivity rate can be an indication of how wide spread COVID-19 infections are among our population. We all want the positivity rate to come down which would indicate a declining number of people getting sick from the virus.”