Evanston had 7 new confirmed cases of COVID-19 today, the seventh day into Phase 4 of the Restore Illinois Plan. The State had 868 cases, one less than yesterday. In the last six days, there has been an increase in cases in the State from 646 to 868.

Today CDC reported there were 53,301 new COVID-19 cases in the nation, the second highest in a single day.  On a nationwide basis, the average number of new COVID-19 cases in the last seven days is 45,335 per day, compared to an average of 21,596 in the first seven days of June, or a 110% increase.

New COVID-19 Cases in Evanston, Cook County and Illinois

Each region of Illinois moved to Phase 4 of the Restore Illinois plan on June 26, which opened up more businesses and activities, subject to guidelines approved by the Illinois Department of Public Health. Under the plan, a Region may be moved back into Phase 3 based on the following factors:

  • A sustained rise in the COVID-19 test positivity rate
  • A sustained increase in hospital admissions for COVID-19 like illness
  • A reduction in hospital capacity threatening surge capabilities
  • A significant outbreak in the region that threatens the health of the region

This article presents data, as of July 3, relevant to these factors and to the ability of the State to conduct adequate testing and contact tracing.

Governor JB Pritzker said last week he will not hesitate to move Illinois back to phase 3, or to reinstate certain restrictions, if there is a surge in infections.  He said the State is monitoring what is happening in other states that are experiencing a surge in cases and hospitalizations.

New Cases in Evanston, Cook County and Illinois

The data below show the number of new confirmed COVID-19 cases in Evanston, Cook County, and Illinois. The number of new cases is important because about 30% of the people who have COVID-19 are hospitalized, said Dr. Ngozi Ezike, Director of Illinois Department of Public Health. In addition, people who have COVID-19 are infectious and may spread the disease.*

New cases and deaths of Evanstonians: There were 7 new confirmed COVID-19 cases of Evanston residents today, July 3, according to data provided by IDPH. The total number of confirmed COVID-19 cases of Evanstonians is now 805. 

Over the last seven days, the City reported an average of 3.7 new COVID-19 cases per day. For the seven days prior, there was an average of 2.0 new cases per day. The trend is shown in the above chart. 

As previously reported, there was an increase of 8 cases in Evanston on June 30. The City has just reported that 5 of those cases were persons who resided in a long-term care facility. Information about the 7 new cases today is not yet available.

As of July 2, the total number of Evanstonians who have died due to the virus  was 69. 

According to data provided by IDPH on June 26, 51 residents or staff of long-term care facilities in Evanston have died due to COVID-19. Thus, 73 % of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities. Two facilities account for 37 of the deaths.

New Cases and Deaths in Cook County and Illinois: There were 393 new cases of COVID-19 in Cook County in the last 24 hours, and 868 in the State. The last six days show an uptick in Illinois cases, going from 646 on June 28 to 738, to 724, to 828, to 869, to 868.

The number of new cases in the State is still much lower than the 3,137 new cases reported on May 1, and the 1,622 reported on May 29, the day the State moved into Phase 3.

Between June 29 and July 3, the average number of new COVID-19 cases per day in Cook County was 404, and in the State, it was 805. The trends are shown in the first two charts in the above chart box.

The number of deaths in Illinois due to COVID-19 increased by 18 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 7,005.

Hospital Admissions and Surge Capacity in the Northeast Region

One metric that will be used to determine whether a region will be moved back to phase 3 is whether there is a “sustained increase” in hospitalizations for COVID-19 illnesses.

Another metric is whether there is a reduction in hospital capacity to care for patients with COVID-19 illnesses. There is no set criteria to assess what constitutes adequate capacity, but IDPH said 14% surplus bed capacity would be adequate for a Region to move to Phase 4.

IDPH reports that in the last 28 days, hospitalizations in the Northeast Region declined by 65%. IDPH does not report the number of hospitalizations in the Region, but there is a downward trend from 28 days ago.

The Northeast Region has available 33% of its medical/surgical beds, 47% of its ICU beds, and 74% of its ventilators. This easily meets a minimum surplus capacity of 14%.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,238 on June 1, and 1,498 on June 26 (the date the State moved to Phase 4 of the Restore Illinois plan). As of midnight on July 2, the number of hospitalizations was 1,349, a decrease of 302 from midnight on July 1. The third chart in the chart box shows the trend in hospitalizations since June 1.

Adequacy of Testing

Widespread testing is essential to controlling the spread of the COVID-19 virus and to open an economy safely.

     Test-Positive 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 said on May 15 that the test-positive rate should be below 5% before opening an economy. A higher test-positive rate reflects that there is an inadequate amount of testing. **

Recently, the Harvard Global Health Institute (HGHI) published a paper saying that a research/policy collaborative agreed that a 3% test positive rate or below is a key indicator of progress towards suppression level testing.***

IDPH reported that the test-positive rate for the Northeast Region as of July 3 was 4%, down 1 percentage point in the last 14 days.

The Northeast Region meets the rate recommended by WHO.    

On a Statewide basis, the test positivity rate on July 3 was 2.5%. The average for the last five days was 2.6%.

       The Number of Tests in Illinois

In a recent paper, HGHI published two testing targets for each State: one for what it calls mitigation level testing, and second for suppression level testing. For Illinois, the mitigation level testing target is 19,116 tests per day. For suppression level testing the target is 68,211 tests per day.***

 While the number of COVID-19 tests that the State has administered has increased almost six-fold since the beginning of April, the average number of tests per day between June 29 and July 3 is 31,131. This is substantially higher that the mitigation level testing target, but less than 50% of the suppression level testing target.

On July 3, there were 34,318 tests.

Contact Tracing

Widespread contact tracing is also essential to controlling the spread of the COVID-19 virus and to open an economy safely. The adequacy of contact tracing is not listed as a factor in deciding whether to move a Region back to Phase 3. But if contact tracing is not adequate, the impact may be an increase in new COVID-19 cases and hospitalizations.

In its criteria to move from Phase 3 to Phase 4, the Restore Illinois plan provided, “Begin contact tracing and monitoring within 24 hours of diagnosis for more than 90% of cases in region.” Dr. Ezike said this is an “internal goal.”

There is no data indicating how close the State is toward meeting this goal. On a Statewide basis, Gov. Pritzker said on May 29 that contact tracing was only being done on about 30% of the known cases, far short of the 90% goal.

On June 23, Gov. Pritzker said he was not in a position to provide metrics regarding the amount of contact tracing being done.

On June 25, the Governor’s Office said in a prepared statement that the State “continues to build up its statewide contact tracing capacities, increasing the ranks of contact tracers by 20% since June 1 for a total of over 550 active contact tracers across the State. 250 new tracers will join their ranks in the coming weeks as Illinois continues to scale up operations, including using new technology to multiply the State's effectiveness in its contact tracing efforts.”  

Cook County has received about $41 million in grant funding from IDPH to rapidly scale-up its COVID-19 contact tracing program in suburban Cook County. The County recently said it would not have contact tracing fully in place until the fall.

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.

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Footnotes

* 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. On June 25, the Director of CDC said that the center’s best estimate is that for every case that is reported there are actually 10 other infections.

** 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 recently posted a paper, “July 6, 2020/State Testing Targets,” in which it published new 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 “suppresson” 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