Evanston reported 60 new Covid-19 cases today, on top of 43 yesterday. Simultaneously the test positivity rate increased to 5.6% indicating that many cases are in the community that have not been detected. This afternoon, the City issued a stay-at-home advisory.

At the State level, today was the eighth day in a row that the number of new COVID-19 cases topped 10,000 in Illinois, and set yet another record with 15,415 cases. Gov. JB Pritzker and Dr. Ngozi Ezike, Director of IDPH, each said new cases were increasing exponentially. Today, the number of hospitalizations due to the virus have hit yet another all-time record.

Evanston’s Stay-at-Home Advisory

The City of Evanston’s Health & Human Services Department (H&HSD) issued an advisory this afternoon that residents should stay at home except for essential activities. The advisory is similar to the recommendations issued yesterday by IDPH, which are set out in the sidebar.

The City advises all residents to:

Stay home as much as possible. Only go out for essential activities, such as school, work, grocery shopping, or visits to the pharmacy. Those who are able to work from home are encouraged to do so.

Limit gatherings. Refrain from attending or hosting gatherings with those who do not live in your household. This includes Thanksgiving celebrations.

Limit non-essential travel. As much as possible, do not engage in any non-essential travel, including vacations or trips to visit relatives or friends.  

Practice proven preventive measures. Wear a face covering over your nose and mouth in public settings, maintain a distance of at least six feet from others, and wash hands thoroughly and often.

“Our collective actions can reduce the rate of infections, prevent our hospitals from being overwhelmed, and, ultimately, save lives,” said Ike Ogbo, Director of Evanston’s H&HSD. “We are asking residents to take these necessary actions today to prevent more restrictive mitigation measures in the future.”

Evanston Mayor Stephen Hagerty told the RoundTable, “The spread of COVID-19 in Evanston is not related to any one particular group. It's community spread. This means all of us need to adhere to the latest protocols issued by public health authorities, including the Stay at Home Advisory.

“The Evanston Health Department continues to conduct contact tracing on each case and analyze the aggregate data, as limited as it is locally, to identify any trends and areas where our public health efforts can be further focused. 

“Given the significant rise in cases Statewide, including Evanston, I am worried that if we all don't do our part right now to slow the spread, our hospitals will experience severe shortages of beds, staff, and supplies, and more lives will be lost unnecessarily. 

“If residents were thinking of traveling for the upcoming holidays or having friends and family to their homes, now is the time to reconsider those plans. We need to protect each other, our families, and our community, and that means sacrifice and hard work on all our parts to limit our interactions in order to slow the spread.” 

IDPH’s Guidance and Bed Capacity

Dr. Ezike said, “The truth remains that the virus is running rampant through our communities and throughout our whole State and throughout neighboring states, the entire country. And the more people go out and move about and are in contact with others, the greater the potential of spread of this virus and the longer this pandemic will last.

“If we want to be able to go out to eat, to finally have that wedding that's been postponed since the spring, to visit family and friends, we need to stay home now to be able to achieve that later. And the only way we can begin to get back to normal is to reverse the trend, to decrease the number of people getting infected every day, to decrease the number of individuals getting into the hospital, to decrease the number of deaths.

“And to do this, we just have to decrease the opportunity to have the virus spread in the first place. I know there's COVID fatigue, but we have to be on guard against complacency.”

When asked whether hospitals had adequate bed capacity to care for an influx of COVID-19 patients, Dr. Ezike said Suburban Cook County and Chicago have not yet reached the peak they reached in the spring. She said their bed capacity now may be just under 20%. She added, though, “We are seeing capacity decrease everywhere.” She said as the number of new cases rises, the number of hospitalizations increase, and in some regions the number of hospitalizations has increased 200% or 300%.

“So everyone's capacity is being threatened. … Everyone is heading in the wrong direction. And so everyone's trying to make plans on how we're going to brace for that and be able to  care for not just the COVID patients, but if someone has a heart attack tomorrow,” that person would also need a hospital bed.

Dr. Ezike said hospitals in some regions are already putting off elective surgeries, not only to make room for COVID-19 patients but to free up hospital staff so that they can take care of COVID-19 patients. She said she is talking to hospital leaders every day.

As an example, Dr. Ezike said, “If there are several hospitals in the region, and there are three or four that are at capacity, we need to bring everyone to the table to try to collaborate to see who can take which patients, what kind of arrangement we can create, so that everyone has a bed.”

Gov. Pritzker said, “As more and more COVID cases show up, …. we want to make sure that everybody has a hospital bed if they need one. And so we're working with all the hospitals to make sure that their patients are being managed properly. If there aren't enough beds at one particular hospital, for example, if that happens, we want to make sure that a patient can be transferred to another hospital.

 “Meanwhile, our hospitals are not overrun,” said the Governor. “But we have hospitalizations that are rising at a rapid rate. And we want to make sure that we don't get to a point where patients are getting turned away.”

Dr. Ezike said everyone has to play their part in making sure that hospitals are not overrun. She said everyone should follow the restrictions imposed by the State, adhere to the recommendations of IDPH, wear masks, and socially distance.

EVANSTON: 60 New COVID-19 Cases Today

There were 60 new confirmed COVID-19 cases of Evanston residents today, which is a record high for the entire pandemic.  The average number of new cases per day in the last seven days is 32.6. For purposes of comparison, on Oct. 12, the seven-day average was 5.6.

There has been a total of 1,838 cases of Evanston residents during the pandemic, 253 of which are active. An accompanying chart shows the trend. [1]

In the last 7 days, there were a total of 228 new COVID-19 cases of Evanstonians. That equates to about 303 new cases per 100,000 people in the 7-day period. The State’s 7-day target is 50 per 100,000.

The test positivity rate over the last 7 days has moved up to 5.6%.

One Evanstonian died due to COVID-19 in the last 24 hours. The total is now 81.

The Impact of NU on Evanston’s Increase in Cases

All Northwestern University (NU) students, staff and faculty who live in Evanston and who test positive for COVID-19 are included in the case numbers reported above, according to the City.  If NU students, staff or faculty live outside Evanston, they are not included. [2]

Northwestern University has posted data on its website reporting that between Nov. 6 and Nov. 12 (the latest period for which data is available) there were 63 new confirmed COVID-19 cases of students, staff and faculty, which includes those who live outside of Evanston.  The test positive rate for NU students, staff and faculty is 1.11%.

SUBURBAN COOK COUNTY, CHICAGO AND ILLINOIS 

Several key metrics used by IDPH to measure the spread of COVID-19 are the trend of new cases, the number of new cases per 100,000 population, and the test positivity rate.  Another key metric is the number of hospitalizations due to COVID-19 and hospitals’ capacity to care for a surge of new patients.

First, New Cases.  In Suburban Cook County, there were 2,959 new COVID-19 cases today, and in Chicago there were 2,990, for a total of 5,949.

 In the State there were 15,415 new cases reported today, which again set an all-time record.

 Today, the 7-day average of new cases per day in the State is 12,345, which is 56% higher than the 7-day average one week ago. It sets yet another record for the highest 7-day average during the entire pandemic.

For purposes of comparison, the average of new cases per day over the seven days ending on May 1 was 2,565, which was the previous high for the State, until the increases in the last several weeks. The 7-day average today is almost five times that.

The trends of new cases in Suburban Cook County, Chicago and the State are shown in accompanying charts.

Second, New Cases per 100,000 Population. This criterion measures the level of contagion in an area and whether it is at a level that can be contained and suppressed. IDPH’s target is that there be fewer than 50 new COVID-19 cases per 100,000 people in a geographic area in a 7-day period. Harvard’s Global Health Institute (HGHI) and the Edmond J. Safra Center say that a stay-at-home order is necessary when the weekly cases exceed 169. [3]

In the 7-days ending Nov. 13, the number of new cases per 100,000 people were as follows for the areas indicated:

-        Suburban Cook County:  654 (compared to 97 on Oct. 1 )

-        Chicago:  599 (compared to 86 on Oct. 1)

-        Illinois:  682 (compared to 111 on Oct. 1)

The new cases are six times the number for the week ending Oct. 1, and each is more than eleven times IDPH’s target. They are three times the number that HGHI says necessitates a stay-at-home order.

An accompanying chart shows the trend in the number of new cases during the week ending Nov. 13, compared to the number of new cases for the weeks ending Oct. 1 and Nov. 6. [4]

Third, a Test Positivity Rate. IDPH’s target is that the test positivity rate be 5% or less, although HGHI and other leading experts say it should be 3% or less.  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. [5]

The most recent 7-day test positivity rates are as follows:

-        Suburban Cook County:  14.4% (as of Nov. 10)

-        Chicago:  14.4% (as of Nov. 10)

-        Illinois:  14.5% (as of Nov. 13)

Each positivity rate is more than double IDPH’s target and four times that of other leading experts. An accompanying chart highlights the rates.

Fourth, Hospital Admissions and Surge Capacity. The 7-day average of new hospitalizations due to COVID-19 in Suburban Cook County and Chicago, combined, was 208 on Nov. 9 (the most recent day for which data is available). The number is up from 54 on Sept. 1.

IDPH reported that as of Nov. 13, Suburban Cook County has a surplus capacity of 19% of medical/surgical beds and 25% of ICU beds; and Chicago has a surplus capacity of 20% of medical/surgical beds and 25% ICU beds. IDPH’s target is 20% surplus capacity.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 5,362, as of midnight on Nov. 12. This is up from 1,596 on Sept. 1. A chart in the chart box shows the trend.

For purposes of comparison, until this week, the highest number of hospitalizations due to COVID-19 was 4,868 on May 6.  Today’s rate is almost 500 more than the all-time high.

The number of patients using ICU beds is 956, up from 347 on Sept. 1. Patients on ventilators is 438, up from 142 on Sept. 1.

Dr. Ezike said on Nov. 12 that the number of hospitalizations “is only going to increase based on the numbers of cases that we've identified for the last several weeks.”

If additional hospital beds are needed in Suburban Cook County and Chicago, the contingency plan is to increase bed capacity by doing the same things that were done in the spring, Gov. Pritzker said on Nov. 10.

Fifth: Number of Tests: The average number of tests per day in the last seven days is 93,787. This is higher than HGHI’s “mitigation” level testing target, but about only 46% of the amount needed to meet HGHI’s “suppression” level testing target.  [6].

The number of new tests reported today was 93,787.  This includes antigen tests.

Sixth: Delays in Getting Test Results: Public health experts convened by HGHI and Edmond J. Safra Center say test results should be obtained within 24 hours.

Dr. Ezike said on Nov. 12 that 53% of the lab tests come back in 48 hours.

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. [7]  Gov. Pritzker said the plan is to expand this method of testing across the State, especially to other college campuses.

The new antigen tests being distributed by IDPH can generate results in 15 minutes.

Seventh: Contact Tracing: Widespread contact tracing is also essential to control the spread of the COVID-19 virus.  Over the summer, the State put $237 million into building up contact tracers throughout the State, said Gov. Pritzker. There are now 3,300 contact tracers and the goal is to have 3,800.

Dr. Ezike said on Oct. 29 that as the number of new cases surge, contact tracers are “being stretched very thin, even as we bring the new contact tracers onboard.” She encouraged people to cooperate with contact tracers.

Gov. Pritzker said on Nov. 6 that there are 97 local health departments operated by cities and counties in the State. The two largest, Chicago and Suburban Cook County, are still ramping up. The remaining 95 health departments on average reach out to 90% of the people who have tested positive for COVID-19.

Deaths: There were 27 deaths Statewide in the last 24 hours, and a total of 10,504 deaths due to COVID-19 during the pandemic.

Dr. Ezike said the number 27 may be low “because there were some data systems that connect with each other that experienced a delay. And that delay has resulted in information for the last 24 hours not being completed.”

…………………………….

FOOTNOTES

1/  Antigen Tests. The Illinois Department of Public Health announced on Oct. 15 that is including both molecular (PCR) and antigen tests in the number of statewide total tests performed in Illinois, and that it is including the positive test results on antigen tests in the confirmed COVID-19 cases reported.  “Previously, due to the limited number of antigen tests and limited information about antigen test accuracy, antigen tests were not included in the total number (which comprised less than 1% of total tests performed). Antigen tests, like BinaxNOW™, are now becoming more readily available, therefore, IDPH will include both molecular and antigen tests in its total number of tests starting October 15, 2020,” said the Illinois Department of Public Health. Dr. Ngozi Ezike, Director of IDPH, said on October 30, “You have COVID if you come up with a positive on the antigen test.” Gov. JB Pritzker said it is “very, very likely” that a person had COVIC-19 if they test positive on an antigen test. The State’s plan is to administer 3 million antigen tests provided by the federal government by the end of this year.

Dr. Michael Mina, assistant professor of epidemiology and assistant professor of immunology and infectious diseases at the Harvard T. H. Chan School of Public Health, said an antigen test detects if there is an antigen which is one of the proteins in the virus, while the PCR test looks for the RNA of the virus.

 

2/ 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.

The RoundTable has asked Northwestern University on two 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 to either request.

 3/ 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” – less 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.

4/ Calculations. The RoundTable calculated 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/ The Test Positivity Rate. 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 (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.”

While stating 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%.

6/ How Much Testing Should be Done.  The Harvard Global Health Institute posted a paper showing testing targets as of October 1, 2020. The targets for Illinois are 438 tests per 100,000 people to meet the “mitigation” target and 1,602 tests per day to meet the “suppression” target. The paper says that Illinois 7 day average of testing is 564 tests per day. Link to paper: https://globalepidemics.org/october-1-testing-targets/

Mitigation Level Testing: In an earlier paper, 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.”

Link to HGHI’s report: https://globalepidemics.org/july-6-2020-state-testing-targets/

7/  Saliva-based Tests. 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