There were 5 New Confirmed COVID-19 cases of Evanstonians today. The number of new cases in the State increased to 1,471, with a seven-day average of 1,569.

CDC reported today that there were 49,716 new COVID-19 cases in the nation, the second day in a row with cases under 50,000. The 7-day moving average is now 59,812 new cases per day.

State’s Action Plan to Combat a Resurgence

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.

Key factors in determining whether to impose additional restrictions are whether the test positivity rate is increasing, whether hospital admissions are increasing, and whether hospitals’ capacity to care for a surge of patients is decreasing.*

Gov. JB Pritzker continued to warn today that some counties, particularly downstate counties, and some rural areas had a rising number of COVID-19 infections, and he said Illinois is heading in the wrong direction. Yesterday he launched “a new mask awareness campaign with a very straightforward tag line: ‘It only works if you wear it.’”

He urged people to wear masks and to socially distance.

Alicia Tate-Nadeau, Director of the Illinois Emergency Management Agency, said yesterday, “If we continue on the track we’re on, we’ll need to look at bringing back some restrictions that we’ve seen over the last few months. Nobody wants that.”

New Cases in Evanston, Suburban Cook County, Chicago and Illinois

New cases and deaths of Evanstonians: There were a total of 5 new confirmed COVID-19 cases of Evanston residents today, according to data reported by the City.** There have been a total of 875 cases of Evanston residents, 27 of which are active.

In the last seven days, the City has reported an average of 2.0 new cases per day. The above chart shows the trend of COVID-19 cases of Evanstonians using data reported by the City.

In the last 29 days, one Evanston resident has died due to COVID-19, and that was on July 11. The total number of Evanstonians who have died due to the virus is 71.

According to data provided by IDPH on July 31, a total of 53 residents or staff of long-term care facilities in Evanston have died due to COVID-19. Thus, about 75% of the deaths of Evanstonians due to COVID-19 were of residents or staff at long-term care facilities. Two facilities account for 39 of the deaths.

New Cases in Suburban Cook County, Chicago and Illinois: IDPH reported there were 294 new COVID-19 cases in Suburban Cook County today, and that there were 221 new cases in Chicago. This was another relatively rare occasion on which the number of new cases in Suburban Cook County exceeded those in Chicago.

In the State there were 1,471 new cases today, ending a three-day decline. The number of cases in the last seven days has been 1,231, 1792, 1,941, 1639, 1,467, 1,298 and then 1,471 today. The average per day in the prior seven days is 1,569.

For purposes of comparison, one of the highest seven-day averages of new cases in the State was 2,638 for the seven days ending May 8. One of the lowest was 602 cases for the seven days ending June 19.

The trends for suburban Cook County, Chicago and the State are shown in the first two charts in the above chart box.

The number of deaths in Illinois due to COVID-19 increased by 19 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 7,545.

Hospital Admissions and Surge Capacity

One metric that will be used to determine whether additional restrictions will be imposed in a region is whether there is a “sustained increase” in hospital admissions for COVID-19 illnesses in the region.

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), and the number was 19 on Aug. 1,  the most recent date for which data is available.

Another metric is whether there is a reduction in hospital capacity to care for patients with COVID-19 illnesses. The criteria say there should be at least 20% surplus capacity of both medical/surgical beds and ICU beds.

IDPH reported that as of Aug. 4, Suburban Cook County has a surplus capacity of 33% of medical/surgical beds and 37% of ICU beds. The 20% threshold is met.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,238 on June 1, and 1,498 on June 26. As of midnight on Aug. 3, the number of hospitalizations in Illinois was 1,496, down only 2 from June 26. The third chart in the chart box shows the trend in hospitalizations.

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

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, and that many infected people are not being tested.***

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

On June 28, the test positive rate for Suburban Cook County was 4.9%. On July 8 the test positivity rate dipped to 4.1%, but it increased to 5.8% on Aug. 1 (the most recent date for which data is available). The test positivity rate for Cook County has been trending upward.

On a Statewide basis, the test positive rate today was 3.5 %. The average for the last seven days was 3.9%, which is an increase from a low of 2.2% on July 8. The State’s test positivity rate has been trending upward.

       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 seven-fold since the beginning of April, the average number of tests per day in the last seven days is 39,877. This is substantially higher than the mitigation level testing target, but significantly less than the suppression level testing target.

On Aug. 4, there were 42,598 tests.

            Delays in Getting Test Results

One critical factor getting more attention recently is how long it takes to get COVID-19 test results. A report published by Resolve to Save Lives on July 21 said it is important to get test results within one or two days so that a person infected can be quickly isolated, and so people who were in contact with the infected person can be informed that they might be infected and that they should isolate themselves. *****

The study recommends that all states should report the median time it takes to report a test result (measured from the time of the test). Currently, no state does that, says the study.

IDPH does not report the time it takes to report test results. In some cases the results are reported the same day or the next day. But IDPH says on its website (updated on June 30) that people who undergo COVID-19 testing will receive a call with test results “in 4-7 calendar days.” This suggests a relatively long delay in getting the test results.

In a report dated, July 26, the White House Coronavirus Task Force recommended that states pool specimens of multiple people and test the pool “to reduce turnaround time to under 12 hours.” *****

Contact Tracing

Widespread contact tracing is also essential to control 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 impose additional restrictions in a Region.  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.” IDPH Director Dr. Ngozi Ezike said this is an “internal goal.”

There is no data indicating how close the State is toward meeting this goal.

On July 22, Gov. Pritzker said about 1,600 contract tracers are now working across Illinois. This would leave about 1,200 positions to fill. He said the 57 local health departments have received grants of $50 million to expand their contract tracing efforts.

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

* 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.

**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.

A study published by the CDC on July 21 concluded that the number of people infected by COVID-19 in different regions of the country was between 2 and 13 times higher than the number of confirmed COVID-19 cases reported in those regions. The study did not cover Illinois. The study was based on antibody tests, which determines if a person has antibodies to the virus. If they have antibodies, it is assumed they were infected by the virus and recovered, perhaps with minor or no symptoms.

*** 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 “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

*****Under this approach, which has been used since 1940, a lab could pool 5 specimens and test the pool for Covid-19. If the result is negative, it would rule out 5 people. If the pool has a positive result, then the remaining portion of the 5 specimens in that pool would be tested individually. If there is a low test positivity rate in a State, this approach can significantly reduce the number of analyses required by a lab to process tests, reduce the amount of materials needed to do so, and reduce the time to provide test results. Researchers are looking at whether processing pooled specimens might miss some cases where patients have low viral lodes.

***** 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

On July 19, Dr. Francis Collins, the Director of the National Institute of Health said speaking in regards to the nation as a whole, “The average test delay is too long. That really undercuts the value of the testing to find out who’s carrying the virus, and then quickly get them isolated so they don’t spread it around.”  It also delays the start of contact tracing and the efforts to advise people that they have been exposed to someone with COVID-19, so that they may self-isolate as well.