Under Governor J. B. Pritzker’s Restore Illinois plan, the Northeast Region is on track to move from Phase 2 to Phase 3 next Friday. Evanston, along with the rest of Cook County and eight other counties, is in the Northeast Region. As reported in articles posted on May 19 and May 20, restrictions will be loosened for many businesses and activities in Phase 3.

Today, Gov. Pritzker discussed the broad parameters of his plan for opening childcare centers, which may be essential to enable many young parents to get back to work.

There are still many new COVID-19 cases in Evanston, Cook County and Illinois, but hospitalizations for COVID-19 are on a downward trend.

Guidance for Opening Childcare Centers in Phase 3

Gov. Pritzker discussed his plan to open childcare facilities at his daily briefing on May 22. He reiterated that all four regions of the State are on track to move into Phase 3 of the Restore Illinois plan in seven days, but added, “We can’t have a conversation about going back to work without talking about childcare. If we don’t have childcare, a large portion of the workforce, especially women who too often bear a disproportionate burden, will be without any way to move forward without caring for their child themselves.”

He said that from the start, his stay-at-home order recognized the importance of childcare for working families, and it focused on essential workers who were continuing to work outside of the home. “And for that reason we included childcare in the list of essential businesses, starting with our first stay-at-home order,” he said.

In the past few months, he said, more than 2,500 childcare homes and 700 centers have been providing care, which is about 15% of the operating capacity of the childcare system in the State.

The stay-at-home order implemented an emergency childcare system that provided access to childcare in small group settings for essential workers, and the State also made all essential workers – from nurses and doctors to grocery store clerks and food producers – eligible for the State’s Childcare Assistance Program. Under that program, most of the cost of childcare for essential workers was paid for. In addition, to help keep emergency childcare centers up and running, the State offered a one-time stipend, and paid enhanced reimbursement rates for emergency childcare.

 “To date, Illinois has not seen significant transmission of COVID-19 in childcare settings, which is encouraging evidence that childcare can be provided safely,” said the Governor. “Public health experts emphasize, however, that there is much that we still don’t know about this new virus. How it spreads and especially what effect it has on children. Therefore, moving forward, Illinois must take a cautious approach that appropriately balances the need to greatly expand childcare with the need to lessen the risk of spreading coronavirus.”

Gov. Pritzker said his team has gathered input from around the State, and that input is “reflected in the plan that my administration is issuing today, shaping our roadmap for safely increasing access to childcare as parents return to work.”

He said, “Following the guidance, all of the 5,500 childcare providers who are not currently operating are being asked to reopen when their community moves into Phase 3 of the Restore Illinois plan.” Before they may open, though, they must develop a Reopening Plan that ensures they have revised operational and preparedness policies in place.

Some of the things that a child care program must include in its Reopening Plan are a way to isolate children or staff who become sick; a plan to address the situation if a child or staff member tests positive for COVID-19; a plan to perform daily health checks for all children, caregivers, staff, and visitors, including symptom checks and temperature checks; frequently sanitization of all high-touch surfaces as recommended in CDC guidance; the requirement of face coverings for all persons over the age of 2 when in the hallways, and for children over age 2 to the extent practicable in classrooms.

 For the first four weeks that they are open, providers will be able to serve no more than 10 children per classroom, said Gov. Pritzker.

“Once they have provided care safely for four weeks and have gotten accustomed to the new health, social distancing and sanitation routines, they will be able to expand to larger group sizes, though not yet their fully licensed capacity – on the strong advice of public health experts.

“These new group size limits will be roughly 30% lower than the levels they were at before the pandemic. For our licensed homes, which tend to be smaller, most will be able to operate at standard capacity.”

Providers that have been successfully operating as emergency childcare providers can move immediately to these new maximum capacities when their region enters Phase 3. Most licensed childcare homes will also be able to reopen to their licensed capacity, recognizing children’s’ need for quality early learning experiences.

“With all centers and homes online, this would bring us to more than three quarters of our previous childcare landscape in Illinois,” said the Governor. 

Some Concessions for Religious Services

Gov. Pritzker announced another change applicable to churches in Phase 3. He said, “From a broad standpoint, I can say that outdoor faith services, including, but not limited to drive-in church services, will be welcomed in Phase 3.

“And we continue to collaborate with faith leaders to ensure that they can hold services in safe and creative ways that allow for worship, while protecting their congregants. I know worship is as essential as food and water for most of us, and it’s my priority to provide guidance to ensure that it can proceed safely.”

Criteria to Move to Phase 3

To move to Phase 3, the Northeast Region must meet benchmarks relating to hospitalizations, testing, and tracing.

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 Restore Illinois 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. Ngozi Ezike, the Director of the Illinois Department of Public Health.

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 7 cases today, for a total of 620 cases, according to information provided by the City of Evanston. The trend is shown in the above chart. 

To date, a total of 27 Evanstonians have died due to COVID-19.

New cases and deaths in Cook County and Illinois: Today, there were 1,425 new confirmed cases of COVID-19 in Cook County and 2,758 in the State. The trend, which has wide variations from day to day, is shown in the smaller chart above.

Since May 1, there have been 32,426 new confirmed cases of COVID-19 in Cook County and 52,519 new confirmed cases in Illinois.

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

The number of deaths in Illinois due to COVID-19 increased by 110 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 4,715.

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 22:

  • Hospital admissions have declined by 46.0% in the Northeast Region since May 1. This is on track to meet the criteria.
  • The Northeast Region has available 20.5% of its medical/surgical beds, 22.2% of its ICU beds, and 63.0% of its ventilators. This is on track to meet the minimum capacity of 14%
  • The test positive rate, using a seven-day rolling average, is 16.3%, which is 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 has been administering in the last six weeks, the average per day between May 18 and 22 is 23,038 – still far short of the target of 64,167 set by HGHI.

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 greater than 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.

IDPH reported today that the test positive rate for the Northeast Region is 16.3%, down 5.3 percentage points in the last 14 days.

While the Northeast Region meets the criteria of the Restore Illinois Plan, it is still 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 on May 18, “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.”

In its May 20 report, “CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again,” CDC recommends using a maximum positive test rate of 20% to move to phase 1, a maximum positive test rate of 15% to move to phase 2, and a maximum positive test rate of 10% to move to phase 3. Link: https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-Activities-Initiatives-for-COVID-19-Response.pdf