Progress as of June 19 in Meeting the Criteria to Move to Phase 4 of the Restore Illinois Plan – Evanston RoundTable

The Restore Illinois plan contains three criteria relating to the trend in hospitalizations, the surge capacity of hospitals, and the positivity rate of testing that must be met for a region of the State to move from Phase 3 to Phase 4. The plan also has an internal goal relating to contact tracing.

This article provides data as of June 19 showing how the Northeast Region is doing in terms of meeting the mandatory criteria, and it also provides data showing the number of new COVID-19 cases and deaths. The earliest data any region can move to phase 4 is on June 26.

New COVID-19 Cases, Hospitalizations, and Surge Capacity

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, Director of Illinois Department of Public Health. In addition, people may be infectious even if they are not hospitalized.*

The data below show new COVID-19 cases in Evanston, Cook County, and Illinois, and the decline in hospitalizations in the Northeast Region.

New COVID-19 Cases

New cases and deaths of Evanstonians: There were 3 new confirmed COVID-19 cases of Evanston residents today, bringing the total to 766 cases. Of those, 33 are active.

Over the last seven days, the City reported an average of 2.0 new COVID-19 cases per day. For the seven days prior, there was an average of 3.3 new cases per day. The trend is shown in the above chart.

No Evanston resident has lost their life due to COVID-19 in the last four days. The total number of Evanstonians who have died due to the virus is 66.

As of June 11, 45 residents of long-term care facilities in Evanston died of COVID-19. Thus, more than two-thirds of the Evanstonians who have died due to COVID-19 were residents of long-term care facilities.

New Cases and deaths in Cook County and Illinois: There were 373 new cases of COVID-19 in Cook County in the last 24 hours, and 692 in the State. While State officials have been concerned about a potential surge of cases due to the mass protests and gatherings following the murder of George Floyd on May 25, a surge has not yet occurred.

Between June 15 and June 19, the average number of new COVID-19 cases per day in Cook County was 329, and in the State, it was 585. The trend is shown in the smaller chart above.

The number of deaths in Illinois due to COVID-19 increased by 44 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 6,580.

Hospital Admissions and Surge Capacity in the Northeast Region

Two metrics being used to determine if a region may move to Phase 4 are 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%.

IDPH reports that in the last 28 days hospitalizations in the Northeast Region declined by 85%. IDPH does not report the number of hospitalizations in the Region, but there is a downward trend.

The Northeast Region has available 34% of its medical/surgical beds, 42% of its ICU beds, and 72% of its ventilators. This easily meets the minimum capacity of 14%.

On a Statewide basis, the number of hospitalizations due to COVID-19 was 3,336 on May 29 (the date the State moved to Phase 3 of the Restore Illinois plan). As of midnight on June 18, the number had declined to 1,837. The second chart in the chart box shows the trend in hospitalizations since May 29.

Adequacy of Testing

Widespread testing is essential to controlling the spread of the COVID-9 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. **

In the Restore Illinois plan, one criterion to move from Phase 3 to Phase 4 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 that the test-positive rate for the Northeast Region as of June 19 was 5%, down 4 percentage points in the last 14 days.

The Northeast Region easily meets the criterion of the Restore Illinois Plan, it has met for the first time the rate recommended by WHO.

On a Statewide basis, the test positivity rate on June 18 was 2.5%. The average for the last five days was 2.4%.

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. On the same day, Gov. Pritzker said, I think were going to need many more tests than that.***

While the State has almost quadrupled the number of tests it has been administering since the beginning of April, the average number of tests per day between June 14 and June 18 is 24,003 still far short of the target of 64,167 set by HGHI.

On June 19, there were 27,171 tests.

The IDPH recommends that those who have participated in a recent mass gathering, such as a march or rally, get tested 5 to 7 days after the event, or immediately if symptoms develop.

Contact Tracing

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

In its criteria to move from Phase 3 to Phase 4, the Restore Illinois plan provides with respect to this criterion: Begin contact tracing and monitoring within 24 hours of diagnosis for more than 90% of cases in region.

While both Gov. Pritzker and Dr. Ezike say that contact tracing is essential to open an economy safely, it appears that the regions will not be required to meet this criterion to move from Phase 3 to Phase 4. Dr. Ezike said it is an internal goal.

IDPH is not monitoring this criterion for any region.

On a Statewide basis, Gov. Pritzker said on May 29 that contact tracing is only being done on about 30% of the known cases, far short of the 90% goal. IDPH has not provided more recent data.

Cook County recently received about $41 million in grant funding from IDPH to rapidly scale-up its COVID-19 contact tracing program in suburban Cook County over the next three to six months.

Where to Get Covid-19 Tests

The City of Evanstons Health and Human Services Department is partnering with AMITA Health St. Francis Hospital to offer two COVID-19 health screening and testing events to Evanston residents who may not otherwise have access to testing or online virtual health visits.

Community testing will be offered at the James Park Field House parking lot, located on Mulford Street west of Dodge Avenue and the Levy Senior Center, on the following days while supplies last:

Testing will be offered in a drive-through format; however, walk-ins will also be accepted.Testing is free, and no appointment is needed to participate. A doctor will be on site to answer questions, and Spanish-speaking team members will be available to assist, as needed.

Participants in need will be provided with a face covering upon arrival, and should maintain a physical distance of at least six feet from non-family members at the event.

Test results are expected to be available within four days of testing. AMITA Health St. Francis Hospital will follow up with all who are tested to provide results, whether positive or negative, and additional education and instructions, as needed.

In addition to these community testing events, residents can access free testing at Statecommunity-based testing sites. Testing may also be provided through a resident's primary healthcare provider.

For more information about COVID-19, please visitcityofevanston.org/covid19or call/text 847-448-4311. For convenience, residents may simply dial 311 in Evanston.

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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.

On May 21, the Imperial College, London, published Report 23: State-level tracking of COVID-19 in the United States on May 21, 2020. One part of the study estimates the number of infectious individuals in every state in the U.S., including Illinois, as of May 17, which includes people who have not been tested for COVID-19 and who may be asymptomatic. As of May 17, the report estimates that there were 176,000 infectious individuals in Illinois, with a potential range of a low of 54,000 to a high of 395,000.

The report says, Despite new infections being in a steep decline in the United States, the number of people still infectious, and therefore able to sustain onward transmission, can still be large. This discrepancy underscores the importance of testing and case based isolation as a means to control transmission.

Link: https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-21-COVID19-Report-23.pdf

** 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 communitys 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

***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 each day 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 HGHIs report: https://globalepidemics.org/2020/05/07/hghi-projected-tests-needed-may15/

And link to accompanying 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

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Progress as of June 19 in Meeting the Criteria to Move to Phase 4 of the Restore Illinois Plan - Evanston RoundTable