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Monitoring Progress in Meeting the Criteria to Move to Phase 4 of the Restore Illinois Plan

Monday, June 01, 2020
Evanston RoundTable
by Larry Gavin

Monitoring Progress in Meeting the Criteria to Move to Phase 4 of the Restore Illinois Plan

By Larry Gavin
6/1/2020 5:42 PM

The Restore Illinois plan contains three criteria relating to hospitalizations, the surge capacity of hospitals, and 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. An article explaining the criteria is available here.

This article provides data 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.

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: The number of Evanston residents who have tested positive for COVID-19 increased by 3 cases today, June 1, for a total of 728 cases, according to information provided by the City of Evanston. The trend is shown in the above chart.

There have been no additional deaths due to COVID-19 in the last 24 hours, and the number of Evanstonians who have lost their lives to the virus remains at 41.

Cases and deaths in Cook County and Illinois: There were 570 new cases of COVID-19 in Cook County in the last 24 hours, and 974 in the State.

Between May 28 and June 1, the average number of new COVID-19 cases in Cook County was 771, and in the State, it was 1,316. The trend is shown in the smaller chart above.

The number of deaths in Illinois due to COVID-19 increased by 23 in the last 24 hours, bringing the total number of deaths due to COVID-19 in Illinois to 5,412.

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 posts summary information about the trend in hospitalizations and surge capacity. The data shows that between May 1 and May 29, the number of hospitalizations in the Northeast Region declined by 55.4%. IDPH has not reported the number of patients who were hospitalized on May 29, so the percentage 55.4% may be the benchmark for determining whether hospitalizations have declined since May 29, the date the Northeast Region moved into Phase 3.

IDPH reports that between May 1 and June 1, the number of hospitalizations declined by 62%, so there has been a decline of three percentage points since May 29.

The Northeast Region has available 29% of its medical/surgical beds, 34% of its ICU beds, and 67% of its ventilators. This easily meets the minimum capacity of 14%.

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 today that the test-positive rate for the Northeast Region was 13%, down 4 percentage points in the last 14 days.

While the Northeast Region meets the criteria of the Restore Illinois Plan, it is almost three times the rate recommended by WHO.

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, Governor J. B. Pritzker said, “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 seven weeks, the average number of tests per day between May 28 and June 1 is 22,860, still far short of the target of 64,167 set by HGHI.

Contact Tracing

Widespread contact tracing is also essential to controlling the spread of the COVID-9 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.

…………………………….

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 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

***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 HGHI’s 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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