As COVID-19 rages again in Illinois, and much of the state is being ordered this week to limit gatherings and suspend indoor dining, the public is clamoring for details about what’s driving the government’s decisions to shut down big parts of the economy.
Government and public health officials have for months pointed to metrics such as rising case counts, hospitalization rates and percentages of positive COVID-19 tests as the backbone of when they decide to restrict the public’s movements.
But, seven months into the pandemic here, those same public officials are disclosing very limited information about where these COVID-19 cases originated.
That may be in part because public health and government officials still know little about who is diagnosed with the novel coronavirus or where they’re getting sick. Of confirmed cases reported to the state, officials still don’t know the types of jobs the majority of those infected have, for example.
And of the information they do have, the public is largely being kept in the dark. Leaders in charge of the COVID-19 response from Chicago, the surrounding suburbs and the entire state won’t share many details, such as whether your favorite pizza place or corner tavern became a hotbed for the coronavirus.
Yet even with this narrow scope of information, government leaders are making huge decisions that affect the economy and peoples’ lives, closing down bars, restaurants and schools to slow the rapid spread of COVID-19.
This has left business owners, in particular, angry and frustrated about why they’re forced to shut down.
“A pancake house is different than a restaurant or a bar. A coffee house is different than fine dining,” said Sam Toia, president and CEO of the Illinois Restaurant Association, which lobbies for the industry. “We would really like to see the metrics of where COVID-19 is coming from.”
Democrat Gov. JB Pritzker has repeatedly defended his decisions to impose restrictions, saying that they’re the best option to slow the exponential growth of the virus. And this week, the state said they’re going to release more information soon about COVID-19 outbreaks.
“People can disagree about where to draw lines,” Pritzker said Thursday. “But when every metric in every corner of our state is trending poorly, we have to take action.”
Absent information from the state, some school districts have turned to releasing their own COVID-19 data, so parents and teachers are better informed if people are sick at school.
“We kind of compare COVID sometimes to a snow day, but every day is a snow day,” said Paul Hertel, superintendent of Des Plaines School District 62. “How are we going to communicate what is happening in [our] district?”
The district, which has about 4,800 students in preschool through either grade and around 830 employees, launched an online tracking system this week. Seven students and staff have the virus, while another 144 are isolating themselves because they’ve been exposed or might have been exposed to someone who has the virus.
State officials said earlier this month they would be releasing more information about school outbreaks, after a Pro-Publica and Chicago Tribune investigation revealed how little is known about them.
Contact tracing problems
In Illinois, contract tracing — tracking where people who have COVID-19 have been and who else they may have exposed — is largely still getting off the ground. While some health experts say this is a key way to track outbreaks, other officials in Illinois say it’s too behind.
Dr. Rachel Rubin, who runs the Cook County Department of Public Health with another physician, said the county isn’t focusing on where outbreaks have been. The suburban region is roughly 700 square miles — too big to monitor and analyze the addresses of people who test positive for the virus and see if clusters arise, Rubin said.
“I can’t tell you how many restaurants are affiliated with particular positive cases, because this requires us to talk to the individual who is positive and ask them where their movements have been over the prior two weeks,” Rubin said. “It also requires them to be honest, and people don’t necessarily want to ‘tattle on their friends.’ ”
“In suburban Cook County, we frankly are not up to speed yet to where we can talk to those contacts right away,” she added.
So the focus now is to find new outbreaks as quickly as possible to prevent them from spreading, not spend weeks trying to trace back an outbreak that’s already occurred, Rubin said.
She didn’t have specific numbers, but she said the county has traced a “fraction” of the just over 75,000 confirmed COVID-19 cases in the region. Instead, the county focuses on specific areas, like schools and people in their 20s, where cases are rising quickly. And the department investigates complaints, such as if people are not wearing masks at specific restaurants.
Still, Rubin acknowledged that as the number of COVID-19 cases rise, contact tracing isn’t as effective.
“There’s no way that you can reach out to all of these people very quickly,” she said, adding that keeping up is “almost impossible.”
It’s unclear how well contact tracing is going at the state level or in Chicago.
The Illinois Department of Public Health largely relies on local health departments to do tracing, then report back. A spokeswoman for the department did not respond to an interview request, nor would she say how much contact tracing has been done statewide or how much the state knows about COVID-19 outbreaks and how that drives decisions.
In Chicago, home to the most coronavirus cases in the state, the city’s public health department also wouldn’t say how much contact tracing it has done, saying the state plans to release details soon. But the city is still ramping up contact tracing and only recently added some hospitals and community clinics as tracers.
In an interview in September, Dr. Marielle Fricchione underscored how much catch-up the city was trying to do. She heads up COVID-19-related case investigations for the city’s public health department. The state-run database where hospitals and labs are supposed to provide data on people who test positive for COVID-19 has major holes in it.
In May, WBEZ reported that in about 80% of cases, the state did not know the types of jobs those who were infected have, which could help prevent future outbreaks. As of September, there was a slight improvement. But the data WBEZ reviewed show the state still doesn’t know in 70% of cases the occupations of people who are infected with the virus.
Blackouts on outbreaks
Besides contract tracing details, the Chicago public health department would not provide the locations of COVID-19 outbreaks. Through a spokeswoman this week, Fricchione said that “outbreak maps are typically too identifying.”
But Mayor Lori Lightfoot has repeatedly said this week that of the cases they’ve tracked, “two-thirds” of people got COVID-19 from someone they knew, or that it originated in nonpublic settings, such as home gatherings or parties. She’s citing data that has so far not been presented to the public in detail, and it’s unclear how many cases she and the city are describing.
Pritzker touched off a firestorm, however, when he publicly blamed restaurants and bars this week as being a part of the city’s spread, and ordered them shuttered by Friday in Chicago and much of the state by this weekend.
Neither Pritzker nor the Illinois Department of Public Health has released comprehensive data that traces the virus to specific bars and restaurants. The state has released this level of detail for nursing home cases.
Instead, the governor’s spokeswoman released a snapshot of about 18,000 cases of COVID-19 that tallied where people who were infected had been in the previous two weeks. The most common response in that snapshot was social gatherings, like weddings and family gatherings. Second was restaurants and bars. The information came from about 70% of counties reporting to the state, but remains a fraction of total cases. There have been nearly 400,000 confirmed cases in Illinois.
Lightfoot initially pushed back on Pritzker’s shut-down plan this week, citing what she said was science that showed the city’s spread was in nonpublic settings. But then she cooled her complaints, urging residents instead to support small businesses.
Top Republicans pushed back, too, this week, calling for Pritzker to release the underlying data to support closing restaurants and bars, if there were any. One pointed to data in DuPage County that shows nursing homes and schools are among places driving COVID-19 flare ups.
“Restaurants don’t show up” in the county’s public health department data on cases, said Illinois House Minority Leader Jim Durkin, a Republican from Western Springs. “Contact tracing during the month of October did not show one case that appears on their list of confirmed cases.”
But in a statement, the health department cautioned against misinterpreting information on its online dashboard that tracks coronavirus cases, saying it was limited data. For example, less than 15% of all cases in the county have been attributed to outbreaks, but that doesn’t mean more cases didn’t happen at places like restaurants as well, the statement said. They just weren’t tied to particular outbreaks.
Still, risks abound
While there may be questions about how to curb the outbreak, Illinois is in a huge surge that officials are desperate to control. Since Oct. 1, the number of people hospitalized for the virus has jumped 73%, and those on a life-saving ventilator to help them breathe has increased 63%.
Public health experts who don’t work for the government say they understand why officials would turn to closing bars and restaurants. Research shows they are risky places where COVID-19 has spread. Consider that people who are dining inside a restaurant take off their masks to eat and drink, potentially circulating the virus.
And the problem is that with a widespread outbreak, government officials may have little choice about what they can legally control. Officials look to where they can tamp down the virus. And it’s harder to control house parties and family gatherings than places that require liquor licenses and permits to operate.
Working in conjunction with mask mandates, social distancing and encouraging people to simply avoid unnecessary contact with large groups, the mandates can have an effect, they say.
“If we close all the bars and restaurants, it’s still going to spread,” said Dr. Linda Rae Murray, a longtime public health expert in Chicago. “It’s a question of lining up all these different interventions and hoping that together, they help bring the numbers down.”
The limits of more information
Most cities and states do not map outbreaks, including New York City, which was the epicenter of the virus in the spring. But Colorado does.
“Reporting helps us have a better understanding of the scope of the pandemic, and it also allows state and local epidemiologists to provide support to businesses and facilities to help them stop the outbreak and prevent ongoing illnesses,” a spokesperson for Colorado’s public health department said in an email.
But some public health experts say while they support transparency, the public doesn’t need to know every detail of every outbreak. That could stigmatize one business, they say, while another one down the block might actually be a higher risk for getting and spreading COVID-19. And in many cases, an outbreak is typically over after people hear about it.
“Saying post-hoc that there was an outbreak at a bar or a location where you might go in your neighborhood gives you a peace of mind that the other places are safe,” said Dr. Emily Landon, an epidemiologist who leads the COVID-19 medical response at the University of Chicago Medical Center in Hyde Park. “And they aren’t. There’s nothing that sets apart one bar from another bar, except someone with COVID happened to visit that night. “
And that person might not know they’re infected and could get others sick.
Identifying the locations of outbreaks is a fuzzy, not a hard, line, Murray said.
“The most important thing is people need to understand what information they need to protect themselves,” Murray said. “I think it’s important for people to know in the workplace that five out of 100 people have COVID, but beyond that I’m not clear if knowing more than that would help. I know some people want to figure out if I had lunch with that person. If we did appropriate contact tracing — and we’re not there yet — then if I actually am in reasonable danger, I would hopefully be contacted and that’s the way to know.”
Kristen Schorsch covers public health on WBEZ’s government and politics team. Follow her @kschorsch.