Chicago Mayor Lori Lightfoot on Monday issued a dire warning: The second surge of COVID-19 is here.

The mayor appeared alongside the city’s top public health official at a morning press conference to say the outbreak in the city is widespread, across all ages and racial groups.

“We can’t get through this without being in this together,” Lightfoot said. “We prolong the misery that we’re seeing spiraling up … Now is the time for each of us to step up.”

Meanwhile, bars and restaurants in suburban DuPage, Kane and Will counties could see a suspension of indoor service as early as Tuesday because of a major spike in COVID-19 cases, Democratic Gov. JB Pritzker warned Monday.

“Every region of this state has started to move in the wrong direction,” the governor told reporters at a press conference in far downstate Murphysboro, where he announced tighter COVID-19 restrictions for that southern Illinois region because of a resurgence in the virus.

COVID-19 spreads when people let their guard down

Lightfoot and Chicago Public Health Commissioner Dr. Allison Arwady implored Chicagoans to double down on wearing masks and staying six feet apart to help prevent the new coronavirus from spreading further.

COVID-19 is mainly spreading through gatherings inside homes, not in public, such as at schools or on transit, they said.

“Two out of three Chicagoans diagnosed with COVID-19 tell us that they know the person who likely infected [them],” Arwady said. “By nature, we worry more about people we do not know. But in fact, where we see the spread of COVID is where we let down our guard.”

She cautioned Chicagoans not to invite people into homes who don’t need to be there, such as having guests over for a birthday party. In a gathering of 10 people, Arwady said there’s a 14% chance that one person has COVID-19. The risk increases as the group gets bigger.

Lightfoot didn’t lay out any specific plans to combat the rise of coronavirus. But in a separate statement, the mayor said she might resume restrictions on some businesses to help limit the spread of COVID-19.

Arwady ticked off a host of metrics public health officials use to better understand how COVID-19 is spreading to explain the rise in cases. City leaders also use these metrics to guide their decisions on when to ease up or implement restrictions to curb the spread of the coronavirus.

Chicago is now seeing a sharp increase in cases similar to what happened early in the first wave of COVID-19 last spring. Over the past two weeks, cases have climbed more than 50%, to an average of just over 500 cases a day. Arwady said she expects the number of cases in Chicago to surpass 600 potentially within the week.

The percent of people testing positive for COVID-19 is 5.4%, reversing progress the city made over the summer. In some parts of Chicago, such as on the Southwest Side, the positivity rate is nearly five times higher.

The number of people hospitalized for the coronavirus is on the rise as well.

Arwady said the city is in a better position than the rest of Illinois, but she cautioned Chicagoans not to get complacent. Illinois is surrounded by states with hot spots of COVID-19, according to a New York Times analysis. Wisconsin, Iowa, Indiana, Missouri and Kentucky are part of the city’s travel quarantine order.

Pritzker said both Region 8, which comprises DuPage and Kane counties, and Region 7, which takes in Kankakee and Will counties, could face tighter COVID restrictions because of repeated days in which the percentage of positive test results for the virus has exceeded 8 percent.

In Region 8, state public health data shows, the positivity rate has risen for 10 straight days, including two straight days above 8 percent. In Region 7, positivity rates have jumped for nine straight days, including two straight days above 8 percent.

Mitigation efforts like those imposed in far southern Illinois will take effect in those collar counties if a third straight day of positivity rates exceeding 8 percent occurs.

“The state is headed in the wrong direction. The number of cases are heading up. The number of hospitalizations are going up. And the number of deaths are going up, and it’s partially because people aren’t worried about this anymore,” said Dr. Ngozi Ezike, the state’s public health director.

Hospitals brace for a second COVID-19 surge

As city and state leaders watch the coronavirus metrics closely, hospitals are preparing for what could come. The next two weeks will be telling, said Dr. Paul Casey, chief medical officer at Rush University Medical Center on the Near West Side. It usually takes five to 10 days for people who have COVID-19 to be so sick they need hospital care.

“We are really overpreparing with the hope that we never need to use everything we prepare for,” Casey said.

Rush is among the biggest hospitals in the region and took on hundreds of patients who were transferred from other hospitals during the height of the pandemic in the spring. Casey said the hospital hasn’t seen a notable spike in cases yet. They typically have 20 to 30 patients with COVID-19, and in the spring, that surged to around 150 a day.

But something Rush is noticing is the percentage of people the hospital tests who are positive for COVID-19, either in the emergency department or in a drive-thru site, is creeping up. It typically hovers around 5 to 8%, but now it’s 8 to 10%, Casey said.

He said one of his biggest concerns is if hospitals do once again get hit with a wave of very sick patients, how that would affect the mental health of doctors, nurses and everyone else who treats them. That took a toll this spring. Health care workers bore the brunt of the types of workers in Illinois who got sick with COVID-19. Some died from it.

AMITA Health, a giant system with 14 general hospitals, is already seeing COVID-19 cases rise, said chief clinical officer Dr. Stuart Marcus. Last Wednesday, the health system treated 94 coronavirus patients. The next morning, the number ticked up to 109.

“It has now increased to 169,” Marcus said. “There’s no question in my mind that we are seeing the beginnings of a surge.”

It’s a small number, considering AMITA has treated some 5,000 COVID-19 patients in the hospital since January. The health system treated a few patients whose cases were among the earliest in the U.S.

Still, government leaders are bracing for the second wave of the coronavirus.

With hospitals stretching from north suburban Evanston south to Kankakee, Marcus said AMITA is likely a reflection of the rise in cases across Illinois.

“Everyone is tired of COVID,” he said, adding that includes the public and his staff.

While the health system is prepared with a stockpile of protective gear like masks and gowns to prevent catching and spreading the coronavirus, Marcus listed some challenges ahead.

Besides potentially treating more coronavirus patients, other patients who have put off seeing a doctor because they were afraid of getting COVID-19 months ago, are now coming back. But now, they’re sicker, Marcus said.

Here’s another challenge: maintaining a staff that’s already burnt out from the first surge in COVID-19. AMITA is part of two national hospital groups, so the health system was able to bring in employees from elsewhere in the country when cases spiked here in the spring. But now that coronavirus is surging elsewhere in the U.S., “the luxury of having staff coming from other parts of the country is no longer here,” Marcus said.

The health system is continuously hiring, and if needed would bring on expensive temporary nurses to help treat patients, he said.

Over the weekend, Marcus said he spent a lot of time looking at COVID-19 numbers, and losing some sleep. He wrote an email to AMITA’s medical staff, letting them know Monday was going to be very different than when they left work on Friday.

Kristen Schorsch, Becky Vevea and Dave McKinney cover health, city hall and state politics on WBEZ’s government and politics team. Follow them @kschorsch @beckyvevea @davemckinney.