Chicago and Illinois are on similar tracks to reopen their COVID-stricken economies now that both Mayor Lori Lightfoot and Gov. JB Pritzker have outlined their visions for returning to normalcy.
But there are differences to their phased-in plans that could mean Chicago residents remain stuck in their homes while their suburban neighbors aren’t.
Those differences can be complicated, and readers and listeners of WBEZ have been asking how to make sense of it all. (You can send your questions about reopening here.)
Here’s a look at how the public health benchmarks for reopening differ between Chicago and the state:
Cases and testing
|Declining rate (over a 14-day rolling average) of new cases based on incidence and/or percent positivity.||No requirement.|
What is case rate? The number of new cases of COVID-19 on any given day. This is usually a number, not a percentage.
So what? When Illinois started testing more people for COVID-19, the number of cases shot up. Now, officials report the number of new cases in the context of how many people were being tested. This change is also reflected in the state’s reopening plan, which requires regions to stay below a certain percentage of positive tests, rather than requiring the number of cases to decline. Chicago, on the other hand, would like to see cases decline over 14 days. They’re using a rolling average, meaning there could be a day or two within that two-week period where numbers go up, but there’s still an overall drop.
|Test at least 5% of Chicago residents per month. The city would need to test 4,500 residents every day to meet this standard.||Testing available for all patients, health care workers, first responders, people with underlying conditions, and residents and staff in congregate living facilities.|
What is testing capacity? The number of tests that can be done on any given day.
So what? Unlike the state, Chicago puts a specific number down on paper for its testing goal. City public health officials say they want to test 5% of all residents every month, which amounts to 4,500 tests per day. As of mid-May, around 3,000 people are being tested each day, though additional testing sites are being added. That includes a massive drive-through for essential workers and first responders at Guaranteed Rate Field.
Case positivity rate
Congregate settings (nursing homes, prisons): Less than 30% positive tests.
Community settings (general population): Less than 15% positive tests.
|At or below a 20% positivity rate, and percent positivity cannot increase more than 10 percentage points over a 14-day period.|
What is positivity rate? The percentage of tests done in a single day that came back positive.
So what? The state wants to see regions below 20% positivity before moving to the next phase of reopening — meaning no more than 20% of the tests taken for COVID-19 in that area can come back positive for the virus. As of mid-May, Illinois’ North East region, where Chicago is located, is the only one above a 20% positivity rate. The remaining three regions across the state are seeing fewer than 10% of tests come back positive as of mid-May.
But a region’s percent of positive cases also cannot increase too quickly — no more than 10 percentage points over two weeks — under the state’s rules. For example, if the Southern Region is at a 5% positivity rate, and within 14 days, goes up to a 16% positivity rate, they would not be able to move to the next phase. In Chicago, however, public health officials want to see fewer positive cases than the state (15% instead of 20%).
But here’s an important nuance in Chicago's approach — the city is separating out so-called “congregate settings,” such as nursing homes and prisons, where cases can come in a cluster. Chicago officials are allowing the percent of positive cases in those settings to be slightly higher than the state (30% instead of 20%). This means that even if there are outbreaks in certain hot spots — such as the Cook County Jail — the city could still move to “cautious reopening” if the numbers outside those places remain low.
|Stable or declining rates (over a 14-day rolling average) of cases resulting in hospitalization, ICU admission and/or death.||No overall increase for 28 days.|
What are hospital admissions? The number of people on any given day whose symptoms were severe enough they needed to be treated at the hospital.
So what? Chicago calls this the “severe outcome rate” and includes deaths. The city wants to see these numbers flat or declining for at least 14 days. (Again, that's as a rolling average, meaning there could be a day or two within that period where numbers go up, but there’s still a drop overall.) The state simply says the number of hospitalizations for people displaying COVID-like illnesses can’t increase for 28 days.
Hospital beds: Less than 1,800 COVID-19 patients
ICU beds: Less than 600 COVID-19 patients
Ventilators: Less than 450 COVID-19 patients
|14% ICU beds, medical and surgical beds and ventilators available.|
What is surge capacity? The amount of space available in local hospitals that can be used to treat new patients for both COVID-19 and other severe illnesses.
So what? Surge capacity is a formal way of saying, “If you get sick, there’s room for you at the hospital.” Illinois wants to see hospitals have at least 14% of their care space available to treat patients. (Or basically, hospitals can’t be more than 86% full.) As of mid-May, Chicago hospitals have had enough space to comply with the state’s benchmark. (They update that data daily here.) But to start reopening, city officials are looking specifically at ICU beds and ventilators used by COVID-19 patients only.
All of these numbers matter because if there’s an outbreak, officials want to be certain people can be treated appropriately. Early projections on this metric are what led the governor and the mayor to build a makeshift hospital at McCormick Place, which has now been deconstructed after treating very few patients.
|Declining (over a 14-day rolling average) emergency department visits for influenza-like illness and/or COVID-like illness.||No requirement.|
What is syndromic surveillance? The number of people who show up to the ER with flu-like or COVID-like symptoms on any given day.
So what? This is another area where Chicago’s plan is more detailed than the state’s. That is not to say the state does not care about how many people are showing up to emergency rooms with flu-like or COVID-19 symptoms. The governor and state public health officials just didn’t outline a specific benchmark for regions to meet, like Chicago has.
|Expanded system in place for congregate and community investigations and contact tracing.||Begin contact tracing and monitoring within 24 hours of diagnosis.|
|What is contact tracing? The practice of finding and notifying people who may have been in contact with someone who has tested positive.|
So what? Chicago and Illinois are on the same page when it comes to contact tracing, or keeping track of to whom the virus may have spread. They want it to happen. The state is slightly more specific on how, in that they say contact tracing should begin within 24 hours of someone being diagnosed. (Worth noting: That 24 hour requirement will apply to Chicago, because the state sets the minimum requirements that must be met. So even if Chicago’s plan doesn’t explicitly include it, the city will have to comply.)
But contact tracing requires manpower — people who can analyze data, make phone calls and communicate important public health directives. Neither the state, nor the city gave a set number of people they say will be needed to do adequate contact tracing. But both are soliciting people to do the work.
Want to know how the different regions in Illinois are doing on these measurements? The state is tracking progress here. Chicago updates data related to coronavirus here and on the city’s data portal.