* Gov JB Pritzker’s press secretary Jordan Abudayyeh sent me a detailed response to some questions that I and others have raised about the governor’s Restore Illinois plan…

REGIONAL MAP

One of the points of the critics is that the regions are too big and it’s holding areas with few cases back.

• But right now, every region is in the green and on pace to move forward to the next phase, so this criticism doesn’t really hold up.

• We’ve heard criticisms from the suburbs that they don’t want to be grouped in with the city, but their own hospital capacity numbers are very similar to the city. If you look at a snapshot of numbers from this weekend of hospital capacity by the 11 EMS regions, pasted at the bottom of this email, you’ll notice that the capacities in the regions that have been grouped together for Restore Illinois are quite similar.

• We recognize the different experiences that more rural counties in the Northeast region have in comparison to the City of Chicago — but in terms of their EMS hospital capacity breakdown, they don’t have dramatically more capacity to handle moving forward before the rest of the region.

5.17 Hospital Data:
*This data is reflective of a snapshot in time on May 17th

Northeast Region:

• Southwest Suburbs/EMS Region 7

o ICU Beds: 23.9%
o Med/Surg Beds: 23.5%

• West Suburbs/EMS Region 8

o ICU Beds: 19%
o Med/Surg Beds: 19.8%

• Northwest Suburbs/EMS Region 9

o ICU Beds: 24.5%
o Med/Surg Beds: 20.5%

• North(east) Suburbs/EMS Region 10

o ICU Beds: 21.8%
o Med/Surg Beds: 17.7%

• City of Chicago/EMS Region 11

o ICU Beds: 21.7%
o Med/Surg Beds: 21.2%

None of the EMS regions in the Northeast Region have an ICU or Med/Surge capacity above 25 percent — a number not tied to Restore, but a stage that IDPH considers with an additional level of concern. Regions 8, 9, and 10 all have at least one measure where their availability is lower than that of the City of Chicago – only Region 7 can claim otherwise, and that’s by approximately 2 percentage points.

For the remaining three regions: all the EMS regions are well above the 14 percent capacity threshold for moving forward under the Restore Illinois plan. In other words, no EMS region is holding back the other EMS region it’s grouped with.

North-Central Region:

• Rockford Region/EMS Region 1

o ICU Beds: 45%
o Med/Surg Beds: 45.8%

• Peoria Region/EMS Region 2

o ICU Beds: 36.6%
o Med/Surg Beds: 36.9%

Central Region

• Springfield Region/EMS Region 3

o ICU Beds: 55%
o Med/Surg Beds: 54.6%

• Champaign Region/EMS Region 6

o ICU Beds: 52.2%
o Med/Surg Beds: 46.6%

Southern Region

• Edwardsville Region/EMS Region 4

o ICU Beds: 39.1%
o Med/Surg Beds: 44.9%

• Marion Region/EMS Region 5

o ICU Beds: 54.7%
o Med/Surg Beds: 58%

14 VS. 28 DAYS
The critics want regions to move forward in 14 days, not 28. They say 28 days is too long to wait.

• The experts don’t agree with those who want to move to reopening quickly.

o The shelved guidance from the CDC would have required a 14-day downward trajectory in health metrics.
o https://apnews.com/d4fb9744fb3524b6aaff1036f3ba9cd2
o The experts have said under this guidance no one is ready to move forward.

• The White House plan does mention a 28-day timeline when talking about travel. So, it’s not like it’s a made-up number.

o The White House plan recommends that communities “minimize” travel in Phase 1, and that in Phase 2, after 28 consecutive days of decline, “Non-essential travel can resume.”
o In fact, the shelved CDC guide advises communities to avoid all nonessential travel in phases of reopening until the last one, when cases are at the lowest levels. Even then, the CDC is cautious and advises only a “consideration” of the resumption of nonessential travel after 42 continuous days of declining cases of COVID-19.
o It’s clear the CDC would lean on the side of longer timelines, rather than shorter ones.
But other states are using 14-day metrics

• It’s important to note, that a lot (I’ll admit, not all) of the states using a 14-day timeline require a DECLINE in metrics, while our plan only requires stabilization.

• If we used a 14-day measurement Illinois wouldn’t move to the next phase anytime soon. Instead, our public health experts determined that as we phased out some restrictions if we could hold stable for 28 days (two incubation periods) we could move to a new phase.

• Also, important to note when comparing us to other states is that some of these states have peaked and are on the other side of their curve. There is no evidence that Illinois is coming off our peak or plateau yet.

o IN requires a 14-day decline in cases – IL would not meet that metric at this time
o KY requires a 14-day period of decreased cases
o NY requires a 14-day decline in hospitalization rates
o NC requires a decline in multiple metrics
o UT requires decreasing trends for 1 week and observe a decreasing trend for 5 weeks to reach a normal risk level.

• Not every state is using 14 days

o WA uses a 21-day metric
o Washington state did three weeks with this reasoning: “The state will stay in every phase for a minimum of three weeks. During that time, the Department of Health and the Governor will re-evaluate the above indicators and determine if the state should remain in the current phase, advance to the next phase or return to the previous phase. No phase will last less than three weeks before moving to the next phase, in order to allow one complete disease incubation period plus an additional week to compile complete data and confirm trends.
o https://www.governor.wa.gov/sites/default/files/SafeStartWA_4May20_1pm.pdf

• We don’t pretend it’s a good thing that there’s such a patchwork of requirements and phases across the nation. In a scenario of proper national governance — one where the CDC playbook doesn’t get shelved — we wouldn’t have a situation where Illinoisans can hop across the border into Missouri or Indiana and live a different lifestyle. The rules might be different, but the consequences are the same.

• Data lags and it could take longer to see the impact of lifting mitigation measures appear in the data. More time means we know more, especially since moving to the next phase doesn’t require a decline.

o Scientists learn new things about this virus constantly — to date, research indicates that symptoms tend to appear for people, on average, approximately 5 days after infection — but hospitalization looks to be around 8 days (former FDA commissioner). Given that infections that lead to hospitalizations are the driving concern of all our mitigation efforts, 14 days — less than one infection → hospitalization cycle — isn’t a lot of time to make sweeping decisions about reopening.
o The novel virus is still being studied and there are discussions about how long the incubation period might need to be adjusted: https://www.businessinsider.com/wuhan-coronavirus-symptoms-24-days-after-infection-2020-2

o Study showing that the impacts of the 14 day quarantine aren’t usually reflected two weeks later: https://www.cebm.net/covid-19/is-a-14-day-quarantine-effective-against-the-spread-of-covid-19