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How remains the question

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Illinois

* My weekly syndicated newspaper column…

While short on details, the state and regional guidance finally issued by the White House last week gives us a set of pretty reasonable, if difficult-to-achieve, goals.

We all know why we need to contain and reduce our risk to the COVID-19 virus: Save lives, preserve health and get people back to work.

And we now know what states are supposed to achieve to get to the finish line:

1) A measurable and sustained reduction in new positive tests over three sets of two-week periods, or the same downward trajectory of positive tests as a percentage of total tests

2) The ability to treat all patients without crisis care (like the tent hospitals in New York City)

3) Robust testing, contact tracing, syndromic surveillance that can catch an outbreak before it actually happens, as well as surveillance testing of asymptomatic members of vulnerable populations

4) An ample supply of personal protective equipment (PPE) and the ability to deploy it along with an ability to surge ICU capacity

Again, details are lacking. The White House says, for example, that states must be able to do things like “Protect employees and users of mass transit,” without explaining what that means.

When all that and more is done, states can then move to the first and quite limited phase of reopening their economies. But if they cannot sustain all four points mentioned above (and more) during that phase, they have to start over again. And then it’s on to Phase Two of the reopening, but with the same mandate to meet all the requirements listed above. And then Phase Three, which looks something like pre-pandemic life.

So, where is Illinois right now? The state seems to be generally OK with its hospital system and Gov. J.B. Pritzker claims that it is improving its PPE supply system.
“If the government can force restaurant cooks to wear a hair net, it can and should require them to wear masks.”

But after weeks of promises, the state’s testing program still lags the nation. Pritzker claimed yet again last week that they’ve fixed the latest glitch, but he’s made similar promises before about other things — like the state’s unemployment insurance application process — so we’ll see.

State leaders have been saying for weeks that testing is very important, but we have yet to see significant progress on that front. You cannot walk until you can crawl and we’re still crawling here.

And Illinois appears to have a long way to go on contact tracing, surveillance, etc.

But the really hard part will be meeting the requirement for a measurable and sustained downward trajectory in newly positive tests.

Decline doesn’t appear to just happen on its own. The upward climb in positive results is relatively swift, but the peak’s other side looks more like a plateau. Illinois Department of Public Health Director Ngozi Ezeki said Friday that she didn’t think Illinois had even reached its peak.

Illinois, like some other states, has slowed the upward curve of newly positive tests, except for April 17, when it spiked up hard. Slowing is good, but it’s not enough to comply with the White House guidance.

I asked Pritzker what scientists were telling him about how to reduce the number of newly positive tests and he said there wasn’t much that can be done except to continue doing what they have been doing.

Pritzker shied away from requiring masks in public, even though some say it could help bend that curve downward. I happen to think it’s a good idea, but the governor said, “we don’t live in a dictatorial society.”

If the government can force restaurant cooks to wear a hair net, it can and should require them to wear masks.

We know the “why” and we now know the outline of “what” states have to do. But when it comes to the sustained reduction of positive tests, the nation really has no plan for “how” that will be accomplished.

But at least we finally have a road map, which should give the nation and our state a bit of predictability.

By the way, the White House guidance also says schools can reopen during Phase Two, even though crowd sizes of 50 people or more “should be avoided.” That seems unwise, but if by some absolute miracle Illinois fixed all of its testing and monitoring issues within two weeks, and new positive test results began to drop immediately and then consistently continued downward for four more weeks, the school year would almost be over anyway.

But that miracle is not going to happen. The governor was right to cancel the rest of the school year.

posted by Rich Miller
Monday, Apr 20, 20 @ 9:13 am

Comments

In the meantime Trump is sabotaging the plan by encouraging Covidiots to revolt and put so many people’s lives in danger.

Comment by Grandson of Man Monday, Apr 20, 20 @ 9:25 am
Until the tests, especially the antibody tests, are safe and accurate and available, “liberating” anyone is a gamble not worth taking by May 1. All we stand to “liberate” is more potentially deadly contagion.

https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html

Comment by Anon221 Monday, Apr 20, 20 @ 9:35 am
“One day at a time”, and ignore the outside “reopen” agitators. The Gov appears to be doing as much as one can under these circumstances, esp w/o test kits and masks.

Comment by Ares Monday, Apr 20, 20 @ 9:35 am
Rich, great stuff here, and another opportunity to that k you did your continued hard work, this crisis has made your work endless and you do it tirelessly.

To the post,

=== State leaders have been saying for weeks that testing is very important, but we have yet to see significant progress on that front. You cannot walk until you can crawl and we’re still crawling here.===

For me, what you wrote effects me in this manner;

We’re all on step 1, maybe only halfway thru step 1. To get me to Wrigley, for example, and be with 40,000+, I need to see step 58 or so. Right now, I’d like to think in baby steps.

Here’s what folks whom want things open don’t understand… about “me”.

You can open all kinds of things, on your own, “freedoms”… go protest, yell at nurses saving lives, ignore doctors who haven’t been home… but if you think I’m going to your business to have a meal, buy your goods, see your play, or have a beer and we aren’t in the ball park of step one… “I’m good”, I’ll wait.

Then there’s the “well, if we do that it’ll be years”

No. It’ll be when the federal government and industry can get states the testing kits and the states can reach their benchmarks, benchmarks Gov. Pritzker admits we are not hitting.

This virus is, depending on the pool of discussion, is 24 to 40 times deadlier than those who contract the flu.

You have phonies, some with “doctor” designations others with no medical background with that distinction, saying 2-3% mortality rate is “fine”, welp, I’m not going to no restaurant, store, social gathering that others think allows “herd immunity” paired with such a lacking of tests and testing.

Crawl to walk, walk to run.

The same people with that want to work, I hear ya, i want to go to those places of business. Business trumping… sorry… trumping science will not help stop or slow this crisis.

Stay smart, stay safe, if you’re not thinking about yourself, think of those you may hurt, or worse.

===… but if by some absolute miracle Illinois fixed all of its testing and monitoring issues within two weeks, and new positive test results began to drop immediately and then consistently continued downward for four more weeks…===

The criteria of the White House plan.

Think before you’re willing to give up a life.

Comment by Oswego Willy Monday, Apr 20, 20 @ 9:52 am
To some degree people need to get this virus to begin immunity. There is probably a higher percentage of the population that already has it that testing will discover. Social distancing worked to prevent our healthcare system from being over run. Now we need to find the sweet spot to begin to get our lives back together. I think the guidelines proposed by the federal government are appropriate. In the mean time if there are folks that want to open things up sooner, well they can be test cases.

Comment by Nagidam Monday, Apr 20, 20 @ 9:53 am
What is the source on IL testing “lagging the nation”? We’re obviously not #1, but I wasn’t aware we were #26 or lower (but, maybe we are). Or whatever the comparison framework is.

I do understand that framing, as a matter of realism, with (always) the general proviso, that this whole “state vs state competition,” during a national pandemic, is nuts. As long as we’re not starting to internalize Trump’s insane premise that 50 states should have the primary responsibility, to ramp up 50 separate testing rollouts, the in-the-moment analysis is of course important.

Comment by ZC Monday, Apr 20, 20 @ 9:53 am
I never really heard but did Illinois have a plan in place to deal with a pandemic? Did that plan require an inventory of equipment for medical professionals? Did anyone ever say if Illinois did have a pre-pandemic inventory?

Comment by ANONY Monday, Apr 20, 20 @ 10:06 am
As to masks, I can see it in crowded areas. I use one if I am going into a grocery store or, especially, drug store. Don’t see any need for one in my own car or walking around the neighborhood while staying distanced.

Regardless of how quickly the State reopens things, we plan to semi self isolate for weeks longer since the wife had multiple high risk factors.

Speaking of drug stores, I was impressed with the setup at the Stevenson Drive & Taylor Avenue CVS. They had a table in front of the cashier, with the card reader on it and a bottle of hand sanitizer for use.

Comment by RNUG Monday, Apr 20, 20 @ 10:09 am
- ANONY -

All 50 states, every state, every territory, the District of Columbia… all federal disaster areas.

Those so concerned about “what about the states”… welp, all 50 are disasters.

If there were only an agency that the federal government had that managed emergencies…

Lemme guess, you’re cool with Illinois bidding against… Nevada, and they both lose out to bidding from… Ohio… then that equipment is seized by… you guessed it… FEMA.

Keep up. This isn’t 1 or 2 states caught flat footed. This is a global pandemic where countries are also vying for the same supplies as… Louisiana… or Connecticut.

=== Did anyone ever say if Illinois did have a pre-pandemic inventory?===

Tell that to Germany, France, England, Spain…

Comment by Oswego Willy Monday, Apr 20, 20 @ 10:12 am
==To some degree people need to get this virus to begin immunity==

I don’t think this has been proven

Comment by Osco Monday, Apr 20, 20 @ 10:20 am
= ==To some degree people need to get this virus to begin immunity===

The only science I’ve seen “lately” to this is the science that *no one knows* if immunity is blanket for all who had it.

Comment by Oswego Willy Monday, Apr 20, 20 @ 10:22 am
ANONY-

Yes. There is and has been a plan, as well as exercises to suss it out.

5.0 was never updated under Rauner. 5.1 is the latest updated in March this year.

http://www.idph.state.il.us/pandemic_flu/Illinois_Pandemic_Flu_Plan.pdf 2014

http://dph.illinois.gov/sites/default/files/publications/illinois-pandemic-influenza-plan-version-51march-2020.pdf 2020

Comment by Anon221 Monday, Apr 20, 20 @ 10:22 am
==To some degree people need to get this virus to begin immunity==

===I don’t think this has been proven===

Its a novel virus. Herd immunity needs to take place like regular flu virus or other viruses that we vaccinate against.

Comment by Nagidam Monday, Apr 20, 20 @ 10:31 am
=== Herd immunity needs to take place===

You first?

Thing is, the asymptomatic folks, they think all is good, then they see a senior, or someone who is weak on immunity, or any of the critical groups this virus hurts worse than a little illness.

Herd immunity was tried in England… until it wasn’t because it overwhelmed the country.

The three Ts, more science, less risking lives, less making the sacrifices of nurses, doctors, all front line folks… because the science isn’t “fast enough” for the few.

With respect.

Comment by Oswego Willy Monday, Apr 20, 20 @ 10:35 am
@ANONY, try the google. Also, look up the Stafford Act, National Response Framework, & National Incident Management System for an understanding of responsibilities between the states and Fed gov’t.

Comment by Annoyed Monday, Apr 20, 20 @ 10:39 am
Cracked me up hearing folks say Dr.Fauci had boxed in Trump with the printer version of how and when to open states…next day he double backed and attacked Governors…
I swear, it should not take a genius to know Trump will always do the wrong thing.
His m.o. is doing opposite so he can claim he is smarter.

Comment by Tigers don't change their stripes Monday, Apr 20, 20 @ 10:44 am
@Nagidam,
Sure, dip some COVID-19 on a string and then insert it in yourself..that’s how the first American smallpox inoculations were administered. Of course, you could die from this but let’s get the herd exposed! Or wait for the non-active vaccine to become available.

Comment by Annoyed Monday, Apr 20, 20 @ 10:47 am
=== Cracked me up hearing folks say Dr.Fauci had boxed in Trump with the printer version of how and when to open states…next day he double backed and attacked Governors…===

Watch how things happen, not what people say.

Example 64,583

POTUS’ bloviating changed nothing any governor is doing or what they plan to do.

How do I know?

Watching and listening to governors.

What should crack you up is how POTUS is marginalizing himself being boxed in by Dr. Fauci as polling indicates… they trust the science more than all caps tweets.

Comment by Oswego Willy Monday, Apr 20, 20 @ 10:47 am
As for this “herd immunity” argument, so far about 750,000 Americans have confirmed COVID cases. Let’s say that about 200,000 have recovered so far.

That means approximately 0.06% of the population has the antibodies to prevent reinfection. Maybe. We have a long way to go until we achieve herd immunity.

Comment by Dance Band on the Titanic Monday, Apr 20, 20 @ 10:48 am
In the absence of ramped-up testing, a robust tracing system, and numerous proven effective treatments, it’s going to be tough to bend the curve sufficiently downward to achieve an RO under 1.0 by some factor(not sure of the recommended one at the moment, maybe RO

Comment by dbk Monday, Apr 20, 20 @ 10:57 am
Trump may not be boxed in, but he has given the Governors a tool to use against him.

What do we do if the reopening conditions cannot be met? By Memorial Day, by Fourth of July, by Labor Day.

Comment by Last Bull Moose Monday, Apr 20, 20 @ 11:01 am
===Herd immunity needs to take place like regular flu virus or other viruses that we vaccinate against===

The key there is the word “vaccinate.” Like OW said, you first, bub. Go volunteer at a COVID-19 hospital ward. Let us know how it goes.

Comment by Rich Miller Monday, Apr 20, 20 @ 11:03 am
=Trump may not be boxed in, but he has given the Governors a tool to use against him.=

Agreed. And the federal government needs to be taking the lead to solving for the testing problem. This can’t be done effectively at the state level. And if you don’t solve that problem we never get through phase 1. Instead of tweeting about “liberating” states the president should be telling us on a daily basis what his administration is doing to solve the critical testing shortage we’re all facing.

Comment by Pundent Monday, Apr 20, 20 @ 11:05 am
The carefully organized “liberation protests” may help with herd immunity. It’s like watching some macabre horror movie. The villian lurks and the characters blather about their Freedoms.

Comment by Froganon Monday, Apr 20, 20 @ 11:06 am
Life has time to wait until more is known…death has none.

Comment by Dotnonymous Monday, Apr 20, 20 @ 11:21 am
@OW & Rich M.

===You first?===

I have posted here as a strong believer in social distancing and the stay at home order. I suppose I should have qualified my herd immunity comment. The reality is eventually, we have to get to herd immunity. That is how over time you control a virus and especially a novel (new) virus. The Flu does overwhelm local hospitals for time to time especially when the vaccine is not hitting all the virus strains. Herd immunity, vaccine and anti-virals help control the Flu. As testing ramps up we will know what is going on but right now we are flying blind, which is why we have social distancing ad a stay at home order.

Comment by Nagidam Monday, Apr 20, 20 @ 11:30 am
===What is the source on IL testing “lagging the nation”?===

You can find data on testing, deaths, and case counts across the 50 states at Worldometers, which aggregates the data released by each state’s department of public health.

As of this morning, Illinois was 27th out of the 50 states + DC for testing per 1M of population. The tests/1M for the US as a whole is about 12,000, and Illinois is currently coming in at 11,178 (will increase of course following today’s data release).

Comment by Homeschool Prom King Monday, Apr 20, 20 @ 1:20 pm
=== we have to get to herd immunity. That is how over time you control a virus and especially a novel (new) virus.===

That’s not now, Ginsburg we aren’t even close to getting the three T’s and control where or what can happen with the virus

Thus is 24 to 40 times more dangerous in fatalities than the flu.

This isn’t a garden variety illness.

Comment by Oswego Willy Tuesday, Apr 21, 20 @ 7:08 am