Sunday, March 29, 2020

10,000 tests daily key for Illinois COVID-19 fight


Pritzker Says Illinois COVID-19 Testing Will Ramp Up

By SEAN CRAWFORD 2 HOURS AGO

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Gov. J.B. Pritzker

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In the midst of a global pandemic that has shut down much of society, concerns remain about getting enough people tested.

Gov. J.B. Pritzker on Sunday said Illinois is testing about 4-thousand people per day.  He expects that number will be at 10-thousand in the next ten days.

“That marker, 10,000, is significant because it’s the number of tests per day that the scientists and experts tell us that we need to get a truly holistic understanding of the virus in each of our 102 counties,” Pritzker said.

The latest numbers show 47 counties have positive cases of COVID-19.  Confirmed cases in Illinois total 4,596 with 65 deaths.  

“Every day we aren’t hitting 10,000 tests or more is another day that we’re not able to get answers that help us get past this current crisis,” he said.

Pritzker admitted the situation has long since moved past the point of containment.   He put the blame on the federal government and the Trump Administration.

“Nationally, there have been some improvements in testing, but we still have so far to go. The United States is still trailing other countries in testing on a per capita basis, several times over. In all the states we are working to fill the gap,” Pritzker said.

“But the most frustrating part of this gap is, it’s not just in the past. The White House has promised millions of tests for weeks now and they’re just not here. To be clear, I also welcome the testing capacity when it actually arrives, but I’m not going to wait on promises from the federal government that may never be fulfilled. We need this testing capacity now, so we’re building it ourselves in Illinois.”

The governor said that’s being done by adding shifts of technicians at all three state labs so they can analyze more samples.  Additional lab robotics are being acquired that speed up the process. He said the Illinois State Police is exploring options to utilize manpower and maximize capacity.

Pritzker also appeared optimistic over a new rapid results test from Illinois-based Abbott Laboratories.  Production is expected to get underway soon.

He praised the Illinois National Guard, which has opened a second drive-thru testing site, this one in McLean County.  Another is located in northwest Chicago. The federal Department of Health and Human Services is operating 3 other sites and some local hospitals have begun testing by car.

Pritzker is asking for a federal rule limiting tests in those locations to 250 per day be expanded to 400.  He said the limit has forced some people to be turned away. The governor said the goal is for everyone who needs a test to be able to get one.

Infant Death

A day after announcing an infant who tested positive for the coronavirus disease had died, there was no additional information released.

The nine-month-old died in Cook County after being hospitalized.

“We know that this is very top of mind for people and we want to be deliberate and allow the processes to take place so we can give you the best information,” said Illinois Department of Public Health Director Ngozi Ezike.  

Ezike said deaths of children from COVID-19 are rare and this could be the first case of its kind in the U.S.  From the data available, she said the disease in children typically results in more cold-like symptoms like fever, sore throat and runny nose.

The governor also tried to reassure parents that COVID-19 deaths among the young is uncommon.  

“It’s so uncommon that, at least when I started to do the work and listen to the experts about it, I got at least some comfort in the idea that this is not something that we should expect to hear a lot more of, because it’s just not happening very often at all,” he said.

Above is from:  https://www.nprillinois.org/post/pritzker-says-illinois-covid-19-testing-will-ramp#stream/0

March 29: 4,596 COVID-19 cases in Illinois



Coronavirus Disease 2019 (COVID-19)

In response to the COVID-19 pandemic, Gov. JB Pritzker has ordered Illinois residents to stay at home. Executive Order No. 10 requires all residents to stay home, with exceptions for essential needs or business activities. Gatherings of 10 people or more are prohibited. The order extends through April 7, 2020.

Coronavirus Disease 2019 (COVID-19) in Illinois Test Results

Positive

4,596 (3,491  3/28/2020)

Deaths

65  (47  3/28/2020)

Total Persons Tested*

27,762   (25,429 3/28/2020)

*Total number of people reported electronically for testing of COVID-19 at IDPH, commercial or hospital laboratories. Deaths are included in the number of positive cases
All numbers displayed are provisional and subject to change.

Information regarding the number of people under investigation updated on 3/29/2020.
Information to be updated daily.

COVID-19 Illinois Positive Cases

Above is from:  http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/coronavirus

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PROJECTIONS from:  http://www.healthdata.org/research-article/forecasting-covid-19-impact-hospital-bed-days-icu-days-ventilator-days-and-deaths

Total COVID-19 deaths projected to August 4, 2020 in Illinois

2,454 COVID-19 deaths   Peak date of cases 4-16-2020


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Cases in U.S.


Updated March 29, 2020

This page will be updated daily. Numbers close out at 4 p.m. the day before reporting.

***On Saturday and Sunday, the numbers in COVID-19: U.S. at a Glance and the figure describing the cumulative total number of COVID-19 cases in the United States will be updated. These numbers are preliminary and have not been confirmed by state and territorial health departments. CDC will update weekend numbers the following Monday to reflect health department updates.***

CDC is responding to an outbreak of respiratory illness caused by a novel (new) coronavirus. The outbreak first started in Wuhan, China, but cases have been identified in a growing number of other locations internationally, including the United States. In addition to CDC, many public health laboratories are now testing for the virus that causes COVID-19.

COVID-19: U.S. at a Glance*†

  • Total cases: 122,653
  • Total deaths: 2,112
  • Jurisdictions reporting cases: 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands)

* Data include both confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since January 21, 2020, with the exception of testing results for persons repatriated to the United States from Wuhan, China and Japan. State and local public health departments are now testing and publicly reporting their cases. In the event of a discrepancy between CDC cases and cases reported by state and local public health officials, data reported by states should be considered the most up to date.

† Numbers updated Saturday and Sunday are not confirmed by state and territorial health departments. These numbers will be modified when numbers are updated on Monday.

Cases of COVID-19 Reported in the US, by Source of Exposure*†

Cases of COVID-19 Reported in the US, by Source of Exposure

Travel-related
712

Close contact
1,326

Under investigation
83,318

Total cases
85,356

* Data include both confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since January 21, 2020, with the exception of testing results for persons repatriated to the United States from Wuhan, China and Japan. State and local public health departments are now testing and publicly reporting their cases. In the event of a discrepancy between CDC cases and cases reported by state and local public health officials, data reported by states should be considered the most up to date.

† CDC is no longer reporting the number of persons under investigation (PUIs) that have been tested, as well as PUIs that have tested negative. Now that states are testing and reporting their own results, CDC’s numbers are not representative of all testing being done nationwide.

Above is from:  https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator days and deaths by US state in the next 4 months


Great forecasting model for US and individual states.  It is updated daily.  Click on following to find current data:  http://www.healthdata.org/research-article/forecasting-covid-19-impact-hospital-bed-days-icu-days-ventilator-days-and-deaths


Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator days and deaths by US state in the next 4 months


 


Publication date:

March 26, 2020

View the COVID-19 US projections data visualization

IMPORTANCE

This study presents the first set of estimates of predicted health service utilization and deaths due to COVID-19 by day for the next 4 months for each state in the US.

OBJECTIVE

To determine the extent and timing of deaths and excess demand for hospital services due to COVID-19 in the US.

DESIGN, SETTING, AND PARTICIPANTS

This study used data on confirmed COVID-19 deaths by day from WHO websites and local and national governments; data on hospital capacity and utilization for US states; and observed COVID-19 utilization data from select locations to develop a statistical model forecasting deaths and hospital utilization against capacity by state for the US over the next 4 months.

EXPOSURE(S)

COVID-19.

MAIN OUTCOME(S) AND MEASURE(S)

Deaths, bed and ICU occupancy, and ventilator use.

RESULTS

Compared to licensed capacity and average annual occupancy rates, excess demand from COVID-19 at the peak of the pandemic in the second week of April is predicted to be 64,175 (95% UI 7,977 to 251,059) total beds and 17,309 (95% UI 2,432 to 57,584) ICU beds. At the peak of the pandemic, ventilator use is predicted to be 19,481 (95% UI 9,767 to 39,674). The date of peak excess demand by state varies from the second week of April through May. We estimate that there will be a total of 81,114 deaths (95% UI 38,242 to 162,106) from COVID-19 over the next 4 months in the US. Deaths from COVID-19 are estimated to drop below 10 deaths per day between May 31 and June 6.

CONCLUSIONS AND RELEVANCE

In addition to a large number of deaths from COVID-19, the epidemic in the US will place a load well beyond the current capacity of hospitals to manage, especially for ICU care. These estimates can help inform the development and implementation of strategies to mitigate this gap, including reducing non-COVID-19 demand for services and temporarily increasing system capacity. These are urgently needed given that peak volumes are estimated to be only three weeks away. The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures in all states that have not done so already within the next week and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths.

Citation:

IHME COVID-19 health service utilization forecasting team. Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator days and deaths by US state in the next 4 months. MedRxiv. 26 March 2020. doi:

Related Content
Data visualizations

COVID-19 US STATE-BY-STATE PROJECTIONS

IHME’s COVID-19 projections were developed in response to requests from the University of Washington School of Medicine and other US hospital systems and state governments working to ...

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Below is a commentary on the University of Washington study by Rich Miller of Capitol Fax.

A look at that University of Washington COVID-19 study and how Illinois fares

Sunday, Mar 29, 2020

* A new study by the University of Washington’s Institute for Health Metrics and Evaluation is quite sobering. Let’s start with the press release

In a forecast based on new data analyses, researchers find demand for ventilators and beds in US hospital intensive care units (ICUs) will far exceed capacity for COVID-19 patients as early as the second week of April. Deaths related to the current wave of COVID-19 in the US are likely to persist into July, even assuming people protect themselves and their communities by strongly adhering to social distancing measures and by taking other precautions advised by public health officials.

The study uses a range of outcomes with a 95 percent uncertainty (or confidence) interval (UI). This produces a lower- and upper-bound estimate. The result should appear between those two bounds in 95 out of 100 simulations. This a very tricky thing to model, as they state in their methods section

Uncertainty in the model estimates is driven by two components: (1) uncertainty from fixed effect estimation and (2) uncertainty from random effects, with the latter dominant because of the high variation between locations.

That “variation between locations” also applies to individual states. So far, though, their numbers are holding up.

* Deaths per day. The study projects the United States will hit its peak of deaths per day on April 14th at 2,341, (or between 1,149 and 4,844 at 95% UI). The study projected 437 national deaths for March 28 (with a range between 380 and 508). The actual number on the 28th was 447, so that’s well within the expected range.

You can also look at the numbers by state. Illinois is expected to hit 91 deaths per day at its peak on April 17th, (or between 18 and 177 at 95% UI). The study projected 11 deaths per day for Illinois by March 28, (or between 6 and 17). Illinois reported 13 deaths yesterday.

According to the projection, Illinois will not return to yesterday’s death level until around May 11th. But it could come earlier (late April) considering the projected range, or later (beginning of June). You can clearly see the difficulty here in predicting when Illinois should lift its stay at home order.

* Cumulative deaths. By March 28, the study had forecast 1,979 cumulative deaths in the US, a number derived from a range of 1,842 to 2,137. The actual total was 2,038. That’s well within the expected range.

For Illinois, the study projected 47 cumulative deaths by March 28, (or between 34 and 63). The actual number was 47.

Point being, each day’s projected number won’t be exactly right, but it will likely be in the expected ballpark over time at a 95 percent UI. Its projection for New York of 722 deaths by March 28 was also pretty spot on. New York reported 728 deaths as of that day.

* In all, the study projects 81,114 total deaths in the United States by July 15th, (or between 38,242 and 162,106). Things start to level off around the first week of June or thereabouts.

Illinois can expect to experience 2,453 deaths by June 4, (or between 507 and 5,850). As noted above, Illinois is projected to start leveling off in earlyish May or so.

* Peak resource use. The study projects peak resources will be needed in the nation as a whole by April 14th. By that point, the nation will be short 49,292 hospital beds and 14,601 ICU beds and 18,767 ventilators will be needed (the researchers could not estimate existing ventilator capacity). But because this is such a large country and the trajectories are different for various regions, let’s focus on Illinois.

Illinois will hit its peak resource day on April 16. We should have 14,552 hospital beds available by that day. The study projects we’ll need 8,885. So, we’re good, right? Well, that number is derived from a range of 1,998 to 16,986, so don’t get too comfortable. Also - and this is very, very important - Illinois is a big and diverse state. Some hospitals may have excess capacity while several may not. It could be a real nightmare for some areas and/or individual hospitals.

Also, just because we have bed capacity doesn’t mean that hospitals have enough gloves, masks, etc. And, partly because of the national PPE and testing shortages and lack of a vaccine, hospital/ambulance/first responder staffing levels could crash as more and more workers contract the virus.

And then there’s the ICU bed issue. Illinois will have 1,131 ICU beds available on April 16, but it will need 1,335, or 204 more than existing capacity (the projected ICU bed range need is between 180 and 2,700). That obviously needs to be addressed, particularly when you factor in any regional disparity.

We’ll also need 721 ventilators by that time, but the expected range could push that number as high as 1,447.

Indiana is in much worse shape. They’ll need an additional 1,973 hospital beds, 876 ICU beds and 854 ventilators. Missouri’s is even worse. Michigan is about to get clobbered. By April 8th, that state is projected to need 10,563 additional hospital beds, 2,564 ICU beds and 1,785 ventilators. New York is a disaster. By April 6th it’s projected to need 35,301 more hospital beds than it had, 6,949 ICU beds and 4,141 ventilators.

* Now, on to some visuals. When you hear people say “flatten the curve,” it means we have to keep the following graph’s curving purple dotted line (hospital beds needed) beneath that straight solid purple line (existing hospital beds available). Same goes for needed and existing ICU beds with the green dotted and straight lines. As noted above, Illinois achieves the flattening goal for hospital beds, but not for ICU beds. A shortage of existing ICU beds will begin on April 7 and last what could be two very long weeks…

Keep in mind that the feds are becoming quite concerned about a spike in Chicago and Cook. As emphasized above, some hospitals will have excess capacity while some will not.

* Indiana will not sufficiently flatten the curve. The state goes above existing hospital bed capacity on April 8th and won’t have excess beds until April 21. Existing ICU capacity is breached on March 31 and that will last through April 24…

* New York went above existing capacity days ago and won’t have available hospital beds and ICU beds until April 22nd…

* Michigan appears to already be above existing ICU capacity and will be above existing hospital bed capacity on March 30. It won’t have an excess capacity of existing ICU and hospital beds until April 19…

* Missouri will be above existing hospital bed capacity from April 12-29 and above existing ICU capacity from April 2 through May 4…

According to the projection, Wisconsin doesn’t hit peak resource needs until May 22nd, so it has time to beef up its existing ICU beds, which are projected to exceed capacity from May 4 through June 4. Ohio, like Wisconsin and Illinois, should have enough hospital beds, but it will experience an ICU bed shortage based on existing capacity from April 9-19. Minnesota will have a shortage of existing ICU beds from April 11 through May 6.

Bottom line: We’re better off than some other states, but it’s still gonna be bad. Please, stay inside.

…Adding… Fauci believes the situation will be worse than the UW study indicates

The U.S. government’s foremost infection disease expert, Dr. Anthony Fauci, says the U.S. will certainly have “millions of cases” of COVID-19 and more than 100,000 deaths.

As the U.S. tops the world in reported infections from the new coronavirus, the director of the National Institute of Allergy and Infectious Diseases predicts 100,000-200,000 deaths from the outbreak in the U.S.

- Posted by Rich

Projected peaks of COVID 19 across the US

UW model says social distancing is starting to work — but still projects 1,400 coronavirus deaths in the state

March 26, 2020 at 7:25 pm Updated March 27, 2020 at 10:01 am

Tents sit at Harborview Medical Center’s emergency room on Thursday to keep respiratory patients separate from others in the hospital while they are evaluated.    (Steve Ringman / The Seattle Times)

A temporary field hospital is being set up on a soccer field in Shoreline for people unable to isolate and recover from COVID-19, the disease caused by coronavirus, in their own homes. The 200-bed hospital was erected by King County.  (Ken Lambert / The Seattle Times)

1 of 2 | Tents sit at Harborview Medical Center’s emergency room on Thursday to keep respiratory patients separate from others in the... (Steve Ringman / The Seattle Times) More

Sandi Doughton

By

Sandi Doughton

Seattle Times staff reporter

A new analysis from the University of Washington projects that even with strict social distancing from coast to coast, more than 81,000 people in the U.S. — and more than 1,400 in Washington state — could die from COVID-19 by the first of July.

Hospitals and intensive care units across the country are likely to be overwhelmed beginning in the second week of April.

Modeling from the UW’s Institute for Health Metrics and Evaluation (IHME) forecasts that hospitalizations will generally peak in mid-April, with 64,000 more patients than licensed beds nationwide. The shortfall in ICU beds is estimated at more than 17,000. Demand will be much higher if all states do not adopt and maintain social distancing, says the report, which also examines the anticipated strain on medical systems for every state.

In Washington, there’s no predicted shortage in overall hospital beds, though some individual facilities — including the UW Medical system — will need extra capacity and have already geared up to provide it. The statewide shortage in ICU beds is forecast to reach almost 100 by April 19, the model’s approximate date for when hospitalizations are expected to peak in Washington.

The findings suggest measures to slow the epidemic are making a difference locally. But restrictions will need to continue into late May or early June in Washington and the rest of the country to bring the disease under control, said IHME Director Dr. Christopher Murray.

“The trajectory of the pandemic will change — dramatically for the worse — if people ease up on social distancing or relax other precautions.”

Gov. Jay Inslee acknowledged as much in a briefing on Thursday, saying the stay-at-home order he issued Monday will probably have to be extended beyond the two-week period initially specified as a minimum.

The UW analysis differs from most modeling of the new coronavirus, partly because it relies on the number of deaths across the U.S. and in other countries — which is a more reliable gauge of the epidemic’s course than confirmed infections, which depends on intensity of testing, Murray said. It also takes into account the impact of social distancing measures, something few other modelers have yet quantified.

Still, all of the UW estimates come with a huge measure of uncertainty, the researchers caution. Each model run is based on a thousand projections, which zero in on the most likely result. But the range of possible outcomes remains wide. For example, while 1,430 represents the best projection of total deaths in Washington by July 1, the statistical range extends from 316 to 2,535.

As of March 26, the state had 3,207 confirmed infections and 147 deaths.

“There’s a tremendous amount we don’t know or understand about what explains the variation across communities,” Murray said. “Every day we get more data, we learn more and the forecast will get better and better and more accurate.”

Earlier in the epidemic, the model’s forecasts for Washington were much more ominous, Murray pointed out. But it seems as if the state’s early actions — including companies shifting to remote work, school closures and limits on gatherings — have already had an impact. Hospitals across the state also moved quickly to cancel most elective surgeries and free up beds.

“If you go back even a week ago or 10 days ago, the case predictions from those models suggested we should have had many more cases by now,” Murray said.

Ten days ago, the models were predicting that the UW Medicine System could expect as many as 950 patients hospitalized with COVID-19 at the the epidemic’s peak, said Lisa Brandenburg, president of UW Medicine Hospitals & Clinics. The latest modeling shows a 20 to 30 percent reduction, or an expected maximum of 750 to 650 patients with COVID-19, the respiratory disease caused by the novel coronavirus.

Since UW Medicine and its four hospitals already prepared for the earlier, worst-case scenario — identifying where to squeeze in extra beds and how to mobilize additional staff — Brandenburg said she’s increasingly confident they will be able to handle the surge.

“Generally speaking, it’s very good news for us that the curve seems to be flattening here in Washington state, but it doesn’t mean we don’t still have a substantial amount of work to be done, in terms of taking care of people in the region.”

Hospitals across the state reported 254 admissions of people with COVID-19-like symptoms in the third week of March. That’s double the number two weeks earlier, but only a 10% increase over the week before.

Many medical facilities and hospitals still don’t have enough protective gear, said Cassie Sauer, president and chief executive officer of the Washington State Hospital Association. Another big unknown is whether there will be enough ventilators for critically ill patients, she said.

The UW analysis estimates nearly 20,000 patients nationwide will need ventilators to keep them alive when hospitalizations peak. In Washington, the estimate is 236, and it’s not clear whether the state will have enough of the vital machines, Sauer said.

“I remain massively worried about this whole thing,” she said. “We don’t know enough about the disease. We don’t know enough about how seriously people are taking the ‘stay home and stay healthy’ order.”

However, Sauer also said some hospitals may soon reopen their operating rooms to a limited number of elective surgeries for people with the most urgent medical needs.

The UW projections show that the “first wave” of the epidemic should begin to wane by the end of May or the first week of June. But if social distancing measures are lifted before then, infections and deaths will surge again, Murray warned.


For example, if the number of deaths in Washington peaks around April 20 then begins to decline, as the model currently projects, public pressure to lift the restrictions will become fierce.

“I think the big issue will be in May,” Murray said. “We’ll still have plenty of infections and cases and deaths, but some people will say: ‘We’ve [gone] past the peak. Why can’t we stop social distancing?’

“But if we do stop, and there are still plenty of cases in the community, we can go right back to exponential growth.”

It remains to be seen whether there will be a second wave of infections in the fall, Murray added. Models predicted one during the 2003 SARS epidemic, but it never materialized.

Beginning Monday, Murray and his colleagues will be updating their model daily and posting the results on IHME’s website: healthdata.org.

From:  https://www.seattletimes.com/seattle-news/health/uw-model-says-social-distancing-is-starting-to-work-but-still-projects-1400-coronavirus-deaths-in-the-state/?utm_source=marketingcloud&utm_medium=email&utm_campaign=Sunday+Morning+03-29-20_3_29_2020&utm_term=