Two weeks ago, an optimistic Gov. J.B. Pritzker floated the idea of lifting much of his mask mandate by the holidays.
But the latest COVID-19 data has not kept improving as winter approaches, and on Tuesday Pritzker offered a more sober assessment.
“New hospitalizations are flat. That is not a good sign. That’s not what’s happened in previous dips from surges,” Pritzker said after getting his coronavirus booster shot in Chicago. “We went down for a while here, but now we’ve leveled out at a level that is much higher than the summer.”
Gov. J.B. Pritzker takes questions at the Breakthrough Urban Ministries FamilyPlex on Nov. 1, 2021. (Antonio Perez / Chicago Tribune)
While the numbers of new cases and hospitalizations are well below their during the recent surge, they remain far above where they were early this summer, and the trends recently have stopped dropping.
The Pritzker administration has yet to say how low the metrics need to go before he’d lift the requirement for masks at indoor public settings, and the latest trends add to the murkiness surrounding the endgame of a now 10-week-old mandate put in place after the Centers for Disease Control and Prevention adopted new guidelines on masks.
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At the time the mandate was issued, Pritzker said all Illinoisans needed to mask up to stop the more contagious Delta variant from spreading so rapidly that hospitals would be overwhelmed.
Illinois hospitals are not faced with that possibility right now, but Chicago-area hospital leaders say caseloads remain far from ideal, and there remains uncertainty about the course the pandemic might take as more kids are vaccinated but colder weather sends more people indoors.
“We are undoubtedly in a better place than we were a month ago,” said Dr. Jorge Parada, Loyola Medicine’s regional director for infection prevention and control. “That said, the fact that we’re better than a disaster doesn’t mean we’re in a good place.”
When Pritzker imposed the latest indoor mask mandate in late August, he cited the rapid uptick in COVID-19 hospitalizations that left Illinois “running out of time as our hospitals run out of beds.”
Running out of beds is a worst-case scenario in a pandemic because it means that care stretched thin not only for those sick from the virus but also for those having other medical emergencies, from heart attacks to strokes.
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In the latest surge, stories emerged across the country of people waiting far longer, or being sent much farther away, to try find an open bed.
By the time the mask mandate was reimposed in Illinois, more than four times as many hospital beds were filled with COVID-19 patients as had been the case just two months earlier.
The good news: The average number of people hospitalized each day with COVID-19 has dropped by nearly half from the last surge’s peak of above 2,300, to around 1,200.
The bad news: The hospitalization numbers stopped dropping a week ago and remain at triple they were in July, when the number was about 400.
During the late summer surge, most of the state’s regions had fewer than 20% of their ICU beds available, a bench mark of concern under guidelines set by the Pritzker administration. The state’s southern region ultimately ran out of ICU beds in mid-September, something that hadn’t happened in any region of the state even in the depths of the deadlier fall 2020 surge.
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The south region has since come back from the brink, with more than 20% of its ICU beds now available. But, even with COVID-19 hospitalizations dropping across the state, half of Illinois other regions remain under the 20% ICU threshold, including four in the Chicago area. One region — covering DuPage and Kane counties — has seen a drop from 26% of ICU beds available to 19% in roughly 1？ weeks.
Though Chicago-area hospitals are no longer in danger of overflowing, they still face stressors because of the number of COVID-19 patients filling their beds. The situation is exacerbated as health systems, like other organizations, are struggling with staffing shortages.
While some local health systems are firing workers who refuse to get vaccinated, that affects only a small fraction of the workforce at many systems. And some hospital systems have not yet started terminating employees who aren’t vaccinated because they haven’t yet hit the deadlines they set for their workers to get shots or face consequences.
Rather, hospital leaders said, part of what’s driving the shortages is burnout after a grueling year-and-a-half.
Those staffing issues are leading to questions about how health systems will manage patients — both in hospitals and doctors’ offices and clinics — especially as the weather turns colder and more illnesses potentially spread, said Dr. Reinhold Llerena, chief population health officer for Amita Health, which has 19 Illinois hospitals.
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“We are at a point now where some clinicians who might have retired in another two or three years are opting to retire much sooner, as early as this year,” Llerena said.
Throughout the pandemic, the CDC has issued masking recommendations that, while not mandates, lead to masking orders from state and local health officials. Illinois lifted its original indoor mask mandate in May after the CDC advised those fully vaccinated that they no longer needed to wear masks indoors.
The mask-free days were short-lived. In late July, as the more contagious Delta variant was spreading across the country, the CDC suggested everybody — regardless of vaccination status — wear masks again indoors in public, at least in communities that met either of two key metrics:
· A rate of more than 50 new diagnosed cases per 100,000 residents per week.
· An 8% or higher rate of COVID-19 tests coming back positive, the so-called positivity rate.
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The positivity rate hasn’t been a major concern in Illinois, remaining relatively low. But the weekly case rate by late August had climbed beyond 200, well into the CDC’s worst transmission category of “high,” before Pritzker imposed the statewide mask mandate.
Since then, the statewide weekly case rate per 100,000 residents has dropped notably, but is still not below the CDC’s “high” spread category, or even below the rate defined for “substantial” spread. And in the past two weeks, the statewide rate has risen slightly, from roughly 129 to 136.
Within the state’s 11 health regions, case rates have plummeted in the two downstate regions that were hardest hit in the summer surge, while rising in two others.
Those mixed trends are being seen in the Chicago area as well. The city of Chicago continues to have the lowest weekly case rate of any region, near 106, but that still puts it in the CDC’s worst transmission category.
When Pritzker told reporters two weeks ago he wanted to remove “certain” mask mandates by the holidays, he called it an “important marker for us.”
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As trends changed in that short span since then, Pritzker on Tuesday said it would take sustained drops for the mask mandate to be lifted for indoor places other than schools.
“And so the question is, Is that just a temporary situation? Are we going to start heading downward in those numbers?” he asked.
Like much of the pandemic, there remain large unknowns that could affect transmission levels, and the need for the mask mandate.
The state is preparing to vaccinate kids ages 5 to 11 while already doling out booster shots to adults who qualify. That includes anyone who, like Pritzker, received the one-dose Johnson & Johnson vaccine. The governor’s booster dose on Tuesday was the Pfizer vaccine.
Experts have said vaccination remains the best way to curb the spread of the virus, even better than wearing masks. So more vaccinations could mean less spread.
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But it’s possible cases could again climb as people gather more indoors to avoid the cold and celebrate the holidays.
That concerns Dr. Charles Bareis, chief medical officer at MacNeal Hospital in Berwyn, which was particularly hard-hit by COVID-19. At the peak of the pandemic, the hospital had nearly 100 inpatients with COVID-19 at one time, he said. The hospital had to transfer many of its COVID-19 patients to Loyola University Medical Center in Maywood, he said.
“During the height of the pandemic we were so full of critically ill patients, if we hadn’t had that offramp to transfer them to the medical center, our hospital would have looked like the hospitals in Brooklyn, treating patients in the hallways,” Bareis said. “We don’t want that to come back.”
jmahr@chicagotribune.com
lschenker@chicagotribune.com
dpetrella@chicagotribune.com
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