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COVID-19 took a big toll in Illinois. Will deaths surge again?

Chicago Tribune logo Chicago Tribune 7/20/2020 By Joe Mahr, Chicago Tribune
a group of people on a boat in the water: People take an architectural boat tour on the Chicago River on July 14, 2020. © Brian Cassella / Chicago Tribune/Chicago Tribune/TNS People take an architectural boat tour on the Chicago River on July 14, 2020.

When the COVID-19 pandemic struck the United States, Illinois was one of the first hot spots in the country, fueling a death toll that remains among the nation’s highest.

Now — after big drops in daily deaths in Illinois and other hard-hit states — the Sun Belt is seeing a massive surge. The daily death rate in Arizona is now as high as Illinois’ ever was, after adjusting for population.

The sharp increases in deaths in these Southern and Western states have added to growing unease in Illinois, where the downward trends on cases and positive test results have started to inch back up.

The Pritzker administration on Wednesday announced faster, more targeted interventions to try to keep Illinois from taking a severe turn for the worse. On Twitter, the governor has warned that “trends can change quickly” and that “what’s happening in Florida, Texas or Arizona could happen right here in Illinois.”

Researchers say that although the latest data does not signal the need for outright alarm, it does suggest that the state, without changes, could be on the verge of another deadly surge.

“I think we have just a large ensemble of yellow flags,” said Jaline Gerardin, a Northwestern University assistant professor of preventive medicine who works with the state on virus modeling.

a group of people walking on a sidewalk: Pedestrians on Michigan Avenue in downtown Chicago on July 14, 2020. © Brian Cassella / Chicago Tribune/Chicago Tribune/TNS Pedestrians on Michigan Avenue in downtown Chicago on July 14, 2020.

In other states, the flags are red. In Arizona and Texas, the number of daily COVID-19 deaths has nearly doubled this month, based on a rolling seven-day average. Big increases are being seen in California and Florida, too, with daily death tolls sometimes hitting triple digits statewide.

In Illinois, which once saw an average of 120 daily COVID-19 deaths, the toll steadily dropped until it was down to about 20 by the beginning of July, where it’s hovered since.

Here’s what the latest data shows regarding COVID-19 deaths, and Illinois’ place in the national context:

a person riding a wave on a surfboard in the water: Rebekah McLaren and Malcolm McLaren cool off with their dog Lido along the lakefront near Diversey on July 14, 2020. © E. Jason Wambsgans/Chicago Tribune/Chicago Tribune/TNS Rebekah McLaren and Malcolm McLaren cool off with their dog Lido along the lakefront near Diversey on July 14, 2020.

Illinois hit hard early

This spring, New York received much of the attention related to the pandemic as its hospitals and morgues were overwhelmed with COVID-19 victims. Illinois largely, but not completely, avoided that fate.

Yet Illinois remains among the worst states overall for deaths tied to COVID-19, even after adjusting for population differences. Data collected from the volunteer COVID Tracking Project indicate the virus has killed 58.8 Illinoisans per 100,000 residents as of Friday.

a group of people sitting at a beach: Crowds cool off along the lakefront near Diversey on July 14, 2020. © E. Jason Wambsgans / Chicago Tribune/Chicago Tribune/TNS Crowds cool off along the lakefront near Diversey on July 14, 2020.

That’s still nearly double the pandemic’s overall death rate in Arizona, more than double Florida’s, nearly triple California’s and nearly five times the rate in Texas.

How can those other states be getting all the headlines when Illinois’ overall death rate is far worse? It has to do with how unevenly the pandemic has taken its toll.

Compare the trajectory of daily deaths in Illinois with that in Arizona, California, Florida and Texas — and then add in the early hot spots of New York and New Jersey.

In New York and New Jersey, the trajectories look like tall, steep roller coasters, topping out at 3.9 and 3.1 daily deaths per 100,000 residents in April. While those rates have dropped dramatically since, and are now far lower than in Arizona, the number of people who died during that spike was significant, pushing New York and New Jersey’s overall COVID-19 death rates to 129 and 176 per 100,000 people, respectively, the data from the COVID Tracking Project shows.

a man and a woman standing in front of a building: Oliver Perhay relaxes at the Green Eye Lounge in Chicago's Bucktown neighborhood on July 14, 2020. © Chris Sweda / Chicago Tribune/Chicago Tribune/TNS Oliver Perhay relaxes at the Green Eye Lounge in Chicago's Bucktown neighborhood on July 14, 2020.

Illinois’ trajectory looks far more gradual, peaking in mid-May at 0.9 deaths per 100,000 residents, then beginning a slower drop. Illinois officials say this later peak was because of an aggressive shutdown that smoothed out the roller coaster into more of a hilly road. That, ultimately, saved lives.

a car parked in a parking lot: Members of the Illinois National Guard work at the COVID-19 test site at South Suburban College in South Holland on July 2, 2020. © Zbigniew Bzdak / Chicago Tribune/Chicago Tribune/TNS Members of the Illinois National Guard work at the COVID-19 test site at South Suburban College in South Holland on July 2, 2020.

As for the other four states, they had a relatively modest early pandemic, with death rates just a fraction of New York’s, New Jersey’s and even Illinois’ at the time. So the recent increases in deaths aren’t enough to bring their total death rates above those in the pandemic’s initial hot spots — not yet, anyway.

a sign above a store: Map Room bartender Chris Jourdan works behind the bar in Chicago's Bucktown neighborhood on July 14, 2020. © Chris Sweda / Chicago Tribune/Chicago Tribune/TNS Map Room bartender Chris Jourdan works behind the bar in Chicago's Bucktown neighborhood on July 14, 2020.

Death trends slow to show

Illinois’ stay-at-home order went into effect March 21, effectively putting the state on a partial lockdown.

a group of people sitting at a park: Kay Haines and Amber Smith relax along Chicago's lakefront near Diversey Parkway on July 14, 2020. © E. Jason Wambsgans / Chicago Tribune/Chicago Tribune/TNS Kay Haines and Amber Smith relax along Chicago's lakefront near Diversey Parkway on July 14, 2020.

At that point, Illinois’ known death toll from COVID-19 was just five people. (Or, if you do the math, the rolling seven-day average was 1.3 deaths per day on March 20.)

Despite the swift measures taken, deaths in Illinois still grew significantly — to an average of nearly 117 a day in early May — before beginning a slow drop. The state was still averaging about 75 deaths a day when Pritzker ended the order May 29.

Researchers note that deaths are lagging indicators of the virus’s spread. People who die were typically infected weeks earlier. That’s why, even if a virus starts spreading wildly, deaths may not see an uptick right away.

It’s also why, once death figures start growing, the trend can take a long time to reverse.

So far, even as Pritzker reopened more businesses in phase three, then launched phase four on June 26, deaths have continued to drop.

Alarming increases

While Illinois deaths were dropping, other states’ tallies were growing, to the point that Arizona now averages more than 60 deaths a day, and California, Florida and Texas have reached an average of 90-plus deaths a day.

The daily death rate, adjusted for population, has doubled in three of those four states since July 1. The highest rate is in Arizona, with 0.89 deaths a day, on average, per 100,000 residents. That’s six times Illinois’ most recent rate of 0.14 deaths per 100,000 residents, and approaching Illinois’ peak death rate of 0.92 deaths per 100,000 residents on May 10.

These rising death statistics, sadly, were expected. That’s because the numbers of confirmed COVID-19 cases and hospitalizations have also been growing.

In Arizona, for example, there are now 3 1/4 u00bd times as many cases as there were on June 15. And although more cases may emerge as more people are tested, increased testing can’t explain away that growth. Over the same period, the number of people tested in Arizona doubled, which is a smaller increase.

By contrast, testing in Illinois has increased at a greater rate than the small rise in cases.

The impact of testing on case numbers is why some researchers focus on the positivity rate, or the percentage of tests coming back positive. Illinois’ rate has hovered near 3% in the past month, based on seven-day averages, which is considered a good sign. Arizona’s has climbed from 17% to 23%.

A recent study published by a group of researchers, most from the University of Illinois, found that as a state’s positivity rate rose so did hospitalizations. That’s true in Arizona, where hospitalization figures more than doubled in the past month, while Illinois’ have dropped.

The lesson, researchers said: Public officials need to pay attention to the metrics and make quick adjustments to restrictions to avoid the need for bigger changes later.

Among the researchers working on that University of Illinois study were Nigel Goldenfeld and Sergei Maslov, who develop COVID-19 case forecasts for the state.

Their paper concluded that, if Illinois’ doesn’t limit the number of so-called super-spreader encounters like those in crowded bars and at large parties, and virus trends began to mirror those in the Sun Belt, Illinois could run out of hospital beds by the fall.

“Nobody wants to overreact. But you also don’t want to underreact,” Goldenfeld said.

Will death tolls rise again?

The real question is whether the virus is spreading or dying out.

Again, there are no easy answers. But there are statistics to watch.

Illinois saw a sustained drop in the daily number of new cases (averaged over seven days) to under 600 cases in late June. It since has risen to more than 1,000, a cause for concern.

And while Illinois’ positivity rate is still low overall, the Pritzker administration also said Wednesday that it’s closely watching the positivity rate in each region of the state to see if movement restrictions should be tightened. Among the options: closing bars and limiting indoor dining, actions suggested by the University of Illinois study.

The state is also watching hospital admissions for COVID-like symptoms, by region. The state doesn’t release those specific figures daily, but on a similar metric — hospital beds occupied by COVID-19 patients — different regions of the state are showing different trends.

In the northeast region, covering Chicago and its suburbs, the average daily count of COVID-19 patients has dropped by 12% over the most recent two weeks that could be analyzed.

Far fewer people are being hospitalized downstate. But the figures have been increasing.

Over those same two weeks, the north-central region saw its figures increase by 20%, the central region by 25% and the southern region by 36%.

Other evolving factors may also affect death trends.

For one, doctors have gotten better at treating COVID-19, suggesting fewer hospitalized patients could die. (Researchers estimate about 1% of those infected die.) Infections also are spreading in younger people, who — while they’re less likely to get seriously ill — could more fuel spread to more vulnerable people.

Researchers offer mixed assessments of the state’s latest guidelines but agree the key to avoiding a surging death toll is to react faster to warning signs than other states where deaths are now surging.

“(There was) all of this missed opportunity where (other states) could have reimposed mitigation, but they didn’t,” the U. of I.’s Maslov said. “We were really worried about this repeating itself in Illinois. Now we are cautiously optimistic that it will not. But time will tell.”

jmahr@chicagotribune.com

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