Illinois is in Phase 2 of Restore Illinois – the five-step plan Gov. J.B. Pritzker unveiled this week to reopen schools, colleges, parks and businesses, while addressing the coronavirus pandemic.
Some state parks are open. More shops can operate to fill online and pick up orders, and in some places, residents can go to a drive-in movie theater. While the stay-at-home order still applies to the whole state, Pritzker said going forward, that will change as it’s a regional plan.
“Reality on the ground looks different in different areas of the state,” Pritzker said at a recent press briefing.
Some Republicans and business groups have criticized the regions for being too vast and the timeline too slow, wreaking further havoc on the economy.
Pritzker defends the plan, saying he’s basing it on guidance from public health and medical experts, and that he consulted with business leaders, mayors and officials from around the state.
Dr. Mark Dworkin – a professor of epidemiology at the University of Illinois Chicago School of Public Health – said Pritzker’s approach is ‘thoughtful,’ but alternatives are possible.
“Especially with no major science behind what we’re doing, but just trying to use expert opinion and good judgment,” he said. “But we should beware of a situation where we’re talking about our politicians because… they are preset to disagree with whatever the other group is.”
An explanation of the phases is below and in the governor’s plan. Movement between the next two phases depends on a region keeping the share of new positive tests low for two weeks, hospital admissions have to be stable for nearly a month, and the region has to have enough hospital beds and equipment to respond to a surge in new COVID-19 patients. Testing must also be expanded and contact tracing robust.
But there’s a catch to moving on from Phase 4, the one before mostly returning to normal: the state could be here for months.
“Until we have a vaccine or an effective treatment or enough widespread immunity that new cases fail to materialize – the option to return to normal doesn’t exist,” Pritzker said.
Debate Over Regions
The plan combines the 11 regions the Illinois Department of Public Health established for Emergency Medical Services into four: Northeast with Chicago and its suburbs; North-Central Illinois from the border with Wisconsin down to Peoria and Bloomington; Central Illinois from Danville to Quincy, including Springfield and Champaign-Urbana, and finally Southern Illinois, including the Metro-East and Carbondale.
“I’m here to raise a warning flag that Watseka, Illinois is very different than Quincy, not only just four hours away,” he said. “The plan is set up in an unworkable way.”
The cities he references are both in the Central Illinois region. Durkin went on to say that the plan would destroy many small businesses and manufacturers.
State Rep. Ryan Spain, who was at the virtual press conference, is a Republican from Peoria, where he says hospitalization rates, new cases and intensive care unit capacity have all been meeting the governor’s benchmarks to start loosening more restrictions.
“We have been meeting them now for the last four weeks,” he said. “So that takes me to the third problem, which is the arbitrary establishment of some of the time periods included in the governor’s plan.”
Spain took issue with May 1 as the start date for IDPH to track metrics. That means no region can open up more until the end of the month.
Pritzker defended the designation, saying that is when some regulations loosened, such as allowing more retail stores to open.
On the region size, public health experts NPR Illinois interviewed said the larger population size in the regions could ensure that smaller or single outbreaks don’t cause big swings in the metrics the public health department is tracking.
“When you get that number of people to assess, you’ve got a good denominator on which to make decisions,” said Dr. Jerry Kruse, CEO of SIU Medicine in Springfield and dean of the Southern Illinois University School of Medicine.
Pritzker has faced criticism for using a 28-day timeframe between phases, while other states, including New York, are using 14 days. Two weeks is thought to be the incubation period for the coronavirus.
Dworkin, the UIC epidemiologist, said four weeks – or two incubation periods – is more cautious.
“It’s giving you more comfort that when you make that change, you’re that much more sure what’s going on,” he said.
Dworkin said he understands living with restrictions until a vaccine or treatment is available is uncomfortable.
But the alternative is worse – more infections and deaths until herd immunity is reached.
“Why would we take the hose off of the fire?” Dworkin asked. “What would we expect to happen if we did that, because we’re tired of holding the hose? We can expect the fire to burn faster and harder than it was with the water on it.”
According to the metric tracker on IDPH’s website, all the regions except Chicago are on track to meet criteria to move on to Phase 3 at the end of May.
The state is divided into four regions, and each can move forward – or backward – through the five phases of the plan as they meet certain medical benchmarks:
Phase 1 (Illinois began in March) : Broad stay-at-home order, with only grocery stores, pharmacies and other essential businesses open. Bars and restaurants are only open for pick-up and delivery orders. Only essential manufacturers can operate.
To move to the next phase: The growth of new cases must slow, and surge capacity of hospital beds and ventilators must be available. Testing must be available for any healthcare worker or first responder with symptoms, and 10,000 tests done daily statewide.
Phase 2 (Began May 1) : Stay-at-home order continues, but more retail stores can open to fill online and pick-up orders, similar to restaurants. Face coverings are required where social distancing isn’t possible, and some outdoor activities, such as boating, fishing and golfing, are allowed.
To move to the next phase: A region must keep the share of new positive tests at 20% or below for two weeks, with no major spikes. Hospital admissions for COVID-19 have to be stable for 28 days, and the region has to have 14% of hospital beds and equipment available to respond to a surge in new COVID-19 patients. Testing availability must expand to anyone with underlying conditions, as well as residents and staff as nursing homes, jails and other congregate settings. Contact tracing begins within 24 hours of diagnosis.
Phase 3: Offices, salons and barber shops can open, with capacity limits and other safety precautions. Face coverings are still required. Any gatherings of 10 or fewer are allowed.
To move to the next phase: The positivity rate and hospital admission criteria are the same as moving from Phase 2 to Phase 3. Testing must be available for anyone, regardless of symptoms. Contact tracing must begin within 24 hours for more than 90% of the cases in the region.
Phase 4: Childcare centers and schools, as well as bars and restaurants can reopen, all with safety guidelines from the Illinois Department of Public Health. Any gatherings of 50 people or fewer are allowed. Travel resumes.
To move to the next phase: A vaccine or effective treatment must be widely available. Alternatively, a region has reached herd immunity and there are no new cases over a sustained period of time.
Phase 5: Conventions, large events and festivals are permitted. All businesses, schools and recreation can resume with safety guidance.