Situational Update Stakeholder Only May 13, 2020 Webinar Recording - - PowerPoint PPT Presentation

2019 Novel Coronavirus (COVID-19) Situational Update Stakeholder Only May 13, 2020

Webinar Recording Link

COVID-19 in Illinois

83,021 Cases 3,601 Deaths 98 Counties in Illinois 471,691 specimens tested

As of 5/12/2020

COVID-19 Cases

As of 5/12/2020

500 1000 1500 2000 2500 3000 3500

Count Earliest Specimen Collection Date

Illinois Confirmed COVID-19 Cases since March 4, 2020 by Specimen Collection Date

Case Count 7 Day Moving Ave

Illness that began during this time may not yet be reported.

COVID-19 Deaths

As of 5/12/2020

20 40 60 80 100 120 140 3/16/2020 3/17/2020 3/18/2020 3/19/2020 3/20/2020 3/21/2020 3/22/2020 3/23/2020 3/24/2020 3/25/2020 3/26/2020 3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020 4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020 5/11/2020 5/12/2020

Count Deceased Date

Illinois Confirmed COVID-19 Deaths

COVID-19 Case Type

As of 5/12/2020

10000 20000 30000 40000 50000 60000 Bellwood Champaign Edwardsville Marion Peoria Rockford West Chicago

Case Count CD Region

Illinois COVID-19 Confirmed Cases by Type and CD Region

Sporadic Cases Outbreak Cases 0% 20% 40% 60% 80% 100%

Sporadic vs Outbreak Cases by Region

Sporadic Cases Outbreak Cases

54,806 Total cases sent surveys

• 37% Cases responded
• 53% Cases report recovered

Recovery Data

As of 5/12/2020

53.5% 53.4% 74.0%

<=14 15-28 >28 DAYS SINCE REPORTED TO PUBLIC HEALTH

% RECOVERED

Bellwood Champaign Edwardsville Marion Peoria Rockford West Chicago Illinois 0% 10% 20% 30% 40% 3/19/2020 3/26/2020 4/2/2020 4/9/2020 4/16/2020 4/23/2020 4/30/2020 5/7/2020 Bellwood Champaign Edwardsville Marion Peoria Rockford West Chicago Illinois

7 DAY AVERAGE POSITIVITY - IL & REGIONS

DATA SOURCE: Electronic Lab Records. Does not include provider reported positives.

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 20000 40000 60000 80000 100000 120000 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 3/14/2020 3/28/2020 4/11/2020 4/25/2020 5/9/2020 Bellwood Champaign Edwardsville Marion Peoria Rockford West Chicago Illinois Total Specimens Tested per Week and Percent Positive Specimens per Week (ELR) by Region, Illinois PERCENT POSITIVITY TOTAL TESTS WEEK ENDING

Outbreaks as of 5/13/2020 Total number of outbreaks = 866

• 50% of Outbreaks are in

LTC/Assisted Living/Skilled Care

Long-term Care: : cases and deaths

Slide Updated 5/13/2020

LTC summary Number of Confirmed COVID-19 Cases Percent of LTC COVID-19 cases (N=6,283) Percent of all Confirmed COVID-19 cases Total 6,283

• 7.6 (N=83,021)

Fatal 1,610 25.6 44.7 (N=3,601) Non-Fatal 4,673 74.4

• Hospitalized

2,860 45.5

• Mean length of stay (cases with discharge date)

7 days overall

50 100 150 200 250 300 350 400 450

Number of Cases Onset Date

COVID-19 Confirmed Cases and Deaths in Long-Term Care Facilities by Onset date, (N=6283)

Non-fatal Deaths

COVID-19 Outbreaks

OUTBREAKS/CLUSTERS OF COVID-19: DEFINITIONS NOTE: TO AVOID DUPLICATE OUTBREAK ENTRY, PLEASE CHECK TO BE SURE THERE IS NOT A CURRENT OUTBREAK ALREADY ENTERED IN ORS FOR THE FACILITY BEFORE ADDING A NEW OUTBREAK.

LTC/assisted living facilities only: 1 laboratory-confirmed COVID-19 case plus others ill with similar symptoms, but may not be tested yet. For all other facilities/locations/events: 2 or more laboratory-confirmed COVID-19 cases linked to the same site (epidemiological link). Health care facilities-not hospitals: there should be a strong link between a laboratory-confirmed COVID-19 case and resultant cases in a health care

• facility. Example: one HCW symptomatic, tested positive and multiple other

staff/patients developed confirmed COVID-19 during the 14 days following exposure.

COVID-19 Outbreaks

• Non-Healthcare Setting

– Cases have an epi link: time and place

• Could transmission between cases have occurred?
• Look for a workplace link between the workplace cases (i.e. same shift, same area in plant, same break area,

etc..)

• Touching contaminated objects (probably less likely)

– Asymptomatic or mild unreported cases are possible – Are there cases in the employee household or among non-work close contacts?

• If no likely link between workplace cases but there are non-work close contact cases, monitor for additional

workplaces cases before classifying as an outbreak.

• Counting outbreak cases in all COVID-19 outbreaks:

– Number of lab-confirmed = the number tested with positive COVID-19 test. – Number meeting case definition = Number with positive lab test PLUS those that aren’t tested but have similar symptoms (meet probable case definition) – Tested negative: NOT A CASE, won’t count towards outbreak

Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 in Children

• Late April, UK reported on 38 kids with multi-system Kawasaki-like disease, multi-system disease

– Older group of kids – Only 2/3 were SARS-CoV2 positive; others had antibodies or close contact with COVID case

• As of May 5, 2020, NY reported 64 suspect pediatric clinical cases compatible with multi-system

inflammatory syndrome associated with COVID-19 (the majority tested positive by PCR or serology).

• This syndrome has features which overlap with Kawasaki disease and Toxic Shock Syndrome.

Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash may also be present. Myocarditis and other cardiovascular changes may be seen.

• The syndrome may include: a child presenting with persistent fever, inflammation and evidence of

single or multi-organ disfunction.

• Need to be cautious in assuming coronavirus link
• Anticipate a HAN and Case Definition from CDC any day
• Contact your LHD to report any suspect cases

Review – ED an and In Inpatient vis visits in in th those under r 18 Dia iagnosed with ith COVID-19 19

Slide Updated 5/12/2020 Number since March 1 Total = 498 ( Inpatient = 107 ; ED= 391 )

Edonly IP Total Percent of Total FeverOrChills 135 31 166 33.3 FeverPlus 132 31 163 32.7 Cough 106 19 125 25.1 FeverOnly 58 12 70 14.1 Short Of Breath 53 15 68 13.7 P_and_I 50 15 65 13.1 ILI 46 14 60 12.0 NVD 30 9 39 7.8 SoreThroat 38 38 7.6 Headache 30 2 32 6.4 DifficultyBreathin g 18 8 26 5.2 AbdominalPain 9 4 13 2.6 BodyAches 11 1 12 2.4

In syndromic for those Under 18 that were seen in ED or Admitted and given a COVID diagnosis (denominator is diagnosis only regardless of CLI symptoms). Table shows primary symptom classifications of the 498

• visits. Categories are NOT mutually exclusive.

Key point is expected symptoms are most common. Rare symptoms, NVS, Abdominal pain or Rash are LOW in children.

Release from Isolation Clarification for Asymptomatics

10 DAYS FROM DATE OF TEST PLUS 3 AFEBRILE AND SYMPTOMS IMPROVING; HOWEVER,

IF THEY DEVELOP SYMPTOMS, YOU SWITCH TO A SYMPTOM- BASED STRATEGY, AND GO FOR 10 DAYS FROM ONSET PLUS 3 AFEBRILE AND RESPIRATORY SYMPTOMS IMPROVING.

COVID-19 Symptoms (wide range)

• Fever
• Cough
• Sore throat
• Shortness of

breath/difficulty breathing

• Muscle aches
• Headache
• Abdominal discomfort
• Vomiting
• Diarrhea
• Loss of Taste/Smell
• Rigors
• We attempt to keep all

related documents up to date, including symptom monitoring tools and guidance documents.

For example…

Breakdown of Symptoms Reported in I-NEDSS thru 5/11

Symtpom Percentage Reporting Cough 75% Fever 56% Muscle Aches 50% SOB 49% Headache 42% Loss of taste/smell 37% Sore throat 31% Diarrhea 26% Chest pain 15% Vomiting 10%

COVID Migrant Worker Guidance & LHDs

• The Division of Environmental Health licenses

approximately 20 migrant labor camps in Illinois.

• Program staff have been working with the

University of Illinois At Chicago, Occupational Health physicians and several state agencies and advocacy groups to develop appropriate guidance documents and coordinate outreach efforts.

• If you’d like to be included in the outreach

activities for migrant worker operations in your jurisdiction, please contact our General Engineering Program Manager, Andy Frierdich, at (217)-782-4837 or andrew.frierdich@illinois.gov.

Case Definition for COVID Deaths (IL

• nly reports out

Lab Confirmed Deaths*)

In a confirmed or probable COVID-19 case, the case will be considered a COVID-related death: 1) If death is within 30 days of symptom onset, diagnosis, positive laboratory specimen collection OR during hospitalization, (unless cause of death found to be entirely unrelated to COVID-19 or complications from COVID-19 – ex: car accident). OR 2) If COVID-19 is listed as a cause or precipitating factor of death on any medical records OR 3) If COVID-19 is mentioned on the death certificate under any of the below circumstances, – Immediate Cause of Death – Underlying Cause of Death – Significant Condition Contributing to Death *If COVID-19 is not mentioned in any place on the death certificate, but meets criteria for #1 or #2, then still “Yes” died from illness or complication of the disease “If the patient died, did the patient die from this illness or complication from this illness?” will need to be updated to “Yes” in the I-NEDSS General Illness Page if the case’s death meets these criteria.

*Currently, we have 102 probable deaths

IVRS (Death Certificate) Match with I- NEDSS

• Any death where COVID is listed as a

cause or contributing cause of death is imported into I-NEDSS as a possible case.

• Daily, any deaths that match to I-

NEDSS cases are updated with Date

• f Death and Contributing Causes of

Death are Listed.

Deaths by age group (n=3,378)

3 18 49 113 285 599 847 1464 200 400 600 800 1000 1200 1400 1600 < 20 20-29 30-39 40-49 50-59 60-69 70-79 80+

Count

Deaths by Age and Race

1468 1898

Female Male

Deaths by Race

Race Cases Per 100,000 American Indian/Alaskan 10 11.24 Asian/Pacific Islander 144 18.13 Black/African American 1105 56.95 White 1841 18.56 Total 3100

Deaths by Geographic Region

Geography Cases Cases Per 100,000 Cook 2303 44.46 Chicago 1343 49.63 Suburban Cook 960 38.80 Collar Counties 661 20.89 Other Urban 212 9.25 Rural 202 9.60 Total 3378

Other Mortality Statistics

• As of today, 55% of deaths are related to an
• utbreak.
• 42% of all deaths involve a skilled care, LTC or

assisted living facility, of which 91% were

• utbreak related.

Updated Resources for Coroners/Medical Examiners (CDC has asked for assistance in distribution)

• Funeral Guidance for Individuals and Families

https://www.cdc.gov/coronavirus/2019-ncov/daily-life- coping/funeral-guidance.html

• Collection and Submission of Postmortem Specimens from

Deceased Persons with Known or Suspected COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance- postmortem-specimens.html

• Above resource also covers Transportation of Human Remains

Post-Mortem Specimens

– For post-mortem testing of deceased persons, if the Medical Examiner (ME) suspects COVID-19, testing can be authorized. Refer to CDC Post-Mortem guidance for specimen information. – For specimens submitted to be tested at IDPH labs, ensure the submission form indicates the submitter is a coroner or medical examiner. – LHDs who authorize post-mortem testing should be sure to include the information it is a post-mortem specimen in the authorization entry, if done, or notify IDPH lab or CD Section. – If COVID-19 testing on postmortem swab specimens is being considered for a suspected COVID-19 case, SARS-CoV-2 RNA may still be detected up to 3 days postmortem and possibly longer based on available data from experiences with MERS-CoV and SARS-CoV; however sensitivity may be reduced with a longer postmortem interval, and duration of illness may need to be considered in interpreting a negative result.

https://dph.partner.illinois.gov/communities/communicabledisease/CDAZ/Pages/COVID% 2019%20Resources%20for%20Public%20Health%20Departments.aspx

To Register for Portal and I-NEDSS Access

• Go to https://portalhome.dph.illinois.gov/

To sign-up to be a Contact Tracer

• https://www.illinoishelps.net/

Remdesivir

• Antiviral for hospitalized patients with severe disease.
• FDA Authorization for Emergency Use
• Federal HHS is distributing supplies
• Distributed to Illinois hospitals based on defined criteria

COVID-19 and Adult CPR

Interim CPR Guidelines for resuscitation during the COVID-19 pandemic

• New guidance aims to balance providing timely high-quality

CPR and protecting the safety of the rescuer

• https://cpr.heart.org/en/resources/coronavirus-covid19-

resources-for-cpr-training

• AHA Article: Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates

with Suspected or Confirmed COVID-19

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONA HA.120.047463

Out of Hospital Cardiac Arrest (OHCA)

• Lay rescuers

– CPR has consistently been shown to improve the likelihood of survival from OHCA, which decreases with every minute CPR and defibrillation is delayed – Rescuers in the community are unlikely to have access to adequate PPE and, therefore, are at increased risk for exposure to COVID-19 CPR, compared to healthcare providers with adequate PP – AHA continues to encourage bystander CPR and defibrillation, for those willing and able

• Public access defibrillation - Because defibrillation is not expected

to be a highly aerosolizing procedure, lay rescuers should use an automated external defibrillator, if available, to assess and treat victims of OHCA.

https://newsroom.heart.org/news/interim-cpr-guidelines-address-challenges-of-providing-resuscitation-during-covid-19-pandemic

https://newsroom.heart.org/news/interim-cpr-guidelines-address-challenges-of-providing-resuscitation-during-covid-19-pandemic

Elective Surgeries

IDPH guidance on elective surgical procedures and when they are permissible during the declared Gubernatorial Disaster Proclamation in response to the ongoing coronavirus (COVID- 19) situation is intended to assist in conserving resources for the care of COVID-19 patients. This guidance does not replace the primacy of the professional medical judgment and the decisions of physicians and other health care workers in hospitals and in ambulatory surgical treatment centers in assessing individual patient needs. Surgeries and procedures for life-threatening conditions or those with a potential to cause permanent disability have been and continue to be allowed . Physicians and other health care workers will continue to determine when such circumstances exist and treat their respective patients accordingly.

THANK YOU

Questions?