By: Mark Glennon*
Until April 3, Illinois failed to collect daily information critical to assessing and managing the COVID-19 crisis – numbers on hospitalizations, bed capacity, ventilator availability and the like – which most other states collect and publish. It began doing so only under pressure, in which Wirepoints played no small role.
Now the state is bragging about the simple step it should have taken long ago, citing it as an example of its prowess in science and data, and using it for a political jab.
Reproduced below is an email directive Wirepoints obtained sent to all Illinois hospitals on April 2 by the Illinois Department of Public Health (IDPH). It belatedly directs all hospitals to provide the hospitalization information, as Wirepoints had written that the state needs to do. The reporting requirement commenced April 3, and IDHP published a compilation of what it obtained that day, which is also copied below.
Illinois still needs to do better, and the experience raises questions about what is going on.
Here are the details:
By late last month, a number of articles in national stories, citing experts, pointed out that the number of “new cases” of COVID-19 commonly seen in headlines to gauge the pandemic’s growth isn’t very useful. New case numbers mostly just reflect the huge surge in testing now being done, and most new case victims aren’t seriously sick and get sent home — or never knew they had coronavirus in the first place.
Instead, the hospitalization and available resource numbers reflect what’s important because they tell us where hospitals could get overloaded. Preventing that overload is the whole point of “flattening the curve.” Most importantly, the number of hospitalized victims is a better indication of how many are at risk of dying.
We began writing to that effect on Twitter in late March, directly asking the state to collect and release the data. Several state lawmakers did the same. ProPublica wrote a national story complaining that certain states, including Illinois, were not providing those numbers. Illinois gave them the run-around.
We wrote in detail about Illinois’ failure to report this data on March 26, and we asked Illinois reporters to challenge Governor JB Pritzker on the issue at his daily briefing. Rich Miller of CapitalFax, who is particularly friendly towards the Pritzker Administration, labeled us and some others who wanted the data “covidiots” on March 27. Later that day, Pritzker said Illinois was collecting the information piecemeal but would work on it “over the weekend.”
Nothing happened, so we wrote again on April 1, saying “This isn’t complicated.” Hospitals compile the information every day and can easily send it in. “Governor Pritzker,” we wrote, “have them send that daily information to the state and total it up! That’s the simple solution.”
That’s exactly what IDPH did in its April 2 email to hospitals. As you can see below, hospitals can just plug in the numbers every day and submit the counts digitally, and the state then can compile the data easily.
We emailed both IDPH and Pritzker’s press secretary April 3 when the numbers were due back, requesting that they share them. We didn’t hear from them that day but they did release the totals in a press release that day, which are below.
And now Pritzker’s media team has taken to Twitter to brag about their prowess with science and data based on the numbers they had to be pushed to collect. They went further and used those figures as part of Pritzker’s tiresome squabbles with the Trump Administration. Pritzker’s press secretary sent this tweet, along with the tweet shown from her deputy:
That talk about their monopoly on science and data appears almost everywhere in comments from Pritzker as well as Chicago Mayor Lori Lightfoot. We who dare question them, goes the implication, are science haters.
Their message is particularly galling when you consider that the federal government had already implemented a daily system for collecting the information, which is discussed below. Did the Pritzker administration just copy it? Did they not know about it? Why not coordinate? Did political squabbling have precedence over federal-state coordination?
Why this is important:
All the models projecting risk of hospital overload and resources needed are useless if current, accurate numbers don’t go in. Junk in, junk out. Where exactly within Illinois is overload approaching? Which states need the most help? To answer those questions, you need to look at hospitalization rates and trends, empty capacity, available ventilators and such.
Those numbers will also be essential when the time comes for making the difficult decision about when to lift the shutdown and get people back to work. If we do it too soon the curve could spike again and overload medical resources; wait too long and unnecessary, further damage to the economy will result.
Open Questions; More to be Done:
What the numbers show and what’s still needed.
The new data show plenty of unused beds, for now, for the state as a whole – 11,502. That seems directionally consistent with the widely cited University of Washington projection, which says that even at the peak of the crisis Illinois should have more than enough beds.
Intensive care beds, however, are tighter, and that’s where attention appears needed. The new numbers show 806 ICU beds now open and the projection shows a shortage of 507 ICU beds at the peak.
Statewide totals don’t mean much, however, for particular regions because shortages may be concentrated. On that point, IDP botched the project because it published only grant totals. What IDPH should do is publish and use the new data by hospital or group it for particular cities or regions. That’s not hard to do. Take a look at how California does that. Many other states are similarly grouping the hospitalization numbers by city, county or region. That’s what the state should be looking at to decide where to focus its efforts, and that’s what the public needs to see.
As the new numbers come in daily, they also need to be displayed in some manner that shows trends.
Shouldn’t the federal government be collecting these numbers from hospitals, compiling and publishing them?
The Center for Disease Control does have its own pipeline for this information, which is very similar to that now in place for IDHP. On March 29, Vice President Michael Pence directed all hospitals to provide a daily report, the form for which is linked here. The federal government should have that information to make comparisons among states to quickly determine where the most help is needed.
On the other hand, the reality in practice is that publishing any data has been left to the states and most states I have looked at are doing a very good job of it. It’s just not that hard to do.
Why didn’t Illinois and the CDC coordinate this better? Who knows.
You can count this among many challenges raised by our federal system in this crisis, which accounts for so much of the squabbling. Let’s face it: Nobody thought through ahead of time what responsibilities in a crisis like this are for federal, state or local units of government. When the time comes to assess how to be better prepared next time, that matter will be key.
Lightfoot and Chicago need to get on the program.
We certainly appreciate that Chicago’s mayor has much on her plate, but she seems to be a few steps behind on this whole matter and out of touch with the numbers.
She has been talking repeatedly about a shortfall of 40,000 hospital beds just for Chicago. “Not 40,000 cases, but 40,000 people who require acute care in a hospital setting,” Lightfoot said. “That number will break our healthcare system… This will push our city to the brink.” But those numbers are silly — far out of line with the newly released numbers, which show the entire inventory of beds at about 28,000. And publicly available projections for hospitalizations say only about 9,300 hospital beds are expected to be needed when the virus peaks for all Illinois.
At Pritzker’s April 3 press conference, a question about hospitalization data went to Lightfoot. “We are still analyzing that data and will releasing that data as soon as it is appropriate,” she answered. Why did she duck that question entirely? Was she even aware of the new data already released by the state? Is she aware the CDC already collects it?
And WBEZ got some numbers on Chicago hospitals, before the new state data came out, but apparently had to use backchannels to get them. “The Chicago Department of Public Health did not respond to requests for comment, and has previously declined to disclose specific figures about beds and ventilators available.” That should all be simplified now and Chicago should be releasing numbers consistent with the hospital reports now going to IDPH.
Why have Chicago and the State of Illinois been slow to collect and publish these numbers?
We can only speculate.
The charitable answer would be that Pritzker, Lightfoot and others want to keep the public sufficiently alarmed to ensure they honor the social distancing rules. For that purpose, it might be better to highlight those scary, daily, new case numbers instead of other data.
And maybe they want to put the worst data forward for purposes of getting maximum help from the federal government. If that’s the motive, however, the constant shots at the Trump Administration are unwise, and stand in stark contrast to the more constructive approach taken by Democratic governors Newsom and Cuomo in California and New York.
The more cynical answer would be that maximum drama is best for political purposes. Or maybe that they simply erred by not focusing on the right numbers.
We leave you to speculate on other possibilities.
All we know is it’s good to now see more meaningful data finally flowing.
*Mark Glennon is founder of Wirepoints.
Email directive from IDHP to all Illinois hospitals:
To: Illinois Hospitals
From: Public Health Emergency Operations Center
Date: April 2, 2020
Re: IMPORTANT: Change to EmResource COVID Query Questions
The Illinois Department of Public Health is further defining the variables in the current statewide COVID-19 Query in EMResource. At the same time, we will be discontinuing the laboratory and PPE requests for information. The new event will be launched by 10pm on April 2, 2020 and hospitals will be able to report this new information by the current reporting time of 10am on Friday April 3, 2020.
The following information will be requested daily at 10am and 6pm:
(please note the expired patients are only reported once daily at 10am)
COVID or PUI in non-ICU beds:
Definition: Number of COVID or PUI patients in non-ICU beds in the hospital. This includes all patients not designated as ICU status.
COVID Pts in ICU Status:
Definition: Total number of confirmed COVID-19 patients designated as ICU status regardless of location in the hospitals. This will include COVID pts that are ICU status holding in other areas such as PACU, ED, and surge ICU areas.
COVID Pts on Vents.
Data released April 3, 2020: