After a year of pronounced shifts in the COVID-19 pandemic related to mass vaccination, more infectious variants and the sorely tested patience of the public, Illinois is facing an even more complicated set of realities entering 2022.
The state is now seeing record numbers of COVID-19 infections — but these cases appear less likely to cause serious illness. At the same time, Illinois’ health care system is in worse shape than it was a year earlier, and the exploding case counts mean even a milder variant could further strain hospitals with COVID-19 patients.
Already, hospitals are treating more patients with fewer workers, leading to a space crunch so severe that hospitals are again canceling nonemergency surgeries to try to free up beds. And while the vast majority of patients aren’t in the hospital because of COVID-19, the odds of an unvaccinated person ending up hospitalized with the virus is notably worse than at any other time during the pandemic.
A year ago, mass vaccination was on the horizon, offering hope the virus could be extinguished through so-called herd immunity and life could return to normal. Now researchers expect the virus and its ever-evolving variants to stick around. The hope is that vaccinations can prevent most infected people from getting too sick and that the latest wave will subside as quickly as it came.
Those adjusted expectations follow another deadly year. The Illinois Department of Public Health blamed COVID-19 for at least 11,000 more deaths in 2021, bringing the total to nearly 28,000 since the pandemic began, with an additional roughly 3,200 deaths considered to have “probable” ties to COVID-19.
Here’s where we are, as the new year begins:
Record case numbers
A year ago, the average number of new cases each day had begun to drop after soaring above 12,000 in fall 2020, and people began preparing for vaccines that leaders hoped would starve the virus out of existence.
The vaccines came, but millions of Illinoisans haven’t taken them. Along the way, the virus spawned new mutations that began to chip away at the vaccines’ effectiveness, particularly their ability to stop somebody from getting infected.
The delta variant fueled smaller surges in spring 2021, in late summer and — most recently — after Halloween. Then the omicron variant emerged, supercharging an already sizable surge.
A state that had averaged about 2,000 cases a day in late October was suddenly seeing daily figures double, then double again, and continue climbing. The week of Christmas — as people rushed to get tested before visiting family and friends — the daily count eclipsed 21,000 new detected cases. On Thursday, when post-Christmas tests began rolling in, there were more than 30,000 new cases.
To put that into perspective, that one-day figure was triple the number of Illinoisans testing positive in all of June.
Another jarring way to look at it: The worst day of the fall 2020 surge saw nearly 1 in 700 Illinoisans testing positive. On Thursday, the most recent date the state posted data, it was closer to 1 in 400.
In Chicago alone, new cases have recently topped 5,000 a day.
“This is one of the steepest increases that we’ve seen, and this is due to the omicron variant,” Chicago’s health director, Dr. Allison Arwady, said during a Facebook Live event Thursday. “This is also why, I am guessing, everyone of you knows somebody, at least indirectly, who has COVID right now.”
The rate of infections for unvaccinated Chicagoans has tripled since late November to reach more than 900 cases a week per 100,000 residents. Vaccinated, but not yet boosted, Chicagoans have seen their infection rate climb to roughly 400 a week per 100,000 residents, with residents who’ve gotten boosters seeing a slightly lower rate, closer to 350 a week per 100,000 people.
Because the number of people tested each day can bounce up and down, public health agencies and researchers typically average out seven days’ worth of case numbers to create a rolling daily average.
Using this measure, the state set a record on Nov. 16, 2020, with an average of 12,384 new COVID-19 cases. But 13 months later, on Dec. 23, the state broke that record. And the average cases have continued to climb in the past week, eclipsing an average of 18,000 new cases a day roughly two months into this surge.
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Case counts don’t offer the full picture of a surge. They may rise because a lot more people are getting tested, as many people did before visiting friends and family over the holidays. And the numbers don’t include people who come up positive on home tests, unless they also get tested through a lab.
A slightly more promising measurement for the latest surge comes from another metric: the case positivity rate, or the percentage of tests that led to a confirmed case. The lower the rate, the better. As of Thursday, the case positivity rate had been climbing fast but, at about 10%, was not yet as bad as the rates seen at peak of the fall 2020 surge, which approached 14%.
A milder COVID phase?
Even though the numbers of detected cases have reached unprecedented levels, that’s not the case with hospitalizations and deaths, at least not yet.
One way to look at this is by comparing this surge with the fall 2020 surge. As of Thursday, the average daily case count was 48% higher than last fall’s peak. But average daily hospital admittances, as measured by federal data, were down 23% from last fall’s peak. And there were 65% fewer average daily deaths.
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It’s a welcome trend seen not only in Illinois, but nationally. Dr. Anthony Fauci, the nation’s top infectious disease expert, told reporters Wednesday that the case spike nationally was “out of proportion” to hospitalization increases.
“Now, we must remember that hospitalizations and deaths are lagging indicators,” he said. “However, the pattern and disparity between cases and hospitalization strongly suggest that there will be a lower hospitalization-to-case ratio when the situation becomes more clear.”
Early studies suggest the emerging omicron variant may be milder than the delta variant that took hold in Illinois this summer and fueled the beginning of this surge. Vaccinations are another factor. Even if delta and omicron are more likely to infect vaccinated people than the original virus, the vaccines continue to limit serious illness and death.
Mass vaccinations were a key development for the pandemic in 2021, creating two tiers of risk.
A Tribune analysis of federal and state data found that fully vaccinated Illinoisans (with or without a booster shot) have been much less likely to be hospitalized during the latest surge than those not fully vaccinated. The latter group currently has a weekly admittance rate roughly nine times the rate for those fully vaccinated, based on a three-week rolling average.
Unvaccinated people also are being hospitalized at nearly double the rate seen for all Illinoisans during the peak of the fall 2020 surge, before vaccines were available.
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As for deaths, the average weekly death rate — even for unvaccinated people — has yet to eclipse the rates from the fall 2020 surge. Better COVID-19 treatments, including broader use of monoclonal antibodies, are helping improve those odds.
Still, the death rate for unvaccinated Illinois residents, per 100,000 people, is now more than triple that for people who are fully vaccinated, even though the latter group tends to be older and more vulnerable to the virus.
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Millions of Illinoisans are still unvaccinated, and public health officials continue to press them to get shots.
“We don’t have to continue to lose people,” IDPH’s director, Dr. Ngozi Ezike, told reporters Monday. “We are not in the same place that we were at the beginning of this pandemic, or even a year ago. … We have a vaccine that’s highly effective, and it can prevent severe illness and death, if we take advantage of this effective tool.”
Getting through omicron
The new year also brings hope that the latest surge will soon ease its grip.
In South Africa, where the omicron variant was first reported, case figures shot up in mid-November, then began dropping by Christmas. A top South African researcher, Fareed Abdullah, tweeted this week that it was “staggering” how quickly the wave peaked then declined: “Peak in four weeks and precipitous decline in another two.”
One early study suggests people who recovered from omicron inherited some ability to better fight off the delta variant, offering hope that such protection, combined with vaccine immunity, could further limit the future danger posed by COVID-19.
But concerns remain that Illinois’ hospital system could be overwhelmed. The Tribune has reported how, even before Christmas, hospitals had the lowest levels of available beds of any point during the pandemic, lower even than during the fall 2020 surge.
State data shows more beds have opened since, as some hospitals have canceled nonemergency surgeries. Still, many regions’ hospital systems remain stressed, according to state measurements. In some regions, such as the one covering Will and Kankakee counties, the number of available intensive care unit beds had dwindled to the single digits. And across Illinois, at last count, the number of open beds remained below 7,000, for a state with nearly 13 million residents.
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Gov. J.B. Pritzker’s administration has said it’s tried to help hospitals outlast the latest surge by distributing promising treatments and directing supplemental staff to the hardest-hit areas. But officials have long declined to tell the public which hospitals are worse off, even as nurses and doctors say some facilities are so overwhelmed that seriously ill patients are being “boarded” in emergency rooms for long periods, up to a week.
A grassroots group of health care workers, the Illinois Medical Professionals Action Collaborative Team, called on the governor Thursday to take a host of steps, including reinstituting indoor capacity limits and deploying more National Guard troops to shore up depleted health care staffing: “Simply put, we can’t keep up. We are drowning and need help immediately.”
The governor’s office did not immediately respond. But on the same day, Pritzker asked hospitals to consider canceling nonemergency surgeries as part of an effort “to take every possible measure to maintain and expand bed capacity,” according to a news release the administration issued.
As much as the pandemic has changed, Pritzker’s plea was similar to what he ordered hospitals to do in April 2020, when COVID-19 was still new.
Chicago Tribune’s Jeremy Gorner contributed.
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