A:  Restore Illinois is the State of Illinois’s five-phase plan to reopen the state. Each phase includes certain business, education, and recreational activities that would be allowed, and is based on regional health care availability in IDPH’s 11 Emergency Medical Services Regions. From those 11 regions, four “health regions” were established under the plan. Each can independently move through the five phases. Movement between each phase is dependent on meeting certain criteria. As new research becomes available and the potential for new treatments and vaccines is realized, the plan is likely to be updated.

All regions in Illinois are currently in “Phase 4,” which indicates “revitalization.” In Phase 4, There is a continued decline in the rate of infection in new COVID-19 cases, hospitals have capacity and can quickly adapt for a surge of new cases in their communities, and gatherings of 50 people or fewer will be permitted. Additional measures can be carefully lifted allowing for schools and child care programs to reopen with social distancing policies in place. Restaurants can open with limited capacity and following strict public health procedures, including personal protective equipment for employees.

Criteria for moving to Phase 5, the final phase of reopening in which the state is “post-pandemic”:

• Vaccine; and
• effective and widely available treatment; or
• the elimination of new cases over a sustained period of time through herd immunity or other factors.

The state is also monitoring a number of “resurgence” metrics that would trigger additional community mitigation interventions. These metrics, which include an increase in COVID-19 disease burden with a simultaneous decrease in hospital capacity OR if there are three consecutive days greater than or equal to 8% test positivity rate on a 7-day rolling basis.

While all regions of Illinois remain in “Phase 4,” all regions are also currently subject to additional mitigation measures. Region 1, which includes most of northwestern Illinois, is subject to “tier 2” mitigation measures because it has sustained “resurgence” criteria for 14 days after Tier 1 mitigations were imposed.

Metrics relevant to the Restore Illinois can be found here. Currently, all regions of the state are on track to move to Phase 4.

A: While all regions of the state remain in Phase 4, which indicates “revitalization,” each region may also be subject to further public health mitigation actions if it experiences a “ resurgence.” The state defines “resurgence” as:

Sustained increase in 7-day rolling average (7 out of 10 days) in the positivity rate 

AND ONE OF THE FOLLOWING:

Sustained 7-day increase (7 out of 10 days) in hospital admissions for a COVID-19 like illness

Reduction in hospital capacity threatening surge capabilities (ICU capacity or medical/surgical beds under 20%)

OR

Three consecutive days averaging greater than or equal to 8% positivity rate (7 day rolling)

New mitigations will be applied on a region by region basis, and will be triggered by:

(1) sustained increase in positivity rate and

A) sustained increase in hospital admissions or

B) reduction in hospital capacity threatening surge capabilities; or

(2) ≥ 8% positivity rate over three consecutive days (7 day rolling)

  There are three tiers of mitigation options that the state will consider once a region meets resurgence criteria. If increases in the above metrics continue unabated after mitigation options are taken, new mitigation options from the next higher tier will be considered. Notably, suspension of elective surgeries and procedures is a “Tier 3” option, the highest tier of mitigation options.

A: IDPH updates testing numbers every day on its website, including the numbers of total persons tested, positive (confirmed) cases, and deaths. You can also find an interactive map showing the number of positive cases in each Illinois county. As more data has become available, IDPH now provides COVID-19 testing data by zip code, as well as confirmed cases, numbers tested, and deaths broken down by age, race, and sex. Illinois was one of the first states where its state health department could do its own testing, and the number of tests given in the state has continued to increase since the beginning of the outbreak in March. Check IDPH’s website for current data.

For national data, the CDC reports the total number of cases nation-wide, along with the number of deaths. It also breaks down positive cases according to demographics and source of exposure, although many cases are still under investigation. The CDC also has an interactive map showing the number of positive cases in each state, the number of cases among people repatriated to the US, and the number of positive cases by date of onset. The CDC is currently rolling out a data tracker that allows users to access visual dashboards including interactive maps, graphs, and other visuals.

Other sources, such as the COVID-19 Tracking Project, have aggregated state-level data on testing to report the total number of tests given each day nationwide, as well as historical data from each state. This site also has data on patients recovered, patients hospitalized, and patients on ventilators, for those states that have made these statistics available. These sources show that testing has clearly ramped up over the course of the pandemic since March, with well over 1% of the national population having now been tested.

A: The Illinois Department of Public Health (IDPH) allows anyone to be tested at its community-based testing sites, regardless of symptoms and without a doctor’s order. A list of these testing sites can be found  here. Testing sites associated with private entities may have their own criteria for who they will test, so be sure to check with the testing site before seeking testing.

The Centers for Disease Control and Prevention (CDC) offers a coronavirus  self-checker, which is a guide to help you make decisions regarding seeking medical care, including testing.

According to new guidance from IDPH*, physicians and other health professionals are strongly encouraged to test for SARS-CoV-2 when patients present with symptoms consistent with COVID-19 or have had a known exposure to an infected person. 

Patients who have a suspected or a known exposure to COVID-19 should isolate at home until test results are known. If the test result is positive, patients should remain in isolation for a minimum of 10 days from onset of symptoms, or from when they last tested positive (if they have no symptoms). Patients with symptoms should stay in isolation until afebrile for 24 hours without use of fever-reducing drugs and other symptoms have improved. Patients with severe illness may need to isolate for longer.

  *Registration in the State of Illinois Rapid Electronic Notification System (SIREN), is required to view this guidance. SIREN is a secure web-based persistent messaging and alerting system, and ISMS encourages physicians and their staff to register. 

A: All of Illinois’s community-based testing sites now offering testing for anyone, regardless of symptoms and without a doctor’s order. “Drive-through” testing is now being made available across the state by some hospitals and health systems, as well as companies like Walmart and Walgreens. Testing criteria may differ depending on testing site. 

IDPH recommends that if you have symptoms like fever, cough, or difficulty breathing and your symptoms are severe, call your doctor’s office or 911 if you are having an emergency. DO NOT physically go into your doctor’s office or go to an emergency room unless you are truly experiencing an emergency. Also do not call or go to your local department of public health. Calling your doctor first prevents the spread of disease both to medical staff and to other patients.

Your doctor will screen you remotely and will then order a test from either the Illinois Department of Public Health (IDPH) or a commercial lab. Although the CDC was the first to develop a test for COVID-19 in the United States, the IDPH was among the first state public health department to perform testing independent of the CDC. IDPH has three labs where tests can be sent, and test results are usually reported back within a few days. Testing for other viruses is not required before ordering COVID-19 testing from IDPH.

IDPH has compiled  a list of testing sites and an interactive map showing their locations. The list includes a link to the testing site’s website, if one exists, along with a COVID hotline for the site, if one exists. You can also find the testing sites’ hours and requirements to be tested.

Most hospitals and commercial laboratories have developed their own ability to test and have their own criteria for testing. As of March 23, the following commercial laboratories are performing testing in Illinois:

ACL Laboratories - West Allis (Advocate Aurora Health)

Arup Laboratories Inc.

Illinois Department of Public Health Lab - Carbondale

Illinois Department of Public Health Lab - Chicago

Illinois Department of Public Health Lab - Springfield

John H Stroger Jr Cook County Hospital Laboratory

LabCorp of America - Raritan

LabCorp of America-Burlington

Loyola University Medical Center Laboratory

Mayo Clinic Hospital

Mayo Clinic Laboratory on First

Mayo Clinic Labs - Rochester Superior Drive

NorthShore University Healthsystem Evanston Hospital Lab

Northwestern Lake Forest Hospital Laboratory

Northwestern Memorial Hospital Laboratory

Quest Diagnostics - Nichols Institute

Quest Diagnostics Infectious Disease Inc.

Rush University Medical Center Laboratory

University of Chicago Medical Center Laboratory

Please note, this list is fluid and is expected to change frequently. For updates, check here.

According to several commercial labs testing for COVID-19, because of the volume of testing being done it generally takes between 3 and 5 days to get results from these labs. These turnaround times may change depending on the availability of supplies, seriousness of case, and the volume of testing being done.

*”Suspect COVID-19” is defined in IDPH’s Interim Guidance. 

A: Per guidance from IDPH, if you notice your symptoms worsening, such as having difficulty breathing, seek medical attention promptly. Before seeking care, call your health care professional, let them know you have tested positive for COVID-19 or believe you may have COVID-19, and follow their instructions. If they ask you to come to their office or go to the hospital, wear a facemask to the facility. If you are having an emergency, call 911 and tell the dispatcher that you have COVID-19 or believe you have COVID-19.

Monitor any symptoms, including:

• noting when new symptoms begin
• checking your temperature two times a day
• keeping a daily records of fever, cough, and additional respiratory symptoms
• Seek further evaluation from a health care professional if your symptoms get worse. 

If you are staying home because of confirmed or presumed COVID-19 infection, you should not attend work or school and should continue to avoid public settings and other situations where close contact with others is possible. Seek medical attention immediately if you develop any of the following emergency warning signs for COVID-19 or other medical emergencies:

• Extremely difficult breathing
• Bluish lips or face
• Constant pain or pressure in the chest
• Severe constant dizziness or lightheadedness
• Acting confused
• Difficult to wake up
• Slurred speech (new or worsening)
• New seizure or seizures that won’t stop

*This list is not all-inclusive, and you should consult your doctor about any other symptoms that are severe or concerning.

A: Early during the pandemic when COVID-19 cases were increasing exponentially, the State of Illinois ordered that non-emergency, non-COVID-19 care be postponed in order to preserve needed resources and capacity for COVID-19 patients. However, as the rate of positive cases has declined across the state, and as hospital capacity has increased and medical resources are more plentiful, Illinois is now allowing non-emergency, non-COVID-19 care, as long as it meets certain criteria. Your doctor will also be taking precautions to reduce the risk of infection so that you can safely visit.

The Centers for Medicare and Medicaid Services have issued recommendations for patients seeking non-emergency care:

1. Do Not Postpone Necessary Care. Some patients have been delaying care for chest pains, stroke symptoms, or other signs and symptoms of potentially serious health conditions. Do NOT postpone care that is urgent or may lead to complications such as heart attack or stroke. Also, do NOT postpone necessary preventive care such as immunizations or cancer screening. Do not hesitate to reach out to your provider if you have any questions about when to seek treatment.

2. Is It Safe to Go to your Doctor or Hospital? Talk with your healthcare provider about your provider’s facilities and the precautions they are putting in place to keep patients safe. Healthcare providers are making preparations to care for you safely. By now, healthcare facilities should have established special procedures for cleaning and disinfecting. They should have updated waiting room guidance and created special places for Covid-19 and non-Covid-19 care within their facilities. All appropriate precautions should be made to ensure that care is as safe as possible for patients.

3. Consider Telehealth or Virtual Visits. Patients may receive certain care by “telehealth” – audio or audio/visual care via your phone or computer. This reduces the risk of transmission of Covid19. Ask your provider if telehealth visits are an option.

4. What to Expect when you Seek Healthcare. To prevent you from getting Covid-19, or giving it to others, you may be asked to do the following by your provider:

• Wear a face covering. A facemask helps limit your risk of getting or spreading disease.
  
  
• Avoid crowded waiting areas. Sometimes you will be asked to wait in your car until your visit. Waiting rooms should have chairs spaced far apart to keep you and others safe.
  
  
• Limit visitors or people who go to your appointment with you. By limiting the number of people, your exposure becomes limited as well. Try to limit visitors or people who accompany you to visits to ONE person. Visitors should also wear a face covering (facemask).
  
  
• Screening before entering a facility. You, and your visitors, may have your temperature taken, or be asked questions about your health status, before entering a healthcare facility. This is to keep you and others safe.
  
  
• Wash your hands often. Use soap and water for 20 seconds, or hand sanitizer when washing your hands is not possible.
  

5. Should I get tested for Covid-19 before seeking healthcare?

Discuss with your provider if you should be tested before going for care. In some cases, such as before surgery, childbirth, or a procedure, it may be necessary to be tested for Covid-19. Some people have shown no symptoms for the disease but have been found to be positive. If testing is not available, in some cases, such as before surgery, you may be asked to self-isolate prior to your surgery to reduce the risk that you have Covid-19. If you ARE positive for Covid-19, discuss your options with your provider about the benefits of proceeding or postponing care.

Vulnerable Populations: When Possible, Stay Home.

A: While many potential SARS-CoV-2 vaccines are currently in development, no vaccine has yet been approved by the FDA. However, as it is anticipated that a vaccine will soon be approved, IDPH has released a draft of its mass vaccination plan. Physicians and other health professionals who will administer vaccines will be required to enroll in the Illinois Comprehensive Automated Immunization Registry (ICARE), a web-based immunization record-sharing application developed by IDPH. The plan also requires adherence to CDC guidance on vaccine administration, storage, and handling, and gives priority access to vaccination to front-line health care workers, first responders, and residents and staff at long-term care facilities.

A: The federal government, private businesses, and multiple state agencies including IEMA, IDPH, and the Office of the Governor are working to coordinate the distribution of stores of PPE to health care professionals. The governor has also formed the Essential Equipment Task Force to ramp up production of PPE. As more PPE is used and produced, the situation will change continually. 

Contact your local department of health with requests for PPE. If you cannot obtain PPE from your local department of health, contact IDPH through their hotline at 1-800-889-3931 or email  dph.sick@illinois.gov. 

A: IDPH recently began allowing access to testing to everyone at its community-based testing sites, regardless of symptoms and without a doctor’s note. A list of community based testing sites can be found here. Physicians may also choose to order tests from various labs or hospitals, or may refer patients to other local testing sites. 

A: Unfortunately, during the current pandemic, health care professionals are at some risk of exposure to COVID-19 and should therefore take steps to assess themselves for COVID-19-like illness. All health care professionals should now be able to access COVID-19 testing, either through the hospital or health system where they work, or at one of these testing sites around Illinois. While waiting for testing results, consult IDPH guidance for what to do about work and how to protect yourself and others.

IDPH also recommends taking your temperature twice daily, and that if you develop signs or symptoms of COVID-19-like illness (with a fever of >100.0⁰ F), you should NOT report to work. If any signs or symptoms occur while working, immediately leave the patient care area, inform your supervisor and/or follow your facility’s protocol, and isolate yourself from other people.

IDPH also recommends the use one of the below strategies to determine when you can return to work:

• 1.Testing- and symptom-based strategy: Stay home from work until:
• Resolution of fever, and
• Resolution or improvement in respiratory symptoms, and
• Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive sets of paired nasopharyngeal and throat swab specimens collected ≥24 hours apart
• 2.Symptom-based strategy (i.e., no SARS-CoV-2 testing to inform decision about return to work). Stay home from work until:
• ≥10 days after illness onset, or ≥3 days after resolution of fever, whichever is longer, and
• Resolution or improvement in respiratory symptoms
• If you were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

A: Governor Pritzker and the Illinois Department of Financial and Professional Regulation announced in March that it will be allowing physicians whose licenses have been expired or inactive for less than three years to restore their licenses for free with CME requirements waived. You will be permitted to work under the direction of the Illinois Emergency Management Agency and IDPH and in a long-term care facility, hospital, or federally qualified health center. Your reinstated license will expire on September 30, 2020.

To reinstate your license, visit this link.

For questions about liability, click here. 

A: In late October, the FDA made remdesivir the first approved treatment for COVID-19. The FDA approved Veklury (remdesivir) for use in adult and pediatric patients 12 years of age and older, weighing at least 88 pounds, for the treatment of COVID-19 requiring hospitalization. This approval follows the earlier emergency use authorization(EUA) of remdesivir to treat certain populations requiring hospitalization for COVID-19. 

In August, the FDA issued an EUA for convalescent plasma for the treatment of COVID-19 in hospitalized patients. The FDA’s fact sheet for health care professionals can be found here. 

On June 15, the FDA  revoked its EUA of chloroquine phosphate (CQ) and hydroxychloroquine (HCQ), which had allowed the drugs to be distributed from the Strategic National Stockpile (SNS). The FDA stated that its revocation was in response to “new information, including clinical trial data results, that have led BARDA to conclude that this drug may not be effective to treat COVID-19 [Coronavirus Disease 2019] and that the drug’s potential benefits for such use do not outweigh its known and potential risks.”

The American Medical Association has also released a statement on the ordering, prescribing or dispensing of COVID-19 medications.

The following sources have information available on the development of potential treatments:

• FDA statement on treatment development
• NIH COVID-19 treatment guidelines
• Investigational agents for antiviral treatment of COVID-19
• US National Library of Medicine’s ClinicalTrials.gov

For further guidance on use of these therapeutics and drugs to treat, cure, or prevent COVID-19, see the CDC’s  Information for Clinicians on Therapeutic Options for COVID-19 Patients.

A: As of May 11, the Illinois Department of Public Health (IDPH) began allowing elective procedures that had previously been postponed in order to conserve resources for COVID-19 patients. However, certain criteria must be met before performing procedures. 

For a summary of IDPH’s guidance on elective procedures, see ISMS’s summary. 

See IDPH’s FAQs on elective procedures here.