Coronavirus testing the pandemic playbook
State’s response was drawn up years before this outbreak
Social distancing. School closures. N95 masks. PPE shortages. Hospital bed surges.
The policies, vocabulary and impact of the pandemic may seem fresh to most Illinoisans, but those terms have long been part of a 15-year-old, 120-page document that’s the state’s guiding plan for responding to a pandemic.
That plan anticipated some of the steps Illinois has already taken, such as limiting public gatherings, isolating the sick and keeping everyone else spread apart by closing schools and limiting commerce. It also predicted shortages of medical supplies, overflowing hospitals and sickened health care workers.
It offers a road map for dealing with a broad range of developments. It also offers a grim reminder that even with planning in place, this type of pandemic was long expected to take a heavy toll.
The plan modeled a “medium” influenza pandemic: up to 4.5 million Illinoisans infected, leading to 12,000 to 38,000 hospitalized, with 4,000 to 9,000 deaths amid likely multiple waves of the outbreak.
Among the considerations in the plan: temporary morgues for large number of dead and targeted delivery of a yet-to-be developed vaccine.
The state has not responded to Tribune
questions about its use of the Pandemic Influenza Preparedness and Response Plan. But state Public Health Director Ngozi Ezike testified on March 4 that Illinois would use it to help guide the state response, and her predecessors confirmed to the Tribune that the plan — even though it references a flu versus a coronavirus — is the one meant to be used for scenarios such as the one unfolding.
“This is definitely the playbook,” said Dr. LaMar Hasbrouck, who ran the Illinois Department of Public Health from 2012 through 2015.
It’s not the only one being used. Local governments have their own playbooks, including Chicago, which honed its plan as part of a federal drill last year called Crimson Contagion that imagined a viral pandemic jumping from China to Chicago, then sweeping America.
Chicago’s health commissioner, Dr. Allison Arwady, said the city made 2019 “the year for pandemic planning,” modeling various scenarios to see how the city and its hospitals could manage.
The city hasn’t released its plan. But the state’s is posted online, and it offers a window into how authorities have long been concerned about a pandemic killing hundreds of thousands of Americans while crippling the country’s ability to respond.
The plan traces back to the 1990s, when the threat of bioterrorism was on the mind of Illinois’ longtime director of public health, John R. Lumpkin. He remembers few paid attention until the Sept. 11 terrorist attacks shifted the national conversation to emergency preparedness and led to a massive investment in public health infrastructure.
That produced an important tool: a nationwide, internet-based reporting system for hospitals and other health care providers to immediately alert government epidemiologists to the details of patients suspected or confirmed of having a disease that should be tracked.
That system was folded into the state’s first pandemic plan, finished in 2005. Since then, the plan has been updated four times, with the latest set of tweaks completed March 2, only 5 ½ weeks after Illinois’ first positive test for COVID-19.
By then, according to the classifications laid out by the state, Illinois was already in the last of six phases of the pandemic plan: increased and sustained transmission in the general population. The plan sketched out a variety of needs and responses:
Surveillance and detection. This is the first step: figuring out exactly which virus is circulating, where and how intensely.
Health care providers use an internet browser to report confirmed or suspected cases of a disease to a database that can be seen by local health departments, the state and the federal Centers for Disease Control and Prevention, or CDC.
The Department of Illinois Public Health gets realtime updates of every suspected case, with a built-in analysis tool that refreshes every 60 seconds. The tool can track “case distribution by city, county and ZIP code; pregnancy status; hospitalization and emergency department admissions; deaths due to influenza; age, sex and race breakdowns; sensitive occupations, including health care workers; out-of-country travel histories; and laboratory confirmation by either CDC or IDPH.”
It’s the kind of system that, as described, could provide much more detail on cases than currently is being publicly disclosed. During the coronavirus pandemic, the state tells the public of positive tests and deaths by county (with a separate total for Chicago) but without any additional level of detail. The City of Chicago does post more demographic data on its cases, but not to the level posted by Los Angeles County, which lists communities where residents have tested positive.
Laboratory testing.
Under the pandemic plan, testing at the state’s three labs (in Chicago, Springfield and Carbondale) shifts to focus on the virus at hand.
The plan envisions those labs testing up to 700 specimens a day “assuming staff is working overtime and other testing areas have been discontinued or delayed.” To handle the surge, the state would work with private labs.
The pace of testing has been frustrating for the public and for many health experts, who say that mass testing can lead to better containment of the virus.
Gov. J.B. Pritzker has said Illinois’ COVID-19 testing capacity is growing quickly but noted the state needs tens of thousands more tests to provide a full picture of the spread of coronavirus cases.
Anti-viral and vaccine
distribution. The plan envisions a need to stockpile anti-viral medicine and distribute it. Unfortunately, experts say they have yet to find anti-viral medicine that they know will help fight COVID-19.
This part of the plan also contains a blueprint for how to handle the emergence of a vaccine, which experts believe could be ready for widespread use in 12 to 18 months. It lays out a scenario where there is only a limited supply of the vaccine and the potential for a public uproar over who gets priority.
Relying on information from national advisory bodies, the state listed broad categories of people who could get access to the vaccine. In order of priority: those at the highest risk of dying from the virus, those mostly likely to spread it to someone who’s at high-risk of dying, anyone in health care or emergency response who hasn’t already gotten the vaccine, those who maintain “other important community services” and, finally, the rest of the population.
But the plan acknowledges that vaccine distribution would need to be customized.
“In addition, priority groups will have to be specifically defined as to which functions are indeed critical to infrastructure and defined by their size within the state,” the plan said.
Restriction of movement. This concept should be pretty familiar to Illinoisans.
It discusses the ways the state can legally and practically tell people where to go and — more crucially — not to go. It ranges from ordering infected people into quarantine to canceling large gatherings and closing schools, workplaces, malls and public transit, with “enforced restriction of movement into and out of defined areas.”
The plan contains some lexicon that’s become top of mind, such as “social distance,” but it does not use the “stay-at-home” language used by the governor’s executive order — a nod to the wiggle room that authorities have to make adjustments.
Emergency and risk communication. The plan acknowledges the “intense and sustained demand for information” and recognizes how important it is to make sure the public knows what’s going on.
It sets up a process that’s supposed to centralize delivery of the message to make sure officials aren’t saying conflicting things, and also to quickly correct false rumors.
Since Pritzker issued a statewide disaster declaration March 9, he’s held daily briefings, with aides such as Dr. Ezike, the public health director. The state also has a special website dedicated to the outbreak, providing statistics, tips, answers to common questions, volunteer opportunities and executive orders.
The plan calls for the state not to sugar-coat what’s happening and be transparent.
“The public must be provided as much information as possible to help them understand uncertainty is part of the process and answers may change as new information and science becomes available,” it states.
Fatality management.
The grimmest part of the plan offers a step-by-step of how to handle the dead.
If fatalities overwhelm hospitals and local health officials, the state would step in. And, if the state can’t handle the situation, it would seek federal help.
Along the way, temporary morgues could be set up, with the plan offering specific guidance for security, parking and other considerations.
“It should be removed from public view, not be a school or other sites of local potential for long-term sensitivity and have sufficient space for body identification procedures. It also should be capable of being partitioned for separation of functions, such as body handling, property inspection, X-ray, autopsy, records maintenance and interviewing,” the plan said.
Among the possibilities: existing mortuaries, hangars, large garages, National Guard armories “or other areas without wooden floors.”
Training. The plan calls for regular training before a pandemic, and Illinois took that to heart last year, as one of a dozen states participating in the federal exercise called Crimson Contagion.
Chicago played the part of a city that first detected the virus from people traveling from China, with the virus spreading across the country, infecting 110 million and killing 586,000, according to projections in a draft report obtained by the New York Times.
Arwady, the city’s health commissioner, said the series of exercises allowed the city to “take our whole pandemic plan from beginning to end. … What would we do? What would our triggers be? How might we think about how we’re going to measure?”
The event included a four-day “functional exercise” in August, during which the city later counted a host of successes, including deploying protective gear and discussing “nonpharmaceutical interventions” such as social distancing and school closures. It also noted areas to improve, such as collaboration, communication and “situational awareness.”
A New York Times investigation of the exercise cited a draft report that showed, more broadly, how unprepared the country was to fight such a virus.
Medical surge. The plan anticipates that hospitals could be overwhelmed and personal protective equipment could be in short supply for health workers — dilemmas already hitting some cities.
To address hospital surges, the plan describes some steps already being taken, such as recruiting retired health care workers and canceling elective surgeries, and some not publicly discussed, such as using trainees or family members of patients.
For personal protection, the plan lists the type of gear that’s become top of mind: gloves, goggles, face shields, gowns and N95 masks. The plan calls for the state to help hospitals figure out where supplies are low and how to get more from federal authorities.
But experts say that’s difficult now with massive worldwide demand for gear and respirators and depleted supplies. That’s prompted the state to form a task force to recruit businesses to donate or make gear — something not explicitly in the plan, which merely calls on the state to procure what’s needed.
“I have medical professionals and first responders begging for things that they need to keep them safe,” Pritzker said Monday. “But so does Gov. Cuomo in New York. So does Gov. DeWine in Ohio. So does Gov. Inslee in Washington state.”