Update, 9/2: Both Illinois and Indiana have climbed over the threshold to be subject to the Chicago quarantine. Unsurprisingly, people from Illinois and right across the border in Indiana have been given a special exemption and won’t have to quarantine if they want to visit Chicago. Maybe it’s time to ditch the quarantine, raise the threshold, or use another metric?
Originally posted on 7/27:
Earlier this month Chicago Mayor Lori Lightfoot took a page out of New York Governor Andrew Cuomo’s playbook and added a 14 day quarantine for people coming from states with a high infection COVID-19 rate.
EFFECTIVE MONDAY: To preserve the gains Chicago has made, we're issuing an Emergency Travel Order directing travelers entering or returning to Chicago from states experiencing a surge in new COVID-19 cases to quarantine for a period of 14 days. More info→ https://t.co/5D7ng691f8 pic.twitter.com/CA26uT7RF6
— Mayor Lori Lightfoot (@chicagosmayor) July 2, 2020
While NY requires just 10 COVID positive cases per 100,000 residents over a 7-day rolling average to be added to the quarantine list, Chicago requires 15 cases per 100,000 residents. NY will also add states with a 10% or higher positivity rate over a 7-day rolling average to their list, while Chicago ignores that metric.
NY currently requires a 14 day quarantine if you come from 31 states, though that is very likely to climb when the this week’s list is announced.
Based on the current COVID spike in Illinois, it’s looking probable that the state will be added to NY’s quarantine list in the near future. Yesterday’s COVID positive numbers in Illinois were 1,541, which divided by a population of 12.67MM means 12.2 positive cases per 100K residents. We’ll have to wait and see what the numbers are based on the 7 day rolling average.
Positive cases always seemed like a strange metric to use.
Ohio recently introduced a quarantine, but it’s based on states that have a testing positivity rate that exceeds 15% and not based on total cases. That seems far more sensible to me.
Why should a state be penalized for doing a lot of testing and finding more cases? What really matters is what percentage of those tests come back positive, and that’s something that won’t arbitrarily change based on how many actual tests are performed.
NY has fewer cases than CA or FL, but that’s because they didn’t do the kind of testing when they got slammed in March that is being done now.
To illustrate using very rough numbers and estimates, NY has 416K cases and 32.3K deaths. Based on the CDC’s current best estimate of an Infection Fatality Rate of 0.65%, that would mean the actual number of cases in NY was 4.96MM out of a population of 19.45MM. In NYC there were 228K cases and 23K deaths. Using that same math would impute about 3.54MM actual cases out of a population of 8.39MM. That would lend some credence to herd immunity in NY being the primary reason for the dropoff in cases there, and not the state’s action.
On the other hand, FL has 424K cases and 5.8K deaths. Using that same math would impute about 892K actual cases. Granted that FL positive case numbers are much higher currently and deaths are a trailing indicator, which will mean more total actual cases as deaths climb, but total cases is a very blunt number to use for comparison purposes.
Of course these back-of-the-envelope calculations are just rough extrapolations and not scientific data. For example, Cuomo’s numerous failures in NY likely contributed to a higher than average infection mortality rate there, which will change the math on total cases. And the CDC’s Infection Fatality Ratio best estimate is currently 0.65%, but can be anywhere from 0.5%-0.8%. But the numbers show that total cases are a poor indicator of success against COVID-19 or as a basis for quarantine.
Update: Based on a question in the comments below, I’ll try to illustrate the difference between Chicago’s quarantine list and Ohio’s quarantine list:
- Scenario 1:
- If my fictitious state of 20MM people only administered 100 tests and 90 come back positive, that’s only 90 total cases which is much less than 15 cases per 100K residents, so we would not be on Chicago’s quarantine list.
- However that would be a positivity rate of 90%, so we would be on Ohio’s more sensible quarantine list when positivity rate exceeds 15% of tests.
- Scenario 2:
- If my fictitious state of 20MM people administered 1MM tests and 3,100 come back positive, that’s more than 15 cases per 100K residents, so we would be on Chicago’s quarantine list. We would effectively be punished for administering so many tests.
- However that would be a positivity rate of just 0.3%, so we would not be on Ohio’s more sensible quarantine list.
OH quarantine map, based on test positivity rate:
Mayor Lightfoot announced today that nearby Wisconsin will soon be added to the Chicago quarantine list this week after exceeding the threshold of 15 positive cases per 100K residents.
Of course the real irony will be if Illinois exceeds the threshold of 15 positive cases per 100K residents. Based on the current trajectory, that seems like to happen over the coming weeks.
That would put the city of Chicago in the rather uncomfortable position of having to walk back the quarantine, increase the threshold, change the metric used, or look rather hypocritical if they leave things as is. After all, why should people coming from a state that exceeds 15 cases per 100K be required to quarantine if Illinois meets that threshold?
What do you think Mayor Lightfoot will do if Illinois exceeds her quarantine threshold?
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79 Comments On "[Update: Illinois Passes Quarantine Threshold] With Illinois COVID-19 Cases Climbing, Will Chicago Require A Quarantine For Anyone Who Has Recently Been In Illinois?"
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She’ll probably just call someone a name
It’s all politics from Day 1 and doesn’t usually change anything on the ground. So I doubt anything will be changed other than making an exception for the rest of Illinois.
You have a typo in the title. Should say “will NY require quarantine…”
Nope, I meant what I wrote. Gotta read the whole post 🙂
Sorry, now I got it.
We have the same joke in our community in FL. Shul/School have policies of quarantine for anyone coming from out of town, while probably anywhere we’ll go is better off then we are regarding the Covid numbers.
Exactly!
Headline needs correcting
Nope.
Isn’t everyone in Chicago in Illinois?
Yes, that’s the irony I wrote about in the post 🙂
Im lost. “Why should a state be penalized for doing a lot of testing and finding more cases? What really matters is what percentage of those tests come back positive”
isnt the definition of finding more cases =tests that come back positive?
No.
Scenario 1:
If my fictitious state of 20MM people only administered 100 tests and 90 come back positive, that’s only 90 cases, so we would not be on Chicago’s quarantine list.
However that would be a positivity rate of 90%, so we would be on Ohio’s more sensible quarantine list.
Scenario 2:
If my fictitious state of 20MM people administered 1MM tests and 3,100 come back positive, that’s more than 15 cases per 100K residents, so we would be on Chicago’s quarantine list. We would effectively be punished for administering so many tests.
However that would be a positivity rate of 0.3%, so we would not be on Ohio’s more sensible quarantine list.
Great explanation, thanks. Its positive tests relative to the number of tested people vs total population
Exactly.
you don’t say…
Scenario 3:
Now suppose the state from scenario 1 wanted to game Ohio’s system.
If they tested another 100 people, we should expect fewer than 90 of those to come back positive. That’s because there was probably some self-selection involved in who got tested. Probably the first 100 people who got tested did so because they had symptoms or known contact with someone who had tested positive. There might be another group of 100 people who would have been interested in getting tested because they have jobs that put them in contact with the public, but didn’t bother to because they heard the lines at the testing center were too long. As the state ramped up testing availability, they’d keep attracting more people in total, but with the marginal testing subjects having progressively lower likelihood of infection. At the extreme, if they tried getting all 20M people tested, they might find themselves knocking on the door of someone who had been self-isolating for the past 3 months and trying to offer to pay them to be tested.
Let’s suppose the dropoff in the expected positivity rate for each incremental cohort of 100 people was 1% (their expected positivity rate is 99% as high as the expected positivity rate for the previous cohort). And let’s suppose that the first sample’s actual positivity rate of 90% happened to have been the expected. Then the next 100 people they tested would have 89.1 expected positives, the following 100 people they tested would have 88.2 expected positives, etc. Then to get themselves off of Ohio’s quarantine list, they could just keep recruiting additional groups of 100 people until they had tested 60K people (actually 59.9K) and had 8978.4 expected positives. (You’ll notice that they got to almost triple the positives of Scenario 2 with only 60K tests, not 1M. It seems like your intuition is that the dropoff, even if not constant, averages something more than 1%.)
The point of a quarantine rule is neither to punish nor to reward another state for doing more testing. It’s to set criteria that rely on data that’s already available and that you judge will be resilient enough against criticism from either side. If a given criterion could be gamed (avoided), whether intentionally or not, that doesn’t make it a bad reason to tell people to quarantine. It just means you might want to consider other criteria to also check against before telling people who don’t meet that criterion that they don’t need to quarantine.
Not according to the media. If you’ve noticed they almost exclusively tout the raw numbers for shock effect, or worse, list or graph the cumulative infections as if every case is still active.
Love the title.
Thanks, based on the comments above I was wondering if the irony was lost on people.
Those comments were all left by New Yorkers 🙂
No they weren’t!
stats are rarely ironic, mendacious perhaps!
Congrats Dan!
You were one of the firsts for posting about masks being beneficial.
One of the firsts about posting about certain people being super spreaders.
Now be one of the first about current viral load of those people who are infectious being of concern not a positive result.
Medcram link https://youtu.be/h7Sv_pS8MgQ with snippets from this week in virology.
Will check it out, I mentioned viral load last week as a reason to wear masks: https://www.dansdeals.com/more/dans-commentary/news-roundup/7-22-20-news-roundup-israel-flights-covid-19-thoughts-cuomo-aa-adding-flights-jetblue-ditching-long-beach-hertz-improvements-dot-complaint-elons-negative-fine/#COVID19_Thoughts
The viral load I was pointing to was about low testing sensitivity tests to test for contagiousness given daily is better then the present high sensitivity tests that are not given as often. Your discussion about the low initial viral load being a significant cause of disease severity is refuted by TWiV (2 minute discussion) https://youtu.be/Gy5Yi5ZKYNY?t=5771. Generally, the initial viral load establishes whether an infection takes place. Here’s a fire department doing their own tests on saliva samples. https://www.wired.com/story/a-wisconsin-city-experiments-with-a-faster-diy-covid-19-test/
Also one of the first to post about quantas not selling international tickets until at least july 2021, which coincidentally or not, is when Google announced today they would be extending work from home provisions for all their employees.
Nice! The This Week in Virology(TWiV) guys and gals were thinking or renaming their podcast to every other day in virology since they have been putting out podcasts a lot more often. Thanks for the response Dan! Thanks for being ahead of the curve in multiple ways. Good link on the T-cell assays. Here’s a gofundme for a T-cell assay machine for one of the researches’ lab on TWiV that she did not directly ask for, but I thought I would give a shot. Maybe best donating to Drew University and asking for funds to be directed to the lab https://twitter.com/BioProfBarker for the tax write off.
https://www.gofundme.com/withdraw/used-elispot-machine-for-viral-research-lab/start
Im heading to Denver with a stopover in Chicago. Would that be a issue?
No.
title needs to be fixed!
“Herd immunity”. You just touched the third rail of covid discussions. Duck!
Seriously though, you hit the nail on the head. States are using arbitrary measures. New Hampshire is ok with travelers from all New England States but not NY or NJ which have great metrics.
Vermont has a cutoff of 400 active cases per million and its anyone’s guess as to how active cases are calculated and there doesn’t seem to be any weight given to testing numbers or positivity rate.
https://accd.vermont.gov/covid-19/restart/cross-state-travel
And the list goes on. So many states have illogical and contradictory criteria or arbitrarily ok neighboring states that have far worse metrics than more distant states from which they require travelers to quarantine. How illogical is that?
Raw positives are simply not an objective standard on their own.There ought to be one objective set of standards, taking into account rolling seven day average positivity rate, hospitalizations, fatalities, or a combination of the above. Then every state could make a determination of the number they are comfortable with.
Talked about it here too:
https://www.dansdeals.com/more/dans-commentary/news-roundup/7-22-20-news-roundup-israel-flights-covid-19-thoughts-cuomo-aa-adding-flights-jetblue-ditching-long-beach-hertz-improvements-dot-complaint-elons-negative-fine/#Cuomo_Vs_COVID19_In_NY_Epic_Failure_Or_Epic_Success?
Pointless discussion as absolutely nothing is being done re: quarantine, regardless if driving or flying into the city. Once that changes then we can talk.
Nothing is done if you’re speeding either, until you’re caught and fined.
I’m not sure when was the last time you were in the highway but there are cops hiding all over the place so not really a good example
Certainly not a great example, but you can be fined in Chicago or NY for violating quarantine as well, even if it’s only rarely enforced.
I’m not sure if it’s different in Chicago, but in NYC, you should be in the clear for getting fined, as long as you’re not identifiably Jewish
No Dan, speeding is enforced. I live in Chicago and they’re publicly legitimately 100% not enforcing this quarantine at all. There is no “caught and fined”. It’s like the pirates’ code: more like guidelines
https://www.google.com/amp/s/www.wbez.org/amp/stories/chicagos-health-commissioner-says-police-wont-enforce-new-self-quarantine-order-for-travelers/15b356dd-9146-43cb-9e22-b0bd049e1105
It may not be enforced by the government but it’s enforced on another level. People from those states aren’t being let into stores, doctor’s offices, and shuls. Even with negative tests and positive anybody tests.
You’re assuming ppl are telling the truth. In reality, most are not.
Why do things that seem so sensible to laymen, so hard for politicians to comprehend? Haven’t been more disappointed in our leaders (coumo Trump etc) in a long time….
For Cuomo it either means he did a horrendous job before or is doing an amazing job now.
Which narrative do you think is better for his political future?
For other experts, my only guess is that they would prefer to err on the side of caution.
I think it would have been a lot worse in NY without Governor Hot Air’s efforts. I personally am skeptical of herd immunity due to unrecognized infections; I don’t think we’re anywhere close to it.
Of course he made some pretty critical mistakes back in the beginning.
NYC cases are close to nil.
In the Willi/BP/CH Jewish communities there, things have been back to normal for months without spikes.
Extrapolating death rates as I did in this post shows that there were millions of undiagnosed positive cases in NYC.
Do you think they’re doing something special that no other city in the country is doing? Considering how hard they got hit early on, the herd immunity theory there seems logical, though I’m certainly open to arguments.
It’s almost certainly herd immunity.
It’s not like Cuomo is doing something that Gavin Newsome isn’t. And yet CA has been surging while NY is plummeting, despite having almost the exact same restrictions.
A long long time ago, in a faraway time called “March”, the ultimate goal was not to limit the number of cases, but to limit the deaths. Remember when “flattening the curve” was a thing?
NY/NJ’s curve played out almost exactly like the un-flattened curve we were warned needed to be avoided.
It is a complete contradiction to be both part of the “flatten the curve” camp, and the “Cuomo is doing a great job because NY cases are currently low” camp.
NY cases are currently low precisely because they didn’t flatten the curve.
@rob you nailed it! Yes, “NY cases are low precisely because they didn’t flatten the curve” and anyone who thinks the low case count is because Cuomo did a great, I have a bridge to sell them.
Haven’t been on top of the news articles lately, although there are localized spikes throughout the region, usually thought to be sparked by travel. Statewide is reporting very few new cases per day, but that is because NYS is for the most part observing social distancing and mask wearing.
I fully expect a second wave once schools reopen.
As for your math (based on the 0.65 infection rate) that would suggest approx 25% of the population is infected (i would count Northern New Jersey and Long Island as part of the NYC region for your example, due to proximity and ease of travel). Even conservative models believe that you need a minimum of 50%, but more likely closer to 70% to achieve herd immunity.
As to why some places appear to have no negative effects with no social distancing or mask restrictions, beats me. Perhaps there is herd immunity in some of the more harder hit neighborhoods, perhaps they just got lucky, or perhaps they are not reporting new cases.
If you’re counting Long Island into the population then you also need to include the deaths there. You can’t just cherry pick the numbers to make your argument better…
@Yehuda_h: in case you may not be aware, private schools and day camps have been up and running for quite some time in NYC so I’m not sure why you believe a second wave is coming. I haven’t seen it yet. Unless only open public schools count for you. Where I live (unfortunately but factually) there is practically zero mask wearing or social distancing and case levels are close to zero as well (and so are deaths if any at all). So if you’re thinking that cases in NY are down due to mask wearing and social distancing, think again. I’m guessing that as Dan repeatedly stated there may very well be herd immunity in effect round these parts.
You can add Lakewood to that list.
“though that is very likely to climb when the this week’s list is announced”
When is that?
I believe Chicago and NY lists come out on Tuesdays.
Thanks!
Open the country!! The elderly and immunocompromised may want to remain cautious, but enough is enough! So much more damage is being caused by these shutdowns!
Mayor Lightfoot is more concerned with tearing down statues of Christopher Columbus, than her black residents being slaughtered like worthless dogs on the streets of Chicago. What a failed disgrace. She’s 100 times worse than Rahm Emanuel was.
Dan, I gotta say I love the title (especially because you completely confused everyone!) and the article.
CLE vs CHI
😀
LOL!!!!! Quarantine is meaningless in America
“What really matters is what percentage of those tests come back positive, and that’s something that won’t arbitrarily change based on how many actual tests are performed.”
Not true at all. That would only be the case if the people you would test are pulled from a random sample. If it’s not a random sample (and it isn’t here), then you can’t just prorate numbers across sample sizes.
It’s also stupid because in this case, state lines are just arbitrary borders…. there are cities in states that are on the quarantine list which have lower numbers than cities not on the quarantine list…. but if you come from the former you’d have to quarantine, whereas if you came from the latter you wouldn’t. It’s not like someone can be on the Oregon side of the Oregon/Nevada border, and if you drive 2 miles over the border your chances of catching it suddenly triple.
There is no single good metric out there to base these decisions on, which is why it’s stupid for elected officials to base it off of one metric. And that’s before you even get to the impossibility of enforcing it…..
This is very true
I lol’d at the title
Quarantine rules apply when traveling to or from place to place. Since Chicago is more or less always in and a part of Illinois, Quarantine rules would not , as in never, come into effect. It would be like doing self distancing.
Althought the wisconsin application does have more interest since many people from illinois own property and vacation in wisconsin and travel back and forth when going “to the lake”.
So the quarantine in this instance would be both bad for tourism in wisconsin, and at the same time, limit the movement of illinois residents to their lake homes and cabins in wisconsin.
In either case, whatever the metric, small sample size is small sample size and layering quarantines is in effect, leading up to a de facto lockdown .
Quoting from an article:
“Mayor Lori Lightfoot said that no one has been fined for violating the quarantine order since it was implemented earlier this summer…..This has really got to be about not just fining people into compliance, but about educating people to understand the risk factors that are out there.”
Lightfoot is proving to be a real disaster.Besides for doing a terrible job running the city she is crude and obnoxious.She wont be criticized by to many in the current atmosphere.She is after all, the right race, the right gender and the right persuasion.She may well be the nail in Chicagos coffin
Rahm Emanuel was mayor of Chicago from 2011 to 2019? And yet already in 2020 Lightfoot is to blame for the Chicago problems that the Rahm Emanuel too couldn’t fix and let Lightfoot inherit?
What’s the position of RahmE and his doctor brother on Chicago trying to depress traffic to Chicago as part of the coronavirus response? Reducing traffic and population mixing is not necessarily a senseless measure to try to put a brake on this coronavirus spreading.
Your original point about total cases has some validity but your comment about Ohio makes equally little sense. What relevance is positive percentage of tested? Clearly, the people going to get tested are sick with something and exhibit symptoms thus, you are favoring a system that has confirmation bias. The State of Ohio is not testing every household regardless of symptoms so percentage of those tested that test positive is also quite a meaningless metric.
Of course it makes sense. You can’t extrapolate to the general population but that’s not the point. The point is to compare one state to the other as well as to look at the trends in that state. Percent positive figures will not be as influenced by the number of tests that are administered so you can compare states that are doing massive testing with those doing less and still have a meaningful comparison.
Put more police on her street to protect her sorry ***
Problem with the data for quarantine ridiculously flawed Son many different ways to get the wanted answer These figures do LIE!!
There is another factor to consider. In NY especially in the frum community the doctors are telling people that are symptomatic not to do PCR testing because they are reported to the city and state. And there is concern that if the numbers rise they will shut down the schools and shuls. Instead they are doing the rapid tests which are not being reported. So the only people whose tests are being reported are those that don’t have symptoms. The end result is that you are getting an artificially low number on positive tests.
Maybe it is time people started to again take his seriously and reduce the spread of the disease though social distancing. Too many of my neighbors have company over for meals and stopped the general wearing of masks.
Deaths from Covid continue, recently the Rosh HaYeshiva of Telshe Yeshiva Chicago. It is time for continued action, not jokes.
@Dan, you are missing a critical point. NY had so many deaths as a result of an overwhelmed and tax health system. They also didn’t have the knowledge and expertise on the virus that they currently have.
Lastly, it slammed the nursing home centers bringing the numbers of deaths up dramatically.
Thus, the actual fatality rate could have well been 2 percent. In that scenario you have about 1.5 million cases in NY.
With these above numbers NY is far from herd immunity (although certain segments of the population will be closer to it then others).
Early on, for purposes of putting on lockdown restrictions and then later rolling them off, Illinois was segmented into 11 subregions. Chicago being one of them.
So referring to chicago restrictions as seperate from the rest of illinois in the instances of control measures like quarantine, while also being combined with the “downstate” portions of illinois for purposes of aggregate statewide measures or state to state comparisons, is generally understood.
This may not be widely understood in less urbane locales such as cleveland and ohio. Addressing Chicago rates of infection, and appropriate responses, specifically rather than lumping together with “downstate” is not unheard of in either of those parts of illinois.
“Ditch the quarantine” aka let people die needlessly? How can you even suggest such a callous thing? The numbers of deaths are only relatively low BECAUSE of the quarantine.
Illinois and Indiana meat the standard to require quarantine. Excluding them while including other states does not mean more people will die as they have the same ratio (according to that metric) of sick people. There would be no difference if you’re around people from Illinois or Hawaii.
Saying that only some states that meet the threshold need to quarantine is hypocritical and illogical.
Applying a given threshold to differently sized geographic delineations chosen for some logical reason is neither hypocritical nor illogical. Perhaps it’s arbitrary, but even a somewhat complex system with multiple criteria would be somewhat arbitrary. Even if it’s designed with rigorous attention to bayesian reasoning, adjusts properly for sampling distortions, etc., why did you pick that confidence level to target?
Of the three choices you suggest they consider (“ditch the quarantine, raise the threshold, or use another metric?”), the first two would seem illogical in a manner that leans toward hypocritical. Those legitimately come off as changing (or eliminating) a rule in the middle of the game when its application would be to one’s own detriment.
It sounds like what they’ve done is to add a little nuance to how they’re applying their metric. There’s a certain logic in defining geographical regions with more granularity for those that contain a larger proportion of the potential inbound traffic that you’re regulating. (Look at VT’s map that has county-level detail for OH, WV, VA, and all the states to their northeast. They also use a single metric that you probably wouldn’t have heard of from any other source – I’m not saying they’ve gotten everything perfect.) If that’s all they’re doing (as walter’s comment above seems to imply), fine.
If they advise Chicagoans that it’s perfectly responsible to pay an unencumbered visit to a given county nearby that is above the same threshold that Chicago is itself above, but also advise residents of that county (or Chicagoans who just took their advice and visited that county) that it’s irresponsible for them to come to Chicago unless they’re going to take extra precautions to avoid spreading the germs they bring (back) with them, that would seem somewhat hypocritical. It would even be reasonable for them to enforce a rule on visitors from such a county without requiring the same of their own citizens when visiting that county, though it would be hypocritical for them to complain if that county then enforced the same rule on visiting Chicagoans.
check out the BS rules- https://www.chicago.gov/city/en/sites/covid-19/home/emergency-travel-order.html