COVID-19 infections are rising again in parts of Illinois. Here’s where and why.


Illinoisans may have hoped for a soft summer landing from the pandemic, but federal and state data show COVID-19 infections are again climbing in some parts of the state.

Blame it on a crisis in neighboring Missouri, on nastier virus variants and lower vaccination rates, or — most likely — some combination of these factors.

But after a monthslong decline in cases from fall and spring peaks, the rate of new daily cases is up in the west-central and southern regions of Illinois, as well as the Metro East region near St. Louis.

Case rates remain relatively low, but there’s concern more of Illinois could follow suit, especially in areas lagging on vaccinations.

“These are small increases right now downstate,” Dr. Allison Arwady, who runs the Chicago Department of Public Health, said Wednesday in an interview. “They haven’t hit the equivalent of what would be trigger levels (for stricter recommendations or rules), but they’re going the wrong way.”

On Monday, a state holiday, Illinois reported zero daily COVID-19 deaths for the first time since the pandemic began. But that good news is tempered by worry over the increasing infections in some parts of the state and surges elsewhere in the country, particularly in Missouri. Those surges have been fueled by more contagious variants of the virus, especially the delta variant first spotted in India.

At the same time, the pace ofvaccinations in Illinois has slowed to levels unseen since early January, despite plenty of availability and millions still qualifying for the free shots.

The upticks in infections have some health care workers suggesting that even people who are vaccinated should mask up again indoors, in hopes of avoiding surges sparked elsewhere.

“We’re ready for this to be over, just like the rest of the world,” said Dr. Shikha Jain, CEO of a grassroots group of medical workers called Illinois Medical Professionals Action Collaborative Team, or IMPACT. “But I think there’s some concern and some nervousness.”

Here’s what we know about the trends:

Rates are rising downstate

Theincreases in cases are emerging in three regions of Illinois that border Missouri, stretching from Alexander County at the state’s southern tip to Hancock County, about four hours southwest of Chicago.

The west-central region, which encompasses the state capital in Springfield, and the Metro East area began seeing their new case figures creep up by mid-June, while the rise in the southern region began about a week later.

All are now reporting an average of eight cases per 100,000 residents, or three to four times higher than the rates being reported in the Chicago area. Contributing to the rising trend are 85 cases from outbreaks linked to a summer camp and a nearby conference in Adams and Schuyler counties, in the west-central region.

Other key metrics are the percentage of COVID-19 tests coming back positive, called a positivity rate, and the number of hospitalizations tied to the disease. Both rates are rising in the same three regions.

The worst positivity rate can be found inthe Metro East region, which includes the suburbs of St. Louis east of the Mississippi River. That rate has more than doubled in two weeks, to roughly 5% of all tests performed.

Health experts also watch hospitalization data because it offers a consistent measure of pandemic trends. Infections may go undetected because of inconsistent testing, but the sickest COVID-19 patients can be expected to seek hospitalization.

In the three regions seeing more cases, hospitalization rates started creeping up later and haven’t crept up as fast, but experts have said it can take a week or more for some infected people to get sick enough to need hospital care. That means a rise now likely reflects the level of infection spread a week or two earlier.

At Blessing Hospital in Quincy, on the state’s western border, the number of hospitalized COVID-19 patients has remained steady, at about 10. But the hospital also does COVID-19 testing, and it has seen the number of people testing positive roughly double since May, to 30 or more a week.

“We’re seeing our highest case counts in many, many months,” said Dr. Mary Barthel, the hospital’s chief quality and safety officer.

Why the rise?

For people following the pandemic’s national trends, the reasons for the increases may not be surprising.

For one: New and more infectious variants are spreading. Epidemiologists have said that’s common in pandemics, as viruses mutate and stronger versions win out. Of most concern is the delta variant, which the Centers for Disease Control and Prevention estimated made up nearly a third of recent COVID-19 cases across the country.

Blessing Hospital nurse Lisa Surratt adjusts devices connected to a COVID-19-positive patient at the hospital's intensive care unit on July 8, 2021, in Quincy.
Blessing Hospital nurse Lisa Surratt adjusts devices connected to a COVID-19-positive patient at the hospital’s intensive care unit on July 8, 2021, in Quincy. John J. Kim

In Missouri, the CDC estimates the variant was behind nearly three-fourths of new infections, as new cases spiked and hospitals began filling up.

Mercy Hospital in Springfield, Missouri, had to borrow ventilators over the holiday weekend while seeking help from respiratory therapists over social media. By Monday, it had 115 COVID-19 patients, nearly 50 of whom were on ventilators.

“Physicians, nurses and respiratory therapists are tired. Heck everyone is tired,” Erik Frederick, the hospital’s chief administrative officer, tweeted Monday.

And that explosion in cases could mean trouble for next-door Illinois, where the delta variant has yet to take hold, making up just 15% of new cases at last count.

The danger next door is highlighted by CDC data that categorizes the nation’s counties by the level of COVID-19 transmission, from low to high. Most of Missouri is rated at a high or substantial level of spread.

In Illinois, some of the highest transmission levels are seen in counties northwest and west of the state capital, near the Missouri border.

Helping to explain the spread is the slowing pace of vaccinations in many rural counties, following trends in vaccine hesitancy established this spring.

At last count, roughly 20,000 shots a day were being administered in Illinois. That low of a pace hadn’t been seen since early January, when vaccine was so scarce that injections were limited to long-term care residents and health care workers.

A Tribune analysis of state and federal data shows that the percentage of people fully vaccinated ranged from at least 60% of all residents in Jo Daviess County, in far northwestern Illinois, to less than 20% in far southern Alexander County.

Perhaps unsurprisingly, the same regions seeing more new cases and higher hospitalizations also rank low in vaccinations.

A spokeswoman for the Illinois Department of Public Health said recent outbreaks were “mostly among the unvaccinated who attend large events with little to no masking or social distancing, often indoors.”

Health officials have previously said that at the mid-June summer camp linked to outbreaks in central Illinois, only a handful of campers and staff had been vaccinated, and the camp wasn’t checking vaccination status or requiring anyone to wear a mask indoors

“The risk of somebody who’s vaccinated is now very different from somebody who is not vaccinated,” Arwady said.

But public health advocates worry about eventual spillover effects. One fear is that, the more COVID-19 lingers, the greater chance today’s variants have of mutating into something that would be dangerous even for vaccinated people.

“If you wanted to evolve the virus to be as dangerous as possible, the perfect situation would be to have a large unvaccinated population together with a vaccinated population,” said Nigel Goldenfeld, a University of Illinois physics professor who has advised the Pritzker administration on the virus’s spread.

“The unvaccinated population will generate new variants, and those that are successful in overcoming the vaccinated population will continue to spread,” he said. “In other words, in Illinois, and in many parts of the U.S., we have a perfect petri dish in which the virus can evolve.”

Mask up?

That fear is one reason the group Jain helps lead, IMPACT, is recommending that even vaccinated residents resume wearing masks indoors.

Current national and state guidelines recommend indoor mask-wearing only for the unvaccinated, but the group said the current guidelines are confusing, are being ignored by many unvaccinated people and are helping fuel spread.

“While the risk to vaccinated individuals remains low, those who cannot get vaccinated (children) or are unable to mount an immune response (immunocompromised, elderly) are now left at the mercy of those unvaccinated to reliably and consistently mask,” the group said in a recent statement.

The group isn’t calling for a return of the mask mandate, and public health officials aren’t suggesting it either. Illinois officials say anybody who wants to wear a mask can do so, but they have not gone so far as to recommend that everyone mask up indoors, as Los Angeles County has done.

Arwady said she wouldn’t recommend indoor masking for vaccinated people unless she saw a notable rise in their risk — particularly if a variant evolves in ways to limit the vaccines’ protection. But that hasn’t happened yet.

For public health agencies, the biggest push remains vaccinating as many qualifying people as possible, so the virus has a hard time finding people to infect.

“Boy, are we lucky to have vaccines working as well as they are,” Arwady said. “If we can get a good uptake on them, you’d have that population-level protection, not just an individual-level protection. And it would just help us put all of this behind us.”