What is the difference between phases and tiers? Pritzker’s COVID-19 response plan explained

While all residents are impacted by Illinois’ COVID-19 response, the steps taken by the governor as part of this plan can be difficult to follow, especially as the state becomes more restrictive in response to the second wave of infections this fall.

Here is what you need to know about what Gov. JB Pritzker’s response has looked like over the past nine months.

The Illinois COVID-19 response

A stay-at-home order was issued in Illinois on March 21, meaning all non-essential businesses were ordered to close and residents were asked to stay home unless visiting essential businesses like grocery stores, pharmacies or hospitals.

Restore Illinois is a five-phase plan to gradually reopen the state’s economy released by Gov. Pritzker on May 5. The plan originally divided the state into four health regions, but the governor later increased this to 11 regions in July to allow for more specific data reporting.

The health regions move through the five phases, advancing on to the next as each region begins to slow the spread of COVID-19. Regions can also move back to an earlier phase if infections increase, according to the plan.

This plan was created by the Illinois Department of Public Health (IDPH) – the state’s top health authority which advises Pritzker in his COVID-19 response.

Phase 1 was the stay-at-home order which stretched from March 21 to May 1. The state moved to the next phase once it had the capacity to conduct 10,000 COVID-19 tests per day and could make testing available to all health care workers and first responders.

Phase 2 began May 1 as a modified stay-at-home order. Non-essential retail stores were allowed to reopen for delivery and curbside pick-up and some outdoor activities, such as golfing and boating/fishing were allowed to resume.

The state moved to Phase 3 when regions met three metrics, including the positivity rate and hospital capacity, tracked by the IDPH and had the capability to offer contact tracing and testing for certain, more vulnerable populations.

The first requirement was a positivity rate at or under 20% and increasing no more than 10 percentage points over a 14-day period. Second, no increase in hospital admissions due to COVID-19-like illness for 28 days. Third, an available surge capacity of at least 14% of intensive care unit beds, medical and surgical beds, and ventilators.

Contact tracing is a process in which health officials gather information from COVID-19-positive people to determine who they came in contact with so they can reach out to those people to inform them of next steps, according to Susan Karras, McHenry County’s public health nursing director. Contact tracers are a resource to the public to guide them on what comes next after they have received a positive test result.

The positivity rate is the percentage of tests conducted that return positive results. The IDPH tracks regions’ positivity rates using a seven-day rolling average, meaning the positivity rate reported each day represents an average of daily rates from the last seven days of available data. Since laboratories need time to process tests, data is available on a three-day lag from when tests were actually conducted.

A region’s surge capacity represents the number of beds in hospitals and intensive care units that are available and able to be staffed to accommodate an increased volume of patients.

For more definitions of key terms, refer to our article on understanding COVID-19 language.

Phase 3 began May 29 for most of the state, with Chicago joining a few days later. Non-essential gatherings of 10 people or fewer were allowed, non-emergency health care providers reopened, and retail stores and personal care services reopened with capacity limits. Bars and restaurants reopened for outdoor dining only.

In moving to Phase 4, regions had to satisfy the same metrics for Phase 3 while also increasing testing and contract tracing. Testing had to be made available to everyone in the region regardless of whether or not they had symptoms. Contract tracing had to begin within 24 hours of a COVID-19 diagnosis for more than 90% of cases in the region, according to the Restore Illinois plan.

Phase 4 began June 26 when gatherings of upwards of 50 people were allowed and schools and childcare facilities could reopen. Non-essential employees could go back to work in person and bars, restaurants, gyms and movie theaters all reopened their indoor spaces with capacity limits. All 11 of the state’s health regions are currently in Phase 4 of the plan, but all regions have been placed under Tier 3 of the governor’s mitigation plan as of Nov. 20.

Phase 5 is a full reopening of the state’s economy and can only occur when a COVID-19 vaccine is distributed, an effective treatment is readily available or no new cases are reported over a “sustained period,” according to the plan. Under this phase, all sectors of the economy are open and festivals and other large events can resume.

Restore Illinois Resurgence Mitigation Plan

As COVID-19 cases began to rise again this fall, Pritzker implemented the state’s three-tiered mitigation plan as a way to place more temporary restrictions on regions seeing a resurgence of infections. These tiers move in the opposite direction of phases with Tier 1 being the least restrictive and Tier 3 being the most restrictive. Each tier offers a menu of restriction options that the state can choose from in deciding how to respond, according to the plan.

Tier 3, which took effect across all health regions on Nov. 20, impacts many industries. Casinos, indoor video gambling, museums, theaters, indoor recreation centers, indoor youth and adult recreation sports and certain personal care services, such as facials and beard trimmings, are shut down, according to the plan.

For bars and restaurants, no indoor dining is allowed, though several across the state have remained open in defiance of the order. In addition, reservations are required for each party and parties cannot exceed six people. Personal care services that don’t require the removal of the client’s mask, as well as gyms, can operate at 25% capacity with a maximum of 25 people. Retail stores are limited to 25% capacity while grocery stories and pharmacies may operate at 50% capacity.

Tier 2 is less restrictive than Tier 3, but is subject to change based on IDPH guidance.

Individual health regions can move to Tier 2 independent of other regions if their metrics improve, according to reporting by Shaw Media. To move back to Tier 2 mitigations, a region must reach all three of these metrics:

• Report a seven-day average test positivity rate of less than a 12% for three consecutive days.

• Have intensive care unit and hospital bed availability that is greater than 20% for three consecutive days.

• Demonstrate a declining seven-day average of COVID-19 hospitalizations for seven out of the past 10 days.

Tier 1 is less restrictive than Tier 2, but is subject to change based on IDPH guidance.