Highs, lows, highs again: What Illinois endured in another year of the COVID-19 pandemic

For a year that started out with so much hope in the ongoing battle against COVID-19, it ended with a great deal of uncertainty.

“At that time, we were very focused on vaccine distribution and responding to inquiries from people wanting to get vaccinated,” said Dr. Kiran Joshi, colead and senior medical officer for the Cook County Department of Public Health. “If you had asked me to predict the future a year ago, I don't know that I would have been able to do that.”

Through Dec. 30, Illinois Department of Public Health officials recorded 1,184,256 new infections in 2021, as well as 11,396 deaths during that time. While that's more than half of all infections recorded in the state since the onset of the pandemic, it's less than 41% of all COVID-19 deaths in Illinois.

Illinois laboratories also processed 31,192,187 COVID-19 tests, while vaccine providers administered 19,046,136 doses since Jan. 1, 2021.

Shots in arms

At the start of 2021, vaccines had just been made available to health care workers and those living in congregate care settings. As eligibility widened in the proceeding weeks, providers couldn't keep up with demand. But in about four months' time, almost anyone 16 and older could finally get inoculated.

Vaccine providers in Illinois were averaging more than 120,000 shots a day by mid-April, peaking at 125,635 shots a day on average for the week ending April 13.

Near the end of spring, the state recorded its lowest single-day total of new cases in 2021 when 102 infections were reported on June 18 by IDPH officials.

Restrictions on gatherings were loosened statewide, businesses were allowed to fully reopen to maximum capacity, and mask mandates were lifted.

But as the state's caseload waned, so did interest in getting vaccinated.

By July 27, the state was averaging just 17,248 inoculations a day that week.

And then came the variants.

“I was sure the vaccine would keep people safe and out of the hospital, and I think it's doing that by preventing severe infection and hospitalizations,” said Dr. Jonathan Pinsky, medical director of infection control and prevention at Edward Hospital in Naperville. “But we didn't anticipate the virus would evolve so quickly to become more transmissible and also evolve to evade immunity.”

First the variants were identified by geographic origins, but ultimately they were designated by a letter from the Greek alphabet.

Just as the state was reopening, the highly contagious delta variant emerged in Illinois, bringing with it an almost immediate surge in cases.

By the end of August, the state was recording more than 3,500 new cases a day and an indoor mask mandate was back in place, nullifying many local school board decisions to make masks optional in classrooms to start the school year.

Delta does it

The angst of the delta surge was tempered somewhat by the expansion of vaccine eligibility to children — first for kids ages 12 to 15 in May and then children 5 to 11 in November.

“I will always remember the feeling of relief when my children got their first dose of the vaccine,” said Dr. Emily Landon, head of the University of Chicago's infectious disease prevention and control program. “But our best chance is global vaccination, including Americans, which is going to be a bit of a stretch in itself, to reduce new variant development.”

Misinformation and natural hesitancy has stymied vaccine uptake throughout the U.S. and throughout the world, public health experts believe.

The U.S. Centers for Disease Control reports that after more than a year of vaccine availability to most Americans, just 62% of the population is fully vaccinated.

“Hesitancy does play a large role for that in communities of color and has been driven by justifiable medical mistrust stemming from historical and unethical medical research,” Joshi said. “So, it's on people like me and the health care establishment to rebuild that trust up again, and we have been doing work to that end.”

Boosters, omicron

A number of incentives were created to try to increase vaccinations throughout Illinois. A special lottery that gave away a total of $10 million in cash payments to fully vaccinated adults and scholarships to fully vaccinated teenagers barely moved the needle.

But as the delta variant took hold, vaccination rates began rising.

“Fear can be a powerful motivator,” Landon said at the time.

Gov. J.B. Pritzker also mandated vaccination for a number of state employees as well as educators and college students throughout the state in late summer.

But the biggest driver for the growth in vaccinations came later in the year when booster shots were recommended to combat the delta surge that was driving larger numbers of breakthrough hospitalizations.

Since the start of 2021, IDPH has reported 5,808 COVID-19 patients treated in hospitals were fully vaccinated. Many had underlying medical conditions or compromised immune systems.

The state also reported 1,521 fully vaccinated residents have died from COVID-19 since Jan. 1. That's 13.4% of all COVID-19 deaths in Illinois last year. But that's also just 0.02% of all fully vaccinated Illinois residents.

So far, IDPH officials report 3,077,848 booster doses have been administered, which is becoming more important than ever, public health officials agree, because of the latest and even more transmissible omicron variant first detected in Illinois just a few weeks ago.

Vaccine providers are currently averaging 46,046 shots a day, according to IDPH records.

Where are we now?

The combination of the lingering delta variant and the introduction of the highly contagious omicron variant this month has led to an explosion in new cases and hospitalizations.

Illinois shattered a single-day record for new COVID-19 cases Thursday with 30,386 new infections.

And while omicron has so far shown to pose a lesser threat in terms of severity of symptoms than delta, medical experts point to a larger problem it can create.

“So many people who work in the hospital are getting infected, so while our health care workers aren't getting ill, they can't be in the workplace, which creates a crisis situation at the hospitals,” Pinsky said.

Barely 10% of the state's staffed intensive care beds were available by the end of the year, IDPH records showed.

There were 5,689 COVID-19 patients hospitalized in Illinois the last time state health officials reported those numbers Thursday. About 90% are unvaccinated, IDPH Director Ngozi Ezike said Thursday.

In the early summer of this year, COVID-19 hospitalizations had dwindled to an average of just 411 patients for the week ending July 5.

Over the past week, testing has become harder to come by as well. Appointments are scarce and home kits are sold out at stores.

“It's key to have widespread availability of cheap testing supplies along with appropriate help and support for people to stay home when sick,” Landon said.

Vaccination uptake needs to increase in order for 2022 not to be a repeat of 2021, public health experts agree. Most say it's time to make it harder for the unvaccinated to remain that way.

“There are still people out there who are convincible, but it's a slimmer margin now,” Pinsky said. “So unless your employer or school requires it, I don't think it's possible to get everyone vaccinated without some requirements.”

Pritzker has urged other municipalities to follow Chicago and Cook County officials' lead to require proof of vaccination to go into bars, restaurants, gyms and other venues beginning Monday.

“In public health, we are always taught to make the right thing to do the easy thing to do,” Joshi said. “But sometimes you also need to make the wrong thing to do impossible.”

Yet public health officials say there are reasons to be optimistic about 2022.

Medical treatments available for those sickened by the virus are more widely available now. A new drug has also been approved that reduces symptoms of COVID-19 in those infected so they don't have to be hospitalized.

There's also plenty of vaccine available, the health officials say.

“If you are looking for a light at the end of the tunnel and to think positively about this, we are at a much safer place than we were a year ago,” Pinsky said. “For those of us who have been vaccinated and boosted, we can feel safer.”