CHICAGO — Just shy of the second anniversary of his proclamation declaring the coronavirus a statewide disaster, Illinois Gov. J.B. Pritzker will try again to turn the page on COVID-19 restrictions Monday when he lifts his much-contested mask mandate for most indoor public places.
Masks still will be mandatory on public transportation and in places such as hospitals and day care centers, and businesses still can require them as they see fit.
But the end of mandatory masking in most settings represents a big step in getting back to normal, even though it comes as the highly unpredictable virus remains in wide circulation.
The current landscape somewhat resembles the optimistic weeks before last summer’s pandemic lull, with cases, hospitalizations and deaths all declining. In some ways, it offers even more hope, with more people vaccinated and boosted and a higher level of natural immunity among those infected in recent surges.
At the same time, there remain plenty of causes for concern: The youngest children still aren’t able to get vaccinated, an even more contagious subvariant of the virus is circulating in Illinois, and overstretched hospitals are caring for far more COVID-19 patients than they were when Pritzker briefly lifted the mask rule in June.
In lifting the mask mandate, Pritzker pointed to plummeting hospitalizations but declined to specify the target that triggered the change. Caught between a pandemic-weary public and federal health officials who until Friday were still recommending masking, the governor’s office ditched the detailed, data-driven rubrics for easing restrictions that were a hallmark of Pritzker’s earlier approach.
The Centers for Disease Control and Prevention provided a backstop for the decision Friday by adjusting federal mask guidelines to focus less on COVID-19 cases and more on hospitalizations and health care capacity. The CDC eased previous recommendations that called for indoor masking across most of the country, mirroring recent moves by Pritzker and other Democratic governors but going further than Illinois by including schools in its new guidelines.
After the Illinois Supreme Court on Friday overturned a lower court order that blocked his school mask rule and the CDC came out with its new guidance, Pritzker said he would no longer require face coverings in schools beginning Monday. Most districts across Illinois had already gone mask optional or announced plans to do so next week.
Pritzker left the door open to requiring masks in schools and other settings once again if Illinois is overcome by yet another surge. But doing so would be a test of his political will in an election year — and a test of the public’s willingness to comply in numbers large enough to slow the spread of the coronavirus as the pandemic enters its third year.
With views on mask wearing firmly entrenched, largely along familiar regional and partisan lines, Pritzker has little to lose by lifting the mandate, said Chris Mooney, a University of Illinois at Chicago political science professor.
“The one thing that I would say for sure most clearly characterizes this move is safety — political safety,” Mooney said. “He’s not out in front, but he’s not behind. He’s kind of going with the pack with the other governors. And he’s going in the direction everybody wants. Everybody wants masks off.”
While never declaring victory over the virus, Pritzker waited for the hopeful time last summer when the pandemic appeared to be waning to launch his reelection bid, showcasing his handling of the crisis and touting that he “followed the science” in his efforts to protect the public.
But the state quickly lost ground to the virulent delta variant. By late August, Pritzker had reissued a mask mandate, and it remained in place as a late-summer wave ebbed, only to be followed this fall and winter by the state’s largest surge to date, driven by the highly contagious omicron variant.
In the intervening months, Pritzker deflected questions about the specific bench mark that would signal the end of the mask mandate while also trumpeting Illinois’ relative success in weathering the latest surges compared with its neighbors, none of which mandated masks.
While no longer publicly tying decisions on restrictions to specific data points, administration officials have continued to monitor cases, hospitalizations, vaccination rates and other statistics as they have throughout the pandemic, Illinois Department of Public Health Director Dr. Ngozi Ezike said in an interview Friday, adjusting those evaluations as they’ve learned more about the virus and dealt with successive waves of variants.
“Your best-picked metrics are still subject to the unpredictable forces that have come with each massive wave and variant,” she said.
In the third year of the pandemic, the focus is on preventing the most severe cases and preserving hospital capacity.
“There is opportunity to just see even the smallest increases and try to dig into that and see, like: What is this stemming from? Which area is this mostly affecting?’” Ezike said. That will allow time for health officials to take the appropriate steps, she said.
The lengthy list of state efforts to fight the pandemic began on March 9, 2020, when Pritzker declared a statewide emergency, two days before the World Health Organization labeled the novel coronavirus a global pandemic. At the time, there had been 11 confirmed cases and no deaths attributed to the virus in Illinois.
Within 12 days, the governor banned gatherings of more than 1,000 people, closed schools, shut down restaurants and bars, and finally closed all “nonessential” businesses and enacted other restrictions through a statewide stay-at-home order that would remain in effect, with minor modifications, for more than two months.
Pritzker’s most enduring effort to contain the virus — the requirement that people 2 and older wear face coverings in public — didn’t take effect until May 1, 2020, by which time the state had recorded more than 59,000 cases of COVID-19 and 2,457 deaths.
The first wave of coronavirus hospitalizations had peaked three days earlier, with 5,037 patients filling hospital beds statewide. That number dropped to 3,337 by the time Pritzker lifted his statewide stay-at-home order on May 29 and continued falling before leveling out below 2,000 patients per day through the summer and early fall.
Hospitalizations spiked again during the brutal fall surge of 2020 as Pritzker slowly rolled back his reopening across the state based on rising cases, positivity rates and other factors. The number reached a new high of 6,175 COVID-19 patients on Nov. 20, 2020.
By June 11, 2021, when vaccines were readily available and Pritzker had lifted nearly all his coronavirus restrictions, including the mask mandate, there were only 684 COVID-19 patients in hospitals. But the reprieve was short-lived, with the arrival of the delta variant and then omicron leading to successive surges.
The number of COVID-19 patients in Illinois hospitals reached an all-time high of 7,380 on Jan. 12 of this year before beginning a precipitous decline.
When Pritzker announced Feb. 9 that he planned to lift the mandate at the end of the month, there 2,380 COVID-19 patients in the state’s hospitals, and the decline has continued, with 1,143 hospitalized as of Thursday night, the most recent figure available.
Since the mask mandate was reinstated in August, Illinois has been a Midwestern outlier, the lone state in the center of the country to require face coverings in public.
Over the past several months, Pritzker has repeatedly touted both his mask rule and the relative strength of the state’s vaccination effort to support his claim that Illinois has outperformed its neighbors in battling the pandemic.
“Illinois has done better than almost every state in the Midwest,” Pritzker said Feb. 9 during an appearance in Champaign. “In fact, we’re better than all of the states around us at keeping people healthy and safe, and certainly out of the hospital, during this last omicron wave, in part because people wear their masks.”
From the time Illinois reimposed its masking mandate Aug. 30 to the most recent figures released last week, Illinois’ hospitalization rate was among the lowest in group that included the five neighboring states, with roughly 883 of every 100,000 residents admitted to the hospital with COVID-19 during that time, according to a Tribune analysis of federal data. That was lower than rates for Indiana (1,053), Missouri (1,126) and Kentucky (1,458), and roughly the same as Wisconsin’s, but not as low as Iowa’s (723).
During the same time, Illinois had the lowest death rate among that group of states. Illinois saw roughly 79 deaths per 100,000 residents attributed to COVID-19, slightly lower than Wisconsin (80) and Missouri (83), and lower still compared with Iowa (88), Kentucky (110) and Indiana (122).
The Pritzker administration cites the mask mandate as the reason Illinois has seen less serious illness and death, but it can be difficult to tease out cause and effect.
While academic studies have continued to find benefits of masking, including lowered rates of infection and serious illness, they don’t necessarily explain why some states without mandates had rates near or better than Illinois. Researchers have previously said there can be a host of other factors that also affect why and where infections spread.
In one of those factors — the level of vaccination — Illinois is also a leader, with nearly three-fourths of residents receiving at least one shot, and nearly a third receiving a booster, the latter considered the most effective way to limit the chance of an infection causing serious illness.
Masks have become a serious political flashpoint, but to some extent the focus on that one safety measure has obscured the importance of other factors that could play even more important roles in slowing the spread of virus, said Sarah Cobey, a University of Chicago researcher whose lab helped the state model the potential spread of the virus early in the pandemic.
“I am sure that masking has saved lives, and removing mask mandates will lead to hospitalizations and deaths, but it seems almost a distraction compared to more substantive measures,” Cobey wrote in an email. “Lack of good support for isolation and sick leave, poor access to testing, low vaccination coverage in many populations, weak to absent ventilation standards, indoor dining, and unclear messaging probably each contribute more to transmission than most cloth and surgical masking.”
Likewise, Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University’s Feinberg School of Medicine, said he doesn’t necessarily object to the mask mandate being lifted, but he would rather see public policy focus on pushing more people to get vaccinated and protecting those who already are.
Pritzker stopped short of ever requiring people statewide to show proof of vaccination to dine in restaurants or workout at gyms, and Chicago and Cook County are dropping their vaccine card rules on Monday along with the city and county mask mandates.
“I want to be in a room and I want to know that everybody there is vaccinated,” Murphy said. “I don’t want to mix with unvaccinated people because that’s going to increase my risk of getting infected.”
As mask rules are eased in Illinois and across the country, there are two possible scenarios that could play out, Murphy said.
One is the path we’ve been down before: Cases begin to surge again, perhaps driven by a new variant, as we saw last summer with delta, or by the BA.2 subvariant, known as “stealth” omicron, that is already in Illinois, Murphy said.
That would test the willingness of Pritzker to tighten restrictions again and the public’s readiness to listen.
“If we have to put those mitigations back, we have to be ready to do it and do it quickly,” Murphy said. “The longer you wait, this thing can really just take over again, like it did with omicron.”
The other possibility is that this winter’s onslaught was the state’s last major surge, with the virus becoming manageable through booster shots and better treatments, among other measures.
“We have a full toolbox now,” Murphy said.
Either way, Illinois is left with a battered health care system that has shed workers while at the same time seeing higher patient loads, even from people not suffering from COVID-19.
Those factors have led to fewer available beds. After the brutal fall 2020 surge, Illinois hospitals bounced back with roughly 10,000 open beds administrators said could be staffed if need be. Last month, that number had fallen below 6,000, before since recovering to about 8,000.
While that may seem like a lot, it’s only one open bed for every 1,600 Illinois residents, and it’s not uniformly spread across the state. That means upticks of patients in certain places can quickly fill up a hospital’s open beds and jam its emergency room, which is what happened across the state during the last surge.
The inherent hope in Pritzker’s decision to lift the mask mandate is that, now more than ever, the virus can’t do as much damage to residents and the health care system as before.
If that’s the case, UIC’s Mooney said, the heated rhetoric over mask mandates and other coronavirus protocols will have plenty of time to cool down before voters head to the polls in November.
While Pritzker will never win over staunchly anti-mask and anti-vaccine voters, Mooney said, “the thing is he doesn’t have to have them. He just has to kind of blunt their anger a little bit. That’s all he needs to do.”
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