The number of new coronavirus cases in Arkansas -- even when excluding a large outbreak among prisoners -- increased Friday for the second straight day, causing the state's top health official to say he's "a little bit concerned" as the state approaches a May 4 target to begin easing some restrictions on businesses.
State officials reported Friday afternoon that, not counting cases among inmates at the Cummins Unit in Lincoln County, 78 Arkansans had tested positive since a day earlier.
That followed an increase of 36 non-inmate cases Wednesday and 67 on Thursday and as the state initiated a campaign for a "surge" in increased testing Friday and today.
The state's death toll from the virus also grew Friday by two, to 47, as a report from the Pulaski County coroner's office indicated that a resident of a Maumelle nursing home was among those who died most recently.
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That brought the number of publicly known nursing home deaths from the virus to 12 in the state.
Including inmates from the Cummins Unit, the total number of positive cases from Thursday evening to Friday evening increased by 211, to 2,810.
Test results from the prison have been added to the state's official total over the course of several days as information from laboratory reports is entered into a state database.
The number of inmates who had tested positive increased by three Friday, raising the total to 690, officials said.
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'MEASURED APPROACH'
At his daily news conference on the pandemic, Gov. Asa Hutchinson said he'll consider multiple factors, including the number of coronavirus patients who are hospitalized, the state's hospital capacity, the percentage of tests that are positive, the availability of protective medical gear and the ability of industry groups to put protections in place as he decides which restrictions can be lifted.
As states such as Georgia and Tennessee move more quickly to lift restrictions on restaurants and other businesses, Hutchinson said he's proceeding cautiously.
"There's a lot of pressure -- well, lift everything at once, as some states are doing," Hutchinson said. "We're taking a more measured approach that is based upon the information that we have that's unique to Arkansas, and making judgments industry by industry."
During the first day of the surge testing campaign, some hospitals reported a slight increase in the number of patients coming in for tests.
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Hutchinson also responded to a complaint by the Arkansas Hospital Association, which it voiced in an email to its members, that it hadn't been consulted on the two-day testing campaign.
Hutchinson said he had checked directly with several hospitals across the state that indicated they had a sufficient inventory of testing supplies. He said he didn't see a need to consult with the association.
"I've assured them if they need additional supplies during the next two days, we will hand-deliver them to them," he said. "We will make sure they have those supplies."
Hutchinson also said he had added $1 million from his quick-action closing fund to make short-term, no-interest loans to businesses.
Earlier, he contributed $5 million to the program, which he said had issued 246 loans and helped save 2,500 full-time and 1,000 part-time jobs. About 100 other businesses had applied for the loans when the money ran out, he said.
UPTICK IN CASES
White House guidelines recommend that states have a downward trajectory of positive tests or percentage of results that are positive for a two-week period before beginning to lift restrictions
Arkansas Department of Health Secretary Nate Smith said the increase in cases Friday was partly because a total of 2,808 results had come in from the department's laboratory and other labs, the highest number of results the state has received in a day.
Just 4.1% of the tests, which included inmate cases, were positive, which he said is "one of our lowest positivity rates since we've been doing testing."
By comparison, he said, 7.9% of the 34,745 results that had come in since testing began in the state had been positive.
Still, he said, "I'm a little bit concerned about the three-day increase in numbers from the community, and we'll be looking at that very carefully."
He said there had been a "slight increase" in the percentage of cases in the northwest part of the state as well as in Crittenden County, across the Mississippi River from Memphis.
"So we're going to give some particular attention there, look more carefully at where those cases are coming from, so we can take appropriate interventions," he said.
From Thursday evening to Friday evening, the number of cases in Crittenden County increased by 11, to 167, the third-highest total in the state behind Pulaski and Lincoln counties.
In the northwest corner of the state, Benton and Washington counties had the highest totals. The cases increased by seven, to 77 in Benton County, and by nine, to 71 in Washington County.
Although the state's campaign to increase testing could add to the upward trend in cases, Smith said he'll also be looking at the percentage of the tests that are positive.
Identifying new cases, he said, will also help the department limit the virus's spread. The department has been doing that by directing people who test positive to isolate themselves at home and investigating to see who may have caught the virus through contact with them.
He said the department would soon be issuing guidance allowing some types of dental office visits to resume May 18. Other services involving a higher risk of transmission will be phased in later, he said.
'NOT CONSULTED'
The testing surge campaign was announced as part of a strategy that also involves encouraging providers to test patients who have symptoms, whether or not they have a known exposure to someone known to be infected with the virus or a history of travel to an area with a large outbreak.
The Health Department is also encouraging providers to test people with possible exposure to the virus -- through travel or contact with an infected person -- even if they don't have symptoms.
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In an email to its members Thursday, the hospital association indicated that many of its members are still facing shortages of supplies needed to conduct the tests.
"We regret that you were not consulted about this plan, so that we could have helped you prepare and reminded the [Health Department] that the number of tests available through your commercial labs is extremely limited," the association said in the email. "We know that many of you continue to have issues around the ongoing scarcity of test kits and supplies, and we will continue to communicate this and advocate on your behalf."
The email advised members to consider "any known outbreaks in your community and your current supply chain status" when deciding how many tests they would be able to perform.
Hospitals should also keep in mind that when elective procedures are allowed to resume Monday, they are required to test patients for the coronavirus beforehand, the association said.
It also advised hospitals to contact the Health Department for help in processing the tests and obtaining supplies and to document their needs "if you have more demand for testing than you have supplies."
"If you were not informed of the 'surge' before the press conference, you can use that as a talking point for press inquiries," the association said in the email.
Bo Ryall, the association's chief executive, said the purpose of the email "wasn't to complain about the governor."
"He doesn't have to consult with us, but we're a facilitator of information," Ryall said. "We want to help him get information out to the hospitals across the state."
Some hospitals, especially in rural areas, are still struggling with a shortage of swabs needed to collect samples and test kits from commercial providers, he said.
He said he hadn't heard of any hospitals that were having trouble accommodating the testing campaign.
"I've heard that the demand is up, for sure, but I've not heard any specifics besides that," he said.
CAMPAIGN RESPONSE
A drive-thru testing site atUAMS Medical Center had seen about 150 people as of 4 p.m. Friday, spokesman Leslie Taylor said in an email.
That was "a little more" than usual for that time of day, with about three hours left before the clinic closed for the day.
"However, it's not out of the ordinary, as we have screened several hundred in a day before," she said.
Earlier in the afternoon, she said the hospital probably had the capacity for a possible surge.
"If someone is not having symptoms and doesn't feel like they need to be tested, this isn't something where everyone needs to come in," she said. "But people who feel like they need to be tested because they have symptoms and have been in contact with someone, this would be most helpful for them."
She said the number of people who come in for testing each day is usually above 100 and has topped 500.
Baptist Health was testing patients at eight sites across the state, including three that were opened in response to the governor's campaign and others that expanded their hours.
"Setting up the sites has gone smoothly and the response seems to be slightly higher than what we have been testing each day," chief medical officer Eddie Phillips said in a statement.
As of 3 p.m., the system had tested 159 people.
The health system began administering an in-house test with a one-hour turnaround April 9 and since then has tested about 30 patients per day.
Because the system has a limited supply of the reagent needed to run the test, it's being used only on high-risk in-patients and health care workers with a high risk of exposure.
"We are working hard to secure additional reagent that would allow us to test for our needs, but also to help rural parts of the state that may not have access to rapid testing," Phillips said.
Additionally, Baptist Health has been sending about 115 tests each day to reference labs that have a turnaround of 24 to 48 hours.
In northeast Arkansas, St. Bernards Healthcare saw higher numbers the past two days, with several individuals calling specifically because of the governor's announcement, spokesman Mitchell Nail said Friday.
"Consequently, the governor is making an impact, and we fully support his efforts fighting the pandemic," Nail said in a statement.
At the system's designated testing facility behind the Arkansas State University campus in Jonesboro, health care providers performed 53 swabs Thursday and 38 swabs as of 5 p.m. Friday. The center has averaged about 20 swabs per day over the past month, Nail said.
Nail said the health care system has a surge plan and ample test kit supplies and personal protective equipment and has not had any problem being able to serve patients asking for a test.
"We plan to assist as many as possible," Nail said. "Test kits are now more readily available, and we continue to be judicious so we have available testing for those at highest risk."
PAROLE EXPEDITED
Early Friday, the Arkansas Board of Corrections voted to expedite parole consideration for a list of 1,244 inmates, in accordance with guidelines set by Hutchinson this week. The list includes nonviolent offenders who are within six months of their original parole date.
It is the second time the board has used its authority under the Emergency Powers Act to reduce prison populations during the covid-19 pandemic.
In March, it voted to speed up parole for a smaller group of 114 inmates.
"This list is going to be a lot more than normal," board Chairman Benny Magness said Friday.
In compiling the list, the board agreed to waive the requirement that inmates considered for early release have to have been in prison for at least six months.
None of the inmates included on the list are guaranteed parole, and their release depends on the completion of any other requirements and approval by the Parole Board. Approvals for parole are already up about 20% during the pandemic, according to Parole Board records.
THURSDAY DEATHS
With the first case being confirmed in Fulton County, only three of the state's 75 counties -- Calhoun, Little River and Montgomery -- had no identified cases as of Friday.
According to a Health Department report, a worker at Southfork Therapy and Living at Salem in Fulton County tested positive for the virus, making it the 34th nursing home where a worker or resident has tested positive.
At the federal prison in Forrest City, 79 inmates and 11 staff members had tested positive as of Friday, Smith said.
Across the state, the number of patients hospitalized with covid-19 increased by 3, to 104.
Twenty-five of the hospitalized patients were on ventilators, up by one from a day earlier.
A report from the Pulaski County coroner's office indicated that the state's most recent deaths from the virus included that of a resident at The Lakes at Maumelle Health and Rehabilitation.
Betty Ellenburger, 91, died at the home Thursday, according to the report.
She had been in hospice care at the home after having a stroke in January, an investigator with the office said in the report.
A nurse at the home said Ellenburger "was improving in health till last week when she began complaining of nausea" and fever, the investigator wrote.
She was tested for covid-19 last week, and the result came back positive Monday.
"The decedent declined in health rapidly and was pronounced dead" at 4:45 p.m. Thursday, the investigator wrote.
Phillip Cate, 79, of North Little Rock also died of the virus Thursday afternoon, according to a coroner's report.
Cate, who had a history of high blood pressure, was admitted to UAMS Medical Center on April 9 and tested positive for covid-19, an investigator said in the report.
He died at 2:55 p.m. in the intensive care unit, the report says.
Ellenburger was the second resident of the The Lakes of Maumelle to die of the virus, according to coroner's reports.
According to a Health Department report Thursday, at least 30 residents and four workers at the home have tested positive.
From Thursday evening to Friday evening, the number of cases among Arkansans in the state's official tally increased by 77 in Lincoln County, where Cummins is located, to 707, and by 13 in Pulaski County, to 440.
Information for this story was contributed by John Moritz, Michael R. Wickline and Eric Besson of the Arkansas Democrat-Gazette.
A Section on 04/25/2020