Arkansas' count of coronavirus cases rose Wednesday by 2,212 while the number of covid-19 patients in hospitals set a new record for the fourth day in a row.
The state's death toll from the virus, as tracked by the state Department of Health, rose by 10, to 2,522.
"I expected the return to higher case numbers today, and all indications are that the number will continue to be high through the week," Gov. Asa Hutchinson said in a statement.
"With COVID-19 virus in every area of the state (and nation), we need to double our efforts to follow public health guidelines."
At record levels since Sunday, the number of patients hospitalized in the state with covid-19 rose by 14, to 1,088.
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Those patients included 186 who were on ventilators, down from 195 a day earlier.
Wednesday's increase in cases was fourth-highest in a single day since the start of the pandemic and just the sixth one that has topped 2,000.
It was the largest increase so far on a Wednesday. The previous Wednesday, Nov. 25, the state's count of cases rose by 1,965.
After mostly falling for the past several days, the average number of cases added to the state's tallies each day rose by 35, to 1,606.
State Epidemiologist Jennifer Dillaha said the uptick "could be a foreshadowing of an increase in cases that we have been concerned about as the result of holiday traveling."
"We had a pretty good number of [polymerase chain reaction] tests as well as antigen tests, so I think people are coming back from the holidays and they're beginning to get tested either post-travel or they've developed symptoms, so the demand for those tests has increased."
She said the case and hospitalization numbers were "worrisome" and "very much headed in the wrong direction."
"We have a high number of cases and we also have a high number of hospitalizations," she said.
"So to me that means that a proportion of those people are going to die. We're going to lose more Arkansans and that is a very distressing thing to me."
Heather Young, a pediatric infectious disease physician, said the state's doctors are very concerned about the continuing increase in cases and hospitalizations and the pressure it puts on health care workers.
There are nearly 350 signatures on an electronic version of a letter sent a few weeks ago to Hutchinson signed "The Physicians of Arkansas."
The doctors asked that the governor enforce a universal mask mandate, close bars and gyms, limit restaurant service to takeout only and restrict all indoor gatherings to fewer than 10 people.
"Many of my physician colleagues are very disheartened by the general public's apathy towards the virus and the blatant disregard for the lives of others, and the lack of leadership," Young said. "My adult colleagues are working as hard as they can, being stretched to the limits to save people's lives on the back end, with minimal preventative measures trying to alleviate these burdens on the front end.
"When we drive home from work and drive past bustling restaurants or see pictures of unmasked indoor gatherings on social media, it's extremely discouraging to know that in a week or two that means even more patients on top of our strained resources."
A directive issued by the Health Department in July in response to an executive order by Hutchinson requires Arkansans to wear masks in most public places where a distance of 6 feet from people from other households can't be assured.
VACCINE PLANS
Dillaha said Wednesday that the Health Department was finalizing its plan for the distribution of the initial doses of coronavirus vaccine, once one is available, and expects to submit an order to the U.S. Centers for Disease Control and Prevention soon.
As a CDC advisory committee has recommended, she said the state is planning to give first priority to health care workers and residents of nursing homes and other long-term care facilities.
The first doses will be "focused, I believe, on health care workers, especially those who work in hospitals and who are at highest risk for infection or exposure," she said.
"The hospitals that receive vaccine will have to prioritize the vaccines that they receive for their highest-risk staff and employees," Dillaha said. "It won't be enough to cover all the hospital's workers."
Health Secretary Jose Romero told state lawmakers on Monday that the state's initial allotment of a vaccine developed by Pfizer and BioNTech was expected to be about 25,000 doses.
Hutchinson said Tuesday that the doses "are being prepositioned, so that once it is approved we should have it in Arkansas within 24 hours."
A U.S. Food and Drug Administration committee is set to discuss a request for an emergency use authorization for the Pfizer vaccine on Dec. 10.
Hutchinson said he has "confidence in the vaccine and the FDA approval process" and would "certainly be willing and interested in taking the vaccine" once it's his turn.
"In terms of priorities, the priority would be health care workers. The priorities would be those in the nursing homes, and I certainly want those to be taken care of first," he said.
LAWMAKER INFECTED
Meanwhile, Sen. Ron Caldwell, R-Wynne, on Wednesday became the latest state lawmaker to acknowledge that he has tested positive for covid-19.
Caldwell, who chairs the Senate State Agencies and Governmental Affairs Committee, said he tested positive for the coronavirus last week and he's at home taking the "hydroxychloroquine cocktail."
He said his wife, Brenda, also tested positive for covid-19 and she is in the hospital on remdesivir.
"I should be off quarantine on Monday," said Caldwell, who is 69.
He said that he's not sure how he was infected with covid-19 and he hasn't been at the state Capitol in the past few weeks.
"We tried to play it safe," Caldwell said.
"We know first hand this stuff is real," he said, noting his wife's sister died last week from covid-19.
The number of state lawmakers who have said they have tested positive for the coronavirus during the past two months is now 14.
Since March 17, 18 state lawmakers have acknowledged testing positive for the coronavirus. There are 35 state senators and 99 state representatives.
ACTIVE CASES RISE
The Health Department reported Wednesday that it had received the results of 10,095 polymerase chain reaction, or PCR, tests and 2,764 antigen that were performed a day earlier.
The total of 12,859 test results was up from the 9,526 that the department reported on Tuesday but down from the 17,297 it reported receiving a week earlier.
Of the cases added to the state's tallies Wednesday, 1,507 were confirmed through PCR tests.
The other 705 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 161,521.
That comprised 140,705 confirmed cases and 20,816 probable ones.
The number of cases that were considered active rose by 284, to 16,378, as 1,918 Arkansans were newly classified as having recovered.
The largest number of new confirmed or probable cases, 258, was in Pulaski County, followed by Benton County, with 166, Washington County with 158, Craighead County with 119 and Faulkner County with 84.
Among prison and jail inmates, the Health Department's count of cases rose by 51.
The state's count of virus deaths rose by eight, to 2,312, among confirmed cases and by two, to 210, among probable cases.
Among nursing home and assisted living facility residents, the death toll rose by three, to 1,064.
The number of people who have ever been hospitalized in the state with covid-19 rose by 89, to 9,110.
The number of virus patients who have ever been on a ventilator rose by eight, to 1,002.
HOSPITAL BEDS ADDED
There were nearly 40 more hospital beds added to the state's inventory count, bringing the number of beds -- whether occupied or empty -- up from 8,978 to 9,016 on Wednesday.
Beds designated for intensive care units increased by seven, going from 1,147 to 1,154, according to Health Department data.
"Hospitals continue to adjust their bed types depending on several factors such as available staff or if they increase the numbers by opening up a new wing with more beds," Health Department spokeswoman Danyelle McNeill said.
Likewise, the state's hospitals sometimes adjust their ventilator inventory by either adding new machines or reallocating others. The inventory of ventilators dropped by 29 on Wednesday, from 1,065 the day before to 1,036.
"A hospital reclassified some of its vents as non-adult vents and is only reporting adult vents in the overall total," McNeill said when asked the reason for the drop in inventory.
With 185 covid-19 patients on ventilators, there were 630 ventilators available for use.
Out of the state's 8,978 beds, 2,384 -- or about 27% -- remained available as of Wednesday. Included in that number are a few hundred beds in psychiatric or rehabilitation facilities that are not used for covid-19 care.
With the increase in ICU beds, there were 84 critical care beds available as of Wednesday. There were 393 covid-19 patients in the state's intensive care units.
The biggest issue in whether a hospital increases or decreases bed space is staffing, Eddie Phillips, chief medical officer for Baptist Health, said.
Since the end of November, the total bed capacity has dropped by 197 beds, going from 9,017 to 8,820, while the maximum flex bed capacity dropped by 147 beds, going from 11,351 to 11,204.
Total bed capacity are hospital beds in the state that can be staffed regardless of whether or not they are occupied.
Maximum flex bed capacity is the number of beds at the hospital regardless of the facility's ability to staff them.
Bonnie Ward, communications director for CHI St. Vincent Infirmary in Little Rock, said the hospital is actively coordinating with the Health Department, other area hospitals and the broader Common Spirit Health network -- which connects all the Catholic Health Initiatives facilities around the nation -- to ensure all patients can continue to receive critical care.
"All CHI St. Vincent facilities have pandemic and surge capacity policies and training in place that we have refined over the years with learnings from other pandemic outbreaks," Ward said.
Those plans include accommodating more critical care patients in their facilities and providing additional staff as needed.
"Our hospitals continue to care for many ill patients, not just related to COVID-19, and we're making sure we have the staff available to provide those patients with the necessary, compassionate care they deserve," Ward said. "CHI St. Vincent is blessed to have staff who feel truly called to serve our healing ministry. We remain well prepared to effectively and expertly care for all patients throughout our care sites and are grateful for the continued support of our community."
SCHOOL CASES
In its daily coronavirus update, the Little Rock School District reported that, in the 24-hour period ending at 3 p.m. Wednesday, it had learned of 11 students from several schools and three employees who had tested positive.
An additional 39 students and 10 employees were required to quarantine after being near someone who tested positive.
The University of Arkansas, Fayetteville reported 19 new cases among employees and students since its last update on Monday.
The number of cases that were active rose from 35 to 48.
Meanwhile, the Fort Smith School District announced that it would be limiting its "blended learning" option, which allows students at its two high schools to take a mix of virtual and on-site classes.
Starting next semester, students currently enrolled in all virtual or in-person classes won't be able to switch to the blended option.
The option will be limited to current blended learning students with a grade of at least 80% at the end of this semester.
Students who chose to continue with the option whose grades fall below 70% for any class will be "returned to a full face to face student, and will not have the option to return to blended status," the district said.
It said blended learning students who "engage with the curriculum" from home will be marked as "virtually present," while those who do not will be marked as unexcused.
"Blended Learning, as it is structured now, has demonstrated very limited success, and warrants a change to ensure future success and progress toward graduation for all students," the district said in the announcement.
WHITE HOUSE REPORT
According to a weekly report from the White House coronavirus task force, Arkansas had 11,761 new cases during the week that ended Friday, up from 11,599 the previous week.
The state's rate of new cases per capita last week was the 24th highest in the country. The previous week, it was the 26th highest.
The state's 115 covid-19 deaths last week translated to a rate of 3.8 deaths per 100,000 residents, the country's 21st highest rate.
The previous week, the state had 174 deaths, translating to a rate of 5.8 per 100,000 residents, the 10th-highest rate in the country.
The report continued to list Arkansas as being in the "red zone" for new cases, meaning it had 101 or more new cases last week per 100,000 residents.
It also continued to list the state as being in the "orange zone" for the percentage of its PCR tests that were positive.
During the week that ended Nov. 25, that percentage was 9.5%, the 30th-highest rate in the country.
That was down slightly from the previous week when, 10% of the state's PCR tests were positive.
States were considered to be in the red zone for test "positivity" if more than 10% of their tests were positive and in the orange zone if the rate was 8%-10%.
Hutchinson has said he wants to keep the state's rate below 10%.
The report listed 35 Arkansas counties as being in the "red zone," meaning they had 101 or more new cases per 100,000 residents last week and that 10.1% or more of their tests were positive.
That was down from 38 counties in the previous week's report.
For the second week in a row, however, all 75 counties had 101 or more new cases per 100,000 residents.
"Europe is experiencing a fall surge similar to the USA and is showing early signs of improvement through country-specific mitigation efforts," the report said.
For instance, it said 48 out of 60 countries require masks in all public settings and most countries have imposed fines for noncompliance.
It said 56 countries have "significant restrictions on gathering size," 38 have "some form of nonessential business closures, initially focused on bars and reducing restaurant capacity," 37 have "some form of entertainment or public space restriction" and 39 have "deployed a contact tracing app."
"We are also seeing states and cities that aggressively mitigated achieving a high plateau and early stability in less than 4 weeks," the report said.
"However, in many areas of the USA, state mitigation efforts remain inadequate, resulting in sustained transmission or a very prolonged time to peak – over 7 weeks."
The report said people under age 40 who gathered with others outside their household should assume they are infected, isolate themselves from others and get tested immediately.
People age 65 or older or with significant medical conditions who attended similar gatherings should be tested immediately if they develop symptoms "as the majority of therapeutics work best early in infection," the report said.
It said nearly 60% of the state's nursing homes have at least one covid-positive staff member and nearly 30% have at least one covid-positive resident, "indicating unmitigated community spread."
Although cases "may be reaching a plateau" in the state, "the percent of nursing homes with at least one positive staff member and positive residents is increasing, indicating virus spread is still broad. COVID-related hospitalizations will continue in the coming weeks."
The report recommended testing all college students weekly who return to campus after Thanksgiving.
It also continued to recommend limiting dining in restaurants to 25% of capacity, instead of two-thirds of capacity, and said the state should consider "pausing" extracurricular school activities "even though athletics are not transmission risks, as the surrounding activities are where transmission is occurring."
Information for this article was contributed by Michael R. Wickline of the Arkansas Democrat-Gazette.