Arkansas' count of coronavirus cases increased Thursday by a record 3,039, the first one-day increase that has topped 3,000.
The state's death toll from the virus, as tracked by the state Department of Health, rose by 38, to 3,112.
"The 3,039 new cases today is a milestone we did not want to reach," Gov. Asa Hutchinson said in a statement. "With over 17,000 COVID-19 test results over the past 24 hours, we see our testing continues to increase and identify cases.
"If we isolate and quarantine as needed, then the identifying of cases will help control the spread. We continue to work on vaccine distribution, but we have to focus on distancing and wearing our mask to slow this virus down."
The number of people hospitalized in the state with covid-19 rose by five, to 1,084.
That was just short of the record 1,088 patients who were hospitalized as of Dec. 2.
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The patients on Thursday included 188 who were on ventilators, up from 184 a day earlier.
The record jump in cases came after several days in which the daily increases had plateaued at an elevated level -- averaging more than 2,000 -- after a surge linked to Thanksgiving gatherings.
"My concern is that it's continued community spread that's beginning to escalate," state Epidemiologist Jennifer Dillaha said.
"We've had fairly stable high numbers, but the Christmas holidays and a lot of activities related to the holidays -- a lot of people movement shopping, gatherings, so many things going on that increase risk for transmission -- I'm thinking that that's what we're seeing."
She said she was still hoping people will be cautious during the winter holidays. Otherwise, "the holiday season may be a relatively sad holiday season for many people," she said.
The record increase in cases came just a day after the state set a record for the most deaths reported in one day -- 58 -- and two days after the death toll topped 3,000.
The increase in cases on Thursday was well above the 2,202 that were added to the state's tallies the previous Thursday, Dec. 9.
Previously, the record for a one-day increase was the 2,827 cases that were added Dec. 4.
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Over a rolling seven-day period, the average daily increase in cases rose Thursday by 120, to 2,241, setting a record.
The number of cases that were considered active also set a record as it rose by 885, to 21,659.
That reflected the increase in cases, minus the 38 deaths, 2,114 Arkansans who were newly classified as having recovered and two people with active infections who died of reasons unrelated to covid-19.
The previous record for the state's active-case total was the 21,489 cases that were active as of Saturday.
VACCINE PLANS
Dillaha told state lawmakers Thursday that she expected the state to receive "a little more than 51,000" doses of the vaccine developed by Moderna next week if it is issued an emergency use authorization by the U.S. Food and Drug Administration.
That was up from Health Secretary Jose Romero's estimate of 45,000 doses earlier this week.
"That should be enough to go a long ways to covering the long-term care facility residents and workers" who will be first in line to receive that vaccine, Dillaha said at a meeting of the Legislative Council's Hospital and Medicaid Study Subcommittee.
Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes, agreed.
"We need probably a little bit more than that, but it's going to be really close," she said.
Her group estimated that the state's long-term care facilities, including nursing homes, assisted-living facilities, residential care facilities and institutions for people with developmental disabilities, have about 53,000 residents and employees.
Dillaha said any long-term care residents or workers who are missed should be covered by the next week's allocation, which she said will be smaller than the first one.
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The state's plans call for the Moderna vaccine to initially go to long-term care facility workers and residents, while the Pfizer vaccine, which began arriving this week, has been going primarily to hospital workers.
The state received about 25,000 doses of the Pfizer vaccine this week.
After all the state's health care workers and long-term care facility residents have a chance to get the shot, the vaccines will be made available to other groups.
The state's tentative plan calls for the next group in line to be "essential workers," such as teachers and prison employees, followed by people age 65 or older or with adults with chronic health conditions.
An advisory committee to the U.S. Centers for Disease Control and Prevention, led by Romero, is scheduled to make a recommendation on those priority groups on Sunday.
"We're waiting for that, but we don't want to wait to start planning," Dillaha said.
As of Thursday morning, she said providers had reported administering 1,341 doses of the Pfizer vaccine.
But she said they have 72 hours to report the information, and the actual number of shots administered was likely higher.
'A SENSE OF HOPE'
The University of Arkansas for Medical Sciences Medical Center gave 852 vaccinations Tuesday and Wednesday to its front-line caregivers.
On Thursday, it administered about 1,000 more doses, spokeswoman Leslie Taylor said.
"The UAMS employees being vaccinated first are those who work with patients on our covid-19 floors, in our ICU, our Emergency Department and other patient care areas," Taylor said.
In a weekly Twitter chat, UAMS Chancellor Cam Patterson said he expects all Tier 1A staff -- those providing direct services to covid-19 patients -- will be vaccinated by week's end.
He said he suspects that by "late December or early January" UAMS will have enough for all employees.
"If you are non-patient-facing staff, then it's the third tier, but that's still only a couple of weeks away that we should get to that group," he said.
St. Bernards Medical Center spokesman Mitchell Nail said the Jonesboro hospital had administered about 800 shots as of Thursday.
"We began with Tier 1 employees on Tuesday and Wednesday, and we continue to schedule individuals who have not had covid recently," Nail said. "Many staffers actually occupy different tiers based on days and locations of their work, so we do not want to overlook those team members. In addition, we want to practice good stewardship of our vaccine resources, so other tiers became eligible to volunteer for it as the week progressed."
Nail said the hospital's physicians, departments and team members who had the greatest exposure risks to covid-19 were identified in the planning stage as the first who should be vaccinated.
"Obvious departments included ICU, Emergency and Respiratory Care, but it also included departments like Environmental Services, which sanitizes our isolation units," Nail said. "From there, we established three tiers based upon an individual's potential exposure."
Planning has proved quite challenging, he said.
"We first needed a central location where we could properly administer the vaccine in a socially-distanced environment. In addition, this environment needed to be near resources where we could act quickly should a patient have an adverse reaction," Nail said. "Secondly, with 975 doses to administer, scheduling eligible employees has also been challenging. At most, we can only have seven patients within our vaccine location at a time, and we have spent many hours on the phone working within a shared spreadsheet to get employees scheduled."
CHI St. Vincent Infirmary spokesman Joshua Cook declined to give vaccination numbers when asked Thursday.
Chief Medical Officer Gerry Jones said previously that St. Vincent received 975 vaccine doses Tuesday, but the hospital is taking a slower approach with the distribution to ensure it goes to employees who need it the most and to monitor potential side effects.
"With the care and safety of our employees and the patients we serve as our top priority, the hospital has taken a deliberate and strategic approach to how we roll out vaccinations to ensure that our health care workers who are at significant personal risk due to age, health factors or possible exposure to covid-19 related to their work and location within the health care setting receive the vaccine first," Cook said.
Cook said the hospital anticipates that all of first-tier staff members will receive the first of the two required vaccinations by early next week.
"We expect to receive more doses of the vaccine each week, so the number of staff who can receive the vaccine will increase very quickly," Cook said.
Natalie Hardin, spokeswoman with Washington Regional Medical Center in Fayetteville, said about 300 doses of the 975 received Tuesday had been administered.
"We plan to administer the remaining doses throughout the next week," Hardin said.
Jennifer Cook, spokeswoman for Mercy Hospital Northwest Arkansas in Rogers, declined to give information about the vials of vaccine received or to whom it was administered.
"We plan to provide more information about our progress when we're a bit further along," Cook said. "Everything is going very smoothly, no one has had an adverse reaction and anecdotal side effects have been extremely minimal."
At the legislative subcommittee meeting, Baptist Health Chief Operating Officer Troy Wells said the Little Rock-based health system, which has 11 hospitals in the state, had given about 1,000 of the shots and had about 4,000 more to give out.
"I can tell you, in walking through one of our hospitals yesterday, something was different, and I think it's a sense of hope," Wells said.
"As I observed people, their demeanor, the way they talked with one another and interacted, and the looks on their faces, despite the masks, I had a sense of hope, and so I'm encouraged and I'm optimistic about the days and months ahead that we'll continue to make some progress despite the dark days we're in right now."
The Arkansas State Hospital in Little Rock expects to receive 100-200 doses from the state's initial allocation, Department of Human Services spokeswoman Marci Manley said.
She said the hospital will get the shots though a pharmacy hadn't started administering them as of Thursday.
Dillaha said the Health Department decided to include the psychiatric hospital in the first round of vaccinations because it wanted to make sure it would be able to accept patient transfers that would free up space in other hospitals.
SIDE EFFECTS
UAMS employees who are given the vaccine are monitored by the Student and Employee Health unit, Taylor said.
"We have not had any reports of side effects," she said.
Joshua Cook said the deliberate and staged process of administering the vaccine to St. Vincent employees allows the hospital to monitor for any side effects.
"While also mitigating any possible disruptions such side effects could have on our ability to staff our facilities caring for those critical patients," Cook said. "That process also allows the hospital to manage, quickly learn from and respond to any other disruptions that could otherwise arise."
Nail said that each St. Bernards employee vaccinated is monitored for at least 15 minutes after receiving the dose.
"If the patients have additional risks, such as a known allergy, we hold them for 30 minutes," Nail said. "In addition, we have a specific hot line each person can call after receiving the injection to report concerns about side effects."
Hardin said Washington Regional monitors each individual for 15-30 minutes post vaccination.
PRISON OUTBREAKS
The cases that were added to the state's tallies on Thursday included 2,282 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 757 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 194,543.
That comprises 165,512 confirmed cases and 29,031 probable ones.
The Health Department's count of confirmed and probable cases, as tracked on its online coronavirus dashboard, rose by more than 100 in eight counties.
Washington County had the largest increase, 346, followed by Pulaski County with 288, Benton County with 233, Craighead County with 156, Jefferson County with 129, Saline County with 112, Faulkner County with 109 and White County with 104.
Among prison and jail inmates, the Health Department's count of cases rose by 119.
The Tucker Unit in Jefferson County had 95 new inmates cases, Department of Corrections spokeswoman Cindy Murphy said.
She said Tuesday that the prison had 295 inmate cases at that time.
The number of cases among inmates rose by 13, to 1,469, at the Ouachita River Unit in Malvern; by 11, to 645, at the Grimes Unit near Newport; by three, to 185, at the Barbara Ester Unit in Pine Bluff; and by one, to three, at the Northwest Arkansas Community Correction Center in Fayetteville.
Of those prisons, the Grimes Unit had the largest number of cases that were active, 182, followed by the Tucker Unit, which had 155, the Ouachita River Unit, which had 41, and the Ester Unit which had 40.
The Fayetteville lockup had just one active case.
The state's death toll from the virus rose by 30, to 2,755 among confirmed cases and by eight, to 357 among probable cases.
Among nursing home and assisted-living facility residents, the state's count of virus deaths rose by 18, to 1,340.
The number of people who have ever been hospitalized in the state with the virus rose by 127, to 10,357.
The number of the state's covid-19 patients who have ever been on a ventilator rose by eight, to 1,125.
Meanwhile, the Health Department reported that 11.2% of the state's PCR tests were positive over a rolling seven-day period as of Wednesday, down from 11.7% as of a day earlier.
The percentage for a given day tends to increase as more test results are reported, however.
Hutchinson has said he wants to keep the percentage -- a gauge of whether the state's testing is adequate -- below 10%.
The percentage of antigen tests that were positive over seven days also fell slightly, from 21.4% as of Tuesday to 21.3% as of Wednesday.
VENTILATORS ORDERED
Even with 43 more hospital beds added to the state's inventory, the number of beds available for use dropped by 140, going from 2,266 to 2,126 on Thursday, according to Health Department data.
The total beds -- whether filled or vacant -- increased from 8,994 to 9,037. (The total includes more than 300 in psychiatric or rehabilitation facilities that aren't for covid-19 care.)
That means that about 76% of the state's hospital beds are full.
Available ICU beds dropped by 18 to a record low of 64. Out of 1,154 critical-care beds, 5.5% were available Thursday afternoon.
There were 376 covid-19 patients in ICU beds, 25 less than the previous day.
Baptist Health Medical Center in Little Rock spokeswoman Cara Wade said the number of ICU patients continued to increase in the past week, and available ICU beds are "extremely limited."
"We are in the process of adding 16 ICU beds at the Little Rock hospital that should be ready in January, so those will help if we need additional capacity," Wade said. "We are also hopeful the state's new system of moving COVID patients to where care is most appropriate will help provide relief for capacity at all hospitals."
Wells said at the hearing the hospital is pursuing a federal waiver that will allow it to provide acute care at the hotel on its campus.
The Inn at Baptist Health has been closed since April 5 due to the pandemic, Wade said.
She said the hotel "could potentially be used for up to 40 non-COVID patients which will help create capacity at Baptist Health Medical Center-Little Rock. This will not serve as a hospital, but instead will be like a patient's temporary home. Our hope is that sometime in January we could begin using this space."
Wells said the health system had 237 covid-19 patients in its hospitals on Thursday.
"That's a new high for us," he said.
Patterson said at the hearing that UAMS is on "Level One surge, which means that we are not doing elective procedures that require an overnight stay, so that those beds are freed up."
"As of this morning, we had had no ICU beds available for anyone who needed them," he said.
"That's a challenge for us, but it's also a challenge for smaller hospitals who need to transfer acutely ill patients to tertiary and quaternary centers like UAMS."
Taylor said the hospital is "still taking patients who come into the hospital through our emergency department."
"We are also accepting patients transferred to us from other hospitals for specialized care only available at UAMS like that in our Level One Trauma Center, our stroke center, and our kidney and liver transplant program. We are not accepting hospital transfers that could be handled elsewhere.
"While the ICU is operating at maximum capacity, we have critical care beds available for in-house patients who need them."
She said the hospital began limiting elective surgeries that require hospitalization last month "in an effort to conserve bed capacity and ensure staffing."
The state inventory of ventilators dropped by two, going from 1,075 to 1,073. About 62%, or 670, ventilators remain available for use, six more than the day before.
"We have not had any issues with having enough ventilators but have ordered additional numbers as part of our preparedness plan in case they are needed in a surge of hospital admissions," Wade said.
Wells said the system was awaiting a shipment of 40-50 ventilators that should be arriving this month.
Total bed capacity -- hospital beds that can be staffed whether or not they are occupied -- dropped by five beds to 9,007.
Maximum flex bed capacity -- the number of hospital beds regardless of ability to staff them -- remained at 11,484.
