Gov. Asa Hutchinson extended his emergency declaration for the coronavirus pandemic on Tuesday as Arkansas' death toll from the virus rose by 66, setting a new one-day high.
Hutchinson also said he was "not satisfied" with the pace of vaccinations in nursing homes, which began last week.
He said pharmacies had received 31,700 doses of the Moderna vaccine, which Arkansas has initially designated for residents and workers in long-term care facilities, but had reported administering only 1,680 doses of the vaccine as of Tuesday morning.
By contrast, providers reported administering 21,137 -- or almost half -- of the 43,875 doses of Pfizer vaccine that the state had received through last week.
The state has initially designated that vaccine for health care workers.
"I expect that pace to pick up considerably in the coming days, but I am not satisfied with the pace of the vaccination, particularly in our long-term care facilities, and I am asking our large retail pharmacies and all of our pharmacies to really understand what's at stake here to help us to get this vaccine administered as quickly as possible because lives are at stake," Hutchinson said of the Moderna vaccinations.
Department of Health spokesman Gavin Lesnick said the Moderna figures Hutchinson cited didn't include an additional 37,100 doses that have been allocated to the state to be administered to long-term care facility residents and staff members by Walgreens and CVS as part of a federal program.
"We will be reporting the doses they administer, but we don't have any in our system yet," Lesnick said.
Providers have three days to report the vaccinations, so the actual number of shots that have been given is higher than the Health Department's tally.
The state's count of cases rose Tuesday by 2,718, dwarfing the 1,941 that were added the previous Tuesday, Dec. 22.
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At a record level since Monday, the number of patients hospitalized in the state with covid-19 rose by six, to 1,161.
Those patients included 198 on ventilators, down from 201 a day earlier.
The state death toll from the virus rose to 3,603.
Hutchinson on Dec. 11 extended the emergency that he first declared in March for 20 days while calling on the Legislature to meet as a Committee of the Whole to affirm his declaration.
Legislative leaders declined to call such a meeting, however, saying the matter could be discussed in the regular legislative session that starts Jan. 11.
An executive order Hutchinson signed Tuesday extended the declaration for 60 days, keeping in place measures such as an expansion of telemedicine, an option for children to attend school virtually and Health Department directives designed to prevent the spread of the virus.
"I fully expect the General Assembly to address this issue [during the session] and I would ask them to measure whether we should extend the emergency," Hutchinson said at his weekly news conference on the pandemic.
"I would expect their action on this just as I asked them to affirm the emergency before Dec. 30."
The previous record for a one-day increase in the state toll was the 58 deaths reported on both Dec. 16 and Dec. 21.
Health Secretary Jose Romero said 65 of the deaths reported Tuesday happened within the past month and one happened in November. Twenty-four of the deaths happened within the past week, he said.
"That's telling us that we're really seeing the fallout of Thanksgiving," when gatherings led to a surge in new cases, he said.
LAWMAKER INFECTED
Among the Arkansans who tested positive for covid-19 recently was Rep. Harlan Breaux, R-Holiday Island, who said he received his diagnosis Tuesday morning.
Breaux, 73, said he and his wife got tested Monday after his wife started experiencing flu-like symptoms, as well as back pain and headaches, on Christmas Day.
He said he did not have any symptoms other than a cough and had not been to the Capitol in Little Rock since mid-December.
Breaux, who is quarantining, said he had been trying to figure out how they became infected, since they rarely go out other than to attend church and go to the store.
Breaux is the 18th lawmaker to have publicly acknowledged testing positive in the past three months. A total of 22 lawmakers have said they have tested positive since the pandemic arrived in the state in March.
The Legislature has 135 lawmakers.
'WORKING OVERNIGHT'
Through the end of this week, the state has been allocated about 68,800 doses of the Moderna vaccine and 92,625 doses of the Pfizer.
That includes 23,400 doses of the Pfizer vaccine that was expected to be shipped this week to provide first-time doses to health care workers at high risk of exposure to the virus.
The state also is expecting 25,350 doses of the Pfizer vaccine to give the second shot of the two-shot regimen to health care workers who received an initial dose two weeks ago.
Romero said the state had received 13,650 doses of this week's Pfizer allotment as of Tuesday morning.
Some of the doses will go to workers with the Department of Corrections' health care vendor, Wellpath, as well corrections officers at prison infirmaries and the hospital at the Ouachita River Unit in Malvern.
Corrections Department spokeswoman Cindy Murphy said those shots could start being given "as early as this week."
UAMS Medical Center has administered about 3,400 doses of the Pfizer vaccine so far, spokeswoman Andrea Peel said.
She said the hospital was out of the vaccine on Tuesday and didn't administer any more shots but expected another shipment today, including some shots for people who already received their first dose.
Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes, said at the governor's news conference that some Arkansas pharmacies that are providing vaccinations to nursing homes received their first shipment of the Moderna vaccine on Dec. 21 and administered shots at the homes on Dec. 23.
Others didn't receive their first shipments until Dec. 23, "right before Christmas when there probably were key staff taking off work."
She said more shots were being administered Tuesday.
"We are working to increase the speed of delivery to vaccines in our long-term care facilities," Bunch said.
In addition to nursing homes, those include facilities for people with significant intellectual disabilities and assisted-living facilities.
"This involves a lengthy consent process with both patients, their guardians and our employees and there are over 300 of these locations that will have to have on-site vaccines," she said.
Facilities could choose to receive the vaccines through Walgreens or CVS under the federal program or choose a different pharmacy.
"I would especially like to thank our Arkansas-based pharmacies that have really stepped up and started offering vaccines very quickly in our facilities to our elders and to our staff," Bunch said.
"They've been working late hours and they've got teams working overnight to do data entry and get things ready."
She said her understanding from "our federal partners" is that every long-term care facility in the state will have been offered an on-site vaccination clinic by Jan. 16.
Hutchinson added that his "hope and expectation" is that all of the state's health care workers and long-term care facility residents and staff members who want to be vaccinated will receive shots by the end of January.
That would allow the state to move on to its next priority group, 1B.
The U.S. Centers for Disease Control and Prevention has recommended that that group include people 75 and older and "front-line essential" workers, such as firefighters, police, prison workers and those working in manufacturing and grocery stores.
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Hutchinson said he also hopes the state will be able to announce by the end of next month when the vaccines will be available to the general public.
Hutchinson also said Tuesday that the $900 billion coronavirus relief measure signed by President Donald Trump on Sunday includes $800 million for Arkansas schools.
Education Secretary Johnny Key said that includes $558 million for elementary and secondary schools, $205 million for colleges and universities and $36.4 million to Hutchinson's office to support elementary and secondary schools and higher-education institutions.
Key said the "framework" for the funds is similar to educational funding the state received under the $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act signed by Trump in March.
But he said the new bill includes language allowing elementary and secondary schools to use relief money for school facilities and repairs that would reduce the risk of virus transmission, eliminate environmental health hazards and improve indoor air quality.
PULASKI COUNTY SPIKE
The cases added in the state Tuesday included 1,449 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 1,269 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 219,246.
That comprised 182,627 confirmed cases and 36,619 probable ones.
The number of cases that were considered active rose by 350, to 21,181, as new cases outpaced recoveries.
Pulaski County had 424 new confirmed or probable cases, the first time a county had more than 400 new cases in a day.
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Benton County had the next highest number, 214, followed by Garland County with 149, Washington County with 145, Faulkner County with 110 and White County with 110.
Among prison and jail inmates, the Health Department's count of cases rose by 40.
Murphy said the number of cases among inmates rose by 24 , to 317, at the Barbara Ester Unit in Pine Bluff; by 16, to 780, at the Grimes Unit near Newport; and by two, to 653 at the nearby McPherson Unit.
Of those prisons, the Ester Unit had the largest number of cases that were active, 137, followed by the Grimes Unit, which had 42, and the McPherson Unit, which had eight.
The state death toll rose by 37, to 3,042 among confirmed cases and by 29, to 561, among probable cases.
The number of people who have ever been hospitalized in the state with covid-19 grew by 106, to 11,168.
The number of virus patients who have ever been on a ventilator rose by 11, to 1,199.
WAITING LISTS
Jerrilyn Jones, the Health Department's preparedness medical director, said the intensive care unit "bed situation is somewhat tight."
Since it went live Dec. 16, the department's COVIDComm system has opened 207 cases for 122 patients, resulting in 64 patients being transferred from one hospital to another.
She said a "case" represents a call being made to try to find space for a patient at a hospital.
The system is designed to match covid-19 patients with hospitals with available beds and other resources.
In some cases, the system wasn't able to find a match, sometimes resulting in the patient remaining in an emergency room and being placed on a waiting list for a bed.
In other cases, patients have been transferred to hospitals in other states, she said.
"The problem is this is a global pandemic. It is affecting the Earth," including neighboring states, Jones said.
"What we need to do is to make sure we're doing all of those things to adhere to the public health guidelines and to avoid getting the disease, because that's going to be the best way to avoid being hospitalized from the disease and needing to be transferred to another facility."
AVAILABLE BEDS DROP
The number of hospital beds available for use dropped by 378 beds, going from 2,302 to 1,924 on Tuesday -- its lowest point since the pandemic hit the state.
The total beds -- whether filled or vacant -- dropped by seven from 8,947 to 8,940. The total includes more than 300 in psychiatric or rehabilitation facilities that aren't for covid-19 care.
That means that about 78% of the state's hospital beds are full.
There were 55 ICU beds available Tuesday out of an inventory of 1,155 critical-care beds -- meaning more than 95% are full.
ICU patients totaled 385, 12 more than the previous day.
The UAMS critical care unit is operating at maximum capacity, said Peel, the spokeswoman.
"We run at max a lot, however, even when we're not in a pandemic," Peel said. "Our biggest challenge continues to be staffing. We do have some employees on quarantine and that adds to the stress."
The state inventory of ventilators increased by nine, going from 1,082 to 1,091. About 60.5%, or 661, ventilators remain available for use, one more than the day before.
Total bed capacity -- hospital beds that can be staffed whether they are occupied -- dropped by seven to 8,910.
According to Health Department data, hospitals in the Northwest region of the state dropped six beds and hospitals in the metro region dropped one bed from their total capacity.
Maximum flex bed capacity -- the number of hospital beds regardless of ability to staff them -- remained at 11,484.
The majority of the 1,161 covid-19 patients hospitalized -- 375 -- were in the metro region, followed by 192 in the southwest, 151 in the northeast, 137 in the Arkansas River Valley, 127 in the northwest, 120 in the north-central and 59 in the southeast.
Metro region hospitals also had 149 ICU patients followed by 66 in southwest, 55 in northwest, 34 in northeast, 34 in the Arkansas River Valley, 27 in north-central and 17 in southeast.
The hospitals with the highest number of patients on ventilators were in the metro region hospitals with 90, followed by the southwest with 29, Arkansas River Valley with 22, northwest with 20, northeast with 19, north-central with 16 and southeast with two.
STEPHENS INC.
Meanwhile, Stephens Inc. was among the workplaces listed on a Health Department report Monday as having five or more active cases among its employees.
According to the report, the Little Rock investment bank had 12 cases, including five that were still active.
A spokesman for Stephens Inc. said, "We cannot comment on employee matters due to privacy restrictions; therefore we are not comfortable confirming or denying the information."
Other work sites included a Tyson Foods Chick-N-Quick plant in Rogers, which had nine active cases among workers; Shelby Group International in Glenwood, which had six; and ConAgra in Russellville, which had five.
Information for this article was contributed by Rachel Herzog of the Arkansas Democrat-Gazette.