Arkansas' count of coronavirus cases on Tuesday rose by more than 1,400 -- the sixth single-day increase in the past week that topped 1,000.
The state's death toll from the virus, as tracked by the Department of Health, rose by four, to 2,112.
At a record level since Friday, the number of patients hospitalized with covid-19 in the state rose above 800 for the first time as it increased by 24, to 810.
The number of those patients on ventilators also set a record as it rose by 11, to 127.
"The numbers aren't good," Gov. Asa Hutchinson said. "The trend is not good, and we have a lot of work to do here in Arkansas and across the nation.
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"We're in for a very challenging time, and we just have to remind ourselves every day as to the risk that is out there and the responsibility that we have."
At his weekly news conference on the coronavirus, Hutchinson also announced updated guidance for places of worship, clarifying that congregants should wear masks at all times, even while singing.
He presented a map indicating that hundreds of cases across the state have been linked to places of worship.
"Unmasked congregational singing is the primary driver of transmission in churches -- even if people are 6 feet apart because singing produces aerosols that can increase the risk of transmission for covid-19," Hutchinson said, reading from a summary of the updated guidance.
The Health Department also issued guidance for winter holidays, recommending against traveling for family celebrations, shopping during peak Black Friday hours or attending holiday parties "where many people are likely to attend."
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Health Secretary Jose Romero said the number of hospitalized patients is likely to continue to increase.
"What we're seeing is an increased number of cases as a result of the Halloween holiday -- the activities that have gone from that," Romero said.
"This is a harbinger. This is something that we may see even more significantly as we enter into Thanksgiving and the Christmas and New Year holidays, so we are concerned about this."
Romero also said the Health Department expects to soon receive 900 doses of an antibody treatment made by drug company Eli Lilly that was granted emergency-use authorization Monday by the U.S. Food and Drug Administration.
The treatment, called bamlanivimab, can be administered on an outpatient basis to covid-19 patients with "mild to moderate disease" who do not require hospitalization.
The doses will be distributed to health care providers around the state, he said.
LAWMAKER INFECTED
Also on Tuesday, state Rep. Joe Jett, R-Success, informed House Speaker Matthew Shepherd that he had tested positive for covid-19, according to a spokeswoman for the House.
Jett follows at least a dozen other lawmakers who have announced positive tests since the start of the pandemic.
The House met on Friday for an organizational caucus with the members separated by plastic partitions.
Jett said Tuesday evening that he and his wife had tested positive earlier in the day, a few days after returning from the caucus. He said he had a headache but otherwise was not showing many symptoms, adding he would continue to isolate for the next two weeks.
Jett said he had mostly stayed home over the weekend, narrowing his possible opportunities for exposure.
"My sense was it was either at the Capitol or when we stopped to get lunch in Bald Knob."
Almost all of the lawmakers were seen wearing masks during the caucus.
House spokeswoman Cecillea Pond-Mayo said contact tracing was still taking place.
ACTIVE CASES RISE
The 1,424 cases added to the state's tallies included 975 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 449 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 124,235.
That comprised 112,736 confirmed cases and 11,499 probable ones.
At record levels since Thursday, the number of confirmed or probable cases that were considered active rose by 386, to 12,874, as 1,034 Arkansans were newly classified as having recovered.
The state's death toll rose by four, to 1,934, among confirmed cases. The number of deaths among probable cases remained unchanged at 178.
The number of Arkansans who have ever been hospitalized with the virus rose by 83, to 7,579.
The number of virus patients who have ever been on a ventilator rose by seven, to 876.
So far this week, the daily increase in the state's cases has been bigger each day than on the same day a week earlier.
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Over a rolling seven-day period, the average number of cases added to the state's tallies each day set a record for the sixth straight day as it rose by 78, to 1,388.
CHURCH CASES
According to a slide Hutchinson presented at the news conference, 3,381 people who tested positive for the virus from May 3 to Oct. 4 said they had been to a place of worship during the 14 days before their diagnosis.
A map on the slide indicated Pulaski County had 251-300 such cases, the largest number in the state.
Washington, Benton, Pope and Craighead counties each had 151 to 200 such cases. Crawford and Sevier counties had 101-150 of the cases.
Scott, Garland, Jefferson, Lonoke, Faulkner, White, Independence, Stone, Lawrence, Greene, Poinsett, Mississippi and Boone counties were each shown as having 51-100 of the cases.
Each of the state's other counties was listed as having one to 50 such cases.
Hutchinson said the number of cases "doesn't mean people are not being careful."
"It just simply means that when you have congregants together, there is a risk associated with it, and the vast majority of our places of worship are taking extra precautions and doing a very good job," he said.
Sonny Tucker, executive director of the Arkansas State Baptist Convention, said churches and other religious organizations, "like all organizations in society, are tired and fatigued" from dealing with the coronavirus.
But he urged churches to follow the Health Department's guidelines.
"When we engage in worship activities and religious activities safely, we show our great respect and love for God by showing respect for the folks that he's given us to serve," Tucker, a member of Hutchinson's economic recovery task force, said at the news conference.
The Rev. Erik Pohlmeier, pastor of Christ the King Catholic Church in Little Rock, had a similar message.
"It's not just a question of do I want to wear a mask or not, but in the practice of charity, in the practice of justice, we need to be conscious of other people, other people who might be more vulnerable than we are," he said.
GUIDANCE UPDATED
The mask requirement recommended in the Health Department's updated guidance for places of worship continues to make exceptions for the worship leader while addressing the congregation, performing singers while they are singing and congregants participating in communion "while actually consuming the Elements."
The recommended requirement also exempts children under age 10, saying it is optional for children age 2-9 and that masks for those younger than 2 are prohibited by U.S. Centers for Disease Control and Prevention guidelines.
The worship leader and performing singers should keep a distance of at least 12 feet from others while speaking or singing without wearing masks, the Health Department guidance says.
Health Department spokesman Gavin Lesnick said the department is considering revising the mask exemption for performing singers.
The department's guidance document for holiday gatherings includes additional recommendations for places of worship.
It advises against having a choir perform and against the use of wind instruments during the service.
"Consider having a solo instead with the singer standing at least 12 feet from anyone else," the document says.
The document also advises against neighborhood caroling and Christmas plays or pageants.
It suggests having several small events rather than one large one and having attendees sign up in advance to limit the group size.
"If desiring to provide meals to the community, consider delivering the meals instead of hosting a large gathering," the document says.
For meals provided on-site, the document suggests having them outdoors if the weather permits, or otherwise using the largest facility available.
It recommends cafeteria-style meal service or individually packaged meals rather than self-service buffets.
HOLIDAY GUIDANCE
The guidance document lists as "lower risk activities" having a small dinner with only household members, hosting a "virtual dinner," watching holiday programs at home or in a vehicle, and shopping online on Black Friday and Cyber Monday.
An outdoor dinner with a group of less than 10 family members and friends while maintaining a distance of 6 feet and wearing masks is listed as a "medium risk" activity.
Those also include visiting a pumpkin patch or Christmas tree farm where mask use is enforced and social distancing can be maintained, and shopping in-person during non-peak hours.
"'Pictures with Santa' events should be modified to maintain 6-feet physical distancing between attendees waiting in line as well as between the attendees and Santa," the document says.
The document also recommends asking "elderly or at-risk" family members whether they feel comfortable participating in holiday activities.
"Many older individuals are trying to protect themselves but do not want to upset their family," the document says. "Please honor their request."
NURSING HOME VISITS
Romero also recommended against relatives taking residents out of nursing homes and assisted living facilities for holiday gatherings, citing the risk to the other residents living in the institutions.
Since restrictions on visits to nursing homes were relaxed last month, he said, deaths among nursing home residents have increased, "and we're concerned that this is going to continue."
Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes, said the restrictions on visitation at the homes have led to an increasing number of requests from family members to take relatives out of the homes for visits.
Once a resident is returned to a home, that resident has to be quarantined in a private room for 14 days.
"It's concerning when we think about what that might look like if a lot of people leave and need to come back at the same time," especially for homes that don't have a large number of private rooms, she said.
She said "probably less than half" of the state's nursing homes are allowed to have routine visits from residents' family members, while such visits are restricted at the others because of residents or staff members testing positive in the past 14 days.
Even at homes where visits are restricted, however, the facilities must allow visits by family members or others that are deemed medically necessary by the residents' health care provider.
Bunch said she would recommend that family members ask about options for visiting a resident at the home rather than taking the person out of the home for a visit.
"Some facilities are able to do outdoor visits right now," she said. "Others could help facilitate FaceTime or window visits."
STATE OUTBREAKS
The state's count of confirmed and probable cases rose Tuesday by 133 in Pulaski County, 125 in Washington County, 116 in Benton County, 90 in Craighead County, 67 in Independence County, 65 in Saline County, 60 each in Greene and White counties, and 58 in Sebastian County.
Among prison and jail inmates, the Health Department's count of virus cases rose by three.
Department of Corrections spokeswoman Cindy Murphy said the number of cases rose by eight, to 1,418, at the Ouachita River Unit in Malvern and by two, to 329, at the McPherson Unit in Newport.
The cases included 159 at the McPherson Unit and 106 at the Ouachita River Unit that were active as of Tuesday, she said.
Meanwhile, projections released Tuesday by the University of Arkansas for Medical Sciences' Fay W. Boozman College of Public Health once again marked an improvement in the state's long-term outlook for infections and hospitalizations.
The latest forecast report, dated Friday, predicts active infections will peak at 35,718 on April 7 under a moderate scenario or 59,421 on March 30 under a worst-case scenario.
Those numbers include infections predicted to be confirmed through tests, as well as undetected infections of people who don't show symptoms and others who are infected but don't get tested.
The previous forecast, dated Oct. 23, predicted active infections would peak at 40,085 on April 3 under a moderate scenario or 62,930 on March 21 under a worst-case scenario.
Under a moderate scenario, the latest forecast predicts hospitalizations will peak at 857 on April 7, with 299 Arkansans in intensive care and 104 on ventilators.
The report also predicts the state's death toll from the virus will rise to 2,887 by Dec. 31, which it said would be an increase of 1,042 from the number of virus deaths as of Nov. 1.
The report said 147 children had been hospitalized with the virus as of Nov. 1, up from 134 as of Oct. 17.
INSTRUCTIONAL SHIFTS
More school districts announced plans Tuesday to shift at least some classes to all-virtual instruction until after Thanksgiving.
In Hope, Beryl Henry Elementary School shifted to online learning Tuesday until the Monday after Thanksgiving after two faculty members tested positive, resulting in the quarantine of almost all of the school's 14 teachers, Hope School District Superintendent Bobby Hart said.
"A rash of kids have been coming to school symptomatic, but we don't know if they are positive," Hart said. "Out of an abundance of caution, we visited with our leadership team and really could not find any alternatives, so we came to the realization that we probably needed to pivot to virtual learning."
Kingston High School in the Jasper School District shifted to remote classes for the remainder of this week until Nov. 30 because of "a large increase in the number of positive covid cases," according to an announcement on the district's Facebook page.
The Berryville School District announced that Berryville middle and high schools are also shifting to remote learning from Thursday until Nov. 30, when students will return to in-person classes. The district's website cited infected and quarantined staff members for the shift.
All grades in the Trumann School District will be remote today through Nov. 20, according to a Facebook post.
As of Tuesday afternoon, the Trumann School District had recorded at least 165 faculty members and students quarantined and at least 14 positive cases.
Tuckerman High School in the Jackson County School District is shifting to remote classes from today through the end of the week, with students scheduled to return Monday, Superintendent Chester Shannon said.
The decision to shift stemmed from a lack of substitute teachers to cover staff members who are quarantined due to close contact with a faculty member who tested positive, Shannon said.
In its daily covid-19 report, the Little Rock School District said seven students and one staff member had tested positive during the 24-hour period ending at 3 p.m. Tuesday.
An additional 31 students and seven employees were required to quarantine.
At Hutchinson's news conference, Education Secretary Johnny Key said 21 schools last week reported shifts to virtual-only instruction because of the virus, up from six the week before.
So far this week, 14 districts have announced such modifications.
He said the Department of Education had received numerous questions as to whether schools would close for face-to-face instruction from after Thanksgiving until January.
"That is a rumor," he said. "That is not something we have recommended to the governor. I wanted to make sure that is clearly stated today. We don't have plans to close down public schools for those weeks after Thanksgiving."
Arkansas State University in Jonesboro reported 100 active cases Tuesday, a figure that is part of a trend of growing caseloads on campus. The day before, ASU reported 91 active cases. On Friday, the university reported 78.
Harding University, a private university in Searcy, reported 48 active student and faculty cases as of noon Tuesday.
Arkansas Tech University reported 23 active cases on its Russellville campus and three active cases on its Ozark campus Tuesday.