As the number of hospitalized covid-19 patients as well as those in intensive care units and on ventilators -- and the number of active cases -- hit new daily highs Friday, Gov. Asa Hutchinson said the state is expediting licensing and waiving fees for the more than 1,100 nursing students graduating next month.
The state also hit a record in the number of polymerase chain reaction (PCR) tests conducted in 24 hours, with 15,095 tests reported Friday.
A new quarantining directive for health care workers was also released Friday, allowing for those providers exposed to the virus to return to patient care within days instead of weeks.
Hutchinson said the state needs those new nurses on board quickly to relieve "some of the challenges that we face."
"The fact that we will expedite that will make it easier for those nurses to enter the profession and go to work at a time that their talents, their heart is critically needed," Hutchinson said.
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Another 2,061 covid-19 cases were added Friday, raising the cumulative total to 141,916.
Deaths from the virus rose by 24 to 2,321.
Covid-19 hospitalizations in the state rose by 36 to 935 while another six patients were placed on ventilators, raising the total to 152.
The number of active state cases reached an all-time high of 17,360, up 362 from the previous day.
State Health Secretary Jose Romero said it's imperative that Arkansans take special precautions during the Thanksgiving holiday. The new guidelines from the Centers for Disease Control and Prevention, he said, discourage holiday travel outside the state.
"Even within the state, you probably should not engage in that," he said, suggesting a "Nuclear Thanksgiving," with fewer than 10 people -- preferably those who have already been living in the home.
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Romero suggested homeowners open windows during the Thanksgiving celebration and get tested for the virus before any travel. He also repeated his admonition that nursing-home residents should not be taken to the family home for the holiday.
BY THE NUMBERS
The county with the most new confirmed and probable cases on Friday was Pulaski County with 209, followed by Washington County with 162; Benton County with 133; Craighead County with 107; and White County with 90.
The counties with the highest number of active cases include Pulaski with 1,823; Washington with 1,398; Benton with 1,078; Sebastian with 819; and Craighead with 770.
Other counties with increasing active cases include Saline with 646; White with 621; Faulkner with 498; and Greene with 488.
Along with the record 15,095 PCR tests on Friday, another 3,383 antigen tests were reported. The PCR tests take longer to get results, but are more accurate than the faster antigen tests.
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"It is significant to look at the testing," Hutchinson said.
The seven-day rolling average for new PCR tests is 10,874, while the average for antigen tests processed is 2,208, according to Health Department data.
Of the 2,061 new cases in Arkansas, 18 were attributed to correctional facilities, and the remaining were the result of community spread.
Out of 1,037 ventilators in the state, 629 are available.
According to a Health Department report, 2,462 hospital beds out of the state's 9,144 remain available. That number includes hundreds of psychiatric and rehabilitation beds that are not used for covid-19 care.
There are 367 covid-19 patients in intensive care. Hospitals created an additional 12 ICU beds since Thursday, but only 76 remain available out of the state's 1,136 intensive-care beds.
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Since Nov. 1, there have been 55 new intensive-care bed spaces created and staffed.
Hutchinson pointed to charts that showed that about 90% of hospital beds are being used for non-covid patients. Of the ICU beds in the state, about 68% are used for non-covid patients.
"It shows a trend line, but it also shows that we have a lot of other health needs in Arkansas besides covid that we have to manage," Hutchinson said. "But covid is what is occupying a significant percent of the metrics."
UAMS Chancellor Cam Patterson -- who is also a member of the Governor's Covid-19 Winter Task Force -- said one option, which has not yet been implemented for the pandemic, is to use the trauma communications system, which is housed at the Health Department.
Created by the Legislature in 2009, the trauma system coordinates treatment of serious injuries and brings the medical entities together to work on behalf of the patients who need them.
The trauma system assesses resources available at different hospitals and medical facilities across the state and allows for the transfer of those resources -- or the patient -- from one hospital to another.
"Imagine applying those same principle to patients with covid-19," Patterson said. "If a patient is in a facility that doesn't have the ability to provide intensive care unit management of that patient, the system would know where those resources would exist and would coordinate with emergency medical systems to enact a transfer of that patient."
Romero, the health secretary, said the state has beds available at this time, but warned about the surge in cases that occurred after previous holidays.
"We are at a high level at this point of occupancy," Romero said. "We still have room, but that number can increase further if we don't abide by the three W's, which are wear your mask, wash your hands and watch your distance."
Larry Shackelford, chief executive officer of Washington Regional Medical Center in Fayetteville, said at the news conference that the state is seeing a rapid increase in those needing inpatient care -- especially in Northwest Arkansas, which has seen a 42% increase in patients in the past few weeks.
The Thanksgiving holiday gives him "pause and concern," Shackelford said, because inpatient needs for covid-19 patients increased in the two weeks after previous holidays like the Fourth of July and Labor Day.
"I want you to understand that, where we are today, we do have capacity, to not only take care of covid patients, but to take care of other patients. But it's important that we act now," Shackelford said. "If we see two weeks from today the kinds of increases that we've seen two weeks following other holidays, then we are going to be at the point that it will be challenging to meet those needs."
HEALTH CARE WORKERS
Hutchinson announced that 1,104 Arkansas nursing students will graduate next month and that the state Nursing Board has been directed to license the new nurses within a 24-hour period.
The application fee, which typically ranges from $100 to $125, will be waived. The nurses still will be required to pay the $30 background-check fee, the governor said.
In addition to getting new nurses to begin working quicker, Patterson said new quarantine guidance from the Health Department for health care workers who have been exposed to covid-19 will speed up getting them back in the hospitals and medical centers.
"To give you a sense of the magnitude of this problem, just at UAMS alone, we have almost 400 employees who are currently under quarantine," Patterson said. "So those 400 employees cannot be at the bedside to manage patients and that brings all kinds of challenges for us as we are constrained by increases of the percent of patients in our hospital."
Typical protocol is for people to remain quarantined for 14 days if they were exposed to the virus.
The new guidelines posted late Friday prohibit health care workers who test positive for covid-19 to work for at least 10 days from the date of symptom onset. If they are asymptomatic, they cannot return to work for 10 days from the date of testing.
Health care workers who have been exposed to the virus can be excluded from the quarantine if:
• The employee has tested negative by PCR from a sample collected at least five days after exposure.
• The employee is a nondirect care worker whose work location is secluded from other people or is always masked when around others regardless of distance.
• Exposed direct-care workers wear masks and a face shield.
• The employee is monitored for symptoms, including temperature check and symptom screening, before the start of a shift and during the day. The employee must immediately leave work if symptoms develop.
• Break rooms must be available so that breaks and meals are scheduled and taken when no other personnel are present.
In extreme conditions where a medical provider is in "desperate need for bedside caregivers," health care workers who test positive but are asymptomatic can return to work in "very limited situations," Patterson said.
"Those conditions do not exist and we hope they never exist," he added.
Under the new guidelines, the covid-19 positive employee must be free of all covid-19 symptoms and will only work on units dedicated solely for covid-19 positive patients.
The virus-positive health care worker must not have any documented occurrences of noncompliance with infection- control policies and must continue to isolate from community activities when not at work until the completion of the designated isolation period, according to the guidance.
COURT ORDERS
The Arkansas Supreme Court on Friday reimposed a suspension of jury trials until at least Jan. 15, as covid-19 infections continue to soar.
The announcement, made in a per curiam opinion from the seven-member court, will allow jury trials already underway to continue for the time being. Judges were also told to continue conducting other court proceedings either in person or through video or teleconferencing.
"The Arkansas Supreme Court does not take lightly the decision to halt jury trials," the per curiam read. "It weighs on this court that we are exposing the hundreds of citizen jurors around the state who are being summoned to do their civic jury duty as well as increasing our court personnel's risk of daily exposure to the virus. The dramatic uptick in cases in Arkansas requires us, as leaders of the state judiciary, to do our part to help protect Arkansans."
The high court suspended jury trials for several months earlier this year after the pandemic first broke out in March. That suspension was lifted on June 30, with instructions to limit the number of participants and spectators in the courtroom.
Pandemic-related delays in criminal cases were excluded from speedy-trial requirements under previous order by the Supreme Court.
Friday's opinion addressed "that there are defendants awaiting trial beyond twelve months," and ordered lower courts to review their dockets for any defendants who have been awaiting trial for more than a year, and who have not posted bond, to determine if there is reason to reconsider bond amounts.
A similar announcement was made Friday morning by Little Rock's traffic court, in response to rising pandemic cases.
A news release stated that Little Rock District Court, 2nd Division, is canceling in-person trials and hearings that had been set for January and February.
Clerks will contact defendants and their lawyers to schedule later dates for either virtual or in-person hearings.
"Based on numbers we were seeing in July and August, we had thought the new year would be a safe time to return to in-person hearings," Judge Vic Fleming said. "But the state at large is now reporting hundreds of new cases per day, and the numbers keep growing."
Those with in-person hearings scheduled are asked to email the court at TrafficCourtContact@littrock.gov or call (501) 371-4733 to reschedule, with email preferred over calling.
Information for this article was contributed by John Moritz of the Arkansas Democrat-Gazette.