With coronavirus infections in Arkansas continuing to soar, Gov. Asa Hutchinson said Tuesday that the state will no longer attempt to trace the contacts of people who test positive in instances where more than six days have elapsed since the test specimen was collected.
The Republican governor made the announcement as the state's count of coronavirus cases increased Tuesday by 2,122 -- the third-highest one-day increase since the start of the pandemic.
At record levels since Sunday, the number of patients hospitalized with covid-19 in the state rose Tuesday by 14, to 988.
Those patients included 160 who were on ventilators, down from a record 164 a day earlier.
The state's death toll from the virus, as tracked by the state Department of Health, rose by 18, to 2,405.
In announcing the change in the state's contact tracing protocol, Hutchinson cited a backlog of cases awaiting investigation, delays in test results being reported to the Health Department and recommendations issued by the U.S. Centers for Disease Control and Prevention on Monday for state health departments "experiencing surge or crisis situations around COVID-19."
"We're trying to utilize and maximize our resources to the best way possible," Hutchinson said.
He said the Health Department or its vendors will still contact all people who test positive and give them instructions to isolate.
But the vendors will not attempt to contact people who were near the infected person if the test specimen was collected more than six days earlier.
In those cases, investigations will be conducted by a non-nurse employee. Nurses employed by the department or its vendors will conduct case investigations for those whose test specimen were collected within the past six days.
Health Secretary Jose Romero said the change is expected to affect 14%-16% of the cases reported.
"Yes, it would be nice to find everybody, but this pandemic is growing within the United States and the CDC sees this as a major problem, and they're trying to do something to help the states deal with a growing number of cases," Romero said.
Health Department spokeswoman Danyelle McNeill said the department is still working on the details of the new protocol, and she didn't know yet when it will be implemented.
Romero also said he expects Arkansas to receive an initial allotment of 45,000 to 90,000 doses of a covid-19 vaccine once a medication receives an emergency use authorization from the U.S. Food and Drug Administration.
A FDA committee is scheduled to discuss a request for such an authorization for Pfizer's vaccine on Dec. 10.
The CDC's Advisory Committee on Immunization Practices, led by Romero, will meet shortly after an authorization is issued to recommend how the vaccine distribution should be prioritized, Romero said.
He said health care workers and, likely, residents of long-term-care facilities will be first in line, although even among health care workers "there may have to be additional prioritization given the amount of vaccine."
The next group will likely include "essential personnel," such as teachers and prison workers, he said.
He said Arkansas will continue receiving additional doses over the first few months of next year, although "it won't be until the second quarter or beginning of the third quarter of next year before we have enough for everybody."
Romero said the state also has a total of 1,200 doses of the two antibody treatments that have been issued emergency use authorizations from the FDA, including the Regeneron Pharmaceuticals treatment that President Donald Trump received.
Both treatments are authorized for patients 12 and older with mild to moderate covid-19 symptoms who are at high risk of developing severe illness.
The treatments are not authorized for hospitalized patients.
ACTIVE CASES RISE
Tuesday's increase in cases was the fourth one-day rise that has topped 2,000.Gallery: Governor Press Update
The biggest was a jump of 2,312 cases on Nov. 13. The second-largest increase was the 2,238 cases added Thursday, followed by 2,061 cases on Friday.
After dipping Monday, the average number of cases added to the state's tallies each day over a rolling seven-day period rose to a record 1,773.
The cases added Tuesday included 1,421 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 701 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 148,312.
That comprised 130,826 confirmed cases and 17,486 probable ones.
The number of confirmed or probable cases that were considered active rose by 330, to 17,057, as 1,772 Arkansans were newly classified as having recovered.
The number of people who have ever been hospitalized in the state with covid-19 rose by 97, to 8,620.
The number who have ever been on ventilators with covid-19 rose by six, to 951.
The state has 352 nurses who conduct case investigations, which involve calling and interviewing people who test positive.
Some of those nurses work for the Health Department, and others are employed by General Dynamics Information Technology or the Arkansas Foundation for Medical Care.
In addition, Hutchinson earlier this month authorized 30 members of the Arkansas National Guard to help with the case investigations.
Through contracts with the vendors and the University of Arkansas for Medical Sciences, the state also has 770 contact tracers.
Those workers call people who test positive to gather a list of others they may have been infected, then call those "contacts" to instruct them to quarantine for 14 days from the time of exposure.
According to charts Hutchinson displayed at the news conference, once information about the case is entered into a Health Department database, the average amount of time before a case investigation started grew from 25 hours during a weeklong period in early October to almost three days as of mid-November.
Similarly, the average amount of time from a case being reported to the start of contact tracing grew from about two days in late October to more than three days more recently.
That's on top of the average of 2½ days as of mid-November that elapsed from the time a specimen was collected by a health care provider to the time the test result was reported to the Health Department.
"On [Thursday], due to the sustained increase in daily cases and the inability to recruit additional nurses for case investigations, contact investigations were assigned to contact tracing staff," a note on one of Hutchinson's slides said.
Hutchinson said the state's surge in cases "caused a clog in the system, which caused a delay in the first case investigation call to the positive case."
He said the delay "to a large extent" was in getting the test results from laboratories, rather than from not having enough contact tracers or case investigators.
"If we need to beef those up we will, but it's not meaningful for them to do the work if they're getting those cases assigned to them with such delay," he said.
In the recommendations it issued Monday, the CDC cited modeling showing that quarantines are most effective when they begin within six days of a person being exposed to an infected person.
It said states should prioritize contact tracing when they are experiencing a "high burden" of cases, which it said could be defined as each interviewer having a backlog of cases that is at least twice as many people as they would be able to interview in a day.
In those situations, states should prioritize case investigations for people whose test specimens were collected within the past six days or who began having symptoms during that time frame, the CDC said.
For contact tracing, states should prioritize household members who were exposed to the infected person in the past six days and people living, working or visiting nursing homes and other congregate living facilities, "high density workplaces" or other settings with the potential for a large number of people to be infected.
Romero said the state has also made other changes to speed up its contact tracing. For instance, instead of making three phone attempts, case investigators now just call once and leave a message if the person doesn't answer the phone. The message directs the person to isolate and lets him know a packet of information is being mailed to that person.
He said the state is "doing OK" with its contact tracing and case investigations staff.
"We weren't looking for this change by the CDC, and I think we can see what that does for our times," he said.
Baptist Health Chief Executive Officer Troy Wells said at the news conference that the Little Rock-based health system has 1,100 to 1,200 patients on a typical day, and that 199 of those patients as of Tuesday were hospitalized with covid-19.
Ninety of the covid-19 patients were at Baptist Health-Little Rock, 45 were at Baptist Health-Fort Smith and 42 were at Baptist Health-North Little Rock.
The others were spread out among the system's smaller hospitals around the state, he said.
Statewide, 60 of the system's covid-19 patients were in critical care units, taking up about a third of the system's critical care unit capacity.
Those covid-19 patients included 47 who were on ventilators.
He said hospitals' biggest needs are for critical care unit beds and nurses to staff them.
In January, he said the Little Rock campus will open a new 18-bed critical care unit.
"This is really important to be able to continue to expand that capacity," Wells, who is a member of Hutchinson's winter covid-19 task force, said.
"Again, having the critical nursing care is also important though. You can open more beds, but you've got to have the staff and the physicians. We think we have a plan to do that, so that's another bit of good news."
Hutchinson said the task force has also been discussing ways of providing more care on an outpatient basis to free up hospital space.
According to the Health Department, Washington County had the highest number of new confirmed or probable cases Tuesday, 205, followed by Pulaski County with 201, Benton County with 174, Saline County with 110 and Craighead County with 73.
Among prison and jail inmates, the Health Department's count of cases rose by 58.
State Department of Corrections spokeswoman Cindy Murphy said the number of cases among inmates rose by 50, to 230, at the Grimes Unit near Newport; by 14, to 174, at the Tucker Unit in Jefferson County; by five, to 141, at the Omega Supervision Sanction Center in Malvern; and by one to 475, at the North Central Unit in Calico Rock.
The Grimes Unit had the highest number of cases that were active, 225, followed by the Malvern lockup, which had 35 active cases, the Tucker Unit, which had 24, and the North Central Unit, which had 22.
WHITE HOUSE REPORT
According to a weekly report from the White House coronavirus task force, Arkansas had 11,599 new cases during the week that ended Friday, up from 11,088 the previous week.
But the state's rate of new cases per capita last week was the 26th-highest in the country. The previous week, it was the 22nd-highest.
The state's 174 covid-19 deaths last week translated to a rate of 5.8 deaths per 100,000 residents, the 10th-highest rate in the country.
The previous week, the state had 92 deaths, or 3 per 100,000 residents, the country's 20th-highest rate.
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 listed Arkansas as being in the "orange zone" for the percentage of its PCR tests that were positive.
During the week that ended Nov. 18, that percentage was 10%, the 29th-highest percentage in the country.
The previous week, the percentage was 10.2%, putting the state in the "red zone" for test "positivity" for the first time in several weeks.
States were considered to be in the red zone for that measure 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%.
When both PCR and antigen tests are considered, however, an average of 11.3% of the state's tests were positive during the past week as of Tuesday.
The White House report also listed 38 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 41 counties in the previous week's report, even though this week's report noted that all 75 counties met the red zone criteria for new cases.
The report continued to recommend that the state limit dining in restaurants to 25% of capacity, instead of two-thirds of capacity, and "pausing" extracurricular school activities "even though athletics are not transmission risks, as the surrounding activities are where transmission is occurring."
"In states with aggressive mitigation, we are beginning to see the impact of that mitigation despite the cooling weather," the report said.
"We are also seeing stabilization in many European countries that implemented strong public and private mitigation, but preserved schooling."
Hutchinson, who last week directed the Health Department to require bars and restaurants that sell alcohol to close at 11 p.m., said Tuesday that he hadn't seen evidence that would justify additional restrictions on restaurants or school activities.
"They've had those recommendations in there from day one, and as I've said, we're not going to be putting economic restrictions on people and businesses without having data to say they're a source of the problem," Hutchinson said.
Despite the state's escalating growth in cases, projections released Tuesday by the University of Arkansas for Medical Sciences' Fay W. Boozman College of Public Health continued to show improvement in the state's long-term outlook for infections and hospitalizations.
The latest forecast report, dated Friday, predicts active infections will peak at 32,435 on April 4 under a moderate scenario or 61,123 on March 31 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 Nov. 6, predicted active infections would peak at 35,718 on April 7 under a moderate scenario or 59,421 on March 30 under a worst-case scenario.
Under a moderate scenario, the latest forecast predicts hospitalizations will peak at 778 on April 4, with 272 Arkansans in intensive care and 95 on ventilators.
College Dean Mark Williams clarified Tuesday that the hospitalization numbers refer to the number of people with active infections on the projected peak who will eventually become hospitalized.
For instance, under the moderate scenario, the forecast predicts that 778 of the 32,435 people with active infections on April 4 will end up in the hospital.
"There's really not a good way to get an actual number of people in the hospital at a given time because the models don't accommodate that," he said.
He noted that the forecast predicts a gradual increase and decline in active cases, suggesting that the state will continue having large case increases, hospitalizations and deaths for several months.
"That's why epidemiologists are going sort of crazy about people going home for Thanksgiving is that it's not going to be over any time in the near future, and that's the scary part," he said.