Arkansas posted on Wednesday its second-highest number of new coronavirus cases in a single day since January as its number of active cases topped 20,000 for the first time since Jan. 22.
The number of patients hospitalized with the virus, however, fell even as the number in intensive care rose to an all-time high.
The state death toll from the virus, as tracked by the Department of Health, rose by 15, to 6,230.
Saying it expected the situation to worsen, the department on Wednesday proposed spending up to $37.68 million in coronavirus relief funds to create and staff 157 "alternative care facility" beds at Baptist Health properties in Little Rock, Fort Smith and Van Buren for up to 60 days.
An advisory panel recommended that Gov. Asa Hutchinson approve the request.
On Wednesday, only 25 intensive-care beds -- about 2% of the 1,172 such beds in the state -- were unoccupied.
Covid-19 patients made up about 41% of the occupied beds after the number grew Wednesday by 18, to 469.
According to the daily numbers reported by the state Health Department, that surpassed the previous record of 458 covid-19 patients in intensive care units on Jan. 11.
After reaching its highest level since mid-January a day earlier, however, the number of patients hospitalized with covid-19 fell by 18, to 1,232.
The number of covid-19 patients on ventilators remained at 260, just short of the all-time high of 268 it reached on Jan. 11.
"A decline in hospitalizations & no increase in ventilator usage bring some relief to hospitals, but it's likely temporary since our cases continue to go up," Hutchinson said in a tweet.
"I'm grateful for the continued increase in vaccinations. Let's stay focused on the vaccination & the success it will bring."
State cases rose Wednesday by 2,838.
Except for a spike of 2,843 cases on July 29, that was the largest one-day new-case total since Jan. 21.
The average daily increase in cases over a rolling seven-day period rose to 2,105, topping 2,000 for the first time since the week ending that same day in January.
With new cases outpacing recoveries, the number of state cases considered active rose by 1,060, to 20,559.
Hutchinson and state health officials have blamed the surge in coronavirus cases on Arkansas' low vaccination rate and the fast-spreading delta variant that has become the most common coronavirus strain nationwide.
In its request for American Rescue Act Funds, the Health Department noted that the number of covid patients in state hospitals had tripled in the span of about four weeks.
"These trends are expected to worsen quickly as COVID-19 infections due to the Delta variant continue to increase in Arkansas," the department said in its proposal.
"As a result of this exponential increase in hospitalizations, both hospital intensive care units (ICU) and medical bed availability is extremely limited throughout Arkansas."
It said the lack of available intensive-care beds was causing patients to be staffed in hospital emergency rooms, causing "severe backups."
Arkansas made a similar arrangement with Baptist Health for 124 hospital beds in Little Rock and Van Buren during the winter surge.
The agreement for the use of those beds expired after March.
To cope with the current surge, CHI St. Vincent Hot Springs announced Wednesday that elective surgeries and other procedures will be paused.
"The postponement of elective procedures is a necessary step to conserve hospital resources, space and the capacity of our healthcare personnel to deliver exceptional, compassionate care," the hospital's president, Douglas Ross, said in a news release. "CHI St. Vincent Hot Springs will continue to provide emergency care and procedures deemed necessary in coordination with a patient's physician."
The hospital also suspended its Saturday clinic at convenient care clinic sites in Hot Springs Village to allow health workers to focus on other areas of critical need. Regular weekday hours of operation for those clinics remain unaffected.
The hospital is advising patients not to avoid necessary critical care, but to avoid emergency rooms unless symptoms are severe.
Patients should contact their primary care provider by phone first and then take appropriate steps to receive care or visit urgent and convenient care clinics.
Safety precautions like limiting visitation and universal masking for staff members and patients will remain in place at CHI St. Vincent facilities, the news release said.
Spokesman Joshua Cook said in an interview that no other CHI St. Vincent facilities are taking this measure as of yet.
Central Arkansas Veterans Healthcare System also has paused non-emergent surgical procedures, spokesman Arlo Taylor said in an email Wednesday.
"We have transitioned to providing urgent/emergent surgical procedures in our surgical and medicine services so we can ensure hospital beds are available for urgent needs during this time," Taylor said. "We encourage our Veterans to get their COVID-19 vaccination and remain vigilant in their masking, hand washing and physical distancing as we weather this pandemic."
In Mountain Home, Baxter Regional Medical Center has paused any procedure that requires an overnight stay, spokesman Tobias Pugsley said Wednesday.
"We're looking at everything on a case-by-case basis and depending on the physician's discretion," Pugsley said.
The hospital continues to see a high covid-19 census with 40 virus patients admitted as of Wednesday with nine in ICU and nine on a ventilator. There also are 32 Baxter Regional employees in home isolation with the virus.
About 90% of the hospital's covid-19 patients are not vaccinated, according to a news release. In addition, 89.1% of the 258 covid-19 patients hospitalized since March 1 were not vaccinated and 81.6% of the 38 covid deaths since that time were not vaccinated.
The community has been supporting the hospital's staff with a steady stream of snacks, dinners and care packages, Pugsley said.
Next week, groups will begin meeting outside the hospital to pray over the facility and will continue to do so through the end of the year.
The hospital posts a blog on its website with regular updates for the community.
"We're a trusted resource because our physicians and our doctors are the ones that take care of everybody. We're trying to be as transparent as possible, but also respect HIPAA laws and patient confidentiality," Pugsley said.
"We want our community to understand the situation that we're in. We're filled to capacity. That's the startling thing, most of the hospitals in the state seem like they're in the same position we are."
Elective procedures have yet to be paused at UAMS Medical Center in Little Rock, Arkansas Children's hospitals in Little Rock and Springdale and Baptist Health's 11 hospitals around the state.
UAMS Medical Center had 66 covid-19 patients on Wednesday, down from 71 a day earlier and a peak of 75 on July 27, spokeswoman Leslie Taylor said.
The patients on Wednesday included 28 in intensive care, 17 on ventilators and four on heart-lung bypass machines.
"It's just kind of a day-by-day thing," Taylor said. "The leadership meets every day, several times a day and they go over bed capacity and where we are."
Arkansas Children's Hospital in Little Rock had 17 covid patients on Wednesday, and Arkansas Children's Northwest in Springdale had two, spokeswoman Hilary DeMillo said.
Of the 19 patients, seven were in intensive care, and five were on ventilators.
DeMillo said none of the patients had been fully vaccinated. More than half were under age 12, making them ineligible for the shots.
"Arkansas Children's monitors our census constantly and has clinical teams developing solutions to help us flex our facilities and staffing to take care of any child who needs us," DeMillo said in an email.
"Any changes we make will be based on safety and children's best interests."
Baptist Health hospitals had 239 covid-19 patients on Wednesday, down from 243 a day earlier, spokeswoman Cara Wade said.
The patients on Wednesday included 92 in intensive care, down from 97 on Tuesday.
Wade said 88% of the patients as of Wednesday had not been vaccinated, and most were under age 60.
"So far, we've not had to make any adjustments to elective surgery schedules," Wade said in an email.
"This is certainly an option and something we continually monitor. Our goal is to continue to provide this needed service to our patients and do so in a safe environment."
Hutchinson said last week that, at his request, the federal government was sending a "surge response team" to Arkansas to evaluate ways to maximize hospital capacity.
Health Department spokeswoman Danyelle McNeill said most of the team arrived Wednesday.
Pulaski County had the most new cases on Wednesday, 357, followed by Washington County, which had 291, and Benton County, which had 193.
The state's cumulative count of cases rose to 394,461.
The number of people who have ever been hospitalized in the state with confirmed infections rose by 111, to 19,009.
The number who have ever been on a ventilator rose by 10, to 1,924.
Also on Wednesday, retired Air National Guard Col. Robert Ator, who is coordinating Arkansas' vaccination effort, said only about 5,700 Pfizer doses ended up having to be discarded after they weren't used by their expiration date on Saturday.
McNeill said 91,000 doses doses with expiration dates at the end of July had not been used as of Friday, but Ator, the Arkansas Economic Development Commission's director of military affairs, said Wednesday that was apparently a reference to the number of unused doses as of July 26.
That afternoon he sent a message to providers telling them to make sure the inventory they reported was up to date, he said.
The result was a reduction of 15,000 doses in providers' reported inventory, he said.
Strong demand throughout the week helped use up most of the doses that remained, he said.
"Honestly, we got lucky and it's really because of the delta variant and people responding to the covid conversations," Ator said, referring to meetings around the state Hutchinson has held to encourage vaccinations.
"We dodged a bullet."
The uptick in the pace of vaccinations continued Wednesday as the number of doses providers reported administering, including second doses of the Pfizer and Moderna vaccines, rose by 11,156.
That was larger by more than 310 than the increase a week earlier.
Already at its highest level since the week that ended May 5, the average number of doses administered each day over a rolling seven-day period rose to 12,241.
Ator said that about 80% of the doses reported Wednesday were for people starting the vaccination process.
He said Pfizer doses, which are the only ones currently authorized for children, have made up the bulk of the doses that have been administered recently as the start of the 2021-22 school year for most public schools approaches this month.
The Pfizer vaccine is authorized for people age 12 and up.
The Moderna and Johnson & Johnson vaccines have been cleared to be given only to people 18 and older.
In one reflection of the increase in demand, the state last week ordered 29,550 vaccine doses from the federal government, its largest order in months.
On Tuesday, it ordered 37,420 more.
"I want to make sure that the public understands that we have plenty vaccine, and it's in every nook and cranny," Ator said.
"We've got just under 1,800 providers around the state, so when you're ready, we're ready to take care of you and get you protected."
According to CDC data updated Wednesday, the number of Arkansans who had received at least one vaccine dose rose Wednesday by 17,692 -- the largest one-day increase in the number since April 3.
The increase on Wednesday brought the number to 1,448,530, or about 48% of the state's population.
Similarly, the number of fully vaccinated jumped by 14,070, the largest one-day increase since April 23.
That brought the number of fully vaccinated to 1,118,090, or about 37% of the population.
After almost two months of ranking 49th among the states and District of Columbia in the percentage of its fully vaccinated residents, Arkansas on Wednesday moved up to No. 48, overtaking Wyoming and remaining ahead of Mississippi and Alabama.
In its percentage of residents who had received at least one vaccine dose, Arkansas moved up from No. 41 to No. 40.
Nationally, 58% of Americans had received at least one vaccine dose, and 49.8% were fully vaccinated.
Information for this article was contributed by Michael R. Wickline of the Arkansas Democrat-Gazette.