Covid-19 hospitalizations remained the same on Monday, but the number of patients admitted to intensive care units and those placed on ventilators climbed higher while the number of available ventilators fell to its lowest point of the pandemic, according to data from the state Department of Health.
After falling the previous day, the number of covid-19 patients in intensive care units rose by 20, to 533, and the number of patients on ventilators rose by 17, to 361.
"Active cases and hospitalizations have declined from last week, but our ventilator usage has reached a new high today," Gov. Asa Hutchinson said on Twitter. "We have the capacity for the current number of COVID patients, and our hospitals continue to work to bring more ICU beds online."
There were 21 fewer ventilators available Monday, with the number of those available dipping to 461 from 482 on Sunday.
"People are often in the hospital for several days before they are admitted to the ICU, and they may be in the ICU a few days before they then require ventilation, so it is a lagging indicator," Chief Medical Officer Jennifer Dillaha said.
Covid-19 hospitalizations were unchanged at 1,257. The number of available ICU beds remained at 21.
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The state's death toll from the virus, as tracked by the Department of Health, rose by 33, to 6,912.
The number of cases in the state that were considered active fell by 1,688, to 22,427.
The state on Monday reported 882 new cases, bringing the cumulative total to 450,265.
Case numbers are typically lower on Mondays because fewer people get tested over the weekend, Dillaha has said. On Aug. 23, the state reported 986 new cases but then continued with four-digit days, with the highest being 2,866 cases on Friday.
Health Department spokeswoman Katie White said that in light of the coming Labor Day holiday weekend, vaccinations as well as mask wearing and social distancing are encouraged.
"Past holidays during the pandemic have often resulted in an increase in cases, so we will be watching to see if there is an increase after Labor Day weekend," White said.
VENTILATOR USE
CHI St. Vincent Infirmary Chief Medical Officer Dr. Gerry Jones said covid-19 patients are put on ventilators only after all noninvasive attempts to help the patients breathe have failed.
"The mainstay of our therapy at this point is steroids and antiviral medications as well as supportive care," Jones said. "The other therapy that has proven to be very effective is proning, having patients lie on their stomachs rather than backs to help improve ventilation."
In addition to the ventilator, the sedating medications and breathing tubes have to be maintained in inventory, Jones said.
"We have been carefully monitoring supplies since the early days of the pandemic and are not currently facing any significant shortages, but we remain watchful as the number of patients requiring ventilators rises," he said.
St. Vincent declined to provide hospital-capacity or ventilator-use data.
University of Arkansas for Medical Sciences spokeswoman Leslie Taylor said the academic medical center had 56 covid-19 patients on Monday with 25 in the ICU, including 15 on ventilators and four on heart-lung bypass machines known as ECMO.
UAMS has been able to maintain adequate emergency respiratory supplies during the pandemic through the direct collaboration of the UAMS supply chain, respiratory department, and external supply partners, Taylor said.
"We currently have 88 ventilators on campus that have proved to be enough to treat respiratory-compromised patients during the pandemic," she said.
As of late Monday, Baptist Health hospitals had 272 covid-19 patients with 145 in the ICU, including 101 on ventilators, according to spokeswoman Cara Wade.
"Though our total number of hospitalized COVID patients is down from our record of 300 a week ago, the numbers of critical patients have unfortunately increased," Wade said in an email. "The COVID patients in intensive care and on a ventilator are the highest we've seen during the pandemic."
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Baptist Health monitors its ventilator inventory daily as well as supplies needed throughout the system. The ventilators can be moved around to the different hospitals in the system, or a patient can be transferred to another facility if there is a need, Wade said.
Having enough ventilator machines in stock is not the only facet, Wade said. Ventilators can only be used in an ICU for covid patients.
"And ICU beds are limited across the state," she said, adding that placing a patient on a ventilator requires caregivers to operate it.
"It requires three people -- a physician, RN, and respiratory therapist to place a patient on a ventilator," Wade said. "Supplies can include the ventilator circuits, oxygen, suction equipment, and an endotracheal tube."
St. Bernards Healthcare in Jonesboro had 87 covid patients on Monday with 27 in the ICU, including 15 on ventilators. The hospital is stretched to its limits, spokesman Mitchell Nail said in an email.
"In fact, this past week has proven especially difficult, as 14 of our patients have died due to virus complications," Nail said. "To accommodate these persistently high numbers, we've added 10 COVID ICU beds as of this morning, bringing our overall ICU capacity from 65 to 75."
St. Bernards inventories its supplies and equipment daily and reports counts in a daily "Safety Huddle."
"We have sufficient supplies for our current census and have the ability to rent ventilators if needed," Nail said. "While the current supply chain shortages are concerning, we feel comfortable with our current supplies."
Bo Ryall, chief executive of the Arkansas Hospital Association, said occasional shortages of supplies, equipment and medications have presented difficulties but are not the greatest obstacles that hospitals are facing at this point in the pandemic.
"Staffing has been and remains the biggest challenge," he said.
VACCINE DOSES
The number of vaccine doses that providers reported having administered, including second doses of the Pfizer and Moderna vaccines, rose by 3,725, to 2,683,076.
"Vaccinations are improving, which is encouraging. Becoming fully immunized is the best way to protect yourself and prevent severe illness and hospitalization," White said. "ADH continues to offer vaccine clinics across the state."
The number of individuals age 12 and over partially immunized fell by 1,029 on Monday, for a total of 340,483, or 13.3% of that group.
Children under 12 can't be immunized under current federal authorization.
The number of individuals fully immunized increased by 2,346, to a total of 1,211,121, or 47.4% of that age range.
As of Monday, 10,235 third vaccine doses had been administered.
There were 91,682 vaccine doses administered in the past seven days, 20,904 more than the previous week, when a total of 70,778 doses were administered.
The Health Department does not base its percentage vaccinated on the state's total population, but on the total population of those 12 and older, which the department said is 2,557,248.
SCHOOL CASES
The number of active cases of covid-19 in the state's public schools is continuing to rise, reaching a high of 3,911, according to an Arkansas Department of Health report Monday.
The 3,911 active cases in public schools marked an increase of 559, or almost 17%, since the agency's previous report of 3,352 on Thursday.
Also on Monday, there were 84 active cases in the state's private elementary and secondary schools, up from 66 on Thursday, and 466 active cases in the state's colleges and universities, up from 404 on Thursday.
The new numbers come as most of the state's more than 470,000 elementary and secondary school students are starting their third week of school.
A total of 186 of the state's 262 school systems have five or more active covid-19 cases, up from 173 districts late last week. The 186 named school systems -- including open-enrollment charter schools -- account for 3,684 of the total 3,911 cases in schools. Districts with fewer than five cases are not individually named in the state agency report for privacy reasons, but their numbers are included in the totals.
The Cabot School District has the highest number of active cases at 140, according to the Health Department. The Fort Smith and Springdale school districts follow with 122 cases of covid-19 each. Rogers has 105 cases; Bentonville, 104; and Little Rock, 79 active cases among students and employees. Jonesboro has 75 cases, followed by Conway with 71.
Despite the increasing number of active cases, schools and districts have remained operating with only a few classes and grades having to temporarily shift to remote instruction, according to data maintained by the Arkansas Department of Education.
The third grade at Preston and Florence Mattison Elementary School in the Conway School District shifted Monday to remote instruction for the remainder of this week.
Not previously reported was a two-day transition to remote instruction last Thursday and Friday for sixth graders in the Centerpoint School District. The district's website on Monday reported 18 covid cases and 106 students quarantined. That's down from 137 quarantines on Friday, when there were 15 active cases reported. The Centerpoint School District implemented a mask mandate on Monday.
The Little Rock School District reports daily Monday through Friday and once on weekends on its covid cases and quarantines. For the 24-hour period that began at 3 p.m. Sunday and ended at 3 p.m. Monday, the capital city district reported that 16 individuals had been identified as having tested positive for covid-19 and that 99 individuals were quarantined for symptoms or exposure. The quarantines included 21 at Stephens Elementary and a total of 22 at the district's Chicot Elementary and Early Childhood Center.
Among the private schools, the individually named campuses with five or more covid cases are St. Joseph Catholic School in Conway with 19, Little Rock Christian Academy with seven, and St. Theresa Catholic School in Little Rock with five.
COLLEGE CASES
The University of Arkansas, Fayetteville began the second week of its fall semester with a surge in the number of coronavirus infections.
Active covid-19 cases increased to 141, up from the 105 active cases listed on UA's website Friday.
The increase reported on UA's website Monday reflects new cases reported over a three-day period that ended Sunday, as well as infections now considered by UA to be "recoveries" because 10 days have passed since the positive test date.
The total of 141 active cases comprises 125 student infections, eight staff members infected and six faculty members with covid-19, as well as two graduate assistants.
HOSPITAL BEDS
Total hospital beds in the state -- whether filled or vacant -- rose by seven, going from 8,813 on Sunday to 8,820 on Monday, according to Health Department data.
Available beds jumped by seven, to 1,833, meaning about 79.2% of the state's hospital beds are full.
The total of intensive care beds, filled or vacant, remained the same at 1,109. Only 21 ICU beds were available Monday, which means that more than 98% of the special-care beds were full. The number available has been as low as eight in recent weeks.
The total bed capacity -- hospital beds that can be staffed, regardless of whether they are occupied -- was at 8,815 on Monday, according to Health Department data. That number rose by 164 beds from 8,651 last Monday.
The maximum flex bed capacity, the number of beds at the hospitals regardless of the facilities' ability to staff them, was at 11,372, a jump of 116 beds from the previous week.
The metro region of the state had the largest number of covid-19 admissions at 343, followed by the Arkansas Valley at 229; the southwest region at 206; the northeast region at 193; the northwest region at 167; the north central region at 76; and the southeast region at 43.
Hospitals in the metro region saw the highest number of covid-19 patients in the ICU with 207, followed by the southwest and northwest regions with 83; the Arkansas Valley with 74; the northeast region with 57; the north central region with 16; and the southeast region with 13.
The metro region saw the highest number of covid admissions requiring ventilators at 153, followed by the northwest region at 71; the southwest region at 57; the Arkansas Valley at 39; the northeast region at 25; the north central region at 12; and the southeast region at four.
All but two of the regions dropped in the number of covid-19 admissions, with the metro region seeing the greatest drop, going from 418 on Aug. 23 to 343 on Monday.
The Arkansas Valley saw the largest increase in covid admissions, going from 222 on Aug. 23 to 229 on Monday. The southeast region also increased its covid admissions, from 41 to 43.
TESTING NUMBERS
There were 931 covid-19 tests reported Monday, comprising 524 PCR and 407 antigen tests.
The number is significantly lower than normally reported, going from 9,342 on Sunday and from 5,446 reported Aug. 23.
There were a total of 79,283 tests -- i 63,029 PCR and 16,254 antigen -- reported within the past seven days. The previous week, Aug. 16 through Aug. 22, there were 73,055 tests, with 59,806 of them PCR and 13,249 antigen.
Since the beginning of the pandemic, there have been a total of 4,528,376 tests reported. Of that number, 469,658 were positive for covid-19, according to Health Department data.
VARIANTS OF CONCERN
According to a Health Department report released Monday, the number of cases in Arkansas found to have been caused by the delta variant, which first emerged in India, rose by 738, from 2,897 on Aug. 23 to 3,635 on Monday.
Cases of the delta variant have more than tripled during the month of August, increasing by 2,731 -- going from 904 on July 31 to 3,635 on Monday.
The number known to have been caused by the alpha variant from the United Kingdom rose by one, to 764.
The Health Department also reported an increase from 56 to 57 in the number of cases found to have been caused by the gamma variant from Brazil.
The total number of cases caused by such variants is unknown because only a small percentage of specimens are sent to laboratories for the genomic sequencing used to determine the strain of the virus.
CASES BY COUNTY
Health Department data indicated that Pulaski County had the largest increase in total cases, with the count rising by 114.
Benton County had the next-largest increase, 77, followed by Washington County with 59.
Information for this article was contributed by Jaime Adame of the Arkansas Democrat-Gazette.