Arkansas Gov. Asa Hutchinson announced new details of the state's covid-19 vaccination plan Tuesday as the count of virus cases rose by 4,107.
The number of people hospitalized in the state with the coronavirus topped 1,300, setting a new high for the fourth day in a row, while the number of virus patients on ventilators and in intensive care units and the state's active case total also rose to new highs.
The state's death toll from covid-19, as tracked by the Department of Health, rose by 36, to 3,836.
At his weekly news conference on the pandemic, Hutchinson said Tuesday that Arkansans age 70 and older, along with "front-line essential workers," such as teachers and grocery store workers, will be included in Phase 1B, of the state's vaccination plan, which he hopes to begin on Feb. 1.
The cutoff for those who qualify based on their age differs from the U.S. Centers for Disease Control and Prevention's recommendation to states that they include people age 75 and older in group 1B.
Hutchinson said on CBS' "Face the Nation" on Sunday that state officials were considering the lower age threshold.
"We looked at it in terms of where our at-risk population is in Arkansas, and it was a consensus that 70 would be a more appropriate age to be in the 1B category," Hutchinson said Tuesday.
"I did not want, and I don't think anybody wanted them to wait until a couple more months down the road before they have access to the vaccine."
John Vinson, chief executive of the Arkansas Pharmacists Association, said including a larger number of people in group 1B would also make it easier to schedule appointments for people to receive the shots since the vaccines come in vials containing six or 10 doses that must be used within six hours after the first shot is administered.
"When you have a little bit larger group of people that you can plug into those appointments, the more likely you are to not waste a dose," Vinson said.
According to information posted to the Health Department's website Tuesday, workers eligible for the vaccine in Phase 1B will also include school staff members besides teachers; workers in food and agriculture, manufacturing, grocery stores, public transit, child care and the U.S. Postal Service; police and firefighters who were not eligible for shots under Phase 1A, and "essential government workers," which Hutchinson said will include state legislators.
The 70-plus age group alone represents "well over 400,000 Arkansans," Hutchinson said.
"So you can see the monumental shift in volume whenever you go into 1B," he said.
Hutchinson said he hopes to complete Phase 1B within two months, allowing the state to move to Phase 1C by April.
Those included in 1C will be people age 65-69, people age 16-64 with medical conditions putting them at a higher risk of developing complications from covid-19,
Essential workers not included in 1B will also be eligible for shots.
That includes workers in transportation and logistics, water and wastewater, food service, shelter and housing, public safety, finance, information technology, communications, energy, the media and public health, according to the Health Department's website.
The people eligible under Phases 1A and 1B could be adjusted later depending on the willingness of people to take the shots and "the opinion of our medical advisers," Hutchinson said.
"We'll continue to study the response and our needs that are out there," he said.
Under Phase 1A of the state's plan, those now eligible for shots include health care workers, and residents and workers at long-term-care facilities.
Hutchinson on Monday also added police and firefighters who are first responders to Phase 1A.
That was another departure from the CDC's recommendations, which placed them in 1B.
"They are putting themselves at risk, they are our first responders," Hutchinson said Tuesday.
Health Secretary Jose Romero said including first responders "fits Arkansas because we are a rural state," where police and firefighters are often the first ones on the scene of a traffic accident.
"This is different from a metropolitan center, where first responders are, for example, ambulance crews or rescue crews," Romero said.
He added that the advisory committee, led by him, that drafted the CDC's recommendations intended for states to make adjustments to the priority groups based on their needs.
Hutchinson said the 1A group includes 180,000 Arkansans and that his goal is to complete that phase by the end of this month.
As of Tuesday, the state reported that hospitals, pharmacies and other entities in the state had received a total of 134,425 doses of the vaccines made by Pfizer and BioNTech, and Moderna, of which at least 37,884 had been administered.
Those numbers don't include an additional 24,700 doses of the Moderna vaccine that were allocated to Walgreens and CVS to administer to residents and workers at long-term-care facilities in Arkansas as part of a federal program.
The Health Department reported that at least 1,324 of those doses had been administered as of Tuesday morning.
The actual number of shots that have been given is higher than the Health Department's figures because pharmacies and other providers have three days to report the doses they administer.
Hutchinson said pharmacies, hospitals and the Health Department's local health units will be involved in administering the vaccine under Phase 1B.
He said A.J. Gary, director of the state Department of Public Safety's Division of Emergency Management, and Maj. Gen. Kendall Penn, adjutant general of the Arkansas National Guard, will help coordinate the distribution of the vaccine under Phases 1B and 1C and to the general population.
A plan for that effort will be posted to the state's website by Jan. 15 "so that everyone can see what's ahead for them," Hutchinson said.
"This will be a private-sector-led effort that is coordinated and directed by the state," Hutchinson said.
A preliminary plan released by the Health Department last month said the vaccine would become available to the general public in Phase 2 of the effort, when a larger number of doses are available.
Citing the continued increase in the state's case count and hospitalizations, the Arkansas Supreme Court on Tuesday extended through Feb. 28 a suspension of all jury trials that hadn't already started.
The suspension, initially imposed Nov. 20, had been set to expire Jan. 15.
"This Order is to be interpreted broadly for protection of the public from the risks associated with COVID-19," the court said in Tuesday's order.
"This Order applies statewide to all courts and court clerks' offices except administrative courts of the executive branch, federal courts, and federal court clerks' offices."
BRINGING 'THE HEAT'
After focusing in previous weeks on long-term-care residents and workers, and high-priority workers in hospitals, the state's vaccination efforts this week under Phase 1A expanded to include a broader population of high-priority workers in outpatient settings.
Vinson said 212 pharmacies are involved in the effort. Some received the Pfizer vaccine, which must be stored at minus-94 degrees Fahrenheit and comes in minimum shipment sizes of 975 doses.
They will be working with other pharmacies to deliver the shots in a "hub-and-spoke model," he said.
Other pharmacies were to receive direct shipments of the Moderna vaccine, which can be stored at normal freezer temperatures and comes in minimum shipments of 100 doses.
Vinson noted that the number of pharmacies is the same as the boiling part of water in degrees Fahrenheit.
"We're about to bring the heat to this virus," Vinson said. "I'm sick of it. I have family members that have been affected by this, and friends. We're ready to fight back and save lives."
Meanwhile, 13,258 vaccine doses had been administered in 108 long-term-care facilities in the state since the vaccinations began last month, said Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes.
"We have identified homes that were given clinic dates later than the window that the governor identified and are working on solutions to get clinics sooner for them," Bunch said. "We are being more proactive reaching out to homes. We are also sharing more educational material with our facilities."
The greatest challenge, Bunch said, is the sheer volume and all the moving parts of the vaccine rollout to the state's 300 nursing homes and other long-term-care facilities.
Vaccination providers have reported 22 adverse reactions to the CDC since vaccinations began on Dec. 14.
All of the reports were based on the Pfizer vaccine.
The CDC listed 56 reactions for the 22 recipients who had a negative experience.
The top three complaints -- from about 36% of the recipients -- after the injections were fatigue, headache and high temperature, according to the report.
About 32% experienced myalgia and nausea; 27% experienced joint pain; 23% experienced pain and dizziness; 19% experienced chills, and 14% threw up and had diarrhea.
About 9% of the recipients experienced physical weakness, cough, injection-site pain, tingling or burning in their mouths and visual impairment.
Other reactions experienced by at least one of those receiving the shots included reactions like a rash, rises in blood pressure, a drop in body temperature, flushing, injection site swelling, joint stiffness, joint swelling, muscular weakness, nasal congestion, sensory disturbance, eye redness, eye floaters, face swelling and tremor.
Others -- at least one person -- experienced labored breathing, an abnormal EKG and cardiac arrhythmia.
A few recipients experienced a loss or distortion of smell or taste.
One person developed diplopia -- the perception of two images as a single object.
Tuesday's spike in cases was the second-highest one-day increase since the start of the pandemic and only the second one that has topped 4,000.
The largest increase was the 4,304 cases that were added to the state's tallies Friday.
At a record level since Saturday, the number of people hospitalized in the state with covid-19 rose by 27, to 1,323.
For the second day in a row, the number of virus patients who were on ventilators also set a record as it rose by 12, to 224.
The number of covid-19 patients in intensive care units also set a record for the second-straight day, rising by 10, to 421.
The cases added to the state's tallies included 2,275 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 1,832 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 238,888.
That comprised 195,930 confirmed cases and 42,958 probable ones.
The number of cases that were considered active rose by 1,351, reaching a new high of 24,408, as new cases outpaced recoveries.
Pulaski County had the highest number of new cases, 418, followed by Washington County with 399, Benton County with 389, Sebastian County with 265 and Garland County with 232.
Among prison and jail inmates, the Health Department's count of cases rose by 14.
Department of Corrections spokeswoman Cindy Murphy said the number of cases among inmates rose by 10, to 789, at the Grimes Unit near Newport.
The nearby McPherson Unit and the East Arkansas Regional Unit near Brickeys each had two new cases, and the Ouachita River Unit in Malvern had one, she said.
Among those lockups, the Malvern Unit had the largest number of cases that were active, 33, followed by the Grimes Unit, which had 27.
Statewide, the average number of cases added to the state's tallies each day over a rolling seven-day period rose by 198, to 2,806, setting a new high.
The state's death toll from the virus rose by 27, to 3,205, among confirmed cases and by nine, to 631, among probable cases.
Among nursing home and assisted living facility residents, the state's count of virus deaths grew by 15 to 1,571.
The number of people who have ever been hospitalized in the state with covid-19 rose by 118, to 11,743.
The number of state patients who have ever been on ventilators with covid-19 grew by 13, to 1,256.
Cam Patterson, chancellor of the University of Arkansas for Medical Sciences, said hospitals in the northeast and north-central parts of the state are "feeling the brunt of the impact" of the state's rising number of patients hospitalized with covid-19.
He said UAMS Medical Center last week was on the verge of implementing Phase 2 of its surge plan.
That would include adding a second bed to single-bed rooms and increasing patient-to-nurse ratios.
He said the hospital did expand its emergency room to an adjacent parking deck to accommodate "more flow through the emergency department if that is needed" and has space that it can use to create more critical care beds.
"For right now the system is holding," Patterson said. "We have capacity to surge and expand if that needs to happen. That capacity is not infinite, but I don't see a critical moment in the next two to three weeks.
"I do anticipate, though that the strain on the health care system will continue to increase on a week-by-week basis as the number of cases continues to increase."
Hutchinson said the state doesn't plan to reimpose a prohibition on elective procedures in hospitals.
During a meeting Tuesday of his winter covid-19 task force, which includes hospital administrators, "the consensus was, we need to develop mechanisms and a commitment by the hospitals that they will increase their ICU capacity but give them the flexibility to do it in their own way."
He said the state would be implementing a plan to do that within the next 10 days, "and we have great acceptance by the hospitals on that."
AVAILABLE BEDS DROP
Even with 60 more hospital beds added to the state's inventory, the number of beds available for use dropped by 132, going from 1,981 to 1,849 on Tuesday -- the lowest point since the pandemic hit the state in March.
Thursday's numbers were 75 beds lower than the previous high of 1,924 set on Dec. 29.
The total beds -- whether filled or vacant -- jumped from 8,895 to 8,955, according to Health Department data. The total includes a few hundred beds in psychiatric or rehabilitation facilities that aren't for covid-19 care.
That means that about 79% of the state's hospital beds are full.
Available ICU beds dropped by two to 47. Out of 1,155 critical-care beds, 4% were available Tuesday afternoon.
The state inventory of ventilators remained the same at 1,101. About 59%, or 651, ventilators remain available for use, nine more than the day before.
Total bed capacity -- hospital beds that can be staffed whether or not they are occupied -- increased by 60 beds, going from 8,865 to 8,925 Tuesday.
According to Health Department data, 12 of the extra beds were added by hospitals in the metropolitan region of the state while 21 beds were added by northwest hospitals and 27 were added by southwest hospitals.
Maximum flex bed capacity -- the number of hospital beds regardless of ability to staff them -- remained at 11,484.
The majority of the 1,323 covid-19 patients hospitalized -- 378 -- were in hospitals in the metropolitan region of the state, followed by 206 in the southwest, 201 in the northeast, 188 in the Arkansas Valley, 149 in the northwest, 136 in the north-central and 65 in the southeast.
Metropolitan region hospitals also had 152 patients in ICU followed by 77 in the southwest, 59 in the northwest, 48 in the Arkansas Valley, 45 in the northeast, 32 in the north-central and 13 in the southeast.
The hospitals with the highest number of patients on ventilators were in the metropolitan region with 93, followed by the southwest with 36, the Arkansas Valley with 28, the northeast with 24, the northwest with 22, the north-central with 19 and the southeast with two.