Arkansans age 70 and older, and employees of schools and child care centers will be eligible to receive the coronavirus vaccine starting Monday, Gov. Asa Hutchinson announced Tuesday.
The move will expand the state's vaccination efforts, which have so far focused on health care workers, staff members and residents of long-term-care facilities, and police and firefighters who are first responders.
"The reason for this is we want to continue to increase as fast as we can getting these doses into the arms of Arkansans and at the same time being able to manage the limited supply that we're given," Hutchinson said.
Hutchinson made the announcement as officials with President Donald Trump's administration urged states to begin vaccinating all people age 65 and older or with chronic health conditions, such as diabetes or lung disease, that put them at greater risk of developing complications from covid-19.
That was a shift from earlier recommendations by the U.S. Centers for Disease Control and Prevention -- adopted by Arkansas -- that health care workers, and residents and workers at long-term-care facilities should be first in line for the shots.
Under Arkansas' plan, people age 65-69 and people age 16-64 with chronic health conditions will qualify for the vaccine under the plan's Phase 1-C, which the state estimates will begin in April.
"I understand there's been some comments nationally, 'Well, maybe we should go ahead and do 65 to 69 and bring in other categories early on,'" Hutchinson said.
But he said with the state receiving only about 50,000 doses a week of the vaccine, the state isn't ready for that yet.
"We have to manage the process in a way that gets vaccines out as quick as possible but also in a way that doesn't -- that gives priority to those that need it the most," he said.
The Trump administration also announced that it would begin sending out all available doses of the vaccine, instead of holding back doses to provide the second shots of the two-dose regimens, potentially doubling the amount of vaccines going to the states each week.
The developments came as Arkansas' count of coronavirus cases rose by 3,209, a smaller increase than the 4,107 cases that were added the previous Tuesday.
After reaching a new high a day earlier, the number of people hospitalized in the state with covid-19 fell by 17, to 1,354.
Those patients included 251 who were on ventilators, down from a record 268 a day earlier.
The state's death toll from the virus, as tracked by the Department of Health, rose by 40, to 4,121.
Hutchinson has said about 180,000 people -- including health care workers, long-term-care facility residents and staffers, and first responders -- are eligible for shots under Phase 1-A of the state's vaccination effort that began last month.
He said Tuesday that more than 400,000 Arkansans will become eligible for the vaccine as the state expands its efforts Monday to include some members of Phase 1-B.
That includes 311,000 people who are age 70 or older, and 132,000 who work in education, including elementary and secondary education and higher education institutions, he said.
"We're looking at Monday adding 443,000 potential new Arkansans to be vaccinated," Hutchinson said.
"Now we know that some will wait, but it's going to take time to get through all of those."
Other members of Phase 1-B -- including grocery store workers, workers in manufacturing and other front-line essential workers -- will become eligible for the shots later, Hutchinson said.
Prison inmates, even if they are age 70 or over, fall under Phase 1-C and won't qualify for the shots next week, Hutchinson said.
He said other Arkansans age 70 and older should call participating pharmacies to schedule appointments.
A list of the pharmacies can be found through the Health Department's website, healthy.arkansas.gov.
School districts should contact the department's local health unit, pharmacies or other providers to schedule vaccination clinics for their employees, he said.
School employees should contact their districts for information on how to get the vaccine, he said.
Hutchinson also announced that he had named Col. Robert Ator, director of military affairs for the state Department of Commerce and the retired commander of the Arkansas Air National Guard's 189th Airlift Wing, as program manager for the state's vaccine distribution effort.
Maj. Gen. Kendall Penn, adjutant general of the Arkansas National Guard, who is also helping with the state's vaccine planning, said officials have identified a need to enroll more hospitals, clinics and pharmacies in the effort.Gallery: Weekly COVID-19 Briefing
He said officials have also established procedures to keep track of the state's vaccine inventory and how much is being distributed.
"We've also built in procedures where if a school district or some other large body wants to give a large clinic, they can request a strike team, which is very much in line with the strike-team concept used during flu season," Penn said.
A plan for distributing the vaccine under Phases 1-B and 1-C and to the general population will be posted to the state's website by Friday, Hutchinson has said.
John Vinson, chief executive of the Arkansas Pharmacists Association, said pharmacies' phones were already "very busy this afternoon" after Hutchinson's announcement.
"They would like to ask the public to remain calm and reassure them that there will be plenty of vaccine for everybody that wants one in category 1-B," Vinson said.
"There are millions of doses available. It just takes a few weeks for enough doses to come into our state to meet that demand."
He said some pharmacies have started waiting lists, while others are waiting to schedule appointments until they know when they'll have available vaccine.
He estimated that 30%-40% of those who will become eligible for the vaccine Monday will want it as soon as possible and that it will take two or three weeks to schedule appointments for all of them.
"I think the key is, please pick one place that has the vaccine and stick with them," he said.
"It's very difficult to schedule if patients call 15 different pharmacies. It works better if you pick a provider that you trust that's in close proximity in geography to where you live."
In a survey by the association Friday of 212 pharmacies and three hospitals involved in the effort to vaccinate health care workers, 60% of the 174 respondents said they had completed vaccinating the health care workers in their counties.
The vaccinations for that group are considered complete when 80% of those eligible have been offered the vaccine or requests for appointments to get the shots have been declining, Vinson said.
"It's frustrating if you're in a county where you're done, and you'd like to start teachers and patients over 70 today if you have vaccine," Vinson said.
On the other hand, he said, it wouldn't be practical to start vaccinating members of Phase 1-B in some counties but not other ones.
"The governor is trying to move everybody at the same time, as I understand it, so there's equality in access on the same date for the new group," Vinson said.
Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes, said more than 23,000 doses of vaccine had been administered at 238 of the state's more than 300 long-term-care facilities as of Tuesday.
Those totals don't include an additional 3,884 that the Health Department reported had been administered to such facilities by Walgreens and CVS under a federal program.
"There are many more clinics scheduled this week and early next week before we start on the second doses," Bunch said in a text message.
"The remaining facilities are primarily the smaller residential care facilities and those that had outbreaks on their original date."
Vinson said the "vast majority" of facilities, including those partnering with the national pharmacy chains, are scheduled to have vaccine clinics by Jan. 20.
Carol Fleming, president of the Arkansas Education Association, called Hutchinson's announcement "welcome news for the educators serving on the front lines of this public health crisis."
"The return to in-person education has resulted in the deaths of more than two dozen educators and, unfortunately, continues to put children and families at risk," Fleming said in a statement.
"Vaccinations will begin to help educators feel more comfortable as they continue working to provide the face-to-face connection for which there is no replacement."
The teacher's union leader also called for the vaccine campaign to be done "safely and equitably."
"We urge state agencies to use consistent and transparent communications on the benefits and safety of vaccines," she said.
At the Beebe School District, Superintendent Chris Nail said officials "are currently in communication with the local pharmacies to determine the dates and times for on-campus vaccinations."
"As soon as the dates and details are set, we will communicate them to our staff and the community," he said.
Even before Hutchinson's announcement, Nail had gathered his staff together to talk about the vaccine rollout.
The first slide in the presentation Tuesday morning was of a strutting badger -- the district's mascot -- with a vaccination needle stuck in his right bicep.
"As you can imagine, many have had questions about the vaccine, so I wanted to reassure our staff that we will be providing an on-campus vaccination option for those who choose it as soon as possible," Nail said.
The slides Nail presented mapped out the logistics of the vaccine rollout in the district -- which will be administered on two different dates by local pharmacists from Burrow's Drug Store and Beebe Drug.
Kindergarten-through-sixth grade, as well as day care and prekindergarten, employees; School Board members; and workers in administration, special education, technology, and maintenance and operations will be first in line to receive the shots, which will be administered in the school's early childhood cafeteria.
The next vaccine day will be held in the district's main cafeteria for employees working in grades seven through 12, as well as the transportation staff.
Food service staff workers will be included in the school they represent.
Nail said the district will provide snacks and drinks, as well as special t-shirts for all employees vaccinated during the on-campus clinics.
"The response has been overwhelmingly positive. We are not trying to push the vaccine on anyone," Nail said. "We just want to provide our employees an opportunity to receive the vaccine in the most seamless way possible. Our employees appreciate that we are affording them this opportunity."
Amanda Goff, an eighth-grade teacher who declined to give her district name, said she was excited to hear Hutchinson's announcement and that clinics should be immediately scheduled at schools during school hours to guarantee that teachers get access as soon as possible.
"Secondary-level educators could see as many as 150 students in classrooms per day. Even with full mask compliance, educators are at risk of contacting the virus and spreading it to loved ones," Goff said. "We don't wear protective gear beyond masks. We should absolutely be next in line to get vaccinated."
Sydney Free, a first-grade teacher at Park Avenue Elementary in the Stuttgart School District, said she was grateful to the governor for moving teachers up in line.
"I'll get it as soon as I can," she said.
Under the vaccine effort being coordinated by the state, hospitals, pharmacies and other health care providers had received a total of 227,500 doses of the vaccines made by Pfizer and Moderna as of Tuesday morning. They reported administering 88,449 of them.
That was up from 80,796 doses that had been administered as of Monday morning.
Walgreens and CVS received another 24,700 doses.
Both the totals received and administered include some booster shots for people who received their initial doses earlier.
Health Secretary Jose Romero said the state doesn't yet have information on how many people received at least one dose or completed the two-shot regimen.
Since the shots began Dec. 14, Arkansas vaccination providers have reported 64 adverse reactions to the CDC -- all stemming from the Pfizer vaccine. The CDC listed 339 reactions, none life-threatening, for the 64 recipients.
The top complaint -- experienced by 40.62% of those recipients -- was headache. Other frequent complaints were fatigue, fever, joint pain, chills, dizziness, injection-site pain and nausea.
ACTIVE CASES RISE
The cases added Tuesday included 2,095 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 1,114 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 259,553.
That comprised 210,873 confirmed cases and 48,680 probable ones.
The number of cases that were considered active rose by 168, to 25,702, as new cases outpaced recoveries.
Pulaski County had the most new cases, 405, followed by Sebastian County with 401, Benton County with 377, Washington County with 268 and Garland County with 177.
Among prison and jail inmates, the Health Department's count of cases rose by 25.
Department of Corrections spokeswoman Cindy Murphy said the number of cases among inmates rose by 22, to 64, at the Northwest Arkansas Work Release Center in Springdale and by two, to 342, at the Barbara Ester Unit in Pine Bluff.
The East Arkansas Regional Unit near Brickeys, the Grimes Unit near Newport and the East Central Arkansas Community Correction Center in West Memphis each had one new case.
Of those prisons, the Springdale lockup had the largest number of cases that were active, 22, followed by the Grimes Unit, which had 12.
The state's death toll rose by 32, to 3,424, among confirmed cases and by eight, to 697, among probable cases.
The number of people who have ever been hospitalized in the state with covid-19 rose by 129, to 12,313.
The number of virus patients in the state who have ever been on a ventilator rose by 10, to 1,306.
Bonnie Ward, executive director of marketing for CHI St. Vincent, said a high level of capacity is continuing at hospitals across the system.
"One of our ministry's key challenges at this moment is simultaneously providing the highest quality of care to those patients while constantly managing our resources in anticipation of future potential surges of patients, both those with COVID-19 and others in need of critical care," Ward said in an email.
"Those resources include our health care providers and we're working constantly to identify and address their needs, including wellness, stress management and other issues so they can deliver the quality, compassionate care our community deserves," the email said.
Ward said patients should not delay critical care needs.
"That includes maintaining regular communication with their doctor to ensure they don't allow an existing or developing condition to worsen to the point that it requires a visit to the emergency department," Ward said.
Even with 65 more hospital beds added to the state's inventory, the number of beds available for use dropped by 58, going from 2,000 to 1,942 on Tuesday, according to Health Department data.
The total beds -- whether filled or vacant -- increased from 8,860 to 8,925.
That means that about 78% of the state's hospital beds are full.
Available ICU beds increased by nine to 52. Out of 1,154 critical-care beds, 4.5% were available Tuesday afternoon.
The state inventory of ventilators dropped by one to 1,103. About 56%, or 616, ventilators remain available for use, one less than the day before.
Total bed capacity -- hospital beds that can be staffed whether or not they are occupied -- increased by 76 beds, going from 8,860 to 8,936.
Meanwhile, projections released Tuesday by the University of Arkansas for Medical Sciences' Fay W. Boozman College of Public Health showed a worse long-term outlook for hospitals compared with its forecast last month.
The latest forecast, dated Jan. 8, predicts active infections will peak at 30,324 on April 23 under a moderate scenario or 62,427 on April 25 under a worst-case scenario.
Those numbers include infections predicted to be confirmed through tests, as well as those of people who don't get tested.
Of those with active infections during the peak under the moderate scenario, 1,995 were predicted to require hospitalization, including 698 who will need intensive care and 244 who will be on ventilators.
The previous report, dated Dec. 18, predicted active infections would peak at 27,868 on April 12 under a moderate scenario or 54,818 the same day under a worst-case scenario.
The number predicted to require hospitalization ranged from 1,839 in the moderate scenario to 3,617 in the worst-case scenario.
The latest report also predicts that the state's death toll will rise to 5,164 by Feb. 28, which it said is an increase of 1,488 compared with the number on Dec. 31.
The numbers don't account for the possible impact of the state's vaccination campaign.
"While we hope and expect the COVID-19 vaccines to have an impact on the epidemic, the impact will not occur in the short or mid-term," researchers said in the report.
"We should expect to see large numbers of new cases, new hospitalizations, and deaths for at least the next two months, particularly among the age groups that are less likely to be currently eligible for the vaccine."