With Arkansas' covid-19 cases continuing to soar, the state's top public health official said Wednesday that he will seek money from the state's allocation of coronavirus relief funds to expand hospital capacity.
"I am sorry to sound like the doomsday guy, but this is a very serious situation, and I am particularly worried," Health Secretary Jose Romero told the state's American Rescue Plan steering committee.
He said the request will include funding for hospital beds and staffing, and will be submitted "when we have detailed plans for funding requirements."
Romero made the comments as the number of coronavirus patients in hospitals continued growing Wednesday after topping 1,000 a day earlier for the first time since January.
The state count of cases rose by 1,703.
Its death toll from the virus, as tracked by the Department of Health, rose by 12, to 6,099.
In May, Gov. Asa Hutchinson appointed the 15-member steering committee to recommend the best uses of $1.57 billion in federal funds that state government will receive under the federal American Rescue Plan signed by President Joe Biden.
Romero, who has been health secretary for the past year, said he previously felt this way back in January "when I felt ... that we were going to go off the cliff. I am at that position today."
"When school opens we will be in big trouble because we will see spread throughout the schools because of the closeness of the students in contact with each other," Romero said.
"We see this now with day cares and summer camps closing at a number that are unheard of relative to last year."
That's because this is a more contagious virus, he said.
"We are in the throes of a significant upsurge in cases."
"The trend that we saw previously with a major reduction in the number of hospitalizations and actual cases has reversed itself," he said. "We're also seeing a significant increase in the number of deaths."
He said Arkansas hospitals are at the breaking point, similar to the position they faced in January, before the trend downward.
"One of the major problems we have today is not just beds, but people to man those beds," Romero said.
Nurses have left the field "because of burnout and because of fear and, in order to attract newer nurses, we are going to have to bring them in from out of state and pay premium prices to bring them to the state of Arkansas," he said.
He said COVIDComm, a system for matching covid-19 patients with available hospital beds and other resources, no longer functions well.
During the past year amid the covid-19 pandemic, the turnaround to move patients into beds across the state took an hour or two at most, he said.
"At this time, COVIDComm which is designed to find these beds, is taking at minimum seven hours and at times having the patients wait in the emergency room at which they are being seen," Romero said.
Patients are having to wait in the emergency room for hours, if not a day or two, before they are transferred to hospital beds, he said.
The emergency rooms are seeing 30% more patients with covid-19, and these patients are significantly sicker than they previously were, Romero said.
He also referred to people who have tested positive after being fully vaccinated.
"We are hearing from the [U.S. Centers for Disease Control and Prevention] that we are starting to see breakthroughs in our individuals that are immunized, and that may require the use of a booster vaccine sometime in the near future," Romero said.
Earlier in the day, a task force of hospital executives, health officials and others met with Hutchinson to discuss ways of increasing hospital capacity.
Hutchinson was scheduled to meet with residents in Heber Springs on Wednesday evening as part of a series of "community covid conversations" he has been holding around the state to encourage vaccinations.
He planned to hold a news conference at the state Capitol today on the coronavirus.
"Today we increased the number of vaccinations by 10,846. To stop the spread of the Delta variant, we must multiply that success every day," Hutchinson said in a tweet, referring to the fast-spreading strain that first emerged in India and has been blamed for the surge in cases in Arkansas.
ACTIVE CASES RISE
While smaller than the spike of 2,052 cases Tuesday, the increase in cases Wednesday was larger by 244 than the one the previous Wednesday.
Already at its highest levels since early February, the average daily increase in the state's case count over a rolling seven-day period rose to 1,609.
The number of cases that were considered active, also at its highest level since early February, rose by 310, to 15,801, as new cases outpaced recoveries.
The number of patients hospitalized with covid-19 rose by 39, to 1,064, its highest level since Jan. 26. It was the 23rd day in a row the number had increased.
After topping 200 Tuesday for the first time since January, the number of virus patients who were on ventilators with covid-19 rose Wednesday by four, to 209.
The number of covid-19 patients who were in intensive care, however, fell by one, to 386.
CDC rankings Wednesday continued to show Arkansas trailing only Louisiana and Florida in new cases per capita over a rolling seven-day period.
Arkansas also continued to have the second-highest number of new deaths per capita, after Nevada, over the previous seven days.
Within Arkansas, Pulaski County had the most new cases, 207, followed by Washington County with 132, and Benton County with 128.
At the task force meeting Wednesday, "there was a lot of talk about expanding beds but the big limiting factor is we don't have staff, so we are in the process of discussing how we can possibly get some more staff," said state Surgeon General Greg Bledsoe, the panel's vice chairman.
"There were some ideas that were batted around, but it's difficult because there's no big pool waiting to be pulled in, because that pool's been depleted over the last year," Bledsoe said.
"A lot of the nurses that would have been available for something like this have been contracted through travel agencies or are burned out or just aren't available for other reasons, and so we're sort of thinking about second and third and fourth options for this. That's one of the biggest issues that we're dealing with."
An emergency room physician, Bledsoe said he was working at a hospital in western Arkansas earlier this week that had no available intensive care unit beds and a non-covid patient who needed one.
"We called every hospital in Arkansas over the course of 12 hours, and no one had an ICU bed that was appropriate for this patient," he said.
"We called Oklahoma, Missouri and Texas, and could not find a bed for this patient.
"Eventually he stayed in our emergency department for about 16 hours, and when I left my emergency department shift, he was still there, and we were in the process of trying to call in extra nurses to open up more beds.
"That story is being repeated by colleagues of mine all over the state. These are not covid patients. These are non-covid patients who don't have a bed because our hospitals are so full, in part because of covid."
At the same time, he said he's also been hearing from people in conversations and on social media who suspect hospitals are inflating the numbers.
"I think the big thing that I want to tell the public is that this is real," he said. "I'm seeing this with my own eyes."
After reaching record levels Monday and Tuesday, the number of covid-19 patients at the University of Arkansas for Medical Sciences Medical Center in Little Rock fell Wednesday by three, to 72, spokeswoman Leslie Taylor said.
She said 24 of the patients Wednesday were in intensive care, 18 were on ventilators and five were on heart-lung bypass machines.
In about the past week and a half, she said the number of people going into its drive-thru testing clinic has increased from 50 or 60 a day to 500 on Monday and about 300 Tuesday and Wednesday.
"Something different today, most of the people that we were testing weren't coming in for procedures," she said, referring to the tests required by the hospital before surgeries.
"We were seeing a lot of folks who were having symptoms or who had been exposed."
At Arkansas Children's Hospital in Little Rock and Arkansas Children's Northwest in Springdale, the number of patients remained at the all-time high of 24 it reached a day earlier, spokeswoman Hilary DeMillo said.
She said five of the patients Wednesday were in intensive care, and two were on ventilators.
Baxter Regional Medical Center in Mountain Home had 38 covid-19 patients, down from a record 43 a day earlier.
Between covid-19 and other patients, CEO Ron Peterson told radio station KTLO that the hospital's 17 ICU beds were all full.
He said other hospitals were in similar situations.
"There really are no other facilities to send our patients to right now, and that's what people have to realize," he said.
"When you hear about the Springfield news or even Little Rock news, hospitals are full, not just Baxter Regional Medical Center, so it's not a question really of sending patients, it's how can we best take care of those patients here."
At Unity Health-White County Medical Center in Searcy, the average age of the covid-19 patients has trended downward in the past few months and is about 15 years younger than it was in January, when the vaccine first became available in Arkansas, said Roddy Lochala, Unity Health's chief medical officer.
He attributed that to two factors: lower vaccination rates among young people and the highly transmissible delta variant circulating in the community.
On Wednesday, the hospital had 26 coronavirus patients, including three who were on ventilators.
The ages ranged from 22 to 75. Two of the three who were on ventilators were in their 40s, he said.
The hospital has had a total of 562 coronavirus patients between January and July 20, Lochala said. Of those, eight were vaccinated, or about 1.4%.
White River Medical Center in Batesville had 32 covid-19 patients as of Wednesday, spokeswoman Sheila Mace said.
She said she could not release the percentage of vaccinated patients or the number of patients in the ICU or requiring ventilators on a specific day because of concerns.
In a statement this week, the Arkansas Hospital Association said it "strongly supports" policies that require vaccination for hospital employees.
The Missouri-based Mercy Health System, which has hospitals in Rogers, Fort Smith and Berryville, announced earlier this month that its employees will have to be vaccinated by Sept. 30.
Arkansas Children's CEO Marcy Doderer last week announced a requirement for upper-level staff members to receive at least one dose by Aug. 20 and be fully vaccinated by Sept. 30.
Arkansas' surge in cases and hospitalizations comes weeks before the start of a public school year in which schools will be barred by a state law from requiring students or employees to wear masks.
In a letter dated Tuesday, attorney Tom Mars of Rogers urged Hutchinson and legislative leaders to repeal the law, Act 1002, which took effect Wednesday.
He said he represents several parents of public school children whose health is threatened by the law and that he's prepared to file a lawsuit this week in Pulaski County Circuit Court to halt its enforcement and challenge its constitutionality.
"Please let me know if you come to an agreement to remove the barriers that are preventing local school officials from creating this safest possible environment for Arkansas' K-12 public school children," Mars wrote.
Hutchinson said Tuesday that he will be evaluating options for changes to Act 1002 and will not make a decision until legislative leaders have an opportunity to discuss options further with their members.
Senate President Pro Tempore Jimmy Hickey, R-Texarkana, who said he received Mars' letter late Tuesday night, said he has started surveying senators and hopes to talk to each one by the end of this week or early next week.
He noted that the legislation changing Act 1002 would have to get a two-thirds vote in the Republican majority 35-member Senate and 100-member House to go into effect immediately.
Senate Republican leader Scott Flippo of Mountain Home said he doesn't believe there is enough support in the state Senate to change Act 1002.
He said he has spoken to 12 or 13 Republican senators and 10 or 11 of them indicated they are "a hard no."
He said he has heard from both sides about Act 1002 and heard more from people who want lawmakers to not change the law.
Sen. Joyce Elliott, D-Little Rock, said she has a "gut feeling" that it is going to be incredibly difficult to get a majority of the Senate to vote to change Act 1002.
She said she has been bombarded by people from outside of her Senate district with conspiracy theories and other misinformation about masks.
The law's sponsor, Sen. Trent Garner, R-El Dorado, said he doesn't believe a majority of the House and Senate want to change it.
House Speaker Matthew Shepherd, R-El Dorado, has reviewed Mars' letter, and continues to have conversations with representatives about changing Act 1002, but "there is no formal [vote] count at this point," said House spokeswoman Cecillea Pond-Mayo.
House Republican leader Austin McCollum of Bentonville said he's continuing to discuss this matter with fellow House Republicans who are consulting education and health experts.
Joel Tumilson, a physician and Health Department outbreak response specialist, said Wednesday that the school year will not be without its bumps but has the potential to be safe if schools use multiple precautions.
He urged parents to familiarize themselves with the strategies their child's school will use to stop the spread of the virus.
Those can include masks, physical distancing, cohort grouping, lunch service, playground use and measures on buses.
"I would say that if your school district is maintaining as many of those mitigation strategies as possible, one on top of the other, then I think you can be confident that your kids can go to school fairly safely," he said.
"Is it 100% safe? No. There is very little that is."
There will be cases where classrooms or schools will have to pivot for a short time to remote instruction because of a covid outbreak, he said.
Tumilson spoke with reporters a day after the state released 2021-22 covid-19 guidance for schools.
"In some sense it will be difficult because everyone was kind of hoping we would be done with it," he said about the school year and covid-19.
"That's not a hope that has been borne out. But I think in some sense it will be less difficult because the things we are asking schools and kids in school to do are not new. They are things they did last year and can continue doing. We just have to get back into the routine of doing those things."
The state guidelines recommend, in part, the wearing of masks in all indoor school settings with children under 12 or in any classroom setting where the vaccination status of students of any age can't be confirmed. The guidelines also acknowledge that schools can't require students or staff members to wear masks.
Tumilson elaborated on other factors regarding covid-19 and operation of schools:
• Ventilation: "The key is to increase outside airflow. The CDC recommendations say you can do this without it being terribly expensive. Open windows. Put fans in windows to blow air from outside in and leave the door open to increase circulation. Adjust the way your air handling system works to have as much outside air flow brought in and exchanged as possible. As far as what you can add to a room: Hepa filters look like the best thing," he said.
• Masks for students: "Find one that fits and is comfortable." The selected mask should seal around the nose and mouth and be without gaps. It should be comfortable enough that the kids will put them on and leave them alone.
"The good news we found out last year -- nobody knew whether kids can wear masks consistently -- they can and they should," he said.
• Symptoms: The delta variant of the virus can cause all the same symptoms evident throughout the covid-19 pandemic but initial symptoms of the variant tend to include runny noses, congestion, sore throats and headache.
"Those are the symptoms we love to ignore," he said. "We say, 'it's my allergies or just a headache.' Those are the ones we skim over, but they are the symptoms that show up first more often. Other symptoms such as fever develop later with this delta variant."
Act 1002 also bars other state and local government entities from requiring masks.
It makes an exception for facilities operating by the state Department of Corrections, but not for county jails, many of which have experienced coronavirus outbreaks.
Craighead County Sheriff Marty Boyd, who was sworn in this year as president of the Arkansas Sheriffs' Association, said he'll nevertheless continue to require masks for his staff and inmates.
He said he has a responsibility under the state constitution for their safety.
"We have 31 covid-positive cases right now, and that includes employees and inmates," Boyd said. "We are taking every precaution we can now."
Boyd said when an inmate in a quarantined section of the jail is transported anywhere else in the facility, the inmates and staff members are required to wear masks.
The Pulaski County sheriff's office is also planning to keep its mask requirement, spokesman Lt. Cody Burk said.
"When they are outside their cells, or around groups of people or even when they are in the facility, they are required to wear masks," he said. "We haven't had any plans to change this at this point."
Burk said the active covid-19 cases within the facility as of Wednesday consisted of 20 inmates and six employees.
"We are doing testing on inmates, and if someone comes in, we do temperature and pre-screening questions," he said. "We are isolating people who are coming in for 14 days."
Poinsett County Sheriff Kevin Molder said he doesn't have a mask requirement in place, but his employees have been willing to wear them voluntarily anyway.
"When covid started we had deputies and detention staff wear masks when they were working around the facility," he said. "Our employees are still wearing masks around the inmates because I think our employees are willing to do what it takes to maintain the safety and health of everyone in the facility."
He said his jail has avoided any covid-19 outbreaks so far, but that is because he has never changed any of the procedures since the pandemic began.
"We have a system in place," he said. "We are still doing temperature checks, we are still asking questions, and we have the same precautions we have always had in place."
Meanwhile, Health Department figures continued to show an uptick in vaccinations in the state driven by people receiving their first vaccine doses.
At 10,846, the increase in the doses that providers reported having administered, including second doses of the Pfizer and Moderna vaccines, was larger by more than 1,000 than the one a week earlier.
Already at its highest level since the week ending May 14, the average number of doses administered each day over a rolling seven-day period rose to 9,425.
According to the CDC, the number of Arkansans who had received at least one vaccine dose rose by 8,181, an increase that was larger by more than 2,700 than the one a week earlier.
Already at its highest level since the week ending April 23, the average daily increase in the number of Arkansans who had received at least one vaccine dose rose to 7,174.
The increase Wednesday brought the number to 1,388,435, or about 46% of the state's population.
The number of Arkansans who had been fully vaccinated rose by 2,191, to 1,089,475, or about 36.1% of the population.
Among the states and District of Columbia, Arkansas moved up from No. 43 to No. 42 in the percentage of its residents who had received at least one vaccine dose.
It continued to rank 49th, however, ahead of only Mississippi and Alabama, in the percentage who were fully vaccinated.
Nationally, 57.1% of people had received at least one dose, and 49.3% were fully vaccinated.
Information for this article was contributed by Stephen Simpson and Cynthia Howell of the Arkansas Democrat-Gazette.