Arkansas' count of coronavirus cases rose Tuesday by 485 -- the largest single-day increase since March 5 and the first one since March 12 that topped 400.
Already at its highest level since March 10, the number of people hospitalized in the state with covid-19 rose by four, to 285.
The state death toll from the virus, as tracked by the Department of Health, rose by eight, to 5,884.
"COVID-19 won't go away until more people take the vaccine," Gov. Asa Hutchinson said in a tweet.
"Until we increase the number of shots, we will continue to have increased numbers of hospitalizations and new cases like we did today. It is sad to see someone go to the hospital or die when it can be prevented."
Tuesday's increase in cases was larger by 395 than the one a day earlier and by 183 than the one the previous Tuesday.
The average daily increase in the state count over a rolling seven-day period rose to 259 -- its highest level since the week ending March 18.
With new cases outpacing recoveries, the number of cases considered active rose by 251, to 2,570, the largest total since March 21.
State Epidemiologist Jennifer Dillaha called the numbers "alarming."
"My thought is that we're seeing the spread of the delta variant," she said, referring to a strain of the virus that first emerged in India and later became the dominant one in the United Kingdom.
"It's a pattern of just very quick spread. We know we have it in the state. We're not able to quantify what the proportion of cases is at this point, but the combination of the quick spread, the increase in hospitalizations, and we're seeing an effect on younger people, which is consistent with what they've seen in the United Kingdom and other countries."
With 43 new cases, Baxter County had the most of any county except Pulaski, which had 71.
Saline County had the next highest number of new cases, 26.
Before Tuesday, Baxter County, with a population of just under 42,000, had just 34 active cases.
Dillaha said she didn't know the reason for the county's increase.
"None of the counties in Arkansas have near the level of vaccinations we need to stop the spread, so I think it will likely happen that as the clusters get going in a certain county, we'll see a spike in cases," she said.
"We'll just go from county to county."
She added that "with the delta variant, you can have a lot of cases that aren't necessarily in a confined setting because it's just so transmissible."
Home to Norfork Lake and other outdoor recreation destinations, Baxter County borders Missouri, which had the country's largest number of new cases per 100,000 residents during the past seven days as of Monday.
Arkansas had the fifth-highest rate, 54 new cases per 100,000 residents, after Wyoming, Utah and Nevada.
Missouri's rate was 78.1 per 100,000 residents.
"I don't have a clue at this time," said County Judge Mickey Pendergrass of the reason for Baxter County's spike in cases.
"It's a time for people to be traveling, so that could be a good indication. We've had a large influx of people coming here."
Dillaha said she didn't know of any particular type of activity or setting behind the statewide uptick in cases.
Because the delta variant spreads so easily, "people may get this virus as they go about their daily activities in their communities, and they may be less likely to know who they got it from because it may not take the prolonged interaction that many people might assume that they need now to get the virus," she said.
Also on Tuesday, the state Board of Corrections unanimously approved an extension of the mask mandate at prisons until July 30.
The mandate requires all employees, offenders, contractors, volunteers and visitors to be masked while at a Department of Corrections facility.
Corrections Secretary Solomon Graves told the board there is still concern about spread of covid-19 with new variants of the disease being discovered.
He said he wanted to keep the mask mandate in place until a majority of the inmate population is vaccinated.
"My hope is that with the beginning of our commissary incentive program, we will be closer to the herd immunity goal set by the [U.S. Centers for Disease Control and Prevention]," he said.
Cindy Murphy, a spokeswoman for the Department of Corrections, said 7,738 offenders out of the roughly 15,000 inmate population have been vaccinated.
Out of the department's 4,460 employees, 2,211 have been vaccinated.
Graves said he will review the vaccination numbers again on July 15 to see if the mask mandate could be lifted.
YOUNGER AND SICKER
Tuesday was the eighth day in a row when the number of covid-19 patients in the state's hospitals went up.
After falling by one a day earlier, the number of coronavirus patients on ventilators rose by one, to 64.
That was tied with the number on Sunday for the largest since March 12.
The number of covid-19 patients who were in intensive care units, however, fell by six, to 128, after reaching its highest level in more than three months a day earlier.
In Little Rock, the University of Arkansas for Medical Sciences Medical Center had 22 covid-19 patients on Tuesday, up from just nine two weeks earlier and the most it's had since February, spokeswoman Leslie Taylor said.
Five of the patients on Tuesday were in intensive care.
"We do think some of this might be Memorial Day still trickling in -- patients who were out in crowds and celebrating -- and we're a little bit concerned with what's going to happen with the Fourth of July," Taylor said.
Compared with earlier in the pandemic, she said, the patients have tended to be younger and sicker.
About four of them recently have been put on an extracorporeal membrane oxygenation, or ECMO, machine, which she said is similar to a heart-lung bypass machine used in open-heart surgeries.
"We've had a 100% rate of getting them off of the machines and having them survive," she added. "That's much better than the national average."
The hospital's recent covid-19 patients have included some who were pregnant, she said.
"Some we've had to perform emergency surgeries to deliver the babies," with the babies going to the neonatal intensive care unit, she said. "Some have had miscarriages."
About 99% of the patients have been unvaccinated, she said.
"Covid doesn't discriminate based on age, so we do encourage people to go get the vaccine, because we don't want to see them here in the ICU," Taylor said.
The Baptist Health system, which has 11 hospitals in Arkansas, had 81 covid-19 patients as of Tuesday, up from 54 a week earlier but still down from more than 270 in January, spokeswoman Cara Wade said in an email.
Like UAMS Medical Center, she said Baptist has been using ECMO machines for patients with "severe COVID illness with respiratory failure."
"In April and May, patients requiring this high level of support on ECMO dropped to around 2 to 3 per day," Wade said.
"Now we are seeing that number increase to 5 to 6 COVID-19 positive patients a day on ECMO and we receive calls from across the country looking for this level of care."
She said the age of the patients and severity of illness is about the same as it was in the winter for "regular hospitalized patients."
"However, for those with severe illness on ECMO, we are seeing a younger age group that is more in their 30s and 40s," Wade said.
In a statement Monday night, a coalition of health care providers in Washington and Benton counties said hospitals there were caring for 31 covid-19 patients, which they said was "a 182% increase since the beginning of June."
"The vast majority of the 31 patients have not been vaccinated," the group said.
They said their clinical leaders and administrators are "very concerned about the uptick in cases" in the region and neighboring states, "particularly Missouri."
"The Delta coronavirus variant is causing the virus to spread quickly and is filling hospitals just over an hour from us with COVID-19 patients again," the group said in the statement.
"Our NWA hospitals have been relatively full caring for patients with medical conditions other than COVID-19. A hospital administrator shared today, we are seeing a trend of sicker COVID patients this week and in more critical care, on top of caring for a pretty significant increase in overall critical care (non-COVID) recently."
A number of the covid-19 patients have been "younger than we've seen before but overall, their ages are a wide range as are their demographics, including ethnicity and disease state," the group said. "Essentially there are no overarching demographics or disease states at this time."
The coalition includes Washington Regional Medical System, Mercy Health System, Northwest Health System, Arkansas Children's Northwest, the Veterans Health Care System of the Ozarks, UAMS Northwest and Community Clinic.
At St. Bernards Medical Center in Jonesboro, spokesman Mitchell Nail said the number of covid-19 patients was "starting to trend up, but at the same time, they're not what other places in the state are seeing."
He said he didn't expect that to last, however.
"I think the northeast region will follow the rest of the state as the numbers start trickling up, especially if our vaccination numbers don't go up," he said.
He said about 20% of the hospital's covid-19 patients were in intensive care, which he said was a smaller percentage than earlier than in the pandemic.
He credited monoclonal antibody treatments, which he said can keep people out of the hospital and shorten the stay for those who do end up hospitalized.
He said the hospital has been seeing younger patients as well as older ones who still haven't been vaccinated.
"I think now, more than ever, it's important for people to get vaccinated, especially when you're seeing variants, you're seeing an uptick in cases, and people are getting out," he said. "Unvaccinated people are out and unmasked, and I just think that's a ripe opportunity for the spread of this virus."
Hutchinson announced late last month that Arkansans who received a vaccine dose on or after May 26 would be eligible to claim one of two rewards: a $20 scratch-off lottery ticket or a pair of gift certificates for hunting and fishing licenses worth a total of $21.
He said the state was buying 50,000 of the lottery tickets and 50,000 pairs of gift certificates and could buy more if the incentives proved effective.
People can claim the rewards at vaccination clinics organized by the Health Department or the Arkansas Foundation for Medical Care or by bringing their vaccination card to one of the department's local health units.
Health Department spokeswoman Danyelle McNeill said 1,844 people had received lottery tickets and 626 had received Game and Fish Commission gift certificates as of Tuesday.
Scott Hardin, a spokesman for the Department of Finance and Administration, the number of people who had cashed in a winning ticket distributed as an incentive rose over the past week by 145, to 445.
The total amount of winnings awarded so far increased by $7,720, to $20,310.
Five people so far have won $500 each. The rest have won smaller amounts ranging from $100 to $20.
Two tickets each worth $1 million remained in circulation in the game, known as the $1 Million Spectacular, Hardin said.
Despite the incentives, however, the pace of vaccinations has been slowing.
At 3,990, the increase on Tuesday in vaccine doses that providers reported having administered, including second doses of the Pfizer and Moderna vaccines, was smaller by more than 2,500 than the increase a week earlier.
The average number of doses administered each day over a rolling seven-day period fell to 4,723, its lowest level since the week ending June 5.
That week, the average dropped to 4,655, its lowest level since at least January, as the result of a slowdown in vaccinations around Memorial Day weekend.
According to the CDC, the number of Arkansans who had received at least one vaccine dose rose Tuesday by 758, to 1,244,203, representing about 41.2% of the state's population.
The number who had been fully vaccinated rose by 867, to 1,008,252, or about 33.4% of the population.
Among the states and District of Columbia, Arkansas continued to rank 45th in the percentage of its residents who had received at least one vaccine dose and 49th, ahead of only Alabama and Mississippi, in the percentage who were fully vaccinated.
Nationally, 53.5% of people had received at least one dose and 45.3% were fully vaccinated.
Dillaha said all the deaths reported Tuesday happened in June.
Most occurred within the past couple weeks, she said, although one was from earlier in the month.
The cases that were added to the state's tallies included 195 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 290 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 346,180.
That comprised 269,727 confirmed cases and 76,453 probable ones.
The Health Department didn't report any new cases among prison and jail inmates.
The state's death toll rose by seven, to 4,672, among confirmed cases and by one, to 1,212, among probable cases.
Among nursing home and assisted living facility residents, the state's count of virus deaths rose by one, to 2,092.
The number of people who have ever been hospitalized with confirmed infections in the state grew by 49, to 16,753.
The number who have ever been on a ventilator rose by six, to 1,711.