Amid a recent uptick in coronavirus cases, Gov. Asa Hutchinson on Monday made Arkansas the latest state to broaden eligibility for booster shots of the Pfizer and Moderna vaccines.
Under the new policy, boosters are available to anyone 18 or older who received their second shot of one of the two vaccines at least six months ago.
"This is a change in policy that we're implementing here in Arkansas," Hutchinson said.
"I think it'll eliminate some confusion, and it'll also encourage everyone across the board that meets this criteria to go get the booster shot. That's the best protection from the virus and from serious health consequences."
Previously, in line with federal recommendations, the state had limited the boosters to people 65 and older, residents of long-term care facilities, people with health conditions putting them at risk of serious complications from covid-19 and people at heightened risk of catching the virus because of their jobs or living situations.
Hutchinson said boosters are needed because "the data indicates that the effectiveness of the vaccine deteriorates over time."
Following federal guidance, Arkansas health officials also continue to encourage booster shots for anyone who received the single-shot Johnson & Johnson vaccine at least two months ago.
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The change in policy on Moderna and Pfizer boosters came as the state's count of cases rose by 151, the third daily increase in a row that was larger than the one a week earlier.
The number of people hospitalized with the virus remained at 282.
Rising for the second day in a row, the number of the state's virus patients who were on ventilators went up by one, to 59.
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The number who were in intensive care fell by six, to 119, its lowest level since June 18.
The state's death toll from the virus, as tracked by the Department of Health rose by 12, to 8,579.
Also on Monday, the University of Arkansas for Medical Sciences notified its employees that they must be fully vaccinated by Jan. 4.
The announcement came despite a state law, signed by Hutchinson in April, that requires state-run health care facilities to seek approval from the Legislative Council for such mandates.
UAMS spokeswoman Leslie Taylor said the policy was prompted by a rule issued earlier this month by the federal Centers for Medicare and Medicaid Services requiring facilities that receive Medicare or Medicaid reimbursement to have vaccine mandates.
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"As you know, the state of Arkansas has joined a lawsuit challenging the federal mandate," Taylor said, referring to a suit filed by 10 states on Wednesday in federal court in Missouri.
"We have no way of knowing right now if that suit will result in an injunction. In the meantime we have been given a very short timeline by CMS. We can't wait and have to go ahead and act to meet those deadlines or we risk losing funding that will result in closing essential programs."
A Legislative Council co-chairman, Sen. Terry Rice, R-Waldron, said the move is contrary to the state law, Act 977.
"They're ignoring state law for federal law," Rice said.
"I understand their need for safety and I know it's well intended. There will be people who will get the shot or be out of a job, and that's a shame."
He said people have legitimate concerns about taking the vaccine that aren't being honored.
"It's going to be a shake out," Rice said. "I don't know what it's going to be, but I think it's better to entice people to get the vaccine instead of forcing them."
Taylor said implementing the requirement was "a hard decision for us as we care about and value all of our employees regardless of their stance on the vaccine."
"However, failure to comply with the CMS rule could result in the loss of CMS funding, which in the case of UAMS is about $600 million a year," she said.
That funding loss -- nearly 60% of UAMS's total funding -- would force the academic medical center to close programs in three of its mission areas including patient care, education and research, Taylor said.
It would also result in the loss of thousands of jobs.
"Losing this funding would severely hamper our ability to train tomorrow's physicians, nurses, pharmacists and other health care professionals, offer unique clinical programs and search for cures in our laboratories," Taylor said. "The results would be devastating for the health and health care of our state."
Employees taking a vaccine with a two-dose regimen must have their first shots by Dec. 5.
Employees also have the option of requesting a medical or religious exemption.
"An employee's failure to either get fully vaccinated or obtain an exemption by Jan. 4 would result in termination," Taylor said. "We don't want to lose any of our employees but the alternative would result in the loss of many more jobs and programs."
She said about 80% of UAMS employees are fully vaccinated, and many have received booster shots.
"We are hopeful that our medical staff can work with those who are not vaccinated to answer their questions and provide enough information that will help them trust the science and decide to get the vaccine," she said.
The potential conflict between Act 977 and the federal rule also affects the state's five human development centers, the Arkansas State Hospital in Little Rock and the Arkansas Health Center in Benton, all run by the state Department of Human Services.
Human Services Department spokeswoman Amy Webb said last week the department had made its staff aware of the federal requirement and was working with Attorney General Leslie Rutledge's office to "watch the litigation and the potential impact it may have."
Hutchinson's announcement on the Pfizer and Moderna boosters came after similar moves last week by Colorado, California and New Mexico.
New York City also expanded eligibility for boosters on Monday.
At his weekly news conference at the state Capitol, Hutchinson said Arkansas Health Secretary Jose Romero had informed the U.S. Centers for Disease Control and Prevention about Arkansas' change in policy.
Asked last week about states that have broadened booster eligibility, CDC Director Rochelle Walensky said the U.S. Food and Drug Administration is "looking at the data for expanding boosters to all populations."
"For those who are eligible for a boost now, we would absolutely encourage that they get boosted: those over the age of 65, certainly those with co-morbid conditions, and then people who work and live in high-risk settings," Walensky said at a White House covid-19 response team briefing with reporters.
According to the CDC, 244,138 Arkansans, representing 16.6% of the state's fully vaccinated population, had received a booster dose as of Monday.
That number includes third doses of the Pfizer and Moderna vaccines that were authorized in August for certain people with compromised immune systems 28 days after their second dose.
As of Monday, about 22% of the state's active cases were among people who had been fully vaccinated, up from about 19% just over a month earlier.
Romero said, however, that such "breakthrough" infections don't appear to be driving the uptick in new cases.
"Our biggest problem is the unvaccinated," he said, noting that infections in fully vaccinated people tend to be milder than those in the unvaccinated.
Since Feb. 1, more than 88% of the state's hospitalizations from covid-19 and 86% of the deaths have been among people who were not fully vaccinated.
Cases have been increasing particularly among children and young adults, Romero said.
"What's concerning is that we are clearly seeing in-school transmission, which we didn't see last year," he said.
"Last year, we saw that these guys were getting infected from their extracurricular activities, that is, sports, band whatever you want to call it. This is in the school itself."
He attributed change to school districts lifting their mask mandates at a time when many students still aren't vaccinated.
According to the CDC, 49.7% of Arkansas children age 12-17 had received at least one vaccine dose as of Friday, and 40.1% were fully vaccinated.
In addition, 11,397 children age 5-11, who became eligible for a low-dose version of the Pfizer vaccine earlier this month, had received an initial vaccine dose as of Monday, representing about 4.2% of the children in that age group.
Hutchinson displayed a chart showing that the pace of vaccinations among the new age group has been slower than it was for children age 12-15 after they became eligible for the Pfizer vaccine in May.
He said the state will target the younger children in its public education campaign.
Romero added that the Health Department can hold vaccine clinics at schools that request them.
Even in districts where masks aren't required, parents can still protect their children by having them wear a mask and getting them vaccinated, Romero said.
He said the Health Department is monitoring whether loosened quarantine guidelines for schools are contributing to the increase in cases but hasn't seen any evidence of that so far.
In one sign of increasing infections among children, active cases among students and employees at the state's public elementary and secondary schools on Monday topped 1,200 for the first time in more than a month, according to a Health Department report.
From Thursday to Monday, total rose by 55, to 1,230.
The cumulative number of cases since Aug. 1, including people who recovered, topped the 25,000-mark as it rose by 499, to 25,296.
The Springdale School District, the state's largest, had the highest number of active cases Monday at 59, which was up from 34 on Thursday.
The Rogers School District, which had the most active cases on Thursday with 53, had 56 on Monday.
The Conway and Fort Smith school districts on Monday each had 54.
Julia Lee Moore Elementary in the Conway School District had to shift to virtual instruction for one day, Friday, because of an outbreak of covid 19.
"Julia Lee Moore Elementary students were back at school today as planned," Conway School District spokeswoman Heather Kendrick said Monday.
"No other schools have had to shift to virtual instruction at this point," she said.
Other school districts in the state also hadn't reported any additional covid-19-related shifts to virtual instruction as of Monday, according to the state Department of Education's Division of Elementary and Secondary Education.
On its website Monday afternoon, the Conway district reported 64 active cases among students, up from 53 on Friday, and a number of cases among staff members of fewer than five.
An additional 347 students were in quarantine after being near an infected person.
Elsewhere in the state, the Bentonville School District had 42 active cases, according to the Health Department report.
The Cabot and Pulaski County Special school districts each had 34. The Little Rock School District, which has had fewer than 10 cases in recent weeks and 16 on Thursday, was listed Monday as having 33.
In its own covid-19 report for a period from 3 p.m. Friday to 3 p.m. Monday, the Little Rock district reported that four students and four employees had tested positive for the virus, and an additional 43 students were in quarantine.
In all, 68 districts had five or more active cases, up two from the 66 on Thursday.
In its reports on school cases, which are released twice a week, the state does not identify districts with fewer than five active cases, but the numbers are included in the totals.
At colleges and universities, the number of active cases among students and employees rose by 17, to 78, from Thursday to Monday.
The University of Arkansas, Fayetteville, had the most active cases, 15, which was up from 13 on Thursday.
The University of Central Arkansas in Conway had the next highest number, eight, on Thursday, followed by Harding University in Searcy with seven and Arkansas Tech University at Russellville with six.
Private elementary and secondary schools had 26 active cases as of Monday, up from 25 on Thursday.
No private schools were identified as having five or more active cases Monday.
ACTIVE CASES FALL
The statewide increase in cases on Monday was larger by 10 than the one the previous Monday.
As a result, the average daily increase over a rolling seven-day period rose to 504, the highest average since the week ending Oct. 22.
With recoveries and deaths outpacing new cases, the number of cases in the state that were considered active fell by 351, to 4,785.
That total was still up by more than 500 compared with a week earlier, however.
Sebastian County had the most new cases on Monday, 15, followed by Pulaski County, which had 11, and Craighead County, which had 10.
The state's cumulative count of cases rose to 519,911.
Health Department spokeswoman Danyelle McNeill said five of the deaths reported Monday happened within the past month, and the others occurred in August.
She said 6.5% of the state's coronavirus tests were positive during the seven-day span ending Sunday, down from the 6.8% that was initially reported for the week ending Thursday.
Hutchinson has said he wants to keep the number below 10%.
The number of people who have ever been hospitalized in the state with covid-19 grew by 14, to 27,959.
The number of the state's virus patients who have ever been on a ventilator remained at 2,954.
At 2,769, the increase on Monday in the Health Department's tally of vaccine doses that had been administered was larger by 677 than the one the previous Monday.
Third doses, including booster shots of the Pfizer and Moderna vaccines, made up 46% of the most recent increase.
First doses rose by 1,271, which was larger by 671 than the increase in first doses a week earlier.
After falling a day earlier, the average number of total doses administered each day over a rolling seven-day period rose to 10,433.
The average for first doses rose to 3,506, the highest average since the week ending Sept. 6.
According to the CDC, 59.3% of Arkansans of all ages had received at least one vaccine dose as of Monday, and 48.8% had been fully vaccinated.
Among the states and District of Columbia, Arkansas ranked 36th in the percentage of its population who had received at least one dose.
In the percentage of its population who were fully vaccinated, it was roughly tied with Georgia and Tennessee for 45th, ahead of North Dakota, Mississippi, Alabama, Wyoming, Idaho and West Virginia.
Nationally, 68.4% of people had received at least one dose, and 58.8% were fully vaccinated.