State ventilator use again at new high

The number of covid-19 patients on ventilators in Arkansas jumped to a new high for the second day in a row Tuesday even as the total number of virus patients in the state's hospitals fell to its lowest level since Aug. 1.

The state's count of cases rose by 2,626, an increase that was larger by more than 400 than the one the previous Tuesday.

Arkansas' death toll from the virus, as tracked by the Department of Health, rose by 22, to 6,934.

After rising by 17 Monday, the number of covid-19 patients who were on ventilators rose by 27, to 388, which was larger by 120 than the peak in January during the state's winter surge.

"This is a significant concern, and it reflects the seriousness of the delta variant and the challenges that our hospital personnel face," Gov. Asa Hutchinson said.

The total number of hospitalized covid-19 patients, meanwhile, fell by 45, to 1,212, which was down from an all-time high of 1,459 on Aug. 16 and smaller by 159 than the numbers in January's peak.

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At his weekly news conference at the state Capitol, Hutchinson noted that while the state's daily case increases have "flattened out" after rising steeply in July and early August, new cases among people 18 and younger have continued to shoot up.

He said about 30% of the 22,422 cases in the state that were active as of Tuesday were among people in that age group.

"It is of great concern, and it reflects not a lack of care by the schools, or lack of diligence on even parents' parts," he said. "It simply reflects the seriousness of the delta variant and how it is impacting a larger percent of the younger age.

"We put that out there because people need to be mindful of that, to take the proper precautions and not to say, 'Well, it's not going to have an impact on our young people like last year with the original covid variant.

"Today, it's a different world with the delta" variant.

He displayed a chart indicating that more than 100 people 18 and younger were hospitalized each month in July and August, setting new state records.

"We're concerned about Labor Day coming up," Hutchinson said. "We're concerned about continued activities with school."

He said he didn't plan to limit those activities, but he emphasized the need to take precautions such as wearing masks and getting vaccinated.

Since June 6, people who have been infected and also were unvaccinated have been three times more likely to be hospitalized and 3.2 times more likely to die from covid-19 than those who were infected despite being fully vaccinated, according to the Health Department.

The number of covid-19 patients who were in intensive care, which reached an all-time high of 558 on Aug. 23, fell Tuesday by two, to 531.

The number of intensive care units that were unoccupied statewide, however, fell by two, to 19, as a result of an increase in non-covid-19 patients who were in intensive care.

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The average daily increase in the state's case count over a rolling seven-day period rose to 2,061, which was still down from the nearly seven-month high of 2,351 the average reached the week ending Aug. 7.

With recoveries and deaths outpacing new cases, the number of cases in the state that were considered active fell by five.

YOUNGER, SICKER

Compared with their peaks in January, the record number of patients hospitalized with covid-19 on Aug. 16 was about 6% higher, while the number on ventilators Tuesday was about 45% higher.

"I can tell you that the patients are younger, and the patients are much sicker," Baptist Health Chief Executive Officer Troy Wells said at the news conference.

He said 87% of the patients hospitalized at the health system's 11 hospitals around the state had not been fully vaccinated.

With the help of $37.7 million from Arkansas' allocation of funding from the American Rescue Plan Act, Baptist Health last month opened 157 beds, including 33 ICU beds, for covid-19 patients at its hospitals in Little Rock, Van Buren and Fort Smith.

Outside of that project, Wells said Baptist Health on Tuesday opened 12 more intensive care unit beds at Baptist Health Medical Center-North Little Rock, and it was working on opening eight more ICU beds each in Fort Smith and Conway.

"We haven't stopped looking for real estate, if you will, for ICU beds," Wells said.

"We continue to work hard on bringing in staffing from out of the state from nurses coming off of other contracts that can come to Arkansas."

He said Baptist Health Medical Center-Little Rock is also working to expand its neonatal intensive care unit by eight beds.

The unit has seen an increase in patients as unvaccinated pregnant women become infected with the coronavirus, leading to premature births.

"We found recently that our neonatal intensive care unit has been extremely busy and even out of beds on certain days, and I think that's been the case throughout the Central Arkansas community," Wells said.

PEDIATRIC CASES

With 16 pediatric covid-19 cases, including eight in the ICU, staffing at Arkansas Children's Hospital remains stretched, hospital spokeswoman Hilary DeMillo said.

"Especially among our ICU teams, but we have physical space and resources to accommodate more patients," DeMillo said.

"We believe we are coming down from the unprecedented peak of RSV cases. This combined with the start of school, which typically slows admissions, has created a census that is back to a more manageable number."

Respiratory Syncytial Virus is a respiratory virus that usually causes only mild cold symptoms, but can cause bronchiolitis and pneumonia, especially in infants and older adults, according to the U.S. Centers for Disease Control and Prevention.

"We remain vigilant regarding a host of variables though. With school starting, more kids are closer together, which leads to masking concerns, combined with slow-moving vaccination rates, waning immunity and emerging variants," DeMillo said. "All of this creates a situation that is hard to predict."

As of late Tuesday, there were 6,784 active covid-19 cases in Arkansas children ages newborn to 18 years old, according to Health Department data.

To date, there have been 80,580 covid-19 cases in patients from newborn to 18 years old, according to Health Department data. Of that number, 752 required hospitalization, and 100 were admitted to the ICU.

There have been 3,551 cases in children under 1 year old; 9,602 cases in children 1-4 years old; 24,283 cases in children 5-11 years old; and 43,144 cases in children 12-18 years old.

There was no data on the number of pediatric patients who required ventilator intervention.

Between RSV and the latest covid-19 surge, more pediatric patients are requiring ventilators to be able to breathe, said Dr. Abdallah Dalabih, a pediatric critical care physician at Arkansas Children's Hospital.

"In the previous waves, we did not need to place many pediatric patients on ventilators. The children who needed ventilation in the previous waves had other risk factors that made them more susceptible to lung disease," Dalabih said. "This time we are seeing many children who were previously healthy, and they are arriving with very bad lung disease -- enough to require help with a ventilator. This is different than before. The number of those patients presenting with lung disease severe enough to be in the critical care unit has increased significantly since July 2021."

The children and teens are placed on ventilators when their lungs are not able to do one of two functions: provide oxygen to the rest of the body (oxygenation) or exhale carbon dioxide efficiently (ventilation), Dalabih said.

"The patient first starts to increase their respiratory rate to keep up with the body's demand, then they start breathing deeper and heavier to keep up with the demand," Dalabih said. "We attempt to help the lungs by providing oxygen first through a mask or a cannula, but if that is not enough, we try to help by giving oxygen and air under pressure."

This pressurized air can be given via a bipap machine or a ventilator. The ventilator provides that pressure through a tube inserted in the patient's mouth running directly to the lungs.

"Covid patients facing critical illness treated at ACH who needed to be placed on a ventilator tend to be on a ventilator for one week or up to four weeks," Dalabih said. "This is a long time in the context of pediatrics."

There is no difference in ventilator use or protocol between pediatric and adult patients, Dalabih said. The machines are the same size as those used for adults.

"The difference is if we have a smaller child, then the size of the endotracheal tube would be smaller than those used in adults," Dalabih said. "The tubing of the machine may be also smaller according to the child's size."

Arkansas Children's Hospital has sufficient inventory of ventilators and the disposable parts of the machines such as the tubing, he said.

"We are at a higher risk of running out of respiratory therapists and nurses than running out of ventilators," Dalabih said. "In addition to our main ventilators, we have other smaller ventilators (home ventilators and bipap ventilators), that we can use in the case of a catastrophe where all the primary ventilators are being used."

DeMillo added that the hospital is continuing to convert more patient rooms to negative-pressure spaces to make room for more pediatric patients.

"We are able to add a couple each week, which slowly increases our capacity to care for patients with infectious diseases like covid," she said.

In a memo Friday, Arkansas Children's notified medical staffers that it was adopting a vaccine requirement effective Sept. 30.

Chief Executive Officer Marcy Doderer announced in July that upper-level staff members would be required to be fully vaccinated by that date.

The new requirement applies to all medical staff members.

New employees have been required since Aug. 16 to have had at least one dose of vaccine by their start dates and to be fully vaccinated within the following 30 days.

MASKS RECOMMENDED

Health Secretary Jose Romero said the number of pediatric cases in the state is "increasing, and increasing rapidly."

He said "almost every case in the state" is being caused by the delta variant.

Because it's so much more transmissible than previous coronavirus strains, he said children are more likely to become infected in the classroom than they were last school year.

He said the use of masks remains "a very efficient way of impeding transmission," especially for children younger than 12, who are not yet eligible for the vaccines.

About 44.7% of children and teenagers age 12-18 had had at least one vaccine dose as of Tuesday, and 30% were fully vaccinated, he said.

"We're making slow progress, but we need to do better than that," Romero said.

Within the next week or so, Education Secretary Johnny Key said the state Department of Education plans to ship more "high-efficiency filtration" masks, including child-size masks, to school districts.

He said officials are also planning vaccination clinics this week at high school football games in Camden, Little Rock, Osceola, Prescott and Wynne.

INSTRUCTIONAL SHIFTS

While the number of active cases among public school students and employees reached a record level this week, only a few shifts to virtual instruction have been reported since classes for most students started about three weeks ago.

Shifts this week were affecting first-graders at Clinton Elementary School in the Pulaski County Special School District and kindergartners at C.B. Partee Elementary School in the Brinkley School District.

The entire Augusta School District, meanwhile, is making Friday a half-day of school to be made up in January, according to information reported to the Education Department.

District leaders want to use early student release time "to identify the root causes to the number of students having to be quarantined."

District leaders do not think covid cases are originating at the schools, but 18 students, as well as some staffers, have tested positive in recent days, and 158 people have been quarantined after being near an infected person.

Augusta Superintendent Cathy Tanner was driving an afternoon school bus route and was not immediately available for additional information.

In the 24-hour period ending at 3 p.m. Tuesday, the Little Rock School District reported that 10 students and three employees had tested positive for the virus, and 40 students had been required to quarantine at 19 campuses.

The district also reported that in August, it logged 220 cases among students and 51 among employees, and 1,016 people were required to quarantine.

Some of the cases and quarantines occurred before classes started for students on Aug. 16.

MANDATES PANNED

A law passed during this year's regular legislative session banned schools and most other state and local government entities from requiring people to wear masks, but Pulaski County Circuit Judge Tim Fox on Aug. 6 blocked the enforcement of the law while a lawsuit challenging its constitutionality is pending.

In a filing Tuesday, attorneys for the state's Republican legislative leaders asked the state Supreme Court to stay Fox's ruling, arguing that mask mandates interfere with efforts to encourage more people to get vaccinated.

"Mandates exacerbate distrust in the vaccines and in government efforts to encourage vaccinations among the people that are the target of the State's COVID-19 public health policy -- the remaining unvaccinated Arkansans," the filing by the attorneys for House Speaker Matthew Shepherd of El Dorado and Senate President Pro Tempore Jimmy Hickey of Texarkana said.

Hutchinson, who has hired his own attorneys to represent him in the case in his capacity as governor, has said he regrets signing Act 1002, which bans mask mandates, and agrees that it is unconstitutional.

In a court filing last week, he said he doesn't approve of a statewide mask mandate, but he is in favor of school districts independently exercising that option.

POSITIVITY DECLINING

According to a chart Hutchinson displayed at the news conference, 12.9% of Arkansas coronavirus tests were positive the week ending Monday.

The percentage has been trending mostly downward since the week ending Aug. 4, when it was 16.3%.

Although he said he'd like to keep the rate below 10%, he called the recent decline one of the indicators that "gives us hope we're moving in the right direction if Labor Day does not disrupt our progress."

According to rankings Tuesday from the CDC, Arkansas had the country's 11th-highest number of new cases per capita over the seven-day span ending Monday, down from the ninth-highest the week ending Thursday.

Arkansas' new deaths per capita continued to be the country's second-highest after Louisiana.

Within Arkansas, Pulaski County had the most new cases with 211, followed by Benton County with 182, and Washington County with 159.

The state's cumulative count of cases rose to 452,891.

The number of people who have ever been hospitalized with confirmed infections of covid-19 in the state rose by 130, to 21,300.

The number who have ever been on ventilators with covid-19 rose by 15, to 2,197.

CITY DATA

Also Tuesday, the Arkansas Center for Health Improvement added information to its website on vaccination rates in Arkansas cities, unincorporated communities and ZIP codes.

According to the site, Cave Springs in Benton County had the highest rate, with 56% of its residents fully vaccinated as of Aug. 23.

Four other cities or communities had rates at or above 50%: Brockwell in Izard County, with 55%; Higginson in White County, with 51%; Cammack Village with 51%; and Maumelle with 50%.

The lowest rates were in Brickeys in Lee County and Vendor in Newton County, where just 1% of residents were fully vaccinated.

Among the state's largest cities, the rate was 45% in Little Rock, 36% in Fayetteville, 34% in Fort Smith and 36% in Springdale.

The site notes that the data does not include information on Arkansans who were vaccinated in other states, "which may result in some rates being underreported."

VACCINATIONS UP

At 13,642, the increase in vaccine doses that providers reported having administered, including second and third doses of the Pfizer and Moderna vaccines, was larger by almost 2,700 than the one the week earlier.

The average number of doses administered each day over a rolling seven-day period rose to 13,239. That remained below a nearly four-month high of 13,361 per day the week ending Friday.

According to the CDC, the number of Arkansans who had received at least one vaccine dose rose Tuesday by 1,427, to 1,604,567, or about 53.2% of the state's population.

The number who had been fully vaccinated rose by 2,420, to 1,253,068, or about 41.5% of the population.

Among the states and District of Columbia, Arkansas ranked 37th in the percentage of its residents who had received at least one vaccine dose and 44th, ahead of Louisiana, Georgia, West Virginia, Idaho, Wyoming, Alabama and Mississippi, in the percentage who were fully vaccinated.

Nationally, 61.8% of people had received at least one vaccine dose, and 52.4% were fully vaccinated.

Information for this article was contributed by Andrew DeMillo of The Associated Press.