Hospitalized, ventilator counts up
For 2nd day, patient tallies top records
Already at record levels, the number of covid-19 patients in Arkansas hospitals and on ventilators continued growing on Tuesday as the state’s count of cases rose by 2,620.
After reaching new highs the previous three days, however, the number of coronavirus patients in intensive care fell by two, to 507.
The state death toll from the virus, as tracked by the Department of Health, rose by 24, to 6,346.
Gov. Asa Hutchinson said the state is in a “worse position, in terms of our ICU beds, than we were in January, and largely because of the other health needs that we have that occupy ICU beds.”
He said he plans to meet with a task force of hospital executives, Health Department officials and others to discuss ways to handle the growing number of patients.
“A number of steps are being taken, but everybody has to realize it’s not a good time to get sick because the space is limited,” Hutchinson said.
The Health Department reported Tuesday that 12 of the state’s 1,129 intensive-care beds were unoccupied, up from eight on Monday.
At a news conference at the state Capitol, Hutchinson announced that the state would be increasing the Medicaid reimbursement rate for physicians who administer covid-19 vaccines from $40 to $100 in an effort to get more people vaccinated.
He said only 27,000 of the 627,000 recipients of the traditional Medicaid program in the state who are 12 and older have been vaccinated.
“That is extremely, extremely low in a very vulnerable and at-risk population, and it’s a challenge for us,” Hutchinson said.
“We have to do better for this vulnerable population.”
Among others, the program covers children from low-income families, nursing home residents and poor people who are elderly or disabled.
With classes for most public school districts starting next week, Hutchinson said the state Department of Education will be working to increase the number of vaccine clinics held at schools and will supply schools with “marketing tools” aimed at encouraging vaccinations.
He said the state was also working to supply schools with “high-efficiency filtration masks” for students.
“I recognize that the schools are making differ- ent decisions, and that’s the prerogative they have, but regardless of whether they have a mask mandate in the school or not, there’s going to be children that come there that need masks, that maybe they got rid of their masks last year,” Hutchinson said.
“We want to help the school districts have an adequate supply of that, particularly the high-efficiency filtration masks.”
After setting a record on Monday, the number of patients hospitalized with covid-19 in Arkansas rose Tuesday by 59, to 1,435.
Similarly, the number of virus patients on ventilators set a record for the second day in a row as it rose by eight, to 294.
The previous records for both measures, as reported each day by the Health Department, were set on Jan. 11, when state hospitals had 1,371 covid-19 patients, including 268 who were on ventilators.
REPORT ISSUED
In a report dated Friday, the federal “surge response team” that arrived in Arkansas last week recommended treating more covid-19 patients at small rural hospitals to relieve the stress on large hospitals and implementing “crisis standards of care.”
“At this time many smaller hospitals have been referring patients into their larger regional partners which are overwhelmed with both high acuity COVID19 patients and high acuity patients otherwise displaced by COVID19 patients,” the National Disaster Medical System assessment team said in the report, which was provided to the Arkansas Democrat-Gazette by the Health Department on Tuesday.
The larger hospitals are “out of beds and are holding patients in the Emergency Departments (ED) in anticipation of transfer or possible bed availability from discharges,” the team said in the report.
“Most or all hospitals are on ‘diversion’ or at capacity for med surge and ICU level care.”
The report recommends using telemedicine to allow smaller hospitals to care for sicker patients. It also calls for reducing paperwork requirements for nurses and stretching “nursing ratios to accommodate altered standard of care.”
“Medical facilities are still trying to maintain and sustain a ‘business as usual’ posture,” the team said in the report.
“Implementing Crisis Standards of Care, alongside established surge plans are critical to free up institutionalized mindsets and procedures.”
The report also recommends conducting media campaigns to encourage vaccinations, administering vaccines to patients who visit the hospital or clinics for reasons unrelated to covid-19 and expanding the use of monoclonal antibodies to prevent people infected with the coronavirus from becoming hospitalized.
“As the system is straining and the predicted peak disease burden is still undetermined, urgent action is recommended,” the report says.
Hutchinson said the state has already implemented a number of the report’s recommendations.
For instance, he noted the Legislative Council on Monday approved using federal coronavirus relief funds to make extra payments to hospitals that administer monoclonal antibodies.
Bo Ryall, chief executive of the Arkansas Hospital Association, said he didn’t see “much new” in the report, but called it a good “review of what’s going on in Arkansas.”
As far as small hospitals caring for more covid-19 patients, he said that’s a “hospital-by-hospital decision.”
“The limiting factor with all these are staff – having the staff to add beds or other services,” he said.
ADDITIONAL BEDS
Last week, the Legislature’s Joint Budget Committee approved spending $48.2 million from Arkansas’ allocation of American Rescue Plan Act funds to open 200 additional hospital beds for covid-19 patients at Baptist Health properties in Little Rock, Fort Smith and Van Buren and at Unity Health-White County Medical Center in Searcy.
Baptist Health CEO Troy Wells said Tuesday the health system expects to move “very quickly” to begin opening the 157 beds at its properties once it has signed agreements with the state.
“The beds will open up in phases based upon available staffing,” Wells said in a statement.
“To meet staffing needs for these beds, we are working with external agencies to bring in additional caregivers and support staff to the bedside.”
Unity Health will open the 43 beds at the Searcy hospital as soon as it can find nurses to staff them, spokeswoman Brooke Pryor said.
She said the health system put out a request through an agency on Friday to hire nurses from outside Arkansas.
“If we can’t open all beds at once we’ll open a few beds at a time, if that’s what it takes,” she said.
At its 11 hospitals around the state, Baptist Health had 274 covid-19 patients on Tuesday, above its peak of 273 during Arkansas’ January surge, Wells said.
The patients on Tuesday included 97 who were in intensive care.
“The number of available COVID-19 ICU beds across Baptist Health varies hourly,” Wells said.
“There are very few available ICU beds at our hospitals, and they may fill up at any given time. At one point Tuesday, Baptist Health did not have any ICU beds, including for COVID-19 patients. We are working on a regular basis to ensure Baptist Health is able to provide care for patients, and we are actively working on a plan to increase our ICU capacity in the coming days and weeks.”
He said 88% of the patients on Tuesday, including 92% of those in intensive care, had not been vaccinated.
Pryor said Unity HealthWhite County Medical Center had 35 covid-19 patients on Tuesday and no empty ICU beds.
None of the covid-19 patients had been vaccinated, she said.
Arkansas Children’s Hospital in Little Rock and Arkansas Children’s Northwest in Springdale had a total of 25 patients on Tuesday, including 11 who were in intensive care and seven who were on ventilators, spokeswoman Hilary DeMillo said.
She said none of the patients had been vaccinated, even though more than half were at least 12, making them eligible for the Pfizer vaccine.
“Arkansas Children’s continues to have beds available for children in need of critical care, though we hover at capacity daily,” DeMillo said in an email.
MASKS URGED
Citing the “rampant” spread of the highly transmissible delta variant across the state, the Arkansas Center for Health Improvement’s health policy board on Tuesday called for K-12 schools and higher-education institutions to require students and employees to wear masks indoors.
It also said schools should consider requesting waivers from the state Education Department to delay the start of the school year.
“Unfortunately, children below age 12 are not currently eligible to be protected through vaccination, and only about one in five of those ages 12-18 is fully vaccinated,” the board said in a statement.
“The combination of these factors is likely to fuel the spread of COVID-19 as in-person instruction begins, and mitigation strategies are necessary to protect students and personnel from exposure and decrease the potential for disruption of in-person instruction and extracurricular activities.”
Later Tuesday, the center said its call for mask requirements had been supported by Arkansas Blue Cross and Blue Shield; Arkansas Children’s Hospital; Arkansas Children’s Northwest; the Arkansas Hospital Association; the Arkansas Medical, Dental & Pharmaceutical Association; Baptist Health; CHI St. Vincent; Mercy Hospital Northwest Arkansas; the University of Arkansas for Medical Sciences; Washington Regional Medical Center; and Rabbi Barry Block of Congregation B’nai Israel.
“The Delta variant is more than twice as contagious as previous strains of this virus, and it is attacking children at a rate we have not seen before,” Center for Health Improvement CEO Joe Thompson, a pediatrician and former Arkansas surgeon general, said in a news release.
“Over the next few weeks, the crisis facing our state could be catastrophic.”
Public schools and other government entities had been barred from requiring masks by Act 1002, signed by Hutchinson in April, but Pulaski County Circuit Judge Tim Fox on Friday issued an order blocking the law from being enforced while lawsuits challenging it are pending.
Noting the high level of transmission in Faulkner County and the surrounding region, University of Central Arkansas President Houston Davis said Tuesday that masks would “immediately” be required in classrooms and other common indoor areas at the Conway university.
He said the university will email students each Sunday on the status of the requirement, which is based on the level of transmission as determined by the U.S. Centers for Disease Control and Prevention.
“We are seeing that the Delta variant spreads much faster than previous variants even among vaccinated individuals when unmasked,” Davis said in a message to campus.
“With concerns for community spread requiring consideration of both vaccination and masking strategies, we must make adjustments to our operations for the next few weeks.”
Masks will be required when the level is “high” and encouraged when it’s listed as “moderate,” Davis said.
When the level is listed as being “low,” the campus will “follow normal business and operational patterns,” he said.
The boards for the Bryant and Pulaski County Special school districts also adopted indoor mask requirements on Tuesday.
The Bryant district’s requirement will be in effect for up to 30 school days. The Pulaski County Special district’s board will review its policy after 60 days.
The Fayetteville School District’s board passed a similar requirement on Monday, with plans to revisit the issue by October.
As of Monday, the Camden Fairview and Fort Smith school districts, Lisa Academy, Episcopal Collegiate School, and all Catholic elementary schools are implementing various forms of a mask mandate.
The school boards for the Jacksonville North Pulaski, Little Rock and North Little Rock school districts are expected to meet this week to discuss the issue.
The Little Rock district on Tuesday reported 16 cases of covid-19 among students and staff, and 26 individuals who had to be quarantined because of symptoms or exposure to covid-19 between 3 p.m. Friday and 3 p.m. Tuesday.
Most district employees started work for the new school year on Monday, with classes starting on Monday of next week.
REVISED GUIDANCE
Hutchinson said he didn’t support delaying the start of classes.
“You’re still going to be left with [children younger than 12] still not able to get vaccinated, so that challenge is still there,” he said. “You’re still going to be faced with low vaccination rates, even though we hope to improve those. And so we don’t see any advantage by delaying school. People are planning on that.”
In revised guidance to school districts on Tuesday, the state Education Department noted that the CDC has recommended that all individuals in schools age 2 and older wear masks indoors.
The guidance also noted Fox’s order.
“Under the order, there can be no enforcement action taken against any school district or charter school that adopts or implements a requirement to use masks/ face coverings,” the department said in the guidance document.
“It is recommended that districts and charter schools consult district legal counsel when considering the adoption or implementation of mask/face covering requirements and the applicability of current local policies.”
Gina Windle, the department’s chief of staff, said the department started working on the campaign promoting vaccinations about a week ago.
She said it will target students, parents and educators.
Key said it will be a continuation of efforts over the past few months by the Education and Health departments.
“You will see a number of social media efforts targeted to our student population, especially those that are in the 12 and up category,” he said.
ACTIVE CASES RISE
The statewide increase in cases on Tuesday was larger by 277 than the one the previous Tuesday.
As a result, the average daily increase in the state’s case count over a rolling seven-day period rose to 2,324, which was still just short of its level as of the week ending Saturday.
With new cases outpacing recoveries, the number of cases in the state that were considered active rose by 562, to 23,377.
Pulaski County had the most new cases, 356, followed by Benton County, which had 225, and Washington County, which had 154.
The state’s cumulative count of cases rose to 407,892.
The number of people who have ever been hospitalized in the state with confirmed infections grew by 136, to 19,462.
The number who have ever been on a ventilator rose by 23, to 1,977.
VACCINATIONS DOWN
Meanwhile, the increase of 11,466 vaccine doses that providers reported having administered, including second doses of the Pfizer and Moderna vaccines, fell short of the increase of more than 30,000 doses the previous Tuesday, according to Health Department figures.
The average number of doses administered each day over a rolling seven-day period fell by about 2,000, to 10,195.
According to the CDC, 49.4% of Arkansans had received at least one dose, and 37.7% were fully vaccinated.
Among the states and District of Columbia, Arkansas ranked 40th in the percentage of its residents who had received at least one dose.
It was essentially tied with Louisiana for having the 47th-highest percentage of its residents who had been fully vaccinated, ahead of Wyoming, Mississippi and Alabama.
Nationally, 58.9% of people had received at least one dose and 50.3% were fully vaccinated.
“We have to do better for this vulnerable population.”
— Gov. Asa Hutchinson, noting that only 27,000 of the 627,000 Arkansas recipients of traditional Medicaid who are 12 and older have been vaccinated