The number of people hospitalized in Arkansas with covid-19 reached a new high Wednesday as the state's count of cases rose by 2,893 -- the second-largest one-day increase since the start of the pandemic.
The state's death toll from the virus, as tracked by the Arkansas Department of Health, rose by 38, to 3,376.
At a record level since Tuesday, the number of virus patients in state hospitals rose by seven, to 1,110.
Those patients included 174 who were on ventilators, up from 173 a day earlier.
"Today's high number of cases is concerning as we're two days away from Christmas," Gov. Asa Hutchinson said in a statement Wednesday.
"This is frequently a time to gather with our family in large groups, but this year that presents an increased risk of spreading COVID-19, so let's plan with our safety guidelines in mind. Please protect yourself and your family."
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Also Wednesday, state Epidemiologist Jennifer Dillaha said officials were working on the state's order for its third allotment of the vaccine developed by Pfizer and BioNTech, which the state has initially designated for health care workers.
While the vaccinations so far have gone mostly to high-risk hospital workers, other types of health care workers were being considered as possible recipients of the 23,400 doses the state expects to receive next week for people receiving their first dose of the vaccine.
The order for those doses was due at the U.S. Centers for Disease Control and Prevention this morning, she said Wednesday.
The state also expects 17,700 more doses next week of the Moderna vaccine, which it has initially designated for residents and workers at nursing homes and other long-term-care facilities, along with 25,350 doses of the Pfizer vaccine to provide booster shots for those who already received their first injections.
"We're making very good progress in covering the hospital workers, and so now we're going to be able to provide vaccines to locations around the state where health care workers who don't work in hospitals or long term care can begin to get vaccinated," Dillaha said.
The allotment will include doses for workers at the state's prison hospitals, she said.
Other high-priority workers under consideration to receive shots next week include those working in primary care, urgent care, home health, personal care, hospice, dental clinics and dialysis centers, Dillaha said.
"Hopefully we can get those done fairly quickly and begin to make vaccines available to additional health care workers," she said.
The increase in cases Wednesday was well above the 2,306 that were added to the state's tallies the previous Wednesday.
The state's largest one-day increase, so far, was 3,039 cases that were added on Dec. 17.
After dipping Tuesday, the average daily increase over a rolling seven-day period reached a new high Wednesday as it rose by 84, to 2,348.
"I'm worried about the number of cases, the number of hospitalizations, the number of deaths and what it could mean for us after Christmas," Dillaha said.
She linked the uptick in cases to end-of-the-year sports events and to people going out more in public, "especially if people are going to public locations where other people are not social distancing and wearing masks."
"In general people are out and about more, and I think it's showing," she said.
VACCINE PLANS
Health care providers reported administering a total of 16,203 doses of the Pfizer and Moderna vaccines as of Wednesday morning, although many other shots had been given and not yet reported to the Health Department.
The state has initially designated the Pfizer vaccine for health care workers, with plans to make it available to high-risk health care workers of all provider types before giving it to medium- and low-risk health care workers.
Dillaha said high-risk workers include those who provide care to patients who have covid-19 or are likely to have it, people who perform procedures placing them at increased risk of infection and non-clinical staff members, such as clerks or janitors, who work around covid-19 patients.
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The state's first allocation of the Pfizer vaccine, consisting of 25,350 doses, arrived in the state last week and was designated mainly for workers at the general, acute care hospitals.
This week's 18,525 Pfizer doses were earmarked for high-risk workers at rehabilitation hospitals, psychiatric hospitals, long-term acute care hospitals and surgical hospitals.
Some hospitals that received doses last week also received additional doses this week.
The allotment also included 1,950 doses that the Health Department will distribute to ambulance workers.
Health Department spokesman Gavin Lesnick said those shots will be administered at events around the state from Saturday through Wednesday.
The state this week received its first allotment -- about 51,000 doses -- of the Moderna vaccine.
Nursing home residents and workers are first in line for those shots, followed by residents and workers at centers for people with significant intellectual disabilities and those at assisted living facilities.
Once the vaccine has been made available to high- and medium-risk health care workers and long-term-care facility residents and workers, the state will begin distributing it to the next priority groups, Dillaha said.
Following the recommendation of an advisory panel, the CDC said Tuesday that the next priority group -- "Phase 1b" -- should include people 75 or older and "frontline essential workers," such as firefighters, police, prison workers and those working in manufacturing and grocery stores.
Dillaha said it could be "well into January" before the state moves to that phase, with the amount of time depending on how much vaccine is available and how many people who are eligible for the shot decide to take it.
"It will take us longer of course if a lot of people want the vaccine, which we hope is the case," she said.
'EMOTIONAL' ROLLOUT
The vaccine roll-out at nursing homes and other long-term-care facilities "has been pretty emotional," Rachel Bunch, executive director of the Arkansas Health Care Association, which represents nursing homes, said.
"I expect that to continue into the next couple of weeks," Bunch said. "The sentiment is that this is an answered prayer and light at the end of the tunnel."
Bunch said she doesn't know the total number of vaccines administered so far, but some facilities had on-site vaccine clinics Monday. Some regional vaccine clinics were held Wednesday with more planned today.
"Administration and on-site clinics will ramp up on Monday, and there will be vaccines being administered at multiple facilities around the state," Bunch said.
"It takes time to provide information and obtain consent from family members and staff members."
There are about 53,000 residents in the state's nursing homes, assisted living facilities, residential care facilities and the centers for those with significant developmental disabilities, Bunch has said.
The Arkansas Health Care Association is working on an educational campaign for workers and staff members, she said.
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"We have been compiling information about the vaccine and putting it into a format that our homes can use to share with their employees and family members," Bunch said. "We continue to take lots of calls from homes with questions and troubleshoot issues with numbers of doses, orders, logistics questions, etc."
"The pharmacies that work with our homes are remarkable on a regular day -- and have really stepped up during these extraordinary times offering to help," Bunch said. "Challenges come from the volume and fast-moving pace, and logistics planning."
The team continues to work out how the vaccines will work in the future for new employees and residents, and the availability of more vaccines coming to the state, Bunch said.
"Not to mention anticipation of time lines and what this will mean for changes to our visitation restrictions, covid testing and PPE [personal protective equipment] use in the future," she said."We have a very busy few weeks ahead of us, but the fact that our industry has been able to offer several hundred vaccines to our patients and staff already is a big accomplishment."
HOSPITAL WORKERS
Across the Baptist Health system of nearly 11,000 employees, the first dose of the vaccine has been administered to nearly 5,000 employees and physicians, spokeswoman Margot Vogel said.
"Things have been going well," Vogel said. "We have already been able to quickly administer the first dose of the vaccine to our health care professionals on the front lines and are continuing to offer the vaccine in phases to other employee groups in supporting roles."
The staff members have been excited to get the first dose, she said.
"There has mostly been a mix of joy, hope and relief when they go to get the vaccine," she said.
"A few have had tears of joy. Overall, they feel like this is the first step of slowing down the pandemic."
The hospital will halt the vaccine dosing for the holiday and resume Monday.
There have been "very minor adverse reactions" among some Baptist Health employees vaccinated so far, Vogel said.
"The most common thing people who have had the shot are saying is that the injection hurt less than the flu shot, but they had a sore arm at the site of the injection several hours later," she said.
St. Bernards Medical Center spokesman Mitchell Nail said that by the week's end, the Jonesboro hospital will have provided the first dose of the Pfizer vaccine to 3,300 individuals, including health care workers, long-term-care residents and emergency responders.
"We absolutely believe the covid-19 vaccine will prove essential to lowering our hospital numbers in 2021," Nail said.
The logistics of the vaccine roll-out have gone well, and vaccinations will resume next week, Nail said.
"We've heard the phrase 'early Christmas present' numerous times. Our recipients continually show gratitude and describe the vaccine as hope amid a difficult year," Nail said.
"In addition, they express hope that this vaccine will keep them from unintentionally exposing their families to a deadly virus they encounter every day."
CHI St. Vincent spokeswoman Bonnie Ward said Wednesday that more than 2,000 employees have been vaccinated, so far, at the Little Rock and Hot Springs locations.
"CHI St. Vincent has been able to vaccinate the majority of our high-risk co-workers and has seen little to no adverse reactions," Ward said.
"Vaccination efforts at our facilities have been well-received, and we've seen very good acceptance among our employees and health care providers."
Vaccinations will halt over the Christmas holiday, Ward said, to give "vaccine administrators the opportunity to rest and organize."
"We expect to receive more doses of the vaccine every week, so the number of people who can get the vaccine will increase very quickly," Ward said.
Northwest Health in Springdale has administered more than 1,100 doses so far of the 1,400 doses it has received, said spokeswoman Christina Bull.
"We are first vaccinating individuals who have a high likelihood of contact with covid-positive patients, those caring for vulnerable populations and those whose work is vital to the health care structure and pandemic response," Bull said.
"All is going smoothly," she added.
THE NUMBERS
The cases added to the state's tallies Wednesday included 2,000 that were confirmed through polymerase chain reaction, or PCR, tests.
The other 893 were "probable" cases, which include those identified through less-sensitive antigen tests.
The state's cumulative count of cases rose to 207,941.
That comprised 174,782 confirmed cases and 33,159 probable ones.
The number of cases that were considered active rose by 537, to 22,516, as 2,318 Arkansans were newly classified as having recovered.
Washington County had the most new cases, 272, followed by Pulaski County with 265, Benton County with 260, Faulkner County with 123 and Craighead County with 109.
Among prison and jail inmates, the Health Department's count of cases rose by 140.
Department of Corrections spokeswoman Cindy Murphy said 155 new cases were reported among inmates at six prisons: The Barbara Ester Unit in Pine Bluff, the Grimes and McPherson units near Newport, the Northeast Arkansas Community Correction Center in Osceola, the Southwest Arkansas Community Correction Center in Texarkana and the Tucker Unit in Jefferson County.
She said she didn't have a breakdown Wednesday of how many new cases were in each prison.
The statewide death toll rose by 29, to 2,939, among confirmed cases and by nine, to 437, among probable cases.
Among nursing home and assisted living facility residents, the state count of virus deaths grew by 13, to 1,442.
The number of people who have ever been hospitalized in the state with covid-19 rose by 175, to 10,826.
The number who have ever been on a ventilator with covid-19 grew by 16, to 1,163.
Meanwhile, the Health Department reported that 11.6% of the state's PCR tests were positive over a seven-day span ending Tuesday.
That was up from 11.2% that was initially reported for the week that ended Monday. The percentage for that period later rose to 12.2% as more test results were reported.
Hutchinson has said he wants to keep the percentage -- a gauge of whether a state's testing is adequate -- below 10%.
The Health Department also reported that the percentage of antigen tests that were positive over seven days fell slightly from 22.5% as of Monday to 22.2% as of Tuesday.
BEDS INCREASE
The total hospital beds -- whether filled or vacant -- in the state increased from 8,935 to 8,942 on Wednesday, according to Health Department data. (The total includes more than 300 in psychiatric or rehabilitation facilities that aren't for covid-19 care.)
The number of beds available for use increased by 51, going from 2,175 to 2,226.
There were seven more ICU beds available as of Wednesday afternoon. Out of 1,154 critical-care beds, 62 -- or 5% -- were available.
There were 341 covid-19 patients in ICU beds, three fewer than the previous day.
The state ventilator inventory dropped by three, from 1,081 to 1,078. About 61%, or 656, remained available for use, six more than the day before.
Total bed capacity -- hospital beds that can be staffed whether or not they are occupied -- increased by seven beds to 8,912.
Maximum flex bed capacity -- the number of hospital beds regardless of ability to staff them -- remained at 11,484.
University of Arkansas for Medical Sciences Medical Center spokeswoman Leslie Taylor said that hospital is currently caring for 46 covid-positive patients, with 13 in the ICU.
"We have about 20 regular beds open at this time," she said. "Our ICU is full. We have no available beds."
Staffing and capacity continue to be the biggest issues, Taylor said.
"We have our surge plan, which can be activated if needed," she said.
St. Bernards is seeing a bit of a reprieve in the overall hospitalization numbers, Nail said.
"We currently have ample beds available, and our number of patients hospitalized with covid-19 sits among the lowest levels we have seen in recent weeks," Nail said.
"Our ICU numbers, however, continue to concern us."
He credited the hospital's covid treatment and follow-up clinic as a valuable piece of the ICU puzzle.
"If we can identify covid-positive individuals early who carry a risk of hospitalization, we offer them monoclonal antibody treatments," Nail said. "In turn, these patients often avoid the hospital altogether, let alone the ICU. We prefer to operate proactively, and our covid clinic helps us do so."
Maintaining adequate staffing remains a challenge, Nail said.
The hospital is examining its surge plan to determine if it needs to move to a level that accommodates greater capacity going into the new year, Nail said.
"Viruses often spread after the holidays, and it is not uncommon for us to see higher hospitalization numbers moving into January," Nail said. "Covid will be an additional variable for health care providers in an already busy time. Some of our preparations have included securing PPE, equipment and ventilators."
Ward, the CHI St. Vincent spokeswoman, declined to give specific capacity numbers, but said in an email that the hospital system "remains vigilant in protecting" the community by identifying, isolating and treating people with covid-19 symptoms.
"Our hospitals are currently at high capacity caring for a wide range of patients in need of critical care in addition to those being treated to COVID-19," Ward said. "Patients in need of critical care should not delay that care and allow their conditions to worsen. Our facilities are continuously reviewing our pandemic and surge capacity plans with emergency preparedness teams and are prepared to care for all patients at this time. If our pandemic and surge capacity plans are operationalized, we will work with local public health authorities and inform the community."
Ward said it has been a long year for everyone "in our community, and especially so for the health care heroes."
"Throughout it all, they have risen to the challenge and exemplified the spirit of our healing ministry, which was founded 132 years ago amid a yellow fever epidemic," Ward said. "We are exceptionally grateful for their hard work and sacrifice."
Vogel said Baptist Health has a bed capacity of about 1,200 -- including about 200 critical care beds -- for the entire Baptist system.
"Our bed availability fluctuates daily and sometimes hourly, and we adjust to meet whatever the needs are," Vogel said. "So far we have been successful in staying ahead of the curve so that we are able to provide care to all patients who present to Baptist Health whether that is for covid-19 or other medical conditions."
Concern continues to mount for the hospital's health care workers during such a high patient census, Vogel said.
"Baptist Health's priority is to make sure our staff is getting the rest they need and that we are retaining all of these amazing health care professionals. In spite of the mental and physical fatigue from the last nine months, they continue to amaze every day," Vogel said. "It has been a long nine months since the start of the pandemic, and our staff in so many roles has really come through for the people of Arkansas. It is not an overstatement to call them heroes.."
Lesnick said the state's COVIDComm system, designed to match covid-19 patients to hospitals with available bed space and other resources, had "opened cases involving 56 patients" just before midnight Tuesday.
Not all of those cases resulted in patients being transferred, however, he said.
