Arkansas nursing homes, assisted living facilities and other long-term care facilities that meet state Department of Health criteria will reopen to visitors starting July 1, Gov. Asa Hutchinson said Wednesday.
Hutchinson announced the move as the state's death toll from the coronavirus, as tracked by the Health Department, rose by nine, one of the largest one-day increases so far.
The state's official tally of cases increased by 415, to 13,606, while its count of deaths rose to 197.
The number of coronavirus patients in hospitals also continued climbing, reaching a new high of 217, an increase of three from a day earlier.
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Fifty-three of the patients were on ventilators, up from 48 a day earlier.
Meanwhile, Little Rock Mayor Frank Scott Jr. announced that he had asked City Attorney Tom Carpenter to write an executive order requiring that face coverings be worn in public places in the city.
That came a day after the Fayetteville City Council approved an ordinance requiring masks to be worn in most indoor public places.
At his daily news conference on the pandemic, Hutchinson said "there is some conflict" between Fayetteville's ordinance and executive orders he has issued declaring a public health emergency in the state.
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He said he didn't plan to try to interfere with the Fayetteville measure but that he could reconsider if other cities adopt similar rules.
"We want to have a coordinated approach," the Republican governor said. "We don't want to have a hodgepodge of different types of ordinances across the state."
Also on Wednesday, the Kansas Department of Health and Environment added Arkansas, Alabama and Arizona to the list of states from which travelers are advised to quarantine themselves for 14 days.
Six states -- New York, New Jersey, Massachusetts, Illinois, Rhode Island and Connecticut -- were removed from the list, which also includes Maryland. People who have been on cruise ships or traveled internationally are also advised to quarantine.
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'THE RIGHT STEP'
Despite a recent uptick in new cases, Arkansas entered its second phase of reopening on Monday, allowing restaurants, movie theaters, casinos and other businesses to operate at two-thirds of their normal capacity for serving customers on the premises instead of one-third.
White House and federal Centers for Medicare and Medicaid Services guidelines on lifting restrictions that were imposed to slow the spread of the coronavirus recommend against allowing visits to nursing homes and other long-term care facilities until a state enters its third phase of reopening.
Even though Arkansas has not advanced to Phase 3, which would allow businesses to operate at full capacity, Hutchinson said he decided to allow visitors at long-term care facilities because "we're ahead of schedule with our testing in terms of our Arkansas plan."
That plan includes testing every resident and staff member at the state's long-term care facilities this month, a step that the Centers for Medicare and Medicaid Services guidelines also recommend before relaxing any restrictions.
On Tuesday, Hutchinson said that 13,000 residents and staff members had been tested so far this month, and just 113, or 0.9%, were found to have the virus.
"It's the right step for Arkansas, and it's the right time," Hutchinson said Wednesday. "I don't think, whenever we have that low rate, and we've had that success rate -- it's time to take that step to reengage visitation."
Once routine visits are allowed again, they must be scheduled in advance and limited to two visitors for each facility resident, according to a summary of the plan.
The visitors will be screened for symptoms of the coronavirus and will be required to wear masks. The visits will occur, when possible, in a designated area away from residents' rooms.
Outdoor visits are preferred when the weather permits.
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The rules will also allow facilities to resume communal dining and reopen their beauty salons.
Facilities will be required to complete their testing before the visits can resume.
Health Secretary Nate Smith said facilities where a resident or staff member has tested positive will also have to gain the department's approval before allowing visitors.
The requirements will include making sure hospitals in the area have adequate capacity to handle coronavirus patients and that the nursing home has enough staff and protective gear, he said.
He said the rules will include different requirements for nursing homes that haven't had any cases, that have had one or two cases, that have had three to five cases and that have had more than five cases.
"Obviously we understand that if one person comes in that doesn't follow those protocols, and there's a positive test from that, then we have to take steps once again to start over in that facility," Hutchinson said.
"I think everybody understands what's at stake here and the importance of it."
INSPECTIONS TO INCREASE
A Health Department directive on March 13 has barred visits to nursing homes and other long-term care facilities "unless medically necessary or by law enforcement or other emergency personnel" or by staff members from certain state and federal agencies.
Jerry Sharum, director of the Department of Human Services' Division of Provider Services and Quality Assurance, said staff members with the division's Office of Long Term Care will increase the frequency of their facility inspections.
"Visitation and activities will be reduced or stopped if cases develop or other issues arise that warrant those measures," he said.
He said only about a third of the state's more than 200 nursing homes have cases that are active, meaning that the person tested positive and has not yet recovered. And he said 80% of the cases are in 12% of the facilities.
Rachel Bunch, executive director of Arkansas Health Care Association, which represents nursing homes, said nursing homes are "busy adapting and preparing all of these spaces and educating staff and communicating with family members about these requirements."
"We really look forward to seeing these visits happen," she said.
A copy of the rules for allowing visits wasn't available Wednesday evening.
Herb Sanderson, the AARP's Arkansas director, said he would support reopening nursing homes to visitors if adequate protections are in place.
"I can say that isolation in nursing homes in this environment is a real problem, but so are the safety concerns that would be involved in opening them back up," he said.
Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said it's past time to allow the visits to resume.
While the virus poses a threat, visits are important for residents' mental health and to ensure their care is adequate, she said.
"It's time for the nursing homes to step up and follow the infection control protocols that they've been trained on," she said.
At least 72 of the state's virus deaths have been of nursing home residents, according to a state website.
In addition to those who have died, 543 residents have tested positive, Smith said, up from 528 a day earlier.
LITTLE ROCK ORDER
Hutchinson's March 11 emergency declaration prohibits cities and counties from issuing "quarantine regulations of commerce or travel" except "by authority of the Secretary of Health."
Scott, the Little Rock mayor, said his executive order on masks will be written so it does not interfere with the state's directives.
"Despite the state's reopening, we are still in a pandemic, and people are still getting sick, and there are still deaths occurring right here in our state as well as in Central Arkansas and the state's capital city," Scott said. "We do feel it necessary to have public restrictions as we are traversing around and we cannot keep social distance between one another."
The order should be ready by early next week, the mayor said.
The city will also engage in a second mask distribution effort, purchasing 10,000 masks and passing them out to people in underserved areas in an effort to target people who are subject to health care disparities, Scott said.
A distribution effort in May dispensed 10,000 masks at Kroger and Edwards Food Giant grocery stores south of Interstate 630, where some of the city's poorest residents live.
Fayetteville's ordinance requires anyone in the public portion of a business to wear a face covering.
Exceptions are made for when people are eating, drinking or exercising, or in small-group settings in which a distance of 6 feet can be achieved.
It does not apply to outdoor settings unless social distancing is not possible. People with a relevant disabling condition also are exempted.
The ordinance includes no penalty for residents who go maskless, aside from being denied entry to a store.
Business owners could only be penalized for "willful neglect" of the ordinance. The standard penalty for violating an ordinance is a citation and a fine of up to $500, with continual violation at $250 per day.
The city also allocated $100,000 from Fayetteville's emergency fund to put toward a public safety campaign.
The money will be used to buy masks to hand out to businesses for distribution. That way, customers entering a store without a mask could get one. Businesses could also charge customers a small fee to buy their own masks.
Hutchinson said the state already has "very strong guidelines" requiring masks in some settings and recommending them in others.
But, he said, "I don't believe that we ought to get into penalizing citizens or get into a punitive form of trying to have everybody wear masks."
Cities considering adopting their own requirements should coordinate with the state, he said.
"What you don't want to see is 50 different municipal ordinances all providing different directions and requirements or penalties in reference to wearing of masks," he said. "That's not what we want in Arkansas, and that's not what's helpful to business or us to get to where we need."
State directives already say patrons in bars and restaurants must wear masks until food or drink is served.
Clients at salons, barbershops and tattoo parlors must also wear masks as services permit. Mask-wearing is encouraged, not mandated, at retail shops, grocery stores and gyms.
JAIL INMATES INFECTED
The latest cases added to the state's total included 90 in Washington County, 81 in Benton County, 24 in Lee County and 21 in Pulaski County, Hutchinson said.
Smith said 35 of the 415 new cases were prison inmates. Those are often added to the state's overall count several days after the test is performed, after information from laboratory reports is entered in a state database.
Inmates at both the Benton and Washington county jails are among those who have tested positive, officials said.
Kelly Cantrell, public information officer for the Washington County sheriff's office, said there were no more than 15 positive cases at that jail as of Tuesday, according to results from the state Health Department.
Karas Correctional Health, the jail's medical provider, recently obtained covid-19 testing kits and used them for the first time Tuesday on 40 detainees. Several of those tests showed positive results, so the sheriff's office contacted the Health Department, according to a statement posted on the office's Facebook page.
The Benton County sheriff's office on Monday reported a confirmed case in that county's jail. All inmates and staff members were to be tested by the Health Department, according to Lt. Shannon Jenkins, office spokeswoman.
Jenkins said Wednesday that the sheriff's office was awaiting results of the tests.
UAMS SEES UPTICK
During a presentation Wednesday, University of Arkansas for Medical Sciences Chancellor Cam Patterson told the UA System board of trustees that UAMS Medical Center has seen a significant rise in patient encounters related to covid-19 over the past week.
The number of those visits across the system dropped to about 100 per day by the end of April, but it rose again to more than 250 a day over the past week, he said.
Patterson referred to a recent UAMS College of Public Health model that predicts about 150,000 active infections in Arkansas at a peak forecast for Sept. 30. That's about one person in 30 with an infection, and it could mean as many as 3,000 hospitalizations.
"The thumbnail sketch of that scenario is we believe we have the assets across the state to address a surge of that magnitude," he said, but patients probably won't be evenly distributed.
UAMS officials continue to work to devise solutions for that caseload, he said.
The statewide health system also continues testing for active infections and often discovers new "pockets" of infection, Patterson told trustees.
For example, more than 25% of recent tests conducted in North Little Rock came back positive, suggesting that Pulaski County remains at risk of a more serious outbreak.
UAMS clinicians also plan to conduct widespread antibody testing to assess how many people in Arkansas have already been infected with covid-19 around the state, with special attention to sampling from black, Hispanic and Marshallese populations.
"I think that everybody knows that covid-19 is not going away," Patterson said.
Responding to a question from Trustee C.C. "Cliff" Gibson about visiting privileges for family members of hospitalized people, UAMS Medical Center Chief Executive Officer Steppe Mette said it could be months before the hospital lifts all those restrictions.
In a Twitter question-and-answer with the public earlier the same day, Patterson said no staff members or patients were thought to have been infected with covid-19 while in the academic medical center.
Information for this article was contributed by Rachel Herzog and Kat Stromquist of the Arkansas Democrat-Gazette and Stacy Ryburn and Tom Sissom of the Northwest Arkansas Democrat-Gazette.