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story.lead_photo.caption Nurses Mandy Stuckey (left) and Tonya Green conduct a coronavirus screening in April at a drive-thru site at New Life Church in North Little Rock. The site, and one at Ouachita Baptist Universityin Arkadelphia, is a partnership between two Arkansas companies. More photos at arkansasonline.com/42testing/. (Arkansas Democrat-Gazette/Thomas Metthe)

Covid-19 hospitalizations in the state passed the 900 mark for the first time Wednesday, less than two weeks after topping 700 for the first time, and eight days after topping 800, according to data from the Arkansas Department of Health.

The number of covid-19 hospitalizations rose by six to 901 Wednesday, according to Health Department data.

There were 143 virus patients in Arkansas on ventilators Wednesday. That is also a new record for the state, and it comes at a time when the number of available ventilators in the state -- 615 currently -- continues to shrink.

"Our hospitalizations again reached an all-time high today," Gov. Asa Hutchinson said. "This puts a strain on our medical teams, and it's never been more important for all of us to do our part and be part of the solution. Thanks to everyone for making common sense and necessary adjustments for Thanksgiving."

Another 1,715 new cases were added Wednesday, raising the cumulative reported total since the pandemic began to 137,617. Of those, 118,751 Arkansans are considered recovered.

[CORONAVIRUS: Click here for our complete coverage » nwaonline.com/coronavirus]

Deaths from the virus rose by 30 to 2,275. It is only the third day since the pandemic began in which the total number of recorded deaths was 30 or higher.

On Wednesday morning, a joint letter from hundreds of physicians in the state was delivered to Hutchinson asking the governor to implement and enforce stricter covid-19 interventions.

The letter was signed, "The Physicians of Arkansas" and was followed by several pages of about 300 names, time stamps, the doctor's field of medicine and the date of signature.

Dr. Heather Young, a pediatric infectious disease physician, said the desperation for help has been building as the cases and deaths have rapidly increased.

"They're getting really hammered, and they're going to continue to get hammered. Hospitals are having to figure out how to make additional beds, additional ICU beds. They're reaching their capacity for being able to have patients in the ICU.

[DOCUMENT: Open letter from Arkansas physicians to Gov. Asa Hutchinson » arkansasonline.com/1119docsletter/]

They're having to come up with contingency plans," Young said. "That's now. If we keep going along this trajectory, that's only going to get worse."

Young, as well as the doctors who signed the letter, emphasized that the opinions expressed were from the physicians as individual citizens and in no way representative of the medical institutions where they practice medicine.

"We are seeing ICUs full of COVID-19 patients. Our hospitals are filling up to the brim, and the virus is continuing to spread unchecked in our communities, meaning that the worst is approaching," according to the letter. "Soon we will shoot past our capacity to care for patients. We will need field hospitals, the children's hospitals will need to take adult patients, and our ability to care for patients with routine emergencies such as trauma patients, heart attacks, and strokes will be greatly compromised."

"Health care providers will become overwhelmed and burn out, as many have already. We will see COVID-19 take the lives of many Arkansans, both directly and indirectly."

Specifically, the doctors asked that the governor enforce a universal mask mandate, close bars and gyms, limit restaurant service to take-out only and restrict all indoor gatherings to fewer than 10 people.

[DOCUMENT: Gov. Asa Hutchinson’s response to open letter from Arkansas physicians » arkansasonline.com/1119govsletter/]

The state is at a "crucial point" in the pandemic," the letter reads.

"Arkansas needs strong leadership now more than ever," the doctors wrote in the letter. "We, the physicians of Arkansas, implore you to take the necessary steps to save lives, even if they are unpopular steps to take. Countless lives depend upon it."

Young said the governor is being informed by "some of the smartest people in the state" at the Health Department and "he really needs to listen to them."

"This is not a sustainable trajectory," Young said. "If the governor is unwilling to listen to the options presented by the Health Department or physicians in the state, then in a few weeks, when there are freezer trucks being used for morgues, we're going to say, 'We tried to tell you.'"

[Interactive Arkansas map not showing up above? Click here to see it: nwaonline.com/arvirus]

Hutchinson responded with a letter to the physicians, provided Wednesday afternoon to the Arkansas Democrat-Gazette, expressing gratitude for their "selfless service, invaluable leadership, and adaptability" demonstrated in the face of the pandemic.

The governor thanked the doctors for the suggestions and followed with four paragraphs of restrictions and remedies already in place.

Hutchinson also referred to Executive Order 20-43, which he signed on July 16, creating a statewide mask mandate when social distancing is not possible. The mandate includes a fine up to $500 after the first warning, "and local law enforcement is responsible for enforcement of this mandate," Hutchinson said.

"Please be assured I share your commitment to slowing the spread of COVID-19 in Arkansas, and I recognize the importance of maintaining our hospital capacity," Hutchinson wrote in the letter. "I will continue to be guided by the expertise and experience of public health officials and evaluate appropriate actions to mitigate the impact on our hospital capacity. Thank you again for your letter and for your dedication to the health and safety of all Arkansans."







BY THE NUMBERS

There are 16,577 active covid-19 cases in the state, an increase of one from the day before.

Of the 1,715 new cases, 68 were attributed to correctional facilities, and the remaining were the result of community spread.

The county with the most new confirmed and probable cases was Pulaski County with 176, followed by Washington County with 147; White County with 105; Benton County with 84; and Craighead County with 78.

The counties with the highest number of active cases include Pulaski with 1,701; Washington with 1,373; Benton with 1,206; Sebastian with 782; Craighead with 760; and White County and Saline County with 614.

Other counties with a high number of active cases include Faulkner with 470; Greene with 425; Garland with 389; Jackson with 349; and Jefferson, 408.

Of the 2,275 deaths since the pandemic began, 51 were in correctional facilities, and 939 were in nursing homes.

Results from 9,924 polymerase chain reaction (PCR) tests were reported Wednesday, along with 2,467 rapid antigen tests.

There have been more than 1.6 million covid-19 tests taken since March. The positivity rate as of Wednesday was at 8% for PCR and 17.1% for antigen tests. The PCR tests take longer to get results, but are more accurate than the faster antigen tests.

HOSPITALIZATIONS

The number of Arkansans currently hospitalized with covid-19 began on Nov. 1 with 655 and grew to 901 by Wednesday -- a 37.5% increase.

Hospitals in the state are scrambling to meet the staffing and space needs, even creating ICU beds when capacity is reached and postponing nonessential surgeries to save bed space.

Ventilator use, at a record high, has reduced the state's availability to 615 -- 67% of the state's 1,028 ventilators.

Of the state's 9,144 hospital beds, 2,344 -- or nearly 26% -- are available. The number of open hospital beds includes hundreds of psychiatric and rehabilitation beds that are not used for covid-19 care.

At the beginning of the month, the state had 131 intensive care unit beds available out of its 1,081 beds. On Wednesday, there were only 83 ICU beds available, a nearly 37% decrease.

That drop in availability comes even after hospitals in the state created 42 more ICU beds, according to Health Department data.

"Since March, the state's hospitals have been increasing ICU and critical care capacity to meet the needs of our patients," said Ashley Warren, spokeswoman for the Arkansas Hospital Association. "The latest ICU bed increase was reported by the North Central and Northwest hospital regions. Hospitals are also actively seeking to increase personnel resources -- like critical care nurses and respiratory therapists -- to ensure that the added physical resources can be staffed."

The University of Arkansas for Medical Sciences hospital has maxed out its intensive care unit beds, said spokeswoman Katrina Dupins.

"We are limiting elective surgeries that require hospitalization," Dupins said. "It's not to reserve ventilators, it's to reserve beds."

Baptist Health Chief Executive Officer and President Troy Wells said the health care system has available hospital beds and has added around 30 new ICU beds across the system with plans to add more at the beginning of the year.

"It's important to remember that it is not uncommon to run at or near capacity for ICU beds and this can vary from hour to hour. We flex and adjust when needed, and we have surge plans that would help create additional capacity," Wells said. "Covid-19 is not so much the issue, but it points out an already existing issue with critical care beds and staffing that existed before the pandemic."

Baptist Health is monitoring operating room cases to predict how many will need critical-care beds, Wells said.

"And through-put of non-critical care patients has to be good so that you can move people out of critical care. It's moving patients appropriately through the continuum of care to keep the ICU beds turning over," he said. "You don't want anyone in the ICU a day longer than they need to be, so through-put is extremely important."

The pandemic is also putting more pressure on the existing problem of nurse shortages, especially critical-care staffing, Wells said.

"We feel that we are meeting our patients' needs with quality, safe care, though staffing for health care is always a challenge and something we deal with on a daily basis," Wells said.

Wells said he's hopeful about new treatments for the hospital's use of the drug Remdesivir "with "very good results;" the FDA issued an emergency use authorization last week for Bamlanivimab, a new monoclonal antibody intended to help neutralize the virus and prevent its progression; and on Monday, vaccine developer Moderna announced that its coronavirus vaccine is nearly 95% effective against the virus.

"I'm so proud of our health care workers who keep showing up day after day caring for some of the sickest patients in the state," Wells said. "We cannot say thank you enough for what they are doing in the midst of a pandemic."

LEGISLATORS ILL

The number of state lawmakers who have tested positive for the coronavirus during the past several weeks increased to 13 this week.

Rep. Cindy Crawford, R-Fort Smith, informed House Speaker Matthew Shepherd, R-El Dorado, that she tested positive for the coronavirus, House spokeswoman Cecillea Pond-Mayo said Tuesday.

Crawford "indicated she is doing well," Pond-Mayo said.

Crawford could not be reached for comment by telephone Wednesday.

Sen. Larry Teague, D-Nashville, said Wednesday that he recovered from the coronavirus about three weeks ago, after he tested positive. He suspects he got the virus from one of his wife's therapists.

He said he and his wife both tested positive for coronavirus, and "it was like a bad flu."

He said he didn't tell fellow lawmakers about his positive test for covid-19.

"I didn't come to Little Rock, so I figured they didn't need to know," said Teague, who is a co-chairman of the Joint Budget Committee.

He said he participated in the Senate's Nov. 6 organizational session via Zoom.

Since March, 17 state lawmakers have acknowledged testing positive for covid-19. There are 35 state senators and 98 state representatives with two vacant seats.

Information for this article was contributed by Michael R. Wickline of the Arkansas Democrat-Gazette.

Coronavirus daily updates and cumulative covid-19 cases in Arkansas

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