The number of Arkansans hospitalized with the coronavirus rose to a new high Thursday as the state's count of cases grew by more than 3,300.
The state's death toll from the virus, as tracked by the state Department of Health, rose by 25, to 3,926.
In a statement, Gov. Asa Hutchinson noted that the 3,323 cases added to the state's tally was a smaller increase than the 3,705 added a day earlier, even though the number of coronavirus tests performed Wednesday was higher than the day before.
The increase in cases Thursday was bigger, however, than the 2,708 that were added the previous Thursday, Dec. 31.
As a result, the average number of cases added to the state's tally each day over a rolling seven-day period rose by 88, to 2,968, setting a record for the third day in a row.
And while the number of polymerase chain reaction, or PCR, tests performed Wednesday, as reported in the Health Department's daily updates, was higher than the number the day before, the number of antigen tests was lower.
Compared with PCR tests, a higher percentage of antigen tests reported to the state tend to be positive, possibly because the Health Department recommends PCR testing for people with no symptoms.
"We also continue to receive and administer doses of vaccine throughout the state," Hutchinson said. "It is critical that we all work together to protect ourselves and our neighbors as this virus steadily spreads across Arkansas."
State Epidemiologist Jennifer Dillaha said the numbers of new cases, deaths and hospitalizations are "still worrisome because the numbers are still high."
She said she hopes the growth in cases, fueled by gatherings over Christmas and New Year's, will level off at some point, but said she's "a little bit skeptical."
"I think it's so widespread right now, and it's so easy for people to be exposed and infected that unless people take very serious measures to protect themselves and to prevent the spread of the disease, it's going to be hard for many people to avoid," she said.
After dipping Wednesday, the number of virus patients in the state's hospitals rose Thursday by five, to 1,326.
Those patients included 218 who were on ventilators, up from 217 a day earlier.
That was still short of the record 224 patients who were on ventilators as of Tuesday.
The number of covid-19 patients who were in intensive care units remained at a record high of 427, the same number reported a day earlier.
Meanwhile, the U.S. Department of Health and Human Services announced this week that Arkansas will receive $173.7 million for coronavirus testing and $27.3 million for vaccinations under the $900 billion pandemic relief package signed by President Donald Trump last month.
Dillaha said how the state will spend the money is "still under discussion."
"We're very glad to receive it," she said. "We have some needs that have been identified, so we'll be working to make sure that those needs are addressed using that funding,"
WAITING LIST STARTED
Under Phase 1A of its plan, the state's vaccination efforts have focused on health care workers and residents and workers at long-term-care facilities.
Dell McCarley, a pharmacist with Express RX in Little Rock's Otter Creek area, administered 30 Pfizer vaccines Thursday to a mix of professionals ranging from hospice nurses, anesthesia providers and speech pathologists to a couple of FBI agents.
"We just got through vaccinating several in the last 20 minutes," McCarley said. "It's been pretty constant all day. The phones have been ringing off the wall. Our biggest hurdle is trying to schedule people so we don't have a lot of people waiting."
The pharmacy has a small waiting room with chairs spaced 6 feet apart. Two pharmacists and two assistants try to monitor safety protocols in the waiting area while administering the shots, answering the phone and conducting usual pharmacy business.
For each person, the whole process takes a minimum of 30 minutes -- from administering the shot to 15 minutes of monitoring for any adverse reaction, McCarley said.
"Once we mix a vial up, which is about six doses, we have six hours to administer those," McCarley said.
Since 2013, the Little Rock-based Express RX has expanded to 30 locations across eight Southeastern states. About seven of the company's Arkansas pharmacies are listed by the Health Department as vaccine administrators.
"Our pharmacists are proud to help meet the urgent need for a safe, efficient and effective COVID-19 vaccination program," Galen Perkins, the company's chief executive officer, said in an email. "We look forward to expanding our offerings to additional state residents, as soon as allowed by the Arkansas Department of Health."
McCarley said phone calls take up a lot of the staff's time.
"People call wanting to know if we have doses that are going to expire that they can get even though they're not in 1A," McCarley said, referring to the Health Department's phased vaccine distribution plan.
The company set up an online waiting list at expressrx.net/covid-19-waiting-list-registration.
"About 90% of our calls, though, are elderly people wanting to get on the waiting list," McCarley said. "We send them to the website if they're comfortable with that. If they're not, we take their information."
Those wanting group vaccinations on-site -- such as at fire stations or health care facilities -- are encouraged to call the pharmacy instead of using the online portal, McCarley said.
"I've seen a lot of things in over 32 years as a pharmacist, but this is unique," McCarley said. "I don't think people fully appreciate it. It's a modern-day miracle that we're doing this."
Under the vaccine effort being coordinated by the state, hospitals, pharmacies and other health care providers had received a total of 169,625 doses of the vaccines made by Pfizer and Moderna as of Thursday morning and had reported administering 58,914 of those.
That was up from 50,679 doses that had been administered as of Wednesday.
The vaccines that the state was due to receive through the end of this week include 43,875 of the Pfizer vaccine to provide second shots for people who received their initial shot last month.
Of those, 18,252 were not scheduled to be given until next week -- three weeks after the first shot was given.
Health Department spokesman Gavin Lesnick said he didn't have information Thursday about how many of the doses that have been administered so far have been booster shots.
Walgreens and CVS reported administering an additional 2,374 doses of the Moderna vaccine as of Thursday morning under a federal program for residents and workers at long-term-care facilities.
That was up from 1,533 doses that the two companies had administered in the state as of a day earlier and represented fewer than 10% of the 24,700 doses the companies have been allocated for Arkansans.
The actual number of shots given is higher than the Health Department's figures because providers have three days to report the vaccines they administer.
Until this week, the state had designated the Pfizer vaccine for health care workers -- primarily those working in hospitals -- and the Moderna vaccine, which is easier to handle, for residents and workers at nursing homes and other long-term-care facilities.
This week, the bulk of the state's Moderna and Pfizer shipments went to pharmacies to provide shots to patient care workers in clinics and other outpatient settings.
Those include staff members at primary care and urgent care clinics, dental clinics, pharmacies, blood donation centers, dialysis centers and university health clinics, as well as school nurses, home health and private care aides, and hospice workers.
Police and firefighters who are first responders also became eligible for the vaccine after Hutchinson on Monday added them to the state's 1A priority group.
Dillaha said the state's shipments of vaccines next week will continue to go to pharmacies to continue vaccinating health care workers, with some hospitals also receiving doses allowing them to finish vaccinating their employees.
Once pharmacists have finished vaccinating the high-priority categories of health care workers, they can move on to other types of providers, such as ophthalmologists and dermatologists, she said.
"In some locations with smaller populations, I think we're getting fairly close to vaccinating most if not all of the health care workers that are wanting the vaccine, and so we're trying to make sure that we focus on those areas that still need to provide vaccinations to health care workers," she said.
The Health Department, which has administered the vaccine to ambulance workers and employees in its local health units, reported administering just 585 of the 5,850 Pfizer doses it had received as of Thursday morning.
Dillaha said the department transferred 2,925 doses to pharmacies for the vaccination of health care workers.
The department will transfer additional doses to pharmacies next week, she said.
"We had acquired those doses to vaccinate [emergency medical services workers], but the uptake was low, so we didn't use them," she said.
Hutchinson has said he wants to finish Phase 1A this month. Under the next phase, 1B, which he hopes to start next month, those eligible for shots will include Arkansans 70 and older and front-line essential workers.
Those include teachers and other school staff members; workers in food and agriculture, manufacturing, grocery stores, public transit, child care and the U.S. Postal Service; police and firefighters who were ineligible for shots under Phase 1A; and essential government workers, which Hutchinson has said will include legislators.
Phase 1C, which Hutchinson hopes to start by April, will include people 65-69, those 16-64 with medical conditions putting them at higher risk of developing complications from covid-19 and essential workers not included in 1B.
That includes workers in transportation and logistics, water and wastewater, food service, shelter and housing, public safety, finance, information technology, communications, energy, the media and public health, according to the Health Department's website.
A preliminary plan released by the Health Department last month said the vaccine would become available to the general public in Phase 2 of the effort, when more doses are available.
ACTIVE CASES RISE
The cases added to the state's tally Thursday included 2,277 that were confirmed through PCR tests and 1,046 identified through antigen tests.
The state's cumulative count of cases rose to 245,916.
That comprised 200,531 confirmed cases and 45,385 probable ones.
The number of cases that were considered active rose by 892, to 25,984, setting a new record for the third day in a row, as 2,406 Arkansans were newly classified as having recovered.
Pulaski County had the most new cases, 453, followed by Benton County with 350, Washington County with 289, Faulkner County with 137 and Garland County with 133.
Among prison and jail inmates, the Health Department's count of cases rose by 27.
The state's death toll rose by 21, to 3,273, among confirmed cases and by four, to 653, among probable cases.
Among nursing-home and assisted-living-facility residents, the count of virus deaths rose by 14, to 1,605.
The number of people who have ever been hospitalized in the state with the virus rose by 33, to 11,900.
The number of virus patients who have ever been on a ventilator rose by six, to 1,277.
'TEAM NURSING' STARTED
St. Bernards Medical Center spokesman Mitchell Nail said the Jonesboro hospital has 68 beds available, including regular and ICU beds. According to data from the American Hospital Association, St. Bernards has about 351 staffed beds, whether filled or vacant.
"We fluctuate daily on the numbers of each, all while operating within that 68-bed capacity," Nail said. "Based on our high patient volumes of late, we plan to increase our ICU capacity more than 15% by Jan. 15."
The hospital recently began "team nursing" in the ICU, increasing staff-to-patient ratios for some patients, as staffing challenges persist, Nail said.
To accommodate the increased volumes, St. Bernards also plans to use semiprivate rooms for covid patients as well as observation patients.
"No covid-positive patient will share a room with a covid-negative patient, and we will not mix genders within a room," Nail said. "In addition, patients must wear a mask at all times within a shared room to reduce the risk of virus exposure."
Nail said they are not planning to add space or to establish a triage area. Early in the pandemic, the hospital prioritized obtaining ventilators and personal protective equipment.
"This decision has yielded dividends, as our numbers of critically ill and covid-positive patients have increased," Nail said.
Martine Pollard, executive director of the Northwest Arkansas Health Care Community, declined to give specific capacity numbers for hospitals in the Northwest region of the state, saying only that the hospitals there "have capacity to treat both covid and non-covid patients without double occupancy."
"In the event there is a need for additional beds, we have adequate beds," Pollard said. "Like the rest of the nation, the resource we are most concerned about is our people. And if we do need to expand our bed capacity, staffing those beds will be the challenge and potential limiting factor."
Since the pandemic arrived, the area hospitals came together to form the Northwest Arkansas Health Care Community. Pollard is the executive director.
Participating health organizations include Community Clinic, Washington Regional Medical System, Mercy Health System, Northwest Health System, Arkansas Children's Northwest, the Veterans Health Care System of the Ozarks and the University of Arkansas for Medical Sciences Northwest.
In a daily report released late Thursday, the group said the region's hospitals reached an all-time high of caring for 129 covid-positive patients. There are 117 patients -- both covid-19 and those with other medical needs -- in the hospitals' ICUs.
"While we currently are not in jeopardy of running out of beds, the resource we are most concerned about is our people," Pollard said in the news release. "They are tired, exhausted and we are concerned about their ongoing stress. To prevent overwhelming our health care workforce and hospitals, we ask everyone to please follow the guidelines to slow the spread of the virus. The high community infection rates are concerning and historically are indicators of future hospitalizations."
MORE BEDS AVAILABLE
The number of available hospital beds in the state increased by 17 to 1,934 on Thursday, according to Health Department data.
The total beds -- whether filled or vacant -- dropped by three to 8,951. About 78% of the state's hospital beds are full.
There were five more ICU beds available, going from 42 to 47. Out of the 1,155 ICU beds, 4% were available as of Thursday afternoon.
There were four less ventilators in the hospitals' inventory, dropping from 1,101 to 1,097. About 60%, or 657, remained available -- two more than the previous day.
The state's total bed capacity -- hospital beds that can be staffed whether or not they are occupied -- dropped by three beds to 8,951.
Maximum flex bed capacity -- the number of hospital beds regardless of ability to staff them -- remained at 11,514.
The majority of the 1,326 covid-19 patients hospitalized -- 366 -- were in hospitals in the metropolitan regions of the state, followed by 234 in the southwest, 205 in the northeast, 191 in the Arkansas Valley, 149 in the Northwest, 121 in the north-central and 60 in the southeast.
Metro-region hospitals also had 156 patients in ICUs, followed by 75 in the southwest, 57 in the Northwest, 49 in the Arkansas Valley, 43 in the northeast, 33 in the north-central and 14 in the southeast.
The hospitals with the highest number of patients on ventilators were in the metropolitan regions with 85, followed by the southwest with 38, Arkansas Valley with 31, Northwest with 24, northeast with 21, north-central with 18 and southeast with one.
'RED ZONE' DISTRICTS
Also on Thursday, a weekly report from the Arkansas Center for Health Improvement listed 179 school districts in the state as being in the "red zone" or "purple zone" based on the number of new cases among residents within their boundaries.
That was up from 171 with one of the labels a week earlier.
The center listed 145 districts as being in the red zone, meaning that over a two-week span, they had 50-99 new cases per 10,000 residents who are not incarcerated or residents of nursing homes or state-run centers for the developmentally disabled.
A record 34 districts were listed as being in the purple zone, meaning they had 100 or more new cases per 10,000 residents during the same period.
The Dardanelle School District had the highest rate, with its 157 new cases translating to a rate of 155 cases per 10,000 residents.
In a news release, the center said it was the fourth consecutive week that more than half the districts in the state were in either the red or purple zone.
"We are fighting a battle against COVID-19 that too many are losing," the center's CEO, Joe Thompson, said in the release.
"While we have two highly effective and safe COVID-19 vaccines that are being distributed over the course of the next several months, the call to action remains this: Take the day-to-day precautions of washing your hands, staying at least 6 feet away from people who are not members of your household, and wearing a mask in public. Keep these up even after you get vaccinated. This is how we fight this threat and return to normal."