Arkansas' count of coronavirus cases rose Tuesday by 1,875 -- the biggest single-day new case total in more than five months -- as the number of people hospitalized with covid-19 in the state topped 800 for the first time since early February.
For the first time in more than a week, however, the state didn't report any new covid-19 deaths.
The death toll, as tracked by the state Department of Health, remained at 6,007.
"The good news is that we have no new deaths in today's COVID report, but the increase in hospitalizations and active cases is a trend we must turn around," Gov. Asa Hutchinson said in a tweet.
"The increase in cases will only stop when we follow guidelines and get the vaccine shot. The vaccine keeps people alive."
In an interview Tuesday with the Arkansas Democrat-Gazette, Hutchinson said he had directed the Health Department to "increase the intensity" of a public education campaign, aimed at encouraging people to be vaccinated, in preparation for the start of the school year next month.
He said that calling a special session of the Legislature to revisit a law that will prohibit schools from requiring students and employees to wear masks was "not on the table."
He also said he had no plans to reinstate the public health emergency that expired at the end of May.
"Our sole concentration is getting the vaccines out and encouraging that," Hutchinson said.
"It needs to be emphasized that, while there's not a mandate, every student has the option to wear a mask, and the guideline will be, if you're not vaccinated, you should wear a mask, and so that will provide them protection if that's followed."
In a virtual forum by the U.S. News and World Report on vaccine hesitancy, Arkansas Health Secretary Jose Romero said Tuesday that he expects to see "significant outbreaks within the school system."
"What's already telling me that that's going to happen are the number of day care closures that have occurred because of outbreaks occurring and the camp exposures and closures that are occurring," Romero said.
Also on Tuesday, state Epidemiologist Jennifer Dillaha said the state last week had its second death of a child from covid-19 since the start of the pandemic.
While she declined to provide any other details, a report from the Pulaski County coroner's office said Jordan Sinor, 16, of Harrison died July 14 at Arkansas Children's Hospital in Little Rock.
Sinor, who had Down syndrome, was admitted "from an outlying facility" on July 6 with a diagnosis of covid-19 and acute respiratory syndrome, according to the report.
A doctor at the hospital told an investigator with the coroner's office that the child suffered septic shock because of bacteria in his bloodstream.
Dillaha said in May that the state had had one child death from covid-19 but, citing privacy concerns, declined to provide further details, such as when the death occurred.
Excluding 2,932 cases that were added to Arkansas' count as part of a "data cleanup" on Feb. 28, the increase in cases on Tuesday was the largest in a single day since Feb. 4.
The average number of cases added to the state's tallies each day over a rolling seven-day period rose to 1,151, its highest level since the week ending Feb. 11.
The number of people hospitalized with covid-19 rose by 28, to 815, its highest level since Feb. 4.
The number who were on ventilators rose by two, to 131, its highest level since Feb. 10.
The number in intensive care rose by 22, to 313, its highest level since Jan. 27. It was the first time since early February that the number had topped 300.
Already at its highest level since Feb. 14, the number of cases that were considered active rose by 970, to 11,475, as new cases outpaced recoveries.
Based on numbers as of Monday, U.S. Centers for Disease Control and Prevention rankings Tuesday continued to list Arkansas as the state with the most new cases per capita over a rolling seven-day period.
The 7,659 cases that were added to Arkansas' count during the week ending Monday translated to a rate of 253.8 per 100,000 residents.
Florida had the next-highest rate, 252.3 per 100,000 residents, followed by Missouri, with 232.3 per 100,000 residents.
With 52 deaths during the week, Arkansas was roughly tied with Montana for having the most new covid-19 deaths per capita.
Both states had a rate of 1.7 deaths per 100,000 residents.
Wyoming had the next-highest rate, 1.6 per 100,000 residents.
Dillaha called the increase in cases and hospitalizations on Tuesday "a continuation of the steep upward trend that is occurring in Arkansas, likely driven by spread of the delta variant" that first emerged in India.
Like Romero, she said she was concerned about the potential for outbreaks to occur in schools once classes start next month.
"I think we're all concerned about that, and we're working to make sure that staff and faculty, the teachers in schools can be vaccinated and that eligible children 12 and older can be vaccinated," Dillaha said.
She said a Health Department contractor, the Arkansas Foundation for Medical Care, has been holding vaccination clinics at schools.
Health Department spokeswoman Meg Mirivel said the department also plans to increase the amount of money it's spending this year on its public education campaign aimed at encouraging people to get vaccinated.
She said the total amount of federal grant money budgeted for the campaign remains about $7 million, but the department plans to spend more of it before the end of this year, rather than over the next few years.
The department will seek additional funding for the campaign after this year, she said.
In their latest forecast report, released Tuesday, researchers with the Fay W. Boozman College of Public Health said Arkansas appears to be "at the beginning of an exponential surge, which, in the long-term, may exceed the December/January surge in terms of cases and hospitalizations."
"Our considered opinion is, with low vaccination rates, few Arkansans practicing personal mitigation behaviors, and state policies that seem to discourage protective measures, Arkansas is set to experience increased numbers of COVID-19 infections and hospitalizations," the researchers wrote. The college is part of the University of Arkansas for Medical Sciences.
They said Arkansas' new case numbers may "very quickly" exceed the average of 3,000 a day they reached during the winter, with the number of hospitalized patients reaching 1,650, including 550 who require intensive care.
The researchers said the pace of vaccinations in the state is too slow, and they "strongly" recommended that even those who are vaccinated wear masks and practice social distancing in public places.
"Schools are starting, so we encourage school leaders to promote mask wearing on school campuses and encourage vaccinations," the researchers wrote.
"This can be done to cover a significant proportion of the population at risk of infection and hospitalization. We cannot stand still and witness our children and young adults getting seriously ill at high rates, and perhaps succumb to COVID-19."
DISAGREEMENT ON MASKS
Hutchinson said he didn't agree that people who are fully vaccinated should wear masks.
"We want to focus on getting people vaccinated, and that discourages them," Hutchinson said. "They want to get vaccinated so they can lead a more normal life, and we're saying you can't do that."
He said he didn't want to "second-guess" whether he should have signed Act 1002, the legislation prohibiting government mask mandates, in April.
"Whether I signed it or not, the Legislature would have overridden any veto, and so that's really not a relevant question in terms of what we're dealing with today," Hutchinson said.
"I do think that at that time, everybody knew what needed to be done, and the mandate was not needed at that point. Our cases were very low, so I think it was the right thing to do, but you don't know what the future is, and things can change."
He said state officials are working on their guidance for school districts for the approaching school year and should have it ready to release "within a week or so."
Although the vaccines are not yet authorized for children younger than 12, he said vaccinating people who are eligible will "minimize the risks even for that younger population."
"Then secondly of course, historically based upon the data we have, generally if it is spread in that age group, it's asymptomatic," Hutchinson said.
"If we combine the opportunity to wear a mask with good, layered protections at the school, then we're minimizing the risk to that age group."
Dillaha said the number of young children who develop symptoms from covid-19 has been increasing, however.
"There are some children who become ill with covid-19 and end up in the hospital," she said.
During a visit to Little Rock on Tuesday, White House Vaccinations Coordinator Bechara Choucair talked with a group representing Arkansas' federally funded community health centers about ways of combating misinformation and getting hospitals more involved in administering the vaccines to their patients, said Seth Blomeley, a spokesman for the Community Health Centers of Arkansas.
He said Choucair also met with Romero, UAMS Chancellor Cam Patterson and officials at Arkansas Children's Hospital.
CASES BY COUNTY
Pulaski County had the most new cases on Tuesday, 297, followed by Benton County, which had 167, and Washington County, which had 121.
The state's cumulative count of cases rose to 367,007.
The number of people who have ever been hospitalized in the state with confirmed infections rose by 113, to 17,872.
The number who have ever been on a ventilator rose by 18, to 1,817.
Meanwhile, Health Department figures continued to show an uptick in the state's vaccinations.
At 7,508, the increase in doses that providers reported having administered, including second doses of the Pfizer and Moderna vaccines, was bigger by more than 1,900 than the increase a week earlier.
Already at its highest level since late May, the average number of doses administered each day over a rolling seven-day period rose to 6,559.
According to CDC data, the number of Arkansans who had received at least one vaccine dose rose Tuesday by 1,856.
That was larger by more than 400 than the increase a week earlier.
Already at its highest level since the week ending May 26, the average daily increase in the number of Arkansans who had received at least one dose rose to 4,556.
The data showed that 44.2% Arkansans had received at least one vaccine dose as of Tuesday, and 35.4% were fully vaccinated.
Among the states and District of Columbia, Arkansas continued to rank 45th in the percentage of its residents who had received at least one vaccine dose and 49th, ahead of only Mississippi and Alabama, in the percentage who were fully vaccinated.
Nationally, 56.2% of people had received at least one dose, and 48.7% were fully vaccinated.
Among the Arkansans who have tested positive recently are about 25 inmates in a single pod at the White County jail.
"We had a couple test positive, so we tested the whole pod," Sheriff Phillip Miller said. "We've got our medical contractor here seven days a week. We have offered testing to the entire facility."
Miller said those infected with the virus have been isolated to one pod to quarantine and that the facility is following Health Department protocols.
"All of the inmates were offered the opportunity to get vaccinated," Miller said. "Very few took us up on it."
New detainees are being housed separately from the main population, and inmates are being evaluated daily.
The jail is housing about 254 inmates.
"We've been pretty fortunate to have such a low number of cases," Miller said.
The White County jail inmates are typically charged for medical visits, per county ordinance, but Miller said those who are symptomatic for the virus will not be charged.
"Our medical staff is here to treat the emergent covid cases," Miller said.
Hutchinson hasn't yet announced steps to increase the state's hospital capacity, as he did during the winter, when the number of patients in the state's hospitals topped 1,300.
For instance, in December, he said he made a request to the Federal Emergency Management Agency for the use of 10 beds at the John L. McClellan Memorial Veterans Hospital in Little Rock for non-veteran covid-19 patients.
Later that month, he announced that two Baptist Health facilities -- the J.A. Gilbreath Conference Center at Baptist Health Medical Center-Little Rock and a site at Baptist Health-Van Buren -- would be renovated to house a total of 124 coronavirus patients.
Health Department spokeswoman Danyelle McNeill said last week that the agreements for the use of the beds at the veterans hospital and Baptist Health sites expired after March.
In order for such measures to qualify for FEMA funding, Arkansas would need to have an emergency declaration in place, LaTresha Woodruff, a spokeswoman for the state Department of Public Safety's Division of Emergency Management, said.
Act 403, signed by Hutchinson in March, gave lawmakers more options for terminating such emergency declarations and required requests for extensions of the emergency to be submitted to the Legislative Council for approval.
Hutchinson said Tuesday that he could create more bed space for patients "with cooperation of our hospitals" and that he also has the authority to deploy "resources as needed" through the Arkansas National Guard.
"I look at it every day as to, do I have the power and authority that I need to carry out my duties and to address the pandemic, and I do," Hutchinson said. "If I need any additional authority, we'll act as needed."
The state earlier this month did reactivate its COVIDComm system, which helps match covid-19 patients with hospitals that have available beds and other resources.
Jeff Tabor, the system's program manager, said the system had coordinated the transfer of 10 patients from July 10 through Tuesday.
Hospitals had contacted the system about an additional 19 patients who ultimately were not transferred or who were transferred without the system's coordination, he said.
So far, he said, requests for help have been less frequent than during the winter, when the system handled as many as six transfers in a single day.
The last time the system was online, from Dec. 16 through March 7, he said it handled requests concerning 358 patients, 192 of whom were ultimately transferred with the system's assistance.
"I just hope this is not the calm before the storm," Tabor said.
Information for this article was contributed by Jeannie Roberts and Eric Besson of the Arkansas Democrat-Gazette.