Graphs of today’s numbers, captured by Josh Spurgers:
Excerpts of Today’s Media Update
We’re highlighting portions of the media update that seem relevant, but we encourage you to watch the full update. If you find a part that seems like it should be called out here, let us know.
Arkansas Governor Asa Hutchinson [9:20]:
I’m pleased to announce that we will be able to re-engage our visitation in our long-term care facilities, effective July 1 — is when that will begin.
Note that Phase Two of the White House Guidelines for Opening Up America Again, it says that “visits to senior care facilities and hospitals should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene.” Then, in Phase Three, it says that “Visits to senior care facilities and hospitals can resume. Those who interact with residents and patients must be diligent regarding hygiene.”
Governor Hutchinson [10:32]:
I want to applaud the Arkansas Health Care Association and a Rachel for their leadership working with the Department of Health as well as DHS in coming up with some guidelines, based upon the testing that we have, that will allow this visitation back in our long-term care facilities.
And so, this visitation will be applicable to our long-term care facilities including nursing homes assisted living facilities and residential care facilities within the Department of Human Services. And this just gives a couple of highlights of it. This will apply to facilities that have completed testing and meet the criteria outline and the guidance from the Department of Health. So, that’s a must.
Secondly, we have to remember that our begin date is July 1 for this visitation. There will be some facilities that will not be ready to start at that date, and so it’s dependent upon the readiness of each facility, but hopefully most facilities will be ready to begin on July 1.
Outdoor visits will be preferred, but indoor visits will be allowed for those residents who cannot be safely moved outside or when the weather is too hot. And then, facilities will spend the coming weeks getting ready for this change and the visitation that will be coming, including putting scheduling systems in place, so that visitors do not all inundate at one time. And then, the end-of-life visits will continue. Visits will be scheduled in advance and space will be sanitized between each visit. There will be a minimum of two visitors per residents and we’d ask that mask be worn. The guidance includes also expanding activities from beauty salons for residents and communal dining.
And so, those are some of the points that we wanted to emphasize that allows us — based upon the testing that’s been done — so that we can bring loved ones together again, even though someone might be in a long-term care facility. And this is good news for Arkansas that have been so patient as we’ve gone through this pandemic.
Arkansas Secretary of Health Dr. Nathaniel Smith [15:07]:
This is something we’ve worked very closely with Department of Human Services as well as the nursing homes themselves and their representatives. And we’ve come up with some pretty strict criteria that are designed to keep our nursing homes safe from the spread of COVID-19 but allow that very, very important human interaction. That guidance has taken a lot of work and it’s included input from our federal partners as well — CDC as well as CMS [Centers for Medicare & Medicaid Services]. And so, we’re looking forward to being able to implement that so that we can have some contact between families and their loved ones.
The last thing I wanted to mention is our CDC team that has joined us in the northwest part of the state. They have been very active in in their work they are — this morning — have been meeting with members of the Marshallese community. They’re beginning outreach to the to the Latino community today. And they’ve been doing a deeper analysis of our data. They’ve also met with a team from the Missouri Department of Health. We had a coordination call with our partners there across the state lines as well. They are ramping up their testing in the southwest corner so that we have a unified approach there to bringing the COVID-19 outbreak in that part of our states under control.
Rachel Bunch, executive director of Arkansas Health Care Association [17:10]:
On behalf of the long-term care facilities in the state, we look forward to carefully reopening for visitation once our statewide testing and baseline are complete. Facilities who have negative results and meet the criteria will be able to open for visitors beginning on July 1 and schedule visits for the upcoming holiday weekend and beyond. It will take some time for all homes to meet this. And we’ll do it individually as they meet that criteria and adjust their physical spaces. But we’re dedicated to doing this carefully and adjusting as we go along.
As the governor mentioned we’ve worked closely with DHS and the Department of Health. Dr. Patil and his team, this couldn’t have happened without all of them. Visitation won’t look the same in our facilities. We are busy adapting and preparing all of these spaces and educating staff and communicating with family members about these new requirements. But we really look forward to seeing these visits happen in our homes. Our residents definitely most look forward to visits with their family and friends, communal dining with other residents who are friends, barber and beauty shops reopening within the facilities, and expanded activities.
I’m really proud of the plan that we’ve put together and we look forward to our long-term care facilities continuing to show Arkansas as a national leader.
Jerry Sharum, director of the Division of Provider Services and Quality Assurance with the Arkansas Department of Human Services [19:32]:
We’ve got about three months’ worth of data that we’ve been looking at — of course, guided by the Department of Health and their experts — but we’re seeing that only about a third of nursing homes have active cases. About 80% of those are in about 12% of facilities with those active cases. And only 5% of nursing home totals overall.
If I follow this correctly, 80% of the active cases are in 5% of our nursing homes.
Jerry Sharum [19:53]:
Baseline testing is also indicating and showing strongly that our positive test rate is less than 1%. And that’s for 14,000 tests that we’ve completed already. This data indicates that targeted public health measures and related interventions can work and that we can treat facilities differently, perhaps, based on their circumstances both facility-by-facility but also by way of their facility types — like I mentioned the several different types of long-term care facilities. There are different populations, including those that serve exclusively children, as opposed to those that serve older folks.
And all that indicates that we can begin as the governor mentioned to start the process of reopening in a measured and safe way. That’s what we’ve all been focused on: facilities. Department of Health and Department of Human Services is making sure these residents are safe. So, on a facility-by-facility basis, as the governor mentioned, and whenever that facility is ready, based on their given circumstances and their specific populations, which may have special needs, we will begin this process.
It will include all the requirements that Dr. Smith mentioned and the governor mentioned, including ensuring that baseline testing is complete and all appropriate steps have been taken to address any issues identified there. That hospital and ICU capacity would meet the needs of that that facility in the area. That there’s appropriate staff, appropriate PPE, as well as visitor screening and strict requirements related to these activities and visitation efforts. And these go beyond those that currently exist for screening, so there they’re even more rigorous. This will include facilities operated by the Department of Human Services, including the human development centers and the Arkansas Health Center.
Going forward, as you all can imagine, we will be monitoring this situation very, very closely, looking at the data, all the cases and other information. Visitation and activities will be reduced or stopped if cases develop or other issues arise that warrant those measures. We will continue, as the department, our infection control measures. We will be increasing the frequency of surveys by the Office of Long Term Care and other offices in my division. And in this, I just want to emphasize that we’re in this together it is incumbent upon everybody, especially those who go visit their family. It’s going to be great to see them again, but make sure you follow those requirements, wearing the masks, following all the rules to make sure that we can keep all those residents safe.
Governor Hutchinson [22:49]:
Because we’re ahead of schedule on our testing in terms of our Arkansas plan. We’re doing the testing this month with a low rate. And the need that’s there. That’s a decision that we made with our Department of Health and with our long-term care facilities. It’s the right step for Arkansas and it’s the right time. 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.
With what we’re learning about asymptomatic cases and asymptomatic carriers, why do you feel comfortable letting people into nursing homes?
Governor Hutchinson [23:29]:
Because of what we’ve seen in our testing and the protocols that are in place. And so, here you have visitors that will come. They will be screened. We’ll have an established environment there. There will be requirements for masks. So, the safety protocols are in place. And it’s something that 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. So, I think everybody understands what’s at stake here and the importance of it.
Dr. Smith [24:21]:
It’s a bit difficult to summarize a four- or five-page guidance document in this setting, but when you take a look at the details, you’ll see these involve the visitors coming in wearing masks, visiting — in most cases — not in the residents’ rooms. And we’ve learned a lot of things from other settings. For example, in many work settings, even when there’s an asymptomatically-infected individual, when we’ve practiced physical distancing, wearing masks, etc., we’ve not seen secondary cases. So, as they follow these guidelines that we have, they should allow visitors to come in. Even if we did have someone who is asymptomatically infected, we still would not have a transmission — or be very unlikely to have COVID-19 transmission if these guidelines are followed.
A question that arises from that: When you have a symptomatically-infected individual, do you still see secondary cases when they’ve practiced physical distancing, wearing masks, etc.?
I guess my follow-up question is — how useful is screening when so many people are asymptomatic?
Dr. Smith [25:25]:
Screening is very important because we want to screen out those who are symptomatic. Obviously it won’t catch those who are asymptomatic or pre-symptomatic, but we have other measures in place like wearing masks, in many cases meeting outside, maintaining physical distancing to reduce or eliminate the risk from asymptomatic transmission.
What are we going to consider is too hot? What are some of those factors? Not allowing them out because it’s too hot.
Dr. Smith [26:16]:
In the summertime here it may just be too hot or too unpleasant. As the weather starts to cool in the fall, that might be a preferred option. But we’ve also required that they have a place to meet outside the patient’s room if they are going to meet inside.
We’ll have those guidelines very soon. I believe I’ve seen the final version today. So, I’m not aware of any reason why we wouldn’t be putting those out today.
Jay Bir [26:52]:
We’re seeing some cases in Washington County and Benton County jails. Are we taking any proactive steps in those facilities to where we don’t see something happen like we’ve seen at Cummins?
Dr. Smith [27:04]:
Yes. We are actually working with those facilities to proactively screen — not exactly the same as we’ve done with the long-term care facilities, but a similar approach to proactively screen. Of course, if there are cases or symptomatic individuals, we will go in with a rapid response. But trying to move ahead to a more proactive approach. Hopefully, we’ll be able to eventually cover all the jails in that way.
Jay Bir [27:35]:
What does that look like, beyond screening?
Dr. Smith [27:39]:
We’re talking about testing those who are there in the jail as well as the staff.
I wanted to ask you about the city of Fayetteville — the city council last night approved an ordinance requiring masks to be worn in most indoor public places and businesses. I understand there may be some of their other cities looking at similar proposals. I wanted to see what you thought about that and whether you support cities being able to do that, and also your thoughts on whether there should be a mandate statewide has changed at all.
Governor Hutchinson [28:27]:
In terms of the city of Fayetteville, the ordinance that I have seen — I know that the city council and the mayor is simply trying to enhance the wearing of masks for the citizens’ protection and others and to stop the spread. So, I understand where their heart is. I would prefer that cities not take that step simply because we want to make sure that we educate people, they exercise self-discipline, that they take their own responsibility. And through that education, the example of leaders, follow the right health protocols. That’s the preference. That’s the direction that we’ve gone as a state. And I would discourage other cities from stepping out there. And there is some conflict between what the city of Fayetteville did and the executive orders that we’ve issued.
Less than three hours later, Little Rock Mayor Frank Scott Jr. announced that the city attorney was drafting an executive order requiring face coverings in public spaces.
In the early days of the pandemic, with the outbreak at Cummins, you said then — as I recall — that the inmates are still citizens of Arkansas and the state is responsible for them and they deserve the proper medical care. I’m sure you’ve seen by now that New Yorker article that I’m referencing when I ask you this. It looks like from that article what was happening and what you said should be happening were quite a bit different. Does it cause you to want to consider an investigation of what the corrections department was doing, and if so, who would handle that?
Governor Hutchinson [30:16]:
Well, in terms of The New Yorker article, they did not reach out to my office. They did not ask for a response from my office or a comment from me. They did submit 60 questions to the Department of Corrections, which they answered. And the Department of Corrections pointed out that there were a number of inaccurate assertions and they did not use all the information that was provided by the Department of Corrections. It was clearly an article that was designed to paint the penal system in Arkansas as something out of the 60s. They did not recognize many of the reform efforts that we’ve put into place. So, that’s just part of the New Yorker magazine.
But in terms of where we are, we’ve had Dexter Payne here, the director of Department of Corrections. He has answered questions. We have answered questions on there. The Department of Health has put in enormous resources there. We have medical care that’s provided there.
I’m sure we make mistakes along the way because we learn about this pandemic day after day. But I know they’ve worked very, very hard to keep the inmates safe, to help them to get recovered, and that will continue to be our objective and goal, because they are Arkansas citizens and we have a responsibility there.
If other municipalities — and I’m aware of one other are expected to — enact emergency mask ordinances, would you consider taking legal action to blunt such activity?
Governor Hutchinson [32:14]:
I would expect and ask them to coordinate with our office, so we can see what’s in conflict with the direction that we’re going versus just stepping out there. And 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. 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. And, again, we have some very strong guidelines that we’ve set in every — whether it’s indoor venues or outdoor venues, or whether it is in restaurants or other facilities. We have either required or strongly suggested wearing of masks. Those are guidelines that we have. 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. I want Arkansas to understand the importance of it, when they can’t socially distance. And everybody in this room knows how I’ve emphasized that every day. It’s not something that we’ve neglected. And we’ve set an example. And I think that that’s the right course for us.
I’ve had clinicians reach out to me and say that they’ve had patients that have been not contacted at all by contact tracing or that it was taking four or five days for them to be contacted. Dr. Smith can you tell me how far behind we are contact tracing? And last week, I asked you for a percentage of people that had been contacted by our contact tracers, and I still don’t have that number.
Dr. Smith [34:15]:
In terms of the latter part of your question, it’s not that we want to be evasive in any way. We just — how you asked that question specifically, because it’s a rolling target. Every day, we have new cases added. And some are contacted right away. As you can imagine, when you’re trying to call people up, some people, you may not be able to get a hold of. I mean, I’ve had people trying to get a hold of me for other reasons. If I don’t recognize the number, I don’t necessarily answer it. So, in some of the cases that you’re mentioning in the first part of your question, we would need to really look at the specific circumstance, because it may not be that they were behind. It may be that their call went unanswered or they had a number that wasn’t a good number or whatever. So, in terms of how far behind we are, that really depends — I would need more specifics to answer that question. We are trying to reach everyone as quickly as they come in. Some, we reach right away. And others take longer. But some of those is not just a manpower issue. It’s difficult to get a hold of people these days through the phone.
Misty Orpin [35:36]:
Are you guys not tracking internally to measure your performance?
Dr. Smith [35:41]:
We are, but we’re looking we’re looking at five days out, because we understand that it does take a while to get a hold of people.
Misty Orpin [35:51]:
Then, can you share those percentages, then, for five days out?
Dr. Smith [35:55]:
Certainly. And we actually do a report once a week — a quality improvement — or quality assessment report. We can share that with you, as well.
Dr. Cam Patterson [chancellor of the University of Arkansas for Medical Sciences] said today that they’re concerned about the health care system’s capacity and their ability to accommodate patients by September. He says that he’s strongly advocating with you for more substantial policy measures like masks and social distancing. So what’s your response to that and are you open to that?
Governor Hutchinson [36:28]:
Dr. Patterson and I, I think we talked over the weekend. We talk fairly regularly about this, about hospital capacity primarily. We feel comfortable where we are in our capacity. I talk to northwest Arkansas, which is the pressure point now. And I talk regularly to the hospitals there and we monitor that. So, we watch that in terms of what action we take.
We’ve stated our position. We’ve got our guidelines out there. We are advocating wearing masks every day and ask the Arkansas citizens to do that, particularly whatever you cannot socially distance.
Jay Bir [37:14]:
You’ve got that RFQ out for contact tracers. When do you want to have that in place, to have that contracted out, to help those guys out?
Governor Hutchinson [37:28]:
The timeline that we’re looking at for issuing that is right after the first of July. Of course, it’ll take the contractor a little bit of time to set up the resources. But we’ve expedited that and we’ve accelerated those deadlines. That’s in a normal procurement process so we get it done quicker.
Jay Bir [37:51]:
Is there a number we’re looking at? Like, how many that will be part of this?
Dr. Smith [38:00]:
We have 350 DIS — disease intervention specialists — also nurses and supervisors, informatics individuals. But the short answer is 350. And also where we’ll add to that the folks that are currently working on contact tracing, and hoping to continue to add volunteers.
Jay Bir [38:26]:
Is that 350 total or 350 being added into…?
Dr. Smith [38:31]:
Misty Orpin [38:37]:
So you mentioned that there were inaccuracies in the Cummins article. What were the actual inaccuracies? What were the facts that were incorrect in that article?
Governor Hutchinson [38:47]:
I’ll be happy to show you the 60 responses from the Department of Corrections that was asked. And I think you can see that many of those who are not in there. Part of it is just simply that it’s really not a complete story as to what is happening in our prison system and the efforts that were being made.
Just a follow-up on the Fayetteville ordinance. You said that there is a conflict there, between what they did and your emergency order. Are you planning on taking any action to get them to rescind that or overrule it somehow?
Governor Hutchinson [39:27]:
Well, of course, any citizen could take action if they felt like that was necessary or thought they were aggrieved. But I don’t anticipate state action at this time.
Again, I know the intent of it. I know they’ve got a growing number of cases. So, I don’t intend to interfere with that. If it becomes more of a problem across the state, in different instances of municipalities taking action, we’ll re-examine that. Because we want to have a coordinated approach. We don’t want to have a hodgepodge of different types of ordinances across the state. That’s then been the objective of our directives.
And we’ll continue to look at our own directives, to see if there’s ways that we can strengthen the messaging that we have to Arkansans that this is important.
In fact, later on, I want to just sort of review again for Arkansas the strategy that we have in place. It’s not complicated. It’s simple. But it works. And that is the social distancing, the mask, the contact tracing, the follow-up, the isolation. And these are important to remember that, whenever we do these things and we do them right and we do them together as a state, then we can actually have success in reducing this spread and also continuing our economic activities and our education and life. And that’s and that’s the spirit of Arkansas, right now, and what people want to see done.