For months, New Yorkers saw their hospitals flood with COVID-19 patients and bodies pile up in refrigerated overflow morgue trucks. Meanwhile, other parts of the country never even implemented a statewide lockdown.
For those hoping a slew of Southern and rural states might have avoided the worst of the pandemic entirely, Friday’s case counts provided a grim answer.
Arizona, North Carolina, California, Florida, and Texas hit record daily highs of COVID-19 infections this week, as state public health leaders pleaded with their communities to take the ongoing crisis seriously.
But there are few states whose experience of the coronavirus pandemic has shifted more radically in recent weeks than Arkansas.
On Friday, the state reported that there were 731 new cases, a record increase. Those numbers brought the cumulative total there to 11,547, of which 3,764 were active. At last count, 176 people had died from the virus.
Even if Arkansas saw its first COVID-19 case in March—and has had its share of “super-spreader” events—experts painted a picture of communities there facing the pandemic’s full fury for the first time.
“It’s part of a broad pattern in the U.S. of resurgent infections that are sweeping across many states,” said William Haseltine, a public health expert, former Harvard Medical School professor known for his work on HIV, and the president of the global health think tank ACCESS Health International. “We’re about to see hospital systems in states like Arkansas…. begin to experience what we did in New York, with facilities being overwhelmed by this epidemic.”
Washington Regional Medical System in Fayetteville, Arkansas, called attention to the “serious public health emergency” caused by a “significant” surge in community spread in the northwest region of the state in a letter on Wednesday.
“On May 12, there were four COVID-19 positive patients in Northwest Arkansas hospitals,” said Birch Wright, the chief operating officer and administrator for the facility. “Since then, we’ve seen the number of hospitalizations double every week, and we now have more than 70 COVID-19 positive patients in area hospitals.”
“It is important for our community to understand that we are not seeing more hospitalizations simply because more testing is being done,” added Wright. “We are seeing more hospitalizations because more people in our area are being infected with the virus.”
In the past week, Wright said, Washington Regional had seen a 170 percent increase in the number of tests performed at screening clinics, and a 350 percent increase in the number of hospitalized COVID-19 patients. Of those, it also saw more critically ill virus patients, with more than 30 percent of those who’d been hospitalized requiring ventilator support.
The hospital opened a second inpatient care unit on Tuesday to handle the rush of “suspected and confirmed COVID-19 patients,” noted Wright, in addition to re-opening a separate clinic in Fayetteville dedicated to handling the increased demand for screening and testing for individuals who do not have symptoms but believe they have had exposure.
But even with those stats coming from the state health department and local hospitals, this week, Gov. Asa Hutchinson said the state will move forward with Phase 2 of lifting its restrictions on businesses—like restaurants, schools, and gyms—on Monday, June 15. (Though it never imposed a full lockdown, the state did rein in public gatherings.) That tension mirrors the same phased reopenings in Texas, California, Florida, and Arizona, where cases were also surging on Friday.
As news broke all over the country this week of states’ record-high daily case counts, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said that “we still have a lot of work ahead as we reopen America.” He addressed reporters directly in a telebriefing, the CDC’s first since March 14, to debut a set of guidelines for Americans to follow in daily life, including wearing masks to the bank and washing hands at dine-in restaurants.
“It continues to be extremely important that we embrace the recommendations of social distancing, hand washing, and wearing a face covering in public,” said Redfield. “It’s important that we remember this situation is unprecedented and that the pandemic has not ended.”
During the call, Dr. Jay Butler, the agency’s deputy director of infectious diseases and COVID-19 response incident manager, described the “different levels of transmissions” as “occurring as they [states] gradually ease up on community mitigation efforts”—pointing, however vaguely, to the correlation of rising infection counts and reduced movement restrictions.
Local public health officials said that it’s difficult to know how much individual Arkansans will heed public health warnings.
As Dr. Shane Speights, the medical director for the City of Jonesboro, pointed out, his county has only seen one death, and most people do not know anyone personally who has gotten sick. That may be affecting their willingness to comply with social distancing and other restrictions.
“I don’t think it's blatant non-compliance,” Speights told The Daily Beast. “I think people want to do what’s best for their families. But … imagine hitting your thumb with a hammer and not feeling the pain until four weeks later.”
So where are most of the state’s cases? In the beginning, a large cluster was connected to a church outbreak, even when its faith leaders did everything they could to prevent transmission. Now, according to the state health department coronavirus dashboard, approximately 19 percent of the state’s cases are in correctional facilities, while only 3.9 percent were in nursing homes and 7.7 percent were among health-care workers.
In fact, the largest outbreak in the state was at a state prison in Lincoln County, where at least 11 people had died of the coronavirus at the Cummins Unit and inmates said they were afraid of an alleged lack of care.
Jennifer Dillaha, a state epidemiologist at the Arkansas Department of Health, told The Daily Beast on Thursday that the Lincoln County outbreak had been “handled and is under control now.” But Dillaha acknowledged that the state has since been paying special attention to congregate living spaces—like prisons, jails, nursing homes, and summer camps—while trying to get a handle on smaller outbreaks at select poultry plants.
“When we identify a case in either setting, we go in and test residents and employees and separate those who have the illness and those who do not have the illness,” said Dillaha. “That has worked really well for us.”
Still, Dillaha agreed that, despite what she called an “aggressive” testing strategy, cases have been rising—and not just at the same level that access to testing has increased.
In a demographic breakdown of its cases, the Arkansas Department of Health reported that 21 percent of all infections to-date were among the state’s Hispanic population and that 59 percent were in people under the age of 45. Dillaha said officials have not been able to determine whether those cases have been epidemiologically linked to specific environments. They have invited in a team from the CDC—which will arrive on Saturday—in order to “help us assess and investigate the situation, so we can better understand what steps we need to take to break the chains of transmission,” she added.
Dillaha was hesitant to link the surge in cases to any one cause, but noted that, if she had to point to a correlation in timing, “it would probably be the loosening of restrictions.”
“We didn’t have a stay-at-home order, but we did have some limitations implemented by the governor, like gyms and schools and restaurants closed,” said Dillaha. “Now we’re loosening those restrictions and we are starting to see an increase in the number of cases.”
Ultimately, Dr. Speights—who also serves as dean of the New York Institute of Technology College of Osteopathic Medicine’s Arkansas campus in Jonesboro—agreed with Haseltine’s observation that it may be harder for individual Arkansans to fully grasp the risks of congregating in public. Until it’s too late.
“You don’t always get sick immediately,” he continued. “Everything is OK until it’s not. You go along with a few infections, and then all of a sudden it blows up.”
Editor's note: This story has been updated to clarify that an Arkansas state health official noted a correlation in timing between the easing of COVID-19 restrictions and coronavirus cases, but did not draw a causal link.