Arkansas had its first death related to the coronavirus (COVID-19) Tuesday morning. By the time Gov. Asa Hutchinson and his health team briefed the public, a second death in central Arkansas had occurred.

The first to die from COVID-19 complications in Arkansas was a 90-year-old man from Cleburne County who was at the Conway Regional Medical Center in Faulkner County. The second death was an individual in their 50s. Neither individuals were nursing home residents.

Arkansas Department of Health (ADH) Director Dr. Nate Smith said, “One of the deaths had underlying health conditions and the other, the main risk factor was age. Neither of them was travel-related.”

Arkansas had 174 positive cases Monday, 202 Tuesday morning, and 218 by Tuesday afternoon. Three new counties with positive cases have also been added to the growing list: Pike, Hempstead and Cross.

Hutchinson said his health team told him, “What we’re seeing is the calm before the storm. I know many people don’t see this as a calm, but I think the way that is phrased makes us understand that we’re still on the lower end of the slope as it goes up. We’re still on the front end of this COVID-19 emergency that we have in Arkansas.”

Smith said, “In terms of our numbers, we’re at 218, which is up 44 since our last press conference. For the first time, we have more positive results coming in from our commercial labs than from our Department of Health lab.”

87 of the positive tests results have come from ADH and 131 have come from commercial labs.

Smith said, “The UAMS laboratory has begun testing and we’ve already gotten a positive result from them.”

According to Smith, of the 218 positive Arkansas cases:

• 11 children

• 73 age 65-years and older

• 134 age 19-64 years

• 14 currently hospitalized

• 6 currently on ventilators

• 38 in nursing homes

• 10 recovered

There are eight total staff and 35 residents who have currently tested positive in the nursing homes.

Dr. Smith’s new warnings and clarifications

With the two COVID-19 deaths, as well as other recent deaths, Smith broached the subject of funerals. “It is very important that we remember our loved ones and we honor their lives but funerals can also be a time when COVID-19 can pass easily amongst family members, especially if there are older or more vulnerable individuals at the funeral. I think we need to think about ways we can honor the lives of our loved ones in a way that doesn’t increase the spread of COVID-19.”

Suggestions included smaller family gatherings, maybe outside as the weather gets better. Or, putting off a larger memorial service until later on.

Smith said, “Remember, it’s not just our family members, but also our funeral home directors that can be exposed.”

There is emerging evidence, according to Smith, that smoking may increase a person’s risk for COVID-19.

“There is increasing evidence that smoking is a significant risk factor for serious illness and even death from COVID-19. For those who smoke, this is a time to strongly consider quitting.

We do have quite a few individuals in our state who still smoke. This is a great time for people to become the healthiest version of themselves. That gives people the best chance if they do become infected.”

Smith said there are many references at the ADH Wellness Helpline 1-800-283-WELL (9355) or visit www.BeWellArkansas.org to assist those who want to quit smoking.

Smith also believes there has been some miscommunication. “I’ve heard some reports that some employers believe their employees have to be tested for COVID-19 before they’ll let them on site," he said. "Our guidance was that (employers) would screen visitors and employees for symptoms on a daily basis. Perhaps even check temperatures. But, it would not be appropriate for a worker who has no symptoms to get screened for COVID-19 before coming to work.”

Many people are wanting to know where the cases and potential contact with known cases have occurred so they can steer clear of a particular location.

Smith said, “With COVID-19 being reported from many parts of our state, we need to consider any public space is potentially a place where people can become infected. Be careful not to make unnecessary trips out of our homes and to crowded cases.”

Monday’s mention of chloroquine and side effects has also come back up. Smith, as well as other doctors and sources worldwide, have warned even a single adult chloroquine tablet can be fatal to a child four or younger.

“Any prescription medication should be administered under the care of a physician and, hopefully, a physician who is familiar with that medication, the side effects and its drug interactions," Smith said. "And a clinician who has looked at the literature and understands what the risks and the benefits are. I think it’s inappropriate for people to be taking this as a prophylactic, thinking it’s going to be protecting them. There is no data or evidence to suggest that.”

Smith asked that people be mindful on how they use medications.

Dr. Jennifer Dillaha, the ADH medical director for Outbreak Response and Immunizations, said, “I encourage the public to take social distancing very seriously, particularly our young adults. It is hard for many young people to stay away from our friends, because our friends are important to us. If they are truly important, it’s going to be important for us through social distancing to protect ourselves as well as our friends and our families.”

Dillaha gave similar suggestions the healthcare team has been reiterating for two weeks such as avoiding public places where we’re interacting with a number of people, avoiding unnecessary trips to the store, and so forth. Yet, some stores are still quite crowded and many do not maintain the six foot distance barrier.

She said, “If we’re taking care of ourselves, in turn we’ll be helping to take good care of our families by not bringing this virus home or sharing with our friends."

Dillaha also reminded the need to check on the invalid, those without transportation, or those with other special needs.

She said, “This can be a hardship. We in Arkansas can be helpful to our neighbors, friends, and families who are older and unable to get out as much by helping take care of their needs in terms of shopping or errands. We, as a community, need to be mindful and encourage each other to stay in touch, not be too isolated and carry on with our social distancing with what is going to help slow the spread of COVID-19 and flatten the curve.”

New supplies received

Arkansas received 24 pallets of personal protective equipment (PPE ) Tuesday at 2 a.m. from the federal government’s strategic stockpile. This includes 27,895 masks. Other items such as gloves and gowns were delivered as well.

Hutchinson expressed, “This is good news."

Another million units of PPE ordered through UAMS are scheduled to arrive by this coming weekend.

The combination from the strategic stockpile and the incoming million units "will cover us for the next 60 days at our current usage rate,” Hutchinson said.

Arkansas will continue to buy PPE because the usage rate could accelerate.

Hutchinson said, “We want to have as good of a safety cushion as we can have. In 60 days, we could still be in the middle of this and involved with it.”

Arkansas being more rural may actually be a plus. It has taken longer for the virus to affect the state and has not spread as quickly as in some places.

Smith said, “We are one of the last states to have cases. Being a more rural state as opposed to more urbanized areas of the country, we may have a slow ramp up and slow decline, which is good for us, because that will mean our peak number of people who need hospitals and ventilators will be lower than in a big city. When we’ll be able to return to normal commercial activity may be later than the rest of the country because we just had our first case a couple of weeks ago.”

Hutchinson said, “What we are doing is preparing. (COVID-19) has moved quicker in other states. In Arkansas, we do have time to plan. We’re not going to be in the position of some others that we don’t have enough hospital beds. We have time to stockpile different items of equipment we need in the future."

Arkansas General Assembly special session

Hutchinson said, “I would like to have the General Assembly begin their session this Thursday. This is important to make sure we can continue to meet the state needs. That is why this is urgent action. It is important to get everybody together in a quick fashion to make the budget adjustments as needed.”

The proclamation and the legislation is currently being prepared. Hutchinson does not intend to issue the proclamation until there is a consensus from the legislature on the legislation.

Hutchinson said, “We don’t need to get together for a prolonged period of time with contentious debate. I believe we will be together in a bipartisan way in support of what is needed in the special session so we can go home and minimize any health risk. Most importantly, to solve the challenge that we face budget-wise as we look to the future of this emergency.”

When the Arkansas General Assembly meets for the special session, there will be 135 legislators in attendance, assuming they all appear. It will be difficult to practice social distancing, but they plan to brief Dr. Smith on their plans, take extra precautions for the social distancing that is needed, including screening, and try to do what’s consistent for good health requirements.

The assembly is a constitutional requirement. Hutchinson said he’s spoken to the Speaker of the House.

Hutchinson said, “They still have an obligation to come together and get the job done.”

Normal business by Easter?

President Trump announced Tuesday he wants the country to get back to business, “opened up and raring to go by Easter.”

Hutchinson, who had not heard the president’s comments, said, “The president gives hope and he’s speaking in a hopeful way, it sounds like. I think we’d all like to see life back to normal by Easter. Do I think that’s going to happen? As I’ve indicated before, I think we’re still on the lower end of this upswing. I think we’re going to see more cases and more disruption in the near future.”

Smith claimed, “Easter would be early.”

Hutchinson hopes that Arkansas’ economy will continue to move forward and more businesses won’t have to shut down, but he realizes that’s impossible for some companies, especially small businesses.

Hutchinson said, “Some of our entrepreneurs in this state who own restaurants, barber shops, beauty shops — my heart aches for them. I think this is going to be here for some time.”

The governor does not believe it’s helpful to say we’re going to have a shelter in place or we’re going to shut businesses down now.

“As soon as you do that, you’re going to be restarting them. We have to produce,” he said as he mentioned primary needs as the supply chain, grocery stores, utilities and so forth.

Hutchinson added, “We’ve studied some of the orders from other states. They’re very broad, sometimes they’re guidance. We’re trying to get the right balance. Let’s go as far as we can in terms of our personal lives and responsibility and health guidelines."

Hutchinson believes the public can engage in business that has the safety precautions in place. That has the state going the right direction and doing the right thing during the crisis.

He said, “We have to watch that curve, though. As we estimated a couple of days ago, if we don’t do what we need to do now, it will be extended and it’ll be higher and deeper than we want and make it more difficult for us.”

Hutchinson said he heard some anecdotal stories regarding the price of transportation in the supply chain has gone up. The demand for transportation and shipments for goods, not just PPE, has increased.

“In Arkansas, we’ve got a great supply chain," he said. "I don’t see that as an issue except in some of our overseas shipments.”

For those trying to collect unemployment insurance, the system still isn’t where it needs to be to handle the surge of calls and online requests, but it’s improving.

Hutchinson said, “We’ve made some really important steps with the 24-hour emergency line. We shifted some resources there and we’re putting money into the IT upgrade. It’s still a challenge for us but it’s getting better."

Continuing business

Hutchinson said, “I believe we are approaching it in the right way, which is being very specific under Dr. Smith’s leadership of giving a directive as to who should be open, who should not be, concentrating on that face-to-face or person-to-person mission.

“You have to ask the questions, if you go further and close more, when do you open them up when you know we’re going to be in this situation for eight to 12 weeks before it starts peaking?

“As long as the public does what they need and the businesses follow the guidelines that we’ve offered, then we’re going to put the protective measures in place through screening, personal distancing and not gathering more than 10 people. We don’t have to be out and we can stay at home, that’s obviously the best thing we can do as a society.”

Increased testing and quicker results

Hutchinson said, “We do need to expand our testing, but we’re getting enough tests in to get a flavor for where we are going in Arkansas. Our testing platforms have expanded significantly in Arkansas. The commercial labs have expanded significantly and stepped up nationally.”

Smith said, “The capacity for testing across the country is greatly accelerating. There are many testing platforms that are bringing this on, even to the point people are going to get results in less than an hour. I think we’re going to see that continue to expand."

Smith said he is seeing a lot of progress in terms of growth in testing. ADH is currently able to do around 100 tests daily.

Smith said, “We are bringing on a second platform to increase that and additional equipment to support current lab-developed tests hopefully to get above 200 a day.”

UAMS has additional equipment that will allow them higher-throughput. ADH is getting more results from commercial labs.

Smith said, “Our capacity over the past two weeks has greatly expanded. I don’t think I’ve ever seen anything come up that quickly in terms of medical laboratory testing before. The processing of samples takes six to eight hours total. We are doing three runs per day.”

Smith said the additional platform ADH will be utilizing won’t require that step and expects those specimens to return results possibly within an hour. Some of the commercial labs are having a turnaround of two or three days.

Smith said, “We’ve received reports of almost a thousand tests. 218 are positive but the majority continue to be negative.”