In Northwest Arkansas on the COVID-19 front, ‘there’s a flood coming’

Climbing cases of COVID-19 in the northwest corner of the state are taxing the region’s capacity, draining health care resources, and disproportionately affecting the Latino and Marshallese communities.

That’s where things stand today, and without a more substantial effort to contain and reduce cases, the Fall could overwhelm this part of Arkansas and spill over into other areas.

“There’s a flood coming, and we are not ahead of this flood,” said Dr. Pearl McElfish, vice chancellor of the Northwest Arkansas Regional Campus of the University of Arkansas for Medical Sciences (UAMS).

McElfish and Dr. Lisa Low, Medical Director of Community Health at Mercy Northwest Arkansas in Rogers, spoke with Talk Business & Politics editor-in-chief Roby Brock on Wednesday (July 8). Low says at the beginning of COVID-19’s surge in Northwest Arkansas, there was a large Latino population group that showed signs of the disease. Then Marshallese patients added to the patient count in area hospitals. Now, there is an increase of Caucasian patients showing up for acute care.

Today, an estimated 50% of the hospitalized COVID-19 patients in Northwest Arkansas are Latino, and another 20% are Marshallese. According to U.S. Census data, these populations account for 17% and less than 3%, respectively, of the overall population in Benton and Washington counties.

Northwest Arkansas was slow to see new cases – less than a handful of hospitalizations when the state began shutting down in the back half of March and early April. By late April and early May, when the state was reopening, the patient count in NWA began to rise. With elective surgeries and outpatient care returning, it has created a confluence of events leading to congestion and stress on the region’s healthcare resources.

“There’s a lot of pressure on our system,” Low said. “Not only do we have the patients now, but we also have our other patients who we’re trying to take care of who weren’t able to have care for the last few months. So there’s a big backlog of things that need to be done, but now our personnel is stressed and [we’re] trying to bring people back to take care of the patients we have.”

McElfish said during the shutdown, the lack of attention to pre-existing conditions and maintenance healthcare has compounded the situation.

“Part of the stress on the system is COVID. Another part of the stress on the system is the fact that many chronic diseases, things that we typically would have done for strokes, for heart disease, advanced diabetes, and kidney disease, have been delayed. And the delay of those treatments has meant the patients are much sicker,” she said. “So there is this dual burden on the healthcare system by delaying some of the treatment. We have many more sick patients, particularly those with advanced diabetes or advanced heart disease. And then, in addition to that, you have the COVID layered on top of it.”

She and Low said those non-COVID patients still need to seek medical care in order to prevent the situation from worsening.

As of Wednesday, Benton and Washington counties had 132 new COVID-19 cases bringing their accumulated cases to 7,398, roughly 29% of the state’s total. There are 109 patients in COVID-19 units with 39 on ventilators. In addition to the 109 COVID patients, there are another 571 patients in the region’s hospitals for other medical needs, with 113 ICU beds in use.

Projections from UAMS, released earlier this week, suggest the situation will worsen statewide unless resources are added and personal habits improve.

TESTING, TRACING AND TRANSLATION
Testing and contact tracing for COVID-19 are behind in the region, the two healthcare leaders contend. Testing supplies are low, and there is a backlog at processing facilities. Low says that Quest Labs, which processes Mercy Hospital’s test kits, “are swamped.” They have had to slow down results for people, and it can discourage mass testing events or testing potential asymptomatic carriers who pose a significant risk of spreading the disease.

“I think part of the problem is just nationwide capacity,” Low said. “We haven’t gotten ahead of it as a country.”

McElfish agrees there are not enough testing supplies to meet the region’s needs and many other parts of the country. She’s particularly concerned about contact tracing and the language barriers presented by the large Latino and Marshallese populations in Northwest Arkansas.

“We still do not have enough testing supplies to meet our needs fully. It is also around contact tracing and navigation and the resources, particularly when it comes to the Marshallese and Latinx communities. You really need interpretation translation,” McElfish said.

Gov. Asa Hutchinson has pushed the Trump administration to enact the Defense Production Act to ramp up COVID-19 test kit manufacturing. If that were to take place tomorrow, there would still be a weeks-long lag before factories could be converted, and kits could roll off assembly lines and be delivered. Hutchinson has also pushed to spend $20 million in federal funding to hire more contract tracers to address the shortcomings in this area, but again, these jobs won’t get filled overnight.

SUMMER CAMP, SCHOOL AND FLU SEASON
Time is not on anybody’s side.

President Donald Trump announced Wednesday he wants schools to reopen in a little over a month. Hutchinson and state education leaders were already working in that direction. The Arkansas Activities Association has green-lighted Fall sports, such as football.

Just this week, a preview has emerged of a worst-case scenario. Two summer camps – one in Arkansas and one in Missouri – closed after a significant number of camp children and staffers tested positive for COVID-19. One of the camps went so far as to require testing for people attending the camp, and it still didn’t work.

“That’s exactly the same thing that’s going to happen when school starts,” Low said.

McElfish is concerned that the region is not going to be prepared by the time school begins based on what she sees.

“When you think about Springdale and Rogers school systems, which I live in Springdale, my son went to the Springdale school system. I am so proud of the way that they handled the big influx of migrant and immigrant children. But when you think about school starting back up in Springdale, if we do not have a handle on this in the next two, three, four weeks, it’s going to blow,” she said.

Low warns that with Fall comes the traditional flu season, which will further complicate treating COVID-19.

“We’re also looking at flu season starting, and that’s going to add on a whole other mix into this. We’re not going to distinguish very well between COVID and the flu,” she said.

The outlook has its grim warnings with resource shortcomings, the significant hospital influx at present, and what’s on the horizon. Still, Drs. Low and McElfish highlight a variety of positives and the ability for personal responsibility to make a difference.

Low emphasized that Mercy, being tied to an extensive hospital network, can shift resources to help in critical situations. She is complimentary of the Arkansas Department of Health for taking the lead on ramping up testing from where it started as well as pushing to improve contact tracing. Low views passage of local mask ordinances in Fayetteville and Rogers as steps in the right direction.

McElfish views the coordination among healthcare leaders in the region as helping handle the pandemic’s surge in Northwest Arkansas. She believes solid planning is in place in terms of what may be next and that there are some excellent reinforcements to help with the expected surge. She hopes the community and the state step up to take care of minority populations being so disproportionately hit.

Low’s parting advice is for citizens to understand the disease will be here for a long time.

“If there was a message for the public, it is to be patient. We’ve seen that people don’t take it seriously until they panic,” she said. “I think people are starting to take it seriously now, but they need to be patient with the health care system.”