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Then hello again everyone and thanks for joining us in Arkansas as elsewhere, the new year begins as the medical experts feared a continuing surge of COVID infections.

Most of the Omicron variant, less debilitating.

It appears less lethal, perhaps, but demonstrably significantly more contagious.

Witness this week, consecutive days of four digit record setting cases in a moment.

What the COVID spike has done and may do to education at every level in Arkansas.

But first.

What this latest surge is doing and is quite likely to continue to do to our health care system, especially our hospitals.

Bo Rile is the executive director of the Arkansas Hospital Association and Doctor Casey Holder is a vice president at Saint Bernards Medical Center in Jonesboro.

Thanks to both of you for coming in bowl, let me begin with you, Mr Row, let me begin with you.

What's the stress level right now across the state on our hospitals as a whole?

Well, I would say this morning it's bad, but we know it's going to get worse.

It's going to continue.

We've got 935 COVID patients hospitalized this morning as a comparison.

And last January we had 1339 was our high and then last August we had 1456 was our high, so we haven't reached those levels yet.

But the way this is trending, the way it's approaching, we feel like it's going to get close to those numbers in the coming weeks.

And the feedback from your Members Mr Riley.

Any indicate any.

Indication that it is not the new omnicon virus that's that's driving this.

No, no.

As you said, the transmissibility of this omicron makes.

It makes it different, and so everyone feels like its own Cron virus.

Definitely Doctor Holder you at least a day or so ago.

I believe you were quoted as saying every single patient in your ICU, or at least your COVID patients were all unvaccinated.

Right?

Yeah, that was a that was a snapshot of a single day, so you know if we look over a longer period of time, that number is not quite as striking, but it's still a very high percentage of patients and you know, not just at our facility if you saw the governor's conference earlier in the week.

Really all over Arkansas and all over the country that people that are are getting sick with COVID and certainly getting sick enough to have to be in the hospital are our very large number of them are unvaccinated, so that's that's very important and you know, especially with the Omicron variant, we know that you know while being vaccinated does provide some protection, it's not as much as what we saw with the delta variant unless you go ahead and get your booster.

So if you are eligible for your booster.

To really get the the maximum benefit of protection from this new variant, you've got to get your booster in addition to those two doses of your first primary series, with with or without.

The booster Doctor will begin with you.

Are you seeing an increasing number of so-called breakthrough cases?

Absolutely, absolutely so you know one of the things we know about the Omicron variant is it is able to escape our immune response better than the Delta variant or any of the other variants that we've seen throughout this pandemic, and that that has to do with the the number of mutations in this variant and the fact that a large portion of them are.

On the spike protein, which is how our immune response from the vaccine and from previous infection is directed is directed towards the spike protein.

So those mutations have made it less responsive to that immune response.

So we can absolutely expect to see an increase in breakthrough cases.

The important thing to note is those cases, though you still have the protection from the vaccine to prevent severe illness, hospitalization and death.

So, and that's really the goal of the vaccine, any vaccine you know is to prevent severe illness.

Yeah, and Bo rile back to you for a second.

Your your hospital members across we're talking here to doctor Holder, of course.

Who's in Craighead County across the state though?

Are you seeing?

Are your administrators seeing the same pattern of breakthroughs and unvaccinated unboosted patients?

Sure, we're hearing at the the.

Definitely the ones that are having the breakthrough cases we hear hear about those out there.

But when we're talking about hospitalizations, we're still 86% of those who are hospitalized or unvaccinated.

So yes, the booster and the vaccine does help provide protection instead of having death or hospitalization in terms of staffing bull rylar, we are.

Are we having staff shortages now either due to a simple burnout or some nurses?

Anyway, maybe joining the traveling nurse program for higher compensation or nursing and other personnel calling in sick?

I think it's all those things we're having people who are absolutely having burnout, and they're retiring.

They're moving on to other professions we've got.

We're in a competition with the travel industry we're in a competition with other States and hospitals are in competition with each other for for clinical nurses, so that's that's ongoing.

Also, as you mentioned, one of the big problems right now is staff that are calling in and they're exposed to COVID.

Or they had COVID symptoms so they're not able to come in work, so they're quarantined for a week at a time.

So that's definitely limiting the the pool of those available for position.

All right Doctor Holder?

Are you saying the same thing in in Jonesboro?

Yes, yes.

Staffing has been a challenge, not just with nursing as you noted, it's it's really housewide just like this virus is.

You know, impacting individuals out in the community.

It it has the same impact on our on our health care workers.

You know that they are exposed or they become ill with COVID and and the newer guidelines that have just come out related to COVID for health care workers.

You know our little bit more stringent in the way of what is required for people that are vaccinated, even if they've received both doses.

If they haven't exposure, you know, as Bo mentioned, they they have to be able to work for either 10 days or seven days.

If they then test negative, they come back to work, so that's a long time and it's a lot of people.

Are you getting the response from both state and federal Gov?

Particularly well, both state and federal governments, Dr Holder, that you need at your institution?

Yes, we are.

You know, I think to the degree that they're they're able, they can't make tests appear out of nowhere.

You know our medicines appear out of nowhere.

You know there are things we still need, but yes, they've been very helpful.

I'm sure you've seen in the news.

We've got some National Guard individuals coming this next week.

It's gonna be a huge help for us in trying to get testing done for our community and our employees.

So yes, I feel very good about how responsive they've been.

Anytime we've we've gone to them with a need.

Now bow royal.

I guess it is emblematic of the situation or the gravity of the situation that we're seeing as the doctor mentioned, National Guard personnel being pressed into duty to assist health care providers.

Yes, as we've talked about, we've seen the surge in testing that's going on across the state, and we're very thankful for the governor for calling National Guard troops to come out and help hospitals across the state.

While they're not clinical, they can certainly help out in so many other ways and free up personnel to work in a clinical area.

If hospitals are and and providers are have the PPE, the personal protective equipment that they need.

We're reading also that in some instances, the kind of antibodies that are.

Have been used with some success at earlier variants of COVID are not especially effective on the Omicron.

Are we first well Doctor Holder?

Let me start with you.

Have you encountered that situation there in in Craghead?

So the two I think you're referring to the the monoclonal antibody treatments that we've been using now for months and have been very helpful in preventing individuals from progressing to severe illness or having to be hospitalized.

You know, those two that we've been using don't work against Al Micron, and they're not even being distributed anymore, so there is still 1 monoclonal antibody that is effective against Al Mccrone, but and we've been receiving it but, but it's in very limited supply, and so that's been difficult.

Then we have patients that would qualify and just not having it to give to them.

Are your providers Dr there or and Bowral?

I'll go to you in the 2nd Doctor.

Let's start with you.

Are you in a potential in a position or are you already in a situation where physicians are going to have to triage COVID patients?

We're not there yet.

In the in the inpatient setting.

Now we are having to do some triage in the outpatient setting.

You know, like I said, with the that one monoclonal antibody that we don't have enough for everyone, we use a triage system that the NIH put out some treatment guidelines.

Fortunately, we have some other options for outpatients with the new antiviral treatments that are available now.

As well as the ability used to use remdesivir on outpatients that had previously been inpatient only, so we've got some other options and the triage where the triage comes in is just deciding what we have on that day and who needs which one the most.

But working to get anyone and everyone that needs a treatment a treatment bottom line is some patients are not simply not going to be able to get that antibody that they that you would prescribe, or yeah, that you would prescribe.

If you were able.

Right, right?

But we're in a good position in the hospital patients in the hospital we were able to provide them the care that they need when they need it.

We've not had any concerns in that area, yeah?

Yeah, I think we'll see hospitals as the hospitalizations go up.

Obviously she mentioned the the monoclonal antibody antibody shortage, but you'll see hospitals delay some surgeries.

You'll see them if if a surgery requires an overnight stay, they'll delay those so as the as the hospitalizations go up, hospitals will have to react to create more beds to both of you, and Bo will start with you.

I'm reading a lot here about how plainly we are.

Medicine is is.

Far ahead of where it was two years ago when cold, this this COVID first appeared, but it seems to stay one step ahead of medical science.

Now that may be just the nature of of of of any virus, but are we going to have to learn to live with this bow rail for the next several months, maybe even longer?

I think we are going to have to learn to live with this, as we've seen we're entering 2 years now, three different surges and my worry is for hospitals.

It's certainly my job to worry about hospitals, but I'm worried about the viability of hospitals with labor costs skyrocketing, it's hard to to look and see how hospitals are going to survive going on one time, money has been great from federal and state government, but I think we need to look comprehensively at Medicaid, Medicare, commercial insurance payments.

The hospitals to have ongoing money because, as you say, that we're looking at this thing continuing for a long time doctor, it sounds, is Mr. Ryles seems to suggest here that the the the financial problem, the economic impact of this on hospitals and health care providers is every bit as large as as the the clinical aspect of it.

I I would agree.

You know you've heard the term.

No margin, no mission.

You have to be able to.

Pay your employees and buy the supplies that you need to be able to provide the services that that your community needs.

So that's a consideration, certainly, and you know, I would agree that this is something that's it's not gonna go away.

I think it's gonna get better overtime, but I think it's something we will live with for years and years to come, and it may turn into, you know any other virus like we deal with with the flu or a head cold and hopefully won't be as severe.

But I think COVID is something we're going to live with.

For for a long time and you know the frustrating part is.

As we have these new variants, you would think, OK, we're two years into this.

We know how to do this, but you know, like with the Delta variant, it was like starting all over again because it was so different and omicron's been sort of the same.

So a lot of the things we were able to do before don't work, and so you're right in saying it sort of stays one step ahead of us, and so that's been challenging.

You know, to think here we are two years into this, we really ought to know how to deal with it, but that's not.

Always the case.

Doctor Casey Holder Bo Ryall thanks very much for being with us.

Thank you very much and come back soon.

We'll be back in just a moment.

Arkansas school districts large and small, moving again to remote learning.

Others imposing mask requirements on pupils, faculty, staff.

Scores hundreds, possibly thousands of teachers and students, and support personnel staying away from the classrooms and the cafeteria's either diagnosed with COVID or fearful of contracting it.

And the spring semester has barely begun.

So what now?

Where now.

While we're joined by Doctor Ivy Pfeffer, the Deputy Commissioner for elementary and secondary schooling at the Arkansas Department of Education, Doctor thanks very much for being with us.

Recognizing that this we're taping this broadcast at mid morning late morning on a Friday as of this moment, do we know the extent of distance learning?

How many districts?

How many pupils now are going to be for however long, doing remote learning?

Yes, we do have districts around the state who have made a decision to close the on site instruction.

And many of them are providing digital learning as an alternate method of instruction.

We do have a few districts that have closed campus and will be making up school at a later time there.

The districts really range geographically all over this state for varying lengths of time.

Most of them are due to the fact that it's difficult to staff and with the numbers of teachers that they're out, either because they're having to quarantine themselves or they're having to be home with with one of their children.

OK, do we have any estimates though, or did I miss it because of a technical snag there?

Do we have A and any idea as of this moment anyway?

The scope of of the of the shutdown or of the of the adjustments?

To the districts have just planned to be closed for the remainder of this week and most started ramping up yesterday and today with a few just closing today.

I think everyone is planning to assess over the weekend and look at their data.

Look at it in terms of maybe just individual campus closure and making the decisions.

As far as what's going to happen next week.

Well, looking at the clinical data for the last several days, it seems inevitable.

What is the thinking there at the state education department?

It seems inevitable that the number of districts that are going to modify classroom hours classroom situations is going to grow, at least for the balance of January.

We do expect that and districts will be working through the planned way that we've asked them to respond.

And again, I think I want to emphasize that the responses of districts are the way that we planned for them to work through their COVID situations.

While there may be a growing number of districts that have to make modifications, we're hoping that those modifications will be as limited in scope as possible, and again, it may be that the entire district does not have.

Too close to onset instruction.

It maybe one or two campuses within a district.

We are just going to be monitoring that situation through the protocols that we have set up.

Or are we prepared?

Doctors state prepared anyway.

Doctors State Education department.

Then we prepared for a broad, wide scale resumption of at home schooling.

Remote learning, I mean yeah.

We we've not planned for that scenario simply because we've given the districts, the ability to make those individual decisions that they need to make.

If they choose to do that, what is the state prepared to do to assist them if that becomes necessary?

We so at the department we have assigned points of contact for every district, so every Superintendent has A and someone here at the agency that they contact.

They talk through their day to talk through their situations.

We find out from them what their needs are.

If they're needing a consult with the Department of Health to get additional information, we set that up for them.

If they are concerned about the number of a in my days that they have left, we're going to be tracking that to see.

What other measures might need to be put in place for them if they need PPE?

We are working to help make sure that we get supplies sent out to them.

We're monitoring and and the levels of substitutes and and that also helps us in terms of looking at are there policies or things that we need to look at?

Flexibility for them?

Well, in terms of PPE?

Or do you have stores on stock and obviously you coordinate this with as you, as you noted with State health department, is that going to be a situation that the state is prepared to handle on a fairly fast basis?

Yes, we already had placed another order for face masks and that will be delivered to schools.

It'll be delivered in two phases and we had a company that already had a face mask ready to be shipped out for the the medium to larger size mask and they are preparing masks for the smaller children as we speak.

Well of course policy on a matter such as this is shaped on the 2nd floor of the state capital and and and not on the mall there.

But is it the?

Is it the state's plan right now to leave a 2 local districts?

Any requirements for masking?

Yes, and districts and make their own decisions in terms of that and the Department of Health is encouraging that mass be worn as one of the mitigation strategies along with proper ventilation, physical distancing, hand washing because when put together, all of those mitigation strategies layered together really do help.

The main thing that we would also encourage though, is the vaccinations and with the new.

Guidelines that have come out.

That and vaccinations really are an incentive to be vaccinated and boosted to be able to avoid quarantine or to limit the amount of time that you would have to quarantine if exposed well.

In terms of certainly certainly in terms of of masking or vaccination, you would not anticipate at this time any.

I'll use the word mandates anyway at the state level on local districts.

No, we do not anticipate any mandates you mentioned that can Centers for Disease control a moment ago and and the guidelines there has been over the last several days.

Significant confusion.

It would appear now recognizing that you coordinate with the with the health department has that can have you encountered that confusion either at the state headquarters or a feedback from local school districts.

There was some initial questions when the the update came out and the update from the CDC was presented as guidance for the general public and so of course there were questions about schools and we got an updated guidance from CDC and our Department of Health worked with us.

Tuesday afternoon and Wednesday morning and we worked on what that guidance needed to look like for schools.

Although the the requirements are very similar, there are some unique things to school.

For example, if someone does come back from quarantine after day five, they still are going to need to wear a mask for the next 5 days and there are some activities within the school that might make it difficult to participate in.

If a student has a mask on, for example.

And participating in instrumental music class or things like that.

So there are some activities that could be limited in a school environment with a student wearing a mask.

But those were some details that had to be worked out and we were able to share that with schools in the last couple of days.

So so the ambiguity has largely been removed from that situation from the CDC guideline recommendations, yes, we were able to get updated guidance out to schools yesterday.

All right in terms of staffing levels at.

At the state Education Department, are you encountering reports, feedback from local administrators?

Of teacher burnout of teacher stress.

Maybe even some resignations or retirements that were unplanned at at at mid term.

We have seen over the last couple of years, definitely a change in the years of teaching experience.

We do hear reports of of teachers being stressed.

Teachers are being asked to do so many different things, not just.

Not just the typical work that you would see in the classroom, but teachers and support staff have taken on roles during the pandemic to provide all those other academic supports and resources.

So yes, there is a high level of stress.

We have seen a change in our teaching workforce.

About 40% of our teachers have less than three years of experience currently, so we do know that that our workforce is being shaped by the the dynamics of.

What's going on in the world today is is there a plan to to address that doctor?

I mean, what can the state do at this at this stage of the pandemic?

Well, our plan really is even beyond the pandemic and we know that and that that the teacher is the most influential factor on student achievement and so our plan is to really ramp up our grow your own initiatives.

We actually are launching a teacher residency model starting this fall and we're really excited about that.

It's going to.

It can begin as early as high school.

We're going to tap into the talent of our paraprofessionals support.

Specialist in our schools and we're going to provide them with those opportunities to gain some work based experience while they're completing their degree requirements and licensure requirements.

So so we're really optimistic about that.

We just have to keep moving forward and keep supporting the teachers that we have in place now because we know those first few years are very tough and with a large number of novice teachers, we've got to change up some of those support so that we keep them beyond those three to five years when they're really hitting their stride.

And this also doctor.

I mean there is universal agreement that ground was lost owing to the pandemic over the last couple of years among public school.

Well, K12 students, not just in Arkansas but everywhere.

Is there concern there that this latest spike is going to aggravate that situation?

I mean, obviously it can't make it better.

I think that is all depending on how successful we are staying the course and really working with schools and to to to help maintain our on site instruction to the extent possible.

And of course this bag makes it more difficult, but I think when you look at the data that we have right now this year compared to last year and we have so many fewer cases where on site instruction has had to be modified.

Because schools have and done a good job in mitigating the risks and responding in ways where they've not had to close as often as they did last year.

And I talked to a Superintendent who last year at this time had over 70 students who were not on track to graduate this year, that number is down to only six.

They have really ramped up their supports.

They're keeping students in school and that is why it is so important that we do everything we can.

And to keep schools open and to provide that flexibility for decision making at that local level.

Because the the local administrators know their situation best got ended their doctor because we're simply out of time.

We thank you very much for yours and come back soon.

Thank you and that does it for us for this week.

Thanks as always for joining us, see you next week.

Support for Arkansas Week provided by the Arkansas Democrat Gazette.

The Arkansas Times and QR FM 89.