As COVID-19 vaccination rollouts continue and the U.S. returns to a semblance of normality, Arkansas officials are warning of a third surge following a spike in cases.
Arkansas, which never issued an official stay-at-home order during the pandemic, reported 686 new probable and confirmed COVID-19 cases Wednesday -- the largest one-day increase in more than four months.
The state's COVID-19 hospitalizations also rose by 19 to 325, and deaths increased by four to 5,909.
Gov. Asa Hutchinson said in a statement that "the high number of cases today makes it clear that the delta variant is increasing the spread of the virus" in the state.
So far, 34.3% of the state's population has been fully vaccinated, according to the Centers for Disease Control and Prevention.
Hutchinson touted the effectiveness of vaccines during a Tuesday coronavirus briefing, saying 90.5% of current active cases in the state are among the unvaccinated, who, officials noted, also account for 98.3% of Arkansas' 3,765 hospitalizations and 99.6% of the deaths since Jan. 26.
University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson said at the press conference that the delta variant is driving up case numbers.
The delta variant, first detected in the state on May 1, makes up more than 25% of infections in the state and is projected to make up more than half of all infections within a matter of weeks, Patterson added.
"We have to be concerned that this would be a trend that could continue, and if it does, it would appear that we may be in the third surge of COVID-19 here in the state of Arkansas," he said.
Hospitals see more younger patients
Doctors in Arkansas told ABC News that the highly transmissible new variant, low vaccination rates and infrequent mask-wearing are fueling the surge.
Hospitals are seeing more and younger patients arrive, many with more severe symptoms, Dr. Jason McKinney, a pulmonologist and the ICU medical director at Mercy Hospital Northwest Arkansas, told ABC News. He said this isn't because younger people are more susceptible to the virus but because more older people have been vaccinated.
"Most definitely we are seeing the beginning of a third surge," McKinney said. "And as far as our inpatient load of COVID, we're at about 30% of where we were previously. And so that makes me very concerned, because we're very early on."
As of Thursday, Mercy Hospital Northwest was treating about 16 COVID-19 patients at the hospital.
"The misconception of younger people is that if I'm at low risk of dying, I'd rather risk getting the disease and just be sick than get the vaccine," he said, referring to people in their 20s to 50s. "COVID is often a virus that keeps on giving after you've gotten rid of it. And the amount of chronic fatigue, the neurologic problems, the vascular problems, cardiac problems and the pulmonary problems that people suffer from this disease long term, it's scary."
Last week, UAMS Medical Center in Little Rock reopened a unit for COVID-19 patients after shuttering it in April.
Dr. Steppe Mette, CEO of UAMS Medical Center, told ABC News that the hospital has seen a "300 to 400% increase in the number of patients with COVID just over the last three to four weeks."
"So," he added, "we're back to hospitalization numbers that we haven't seen since February or March. And that's happening around the state."
UAMS last reported having 22 COVID-19 patients in hospital beds and nine in the ICU. Around the city, there are over 100 hospitalized with the virus, Mette added. Previously "about a quarter of our patients hospitalized in the ICU, and now we're running more like 50 to 70% in the ICU."
The vaccination rate in Arkansas, one of the lowest in the U.S., has slowed further despite the introduction of several incentive efforts.
Last month, the state launched a million-dollar vaccine incentive program, giving out Arkansas Lottery Scholarship $20 scratch-off tickets or a $20 gift certificate for the Arkansas Game & Fish Commission for new first doses, but it's failed to bring up vaccination numbers.
Only 2,482 lottery tickets and 926 Game & Fish Licenses have been given out as part of the program, a Health Department spokeswoman told ABC News.
Data from Johns Hopkins shows that the state's seven-day average vaccination rate sunk from 27,298 on April 1 to 4,591 on June 30.
Mette said while earlier in the year there were issues of accessibility, now the real battle is vaccine refusal.
"It's more that there is a resistance, refusal or hesitancy to get a vaccine," Mette said. "It's more that they've been influenced by somebody else, that the vaccines are not safe, or they're not necessary, or that the pandemic isn't even anything real or to worry about it. That degree of resistance is pretty concerning."
In a bid to curb an outbreak, some facilities have stopped in-person visitations, an echo of earlier on in the pandemic.
The Conway Human Development Center, a state-run residence for people with disabilities, stopped visitations after 20 staffers and 13 residents tested positive for the virus within a two-week period, according to ABC Little Rock affiliate KATV.
Under the state's recently passed "No Patient Left Alone Act" visitors will be allowed if a resident requires emergency care or hospice care.
Baxter Regional Medical Center in north Arkansas tried to ban visitations at its emergency department last week only to walk that back after realizing it could no longer enforce it.
"We've been through a lot over the past year and a half," McKinney said. "We're worried that we're looking at a similar situation where we've all been working extra days and nights and taking care of a high volume of patients. We're very worried that we're going back in that situation."