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South Carolina’s second-largest school system inserted itself in the center of a nationwide debate last week when it voted by a landslide to mandate face masks, defying the state’s ban on such measures as delta’s spread continues in the southern U.S.

It was a closed-door meeting with hospital staffers that swayed the board of trustees for the Charleston County School District, which approved the rule with an 8-1 vote on Aug. 16. Leadership from the Medical University of South Carolina came armed with data showing that even with only sports practices and summer camps underway, positive Covid-19 cases among public-school students in the last month were on track to surpass those seen in all of the fall semester of 2020.

They also revealed that an increasing number of children were admitted to the hospital with severe cases, including three unvaccinated adolescents put on ventilators and a teen who died of complications related to the virus the week prior. “We want to be in-person and we know this is not going to be easy,” said Kate Darby, the school board trustee who proposed the mask requirement, which is in effect until Oct. 15. “But we also don’t want to have any of our kids in the hospital, any of our teachers in the hospital, any of our kids not make it because of COVID.”

The public-school district is one of many at odds with its state government and some parents over facial coverings, as another pandemic school year begins. Six other states have prohibited mask mandates, including Florida, where COVID-19 cases and hospitalizations have reached record levels. At least seven school districts in the state, including Miami-Dade, Broward and Palm Beach, are openly defying the ban. In Texas, mask mandates saw an early court victory last week, with school boards citing accelerating rates of infection to justify their stances.

At least 305 positive COVID-19 cases among Charleston County public-school students were reported from July 21 through Aug. 17, the day before classes started, said Allison Eckard, a pediatric infectious disease specialist at Medical University of South Carolina Children’s Health. That surpasses the 294 recorded among in-person students in the first semester last year, and at least another 14 tested positive on Aug. 18, she said.”There’s this misconception that kids are not at risk of COVID and if they get it, it’s no big deal, and that’s not true,” she said. “Our children are being admitted with COVID way sicker than they were previously.”

Cautionary tale

Charleston County officials are trying to avoid the same fate that Mississippi suffered.

Some students have been back in the classroom since early August, and 5,933 had tested positive for COVID-19 by Aug. 13, Mississippi Department of Health officials said Aug. 17. More than 20,000 were quarantined because of exposure. That represents 5% of the student population based on last year’s enrollment figures — and not all schools are reporting COVID-19 data to the department.

The state hasn’t blocked mask mandates, so many districts require facial coverings while it’s optional in others.

Paul Byers, an epidemiologist with the state’s health department, said the most dramatic rise in cases is among kids 5 to 17 years old, with those ages 6 to 10 most impacted.

The steep increase across many age groups is straining Mississippi hospitals. The state had six intensive care beds available last Wednesday with a 46-person waiting list and 251 patients being kept in emergency rooms while waiting for a more permanent bed, according to Jim Craig, the health department’s senior deputy and the director of the Office of Health Protection.

Students arrive for classes on the first day of school in Miami on Monday. | REUTERS
Students arrive for classes on the first day of school in Miami on Monday. | REUTERS

More than 625,000 Americans have died from COVID-19, according to the Centers for Disease Control and Prevention. An analysis of just over half a million deaths showed 471, or less than 1%, were in children. But there are still other grave health risks that the virus poses. Beyond acute and long COVID-19, the virus can also trigger a rare, sometimes deadly, condition in kids called multisystem inflammatory syndrome that can damage children’s hearts as well as their digestive, nervous and respiratory systems.

Now, pediatric COVID-19 hospitalizations have surpassed the last surge across the U.S., with an average of 279 admissions each day, according to CDC data from Aug. 20, compared to 217 during the last peak in January.

‘A healthy respect’

Despite the jump in cases among the young, the Charleston school district faces steep opposition in its home turf.

A similar mask requirement for public buildings and large gatherings failed to pass the Charleston City Council last week after a contentious public debate.

“These are our children and we are the parents,” said Ashley Regan, one of 80 speakers during the council meeting Tuesday. “The medical choices for our children are up to the parents and the parents only.”

And it seems South Carolina Attorney General Alan Wilson shares the sentiment. Last week, he asked the state’s supreme court to void another school mask mandate instituted in Columbia, the state’s capital, earlier this month. The lawsuit said it applies to “all cities, towns, counties, and school boards that have passed or are seeking to pass mask mandates.”

Groups representing children with disabilities and their parents filed a federal lawsuit Thursday challenging South Carolina’s ban on mask requirements in schools, according to a statement from the American Civil Liberties Union. Students with disabilities can have underlying health conditions that make them particularly susceptible to severe illness from Covid-19.

The lawsuit argues that South Carolina’s ban effectively excludes those children from school, in violation of the Americans with Disabilities Act. A similar legal challenge was mounted in Texas challenging Governor Greg Abbott’s ban on face covering mandates in schools.

Overturning those state bans would help enforce mask requirements in places like Charleston County where school boards have imposed one anyway.

Charleston’s public school system serves about 49,000 students, and around 70% attended in-person last year. Most of the 294 positive cases among students between September and mid-December were contracted outside of school, said Eckard of the Medical University of South Carolina.

The winter season was worse as the country saw an overall surge in cases, and more than 1,200 in-person students tested positive for COVID-19 from January through mid-June, hitting a peak of 350 for the month of January.

Eckard said pediatricians are nervous about the year ahead. Children’s hospitals are already taxed by a surge in cases of respiratory syncytial virus, a childhood infection that typically manifests in cooler months but emerged recently as mitigation measures like mask wearing were relaxed. This is just as flu season is right around the corner.

“I’m not trying to scare people,” Eckard said. “I’m trying to give people a better sense of what we’re actually seeing and to warn people that they should have a healthy respect for this virus.”

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