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Kids make up a third of Covid cases in Tennessee amid clash over masks in schools

Infectious disease experts warn that Tennessee is currently experiencing its highest growth in Covid-19 hospitalizations since the pandemic began, and children now make up 36% of all active cases.

(CN) — As Tennessee this week joined the few other states that have surpassed 1 million Covid-19 cases, children now make up more than one-third of active cases — a rate never before seen — while the governor has taken steps to limit local school districts’ power to implement certain safety measures.

Dr. David Aronoff, director of infectious diseases at Vanderbilt University Medical Center, said it is “impossible for me to fathom that one out of seven people in the state would have been diagnosed with this disease in such a short period of time.”

But cases and hospitalizations among children and adults also continue to rise, according to Tennessee Department of Health data. Just 6% of ICU beds and 10% of floor beds were available across the state as of Thursday. And now that the state is a few weeks into its latest surge, deaths have also begun to rise to rates not seen since the end of the holiday surge earlier this year.

Coronavirus cases in Tennessee have been steadily rising since mid-July when the delta variant began making its way through the state.

Infectious disease and health policy experts at Vanderbilt University warned in an Aug. 19 report that “Tennessee is now experiencing its highest growth in [Covid-19] hospitalizations than at any point in the pandemic.”

As of Thursday, the state sat at sixth in the nation for new cases per capita, according to New York Times data. The vast majority of those cases are among the unvaccinated. And with just 41% of its population fully vaccinated, Tennessee has kept one of the lowest vaccination rates in the country.

“Having this relatively rapid increase in cases, hospitalizations and deaths has been really disheartening and fatiguing and sad,” Aronoff said, echoing thousands of other physicians across the state. “It is particularly heartbreaking to be caring for patients who are critically ill and had not yet been vaccinated, because the vaccines really are capable of keeping people out of the hospital.”

While Aronoff is still in “response mode” — trying to do everything he can to help the sick — he and others are still dealing with feelings of sadness, frustration and fatigue.

He’s been moved to tears more times during this wave than at any other time during the pandemic, he said.

“I'm not sure what that's due to, but it may in part be because we're seeing younger people who are unvaccinated and, not infrequently, pregnant patients who are really sick with Covid-19,” he said.

Now that vaccines are available, Aronoff said it is “upsetting that we're struggling to get everybody who's eligible protected.”

And while children under 12 years of age are not yet eligible for the vaccine, “it is important for us to understand that the rate at which this disease is attacking children is influenced greatly by how well protected adults are,” he added.

Meanwhile, children have returned to school amid a growing divide between the pro-mask and anti-mask sides and a governor who is determined to keep children in school by not providing any plans for school districts to shift to remote learning if needed while signing an executive order overriding local school districts’ efforts to require staff and students to wear masks. State officials clarified late Wednesday that individual schools may shift to remote learning as long as it's not a district-wide measure.

“Our hospitals are struggling under the weight of Covid, but those hospital beds are filled with adults,” Republican Governor Bill Lee told reporters on Aug. 16 as he announced the order. “Requiring parents to make their children wear masks to solve an adult problem is, in my view, the wrong approach.”

A sign stating masks are required greets visitors outside Belmont University in Nashville, Tenn., before a presidential debate in October 2020. (Patrick Semansky/AP)

But more and more children are ending up in hospitals, according to data, physicians and public health officials.

With children now making up 36% of all active coronavirus cases, state health Commissioner Lisa Piercy is now pointedly encouraging parents to send children to school in masks.

“There's not a single person that doesn't agree that keeping kids healthy and keeping them in the classroom is the best. One incredibly effective way to do that is for schools and for parents to use the best tool that we have for unvaccinated children, and that's masking up their students,” Piercy said in a Wednesday evening news conference.

“When more kids are masked in classrooms, they're more likely to stay in school,” she added. “So if you want your kid in the classroom, I encourage you — send them to school in a mask. Not only does it help them. It also helps reduce community spread and keep adults out of the hospital.”

Some school districts have implemented mask requirements. But Lee’s executive order gives parents the right to opt out of those requirements. It was a compromise to allow “school boards to ensure the health and safety of their students while recognizing the rights of parents to decide what is best for their children,” Lieutenant Governor Randy McNally said.

Lee signed it on Aug. 16, just days after a large crowd of anti-mask parents lashed out at doctors, nurses and other medical experts who are parents themselves and were advocating for mask requirements in schools during a school board meeting in Williamson County — the state’s richest county just outside Nashville — after the district voted to temporarily require masks in elementary schools.

That outburst drew attention from President Joe Biden, who twice mentioned the skirmish in separate addresses. In his second reference, Biden used it as an example of politicians setting a “dangerous tone” by politicizing masks and warned that legal action may be taken against governors trying to throttle local school officials’ powers.

“Unfortunately, as we’ve seen throughout this pandemic, some politicians are trying to turn public safety measures — that is, children wearing masks in school — into political disputes for their own political gain,” Biden said in an Aug. 18 address. “I’ve said before, this isn’t about politics.  It’s about keeping our children safe.  This is about taking on the virus together, united.”

Biden added that he was directing Education Secretary Miguel Cardona to “take additional steps to protect our children. This includes using all of his oversight authorities and legal actions, if appropriate, against governors who are trying to block and intimidate local school officials and educators.”

Under the American Rescue Plan Act, local schools that receive emergency relief funding are required to outline their plans for the safe return to in-person instruction, including how they plan to follow Centers for Disease Control and Prevention guidelines, which include universal mask wearing.

That same day, Lee got a letter from Cardona. It warned that the governor's action “to block school districts from voluntarily adopting science-based strategies for preventing the spread of Covid-19 ... may infringe upon a school district’s authority to adopt policies to protect students and educators as they develop their safe return to in-person instruction plans required by federal law.”

To that, Lee tweeted, “Parents know better than the government what’s best for their children.”

In spite of Lee’s order, however, Tennessee's two largest school districts — in Memphis and Nashville — have said they would still require masks for all, the Tennessean reported. In response, McNally said the Legislature “cannot and will not allow lawful orders to be defied.”

Lee said Wednesday that there were no plans for a special legislative session to take action against districts defying the order, but “there’s always that option.”

By Thursday evening, Shelby County, home to Memphis, sued Lee over his executive order.

Because of the order, the county argues, “other children who share hallways, classrooms, buses, and school facilities with those opted-out students must consequently face heightened risk to Covid-19 exposure.”

The county has asked the judge to temporarily block Lee’s order in Shelby County and to declare it a violation of the U.S. and Tennessee constitutions, and a violation of the county’s obligations under the American Rescue Plan.

Meanwhile, more than 5,000 medical professionals have signed an open letter urging the governor to remove his order that restricts local school districts from issuing mask mandates. A few days later, nearly 100 physicians took turns reading the letter in a Facebook live stream.

“An executive order that allows parents to ‘opt out’ of masks threatens the public health of entire communities and our state at large,” the Aug. 17 letter reads.

“Please allow our local health departments to guide school boards in mandating masks when local spread is high,” the letter continues. “Please trust our expert recommendations as we strive to protect the health and wellbeing of the people of Tennessee.”

The main thing medical professionals want people to understand, Aronoff said, “is that every one of us ... can play a leading role in saving people's lives by doing the things we need to do to reduce the likelihood that we will get infected and pass the virus on to somebody else who could end up in the hospital or worse.”

Things like social distancing, wearing properly fitting masks, and getting vaccinated all help, he said. 

“These are drums that I beat every day,” Aronoff said, because “the reality is that this pandemic rises and falls on the behavior of every individual person, and I want to thank every individual person who's doing all they can to help themselves and others.”

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Categories / Education, Government, Health, Regional

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