Mark Dougherty, an infectious-disease physician in Lexington, Ky., sees the toll the state's most severe coronavirus wave is inflicting on communities with school back in session -- the teacher placed on a ventilator, the bus driver nearing intubation, the critically ill custodian.
He feared their cases would be the "tip of the iceberg" after the mostly Republican state legislature during a special session this month repealed a statewide school mask mandate put in place by the Democratic governor. But most Kentucky school districts made a different choice: They kept mask mandates in place.
All but six of Kentucky's 171 school districts kept the mandates, including those in rural, conservative areas, according to tracking by the state school board association.
"It's not a political decision for us," said Sarah Wesson, superintendent of the school district in Lee County, a small, rural community where three elementary school staffers died in recent weeks. "It's just about the safety of our kids, and we are just trying to do the best we can to stay open and keep our students and staff safe."
The special session has deepened the divide on how to fight a pandemic that persists into a third school year. Kentucky Gov. Andy Beshear, a Democrat, no longer centrally manages the state's efforts to mitigate spread, because the legislature, where Republicans hold veto-proof majorities, now have greater power because of a recent state Supreme Court decision. He said Republicans do not deserve kudos for not banning a proven method of controlling a virus.
"I don't think we can pat ourselves on the back for not having made the worst decision. We have to make the very best decisions. Our hospitals are bursting at the seams," Beshear said last week.
He faulted state lawmakers for "punting" to school boards when public health experts recommend universal masking in schools.
"This argument that covid is different in County X versus County Y when our entire state is in crisis because of the delta variant just ignores reality. It ignores science and it punts the ball," Beshear said.
State Senate President Robert Stivers, a Republican, said the overwhelming support for mask mandates from school boards shows Beshear was wrong to fret they would bend to pressure from vocal mask critics, and it shows localities are best suited for such decisions.
"The majority of the areas that went for Donald Trump are voting at their local level to mask in school," Stivers said last week. "They are doing that because they are looking at the local dynamics. They are probably seeing a high number of cases in their county."
Senate Minority Leader Mitch McConnell, R-Ky., told the Owensboro Times last month that he would defer to school boards if he were the governor, a rebuke of other Republican governors banning mask mandates.
Rand Paul, Kentucky's other Republican senator, has called masking for children younger than 6 "child abuse" in a tweet Sunday.
Beshear, a former state attorney general who narrowly won the governorship in 2019, has largely embraced mask mandates and coronavirus restrictions while leading the red state through the pandemic. But the recent state Supreme Court decision altered the balance of power and forced him to seek more legislative approval for his actions.
The power tussle ramped up as cases began sharply climbing in Kentucky in August with the rise of the delta variant. Kentucky has one of the highest hospitalization rates in the country, with admissions topping 2,500 last week and only about 100 intensive-care beds still available.
Hospitals also have been struggling with fierce competition for travel nurses, said Nancy Galvagni, executive director of the Kentucky Hospital Association. She said rural hospitals in disproportionately under vaccinated areas have been especially strained because urban hospitals can't take their sickest covid-19 patients as they usually do.
Beshear mobilized more than 400 members of the state National Guard to support hospital operations. At Baptist Health, Kentucky's largest nonprofit hospital network, more than 130 troops are transporting patients, cleaning the facilities and helping with testing, said Jody Prather, chief strategy and marketing officer.
Dougherty said the facilities have been running low on anti-inflammatory drugs. One patient was recently placed on a ventilator on a hospital floor because there were no ICU rooms available, he said. Others have been driving hours to Lexington from rural areas.
He hopes the decision by most school boards to keep mandating masks will prevent things from getting even worse.