As a pediatric critical care physician here in South Carolina and the vice president of the S.C. Chapter of the American Academy of Pediatrics, hearing the desperation in parent voices as they grapple with the preventability of this disease is heartbreaking.

Our institution, the largest children’s hospital in the state, has not cared for a single child with COVID-19 or MIS-C who was fully vaccinated against COVID-19 prior to getting sick with COVID-19 (note about half are too young). We have also cared for zero children with complications due to masking. But our state’s children’s hospitals have seen disturbing numbers of children requiring hospitalization, intensive care, ventilator support and worse.

Our children are our most precious gifts, and every preventable child illness and death is devastating. As of Oct. 1 among state schools reporting to S.C. DHEC, over 51,000 students and staff have isolated and 210,000 have quarantined since the beginning of the current school year. As of Sept. 30, the American Academy of Pediatrics and the Children’s Hospital Association weekly report, South Carolina ranks third in the percent of COVID-19 cases that are children (23%) and second in cumulative COVID-19 cases (14,996 cases per 100,000 children). South Carolina does not fare well in terms of vaccine rates and therefore hospitalization or infection rates when it comes to children. A large percent of a large number is a large number. We are talking about children and our future, not numbers.

Are healthy children safe from COVID-19? No. We are seeing healthy children become critically ill with COVID-19 and we are also caring for children with comorbidities. In the state, 1 in 3 children is overweight and 1 in 12 children has asthma; the risk factors for severe disease are common in our state. It is easier to try to distance ourselves from the beast, but risk is all around us. We value all children.

Do parents or elected officials have the right to sacrifice the health of our children? No. The legal precedent is clear that the convenience and freedoms of others cannot supersede the health and safety of children. All 50 states have school immunization requirements and child passenger safety laws. In Phillips v City of New York, a federal appeals court held that unimmunized children could be excluded from attending school during “an outbreak of vaccine-preventable disease” regardless of exemptions. A federal district court blocked the state’s ban on mask mandates in schools. Masking should be required in schools.

Do masks cause discomfort, rise in carbon dioxide, difficulty learning, or other issues?

No. Immunocompromised toddlers have been masking for decades without problems. Many health care workers have been masked for decades without problems. These concerns have been studied and masking is known to be safe and effective. In fact, masking not only prevents spread of COVID-19 but also other serious and potentially deadly viruses that affect children including influenza, RSV and others that typically fill our ICUs in the wintertime.

This past winter masking practices nearly eliminated these typical respiratory viral infections. Severe lung disease from vaccine preventable diseases such as COVID-19 and influenza does, however, cause pain, rise in carbon dioxide, learning loss and potential death. The CDC MMWR has published evidence supporting masking in schools in Florida, Missouri, Wisconsin, Utah and Arizona.

Are health care providers withholding potential beneficial therapies for COVID-19? No. If we have 100 children with COVID-19 and we give each of them candy, 98-99 of them will get better and not require hospitalization. We could be left to assume that candy made them better, but we know correlation is not causation. We have taken an oath to “first, do no harm” and to practice evidence-based medicine. Particularly in pediatrics, we are careful to thoughtfully consider safety in addition to efficacy. We are trained to scrutinize evidence in the literature. The “why not” approach is dangerous. Science is ever-evolving, and there are multiple therapies currently under investigation for a multitude of diseases in children including COVID-19, but we will not put the lives of our patients at risk because a potential therapeutic (and potential source of harm) is gaining traction on social media.

Is the COVID-19 vaccine safe? Yes! It is not scientifically possible to get COVID-19 from the vaccine as these are not live vaccines. According to DHEC data, only 30% of children 12 to 19 in the state have been fully vaccinated against COVID-19. Those who are immunocompromised are not excluded from eligibility; in fact, they are eligible for a booster. COVID-19 vaccines have been studied and are safe and effective in the prevention of hospitalization and death related to COVID-19. Speak with your child’s trusted pediatrician when considering health care decisions such as these. As we say in pediatrics, vaccines cause adults!

Have we done everything in our power to stop the spread of COVID-19, preventable hospital admissions, long-term complications and deaths? No. The proper actions are vaccination of all those who are eligible (12 and older at press time) and universal masking for those older than 2 in schools.

Let us consider today’s actions that will place us on the right side of history, and course correct immediately. Lives hang in the balance. It is time for us all to lead courageously and put the health of our children first. We are our brother’s/sister’s keeper.

Elizabeth Mack, MD, MS is a pediatric critical care physician and vice president of the SC Chapter of the American Academy of Pediatrics