BIRMINGHAM, Ala. — Severe asthma, chronic rhinitis, genetic disorders, pectus carinatum.

“The list goes on,” Sarah Malone says about the health conditions of her four school-aged sons, before even mentioning her own three autoimmune diseases.

Malone’s children are enrolled in Dothan City Schools, where masks are “strongly encouraged,” but not required, and social distancing “will be practiced when feasible,” according to the district’s reopening plans. She’s worried that policy will leave her children vulnerable to COVID-19 infections.

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“Our options are very limited and I’m really frustrated,” Malone said.

She has decided against sending her 5-year-old son to kindergarten this year and has registered her 8-year-old and 14-year-old in virtual school, although the internet connection is very poor where they live.

But her 10-year-old, who has autism and 13 other documented medical diagnoses, has been hardest to place.

“Here’s my child who has all these special needs and I can’t provide an adequate education for him at home. But I can’t send him to school either. What am I supposed to do? What’s his option?” said Malone.

As the highly contagious delta variant continues to spread through Alabama, averaging over 3,000 cases a day, and child hospitalizations nationwide have reached their highest point in the pandemic, there is no statewide mask mandate.

Instead, local school officials have been given the authority to decide which health and safety protocols will be put in place. Approximately half of the state’s 149 districts are requiring masks; only 26 are offering virtual options for all grades, according to AL.com reporting.

Like Malone, many parents with high-risk students — which the Centers for Disease Control and Prevention defines as children with medical complexity, with genetic, neurologic, metabolic conditions or with congenital heart disease — are left with few options to protect their children.

The CDC states that preventive measures such as masking, vaccination and social distancing are especially important for people categorized as high-risk, and have recommended these precautions be taken in schools.

“We have all got to be masked in school because we cannot fully protect the high-risk child who might be in the classroom,” said Dr. David Kimberlin, co-director of pediatric infectious diseases at UAB and Children’s Hospital of Alabama. “Their wearing a mask is helpful, but it’s not as good as everybody wearing one.”

Some of the districts offering remote learning are requiring students to enroll for the full year.

“That sounds punitive,” said Michelle Nalls, a parent with three sons in Hoover City Schools, a district requiring full-year virtual enrollment. Her 14-year-old son has both spina bifida and asthma.

Federal law dictates that students with disabilities, which includes students with certain health impairments, receive their education, to the maximum extent possible, with peers without disabilities.

“There is a question out there as to if you have a child whose health condition means that they really need to be in an environment where people are masked and distanced, does the school have an obligation to institute those policies in a mandatory way to accommodate the needs of that particular child?” said Nancy Anderson, associate director of the Alabama Disabilities Advocacy Program.

Anderson said she suspects the federal government will eventually put guidance in place to address the needs of high-risk kids, and that it is possible there will be civil rights litigation on the matter.

ADAP released their own guidance for children with serious and chronic health conditions in August, which recommends parents share their school’s reopening plans with their health care provider in order to evaluate the risk of returning to in-person learning as well as possible accommodations.

Nalls decided to pull her 9-year-old son, who is not yet eligible for a vaccine, out of his elementary school and to enroll him in a local private school that requires masks and is adhering to CDC guidelines.

Her two older sons, both of whom are vaccinated, will be attending their Hoover City high school in-person.

“Would I like for them to learn virtually and revisit the idea … after looking at the COVID data? Certainly! But once you’re locked in, you’re locked in, so our hands are once again tied,” she said.

Hoover mandated masks for a 30-day period and then will reevaluate the policy, but Nalls said she has lost faith in her district.

“As a parent I could think of nothing other than an escape plan. I thought Hoover was better than this,” she said after the board’s decision. “Education is very important to us in our household, but safety is primary.”

The dilemma also affects teachers who are immunocompromised.

Ashley Lucier is a teacher in Autauga County, which is not requiring masks or social distancing. Both her and her husband are teachers and, without any family living nearby, don’t have child care options. As a result, her 6- and 10-year-old sons will go to school in-person.

Lucier is considered high-risk after donating a kidney three years ago, which resulted in blood clots forming in her lung. She was able to teach some virtual classes last year, but this year her district is switching to Edgenuity, a national learning software that doesn’t use local teachers.

“As a teacher you feel like you’re not really protected at work, and as a parent you feel like you can’t protect your kids,” she said.

Lucier feels safer in school now that she’s vaccinated, but still worries for her sons, who are too young for the vaccine.

Her oldest son, who still remembers when she was in the ICU for a month after complications from the kidney donation, and whose teacher died of COVID-19 last year, is scared for her.

“He was so terrified I was going to get sick, he was having night terrors,” she said. “He didn’t want me to go to work and he didn’t want to go to school because he thought he was going to bring germs back home.”

Lucier says her whole family will be wearing masks when they return to school, but still feels preventing infection is out of her control.

“It’s not that we might get it — at this point we feel like which one of us is going to get it first?”

The Alabama State Department of Education said districts should adhere to federal disability laws when considering protocols for high-risk children, which requires students with disabilities to have their educational needs met as adequately as students without disabilities and provides eligible students with individualized education programs.

“The state Department of Education does not have the authority to mandate masks,” said Michael Sibley, director of communications at the Alabama Department of Education. “And at the same time we are conscious of the fact that there are people in these difficult circumstances, and we acknowledge that.”

Still, Malone feels her children’s needs weren’t taken into consideration by her school system.

She’s written the superintendent and school board several times a week to see what protections they are able to put in place for her son with special needs. She says they haven’t been able to give her any options, including the smaller class size or vaccinated teacher she requested.

Eventually, Malone decided to withdraw her son from the district and now is seeking a suitable virtual option.

“The district is aware of the recommendations, the district is aware of the high-risk children — they have heard our pleas,” she said. “The people in charge have made the decision to disregard it all.”

Hoover City Schools declined to comment for the article. Dothan City and Autauga County did not respond to a request for comment at time of writing.

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