Mark Dougherty, an infectious-disease physician in Lexington, Ky., sees the toll the state’s most severe coronavirus wave is inflicting on communities with the school year 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be the “tip of the iceberg” after the mostly Republican state legislature during a special session earlier this month repealed a statewide school mask mandate unilaterally put in place by the Democratic governor.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 mask mandates, including those in rural, conservative areas, according to tracking by the state school board association. The decision shows how masks are not always as politically radioactive as opposition from high-profile Republicans may suggest. It also reaffirmed the relief some felt after the legislature allowed school boards to make their own decisions, unlike the GOP governors of Florida and Texas, who argue no level of government should be mandating masks.

“It’s not a political decision for us,” said Sarah Wesson, superintendent of Lee County’s school district, 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 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 continues to persist into a third school year. Kentucky Gov. Andy Beshear (D) no longer centrally manages the state’s efforts to mitigate spread because the legislature, where Republicans hold veto-proof majorities, now have greater power due to a recent state Supreme Court decision. He says Republicans do not deserve special 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 in an interview.

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 (R) said the overwhelming support for mask mandates at 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 in an interview. “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 he would defer to school boards on mask mandates if he were the state’s governor, a rebuke of other Republican governors banning mask mandates. A McConnell spokesman referred to these comments when asked about Kentucky school boards overwhelmingly keeping mask mandates. Rand Paul, Kentucky’s other Republican senator, has railed against vaccine and mask mandates, calling masking for children under age 6 “child abuse” in a tweet Sunday. His office did not respond to a request for comment.

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 approval for his actions from the legislature.

The power tussle ramped up as cases began sharply climbing in Kentucky in August with the rise of the delta variant.

New daily infections have been averaging around 4,000 in recent days, eclipsing the previous all-time highs last winter. Kentucky has one of the highest hospitalization rates in the country, with admissions topping 2,500 last week and just over 100 beds in intensive care units still available.

For several weeks, more than half of hospitals had no available ICU beds, said Nancy Galvagni, executive director of the Kentucky Hospital Association. Kentucky hospitals have been struggling with fierce competition for travel nurses with other states hit by delta surges, she said, while rural hospitals in disproportionately undervaccinated areas have been especially strained because urban hospitals can’t take their sickest covid-19 patients like 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 helping by transporting patients, cleaning the facilities and helping with testing, said Jody Prather, chief strategy and marketing officer.

“We have been so strained from a staffing standpoint, we had nurses who were having to do their own transport,” Prather said.

Dougherty, who advises the entire Baptist system on its coronavirus response, said the facilities have been running low on anti-inflammatory drugs used to treat covid patients. One 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 because hospitals have been transferring fewer patients.

He hopes the decision by most school boards to keep mandating masks will prevent things from getting even worse.

“With the delta variant being so contagious . . . we are having classrooms getting infected and infecting their teachers,” Dougherty said. “Schools are right now a much bigger part of driving the pandemic than they were before.”

As Kentucky’s health-care system faced its biggest strain since the pandemic started, Beshear called the special session so the legislature could review his orders, allocate federal relief funds and extend the state of emergency.

The move came after the state Supreme Court upheld a law passed by the legislature to limit his emergency pandemic orders to 30 days without their approval. That forced Beshear to turn to lawmakers to preserve the school mask mandate his administration put into effect at the start of the school year, with cases surging.

The legislature barred him from enacting another statewide mask mandate through the end of 2023 and charged school boards with deciding mask policies. Beshear’s vetoes were overruled. The votes fell mostly on party lines, with some rural Democrats joining the majority and a GOP educator among Republican defectors.

State Sen. Max Wise (R), who chairs the education committee and sponsored the legislation, said school mask mandates should have the support of the communities where they are imposed.

“We feel like, as Kentuckians, we are tired of mandates, we are tired of one-size-fits-all,” Wise said. “Who better to know their communities than local school officials working with local health departments?”

While some feared the legislature’s actions would ignite contentious fights at school boards, the fallout was far more muted.

Jim Flynn, executive director of the Kentucky Association of School Superintendents, said his members are reporting that they are getting the biggest earfuls from people who want masks required in schools. He suspects a slew of school closures since the school year began last month due to outbreaks that forced teachers and staff into quarantine played a role.

“Schools had to shut down because they didn’t have enough staff to operate safely, so I believe communities have seen what’s happened under those circumstances and realized if we value in-person learning, then we need to wear a mask,” Flynn said.

Eric Kennedy, a lobbyist for the school board association, said staffing shortages eclipsed masks as a concern.

“We are trying to get enough bus drivers to drive every bus every morning before the sun comes up,” Kennedy said.

Some Democrats in the state legislature said the timing worked well for school board mask-mandate decisions because of spiking coronavirus cases and hospitalizations that are especially straining rural hospitals. Some school communities are still reeling from loss.

Lee County, with fewer than 10,000 people in the eastern side of the state, is grieving the covid deaths of a custodian and instructional aide at its elementary school barely a month into the school year. This week, the county announced an elementary school counselor died of the coronavirus. It’s unclear whether they were exposed at school.

Wesson said 80 percent of respondents to a survey she distributed favored mandatory masking, and just two opponents showed up to the meeting last Wednesday where the school board approved her recommendation to keep masking.

“They see that’s our way of staying in person right now,” Wesson said in an interview before the third death was announced. “We did have the death of two of our staff members and people are nervous about sending their kids to school, but the masks provide a layer of protection in addition to other mitigation strategies we are doing.”

Even though Kentucky schools are on track to be fully masked through the current surge, Democrats say residents should still feel concerned about the outcome of the special session.

If the virus surges again, or a new variant that can more easily spread or evade vaccine protection emerges, the legislature would need to sign off again on key responses from the Beshear administration.

“A legislature with two chambers is not as effective at emergency crisis management as the executive branch,” said Morgan McGarvey, who leads Kentucky Senate Democrats. “It was irresponsible for us to take away the governor’s ability to deal with this crisis.”

The special session also showcased how some Republican lawmakers in Kentucky are promoting incorrect and misleading claims about the virus and vaccines, according to local news reports.

One lawmaker incorrectly suggested the vaccine produced by Pfizer and BioNTech has not won the approval of the Food and Drug Administration, which it did after extensive review. Another parroted false claims about vaccines causing mass death. Others pushed unsuccessful amendments to prohibit mask mandates, employer vaccine mandates and to compel hospitals to administer unproven treatments for covid-19. They did not return requests for comment.

“We had actual members post on social media, ‘Don’t wear the mask, don’t get vaccines,’ ” said Joni Jenkins, who leads Kentucky House Democrats. “It’s like bizarro world or something when we are seeing worse numbers than we’ve ever seen.”