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North Carolina experts who released a frequently cited report showing minimal COVID-19 transmission within K-12 schools are growing alarmed as more districts defy public health recommendations and instead choose to make mask-wearing optional for all students and staff.

Danny Benjamin and Kanecia Zimmerman, Duke University School of Medicine professors and co-chairs of the ABC Science Collaborative, warned in a virtual news conference with reporters on Wednesday that the 44 school districts that have decided to make masks optional may be flying blind as the delta variant surges. As a result, several dozen children could die, they said.

“Until we get vaccination up to a sufficiently high rate, if you want to prevent COVID transmission in your community, if you want to prevent COVID transmission at your schools, then it’s masking until we have sufficiently high vaccination,” Benjamin said. “Although the mortality rate in children is low, somewhere between 2 and 5 per 100,000, when you consider a state of 1.5 million children (in K-12 public schools), 2 per 100,000 starts to add up to some deaths that’s going to be eventually noticeable.”

Democratic Gov. Roy Cooper is urging districts to mandate mask-wearing but is leaving it up to local school boards to make their own decisions.

Asked in a Wednesday news conference why he isn’t compelling districts to mandate mask-wearing, Cooper replied, “I think everybody knows what to do. We’ve given the school systems the tools that they need to make these decisions in their local areas. We want to concentrate our efforts on vaccination, and that’s what we’re doing.”

Benjamin said that the report he and his team wrote occurred when masking in classrooms was universal and before the more contagious delta variant began spreading rapidly.

COVID-19 cases, hospitalizations and test positivity rates are at their worst levels in months. In all but four of North Carolina’s 100 counties, the U.S. Centers for Disease Control and Prevention recommends people wear masks in indoor public settings, even if they’re already vaccinated, due to substantial or high transmission rates.

Cased reported on Wednesday surpassed 3,400 for the first time since Feb. 20 and the 1,580 people currently hospitalized in North Carolina is the most since Feb. 21.

More than 12% of tests on Monday came back positive, the worst daily positivity rate in more than six months.

There also were 21 new deaths from COVID-19 reported Wednesday. There haven’t been that many reported in one day in North Carolina since June 4. So far, 13,700 people have died from COVID-19 in the state.

Kids under 12 can’t yet get vaccinated and many eligible young adults are unvaccinated, yet 38% of North Carolina’s 116 school boards will allow them to be unmasked — a move Benjamin considers “experimentation.”

Zimmerman said districts’ decisions not to require masks could increase student learning loss. Unlike the past academic year, state and federal health guidelines now allow students in a “mask-on-mask” environment to stay in school, even if they were in close contact with an infected person. But unmasked pupils must miss a week of in-person classes.

“Thousands of kids missed thousands of school days,” Zimmerman said. “If we can do masking, we can keep kids in school. The alternative in the setting of not having masking is increased risk of transmission (and) if you are a close contact, you have to stay out of school for 10 days unless you get a test that you can get at 5 to 7 days. If it’s negative, then you come back on day 8.”