Tennessee doctors are warning the state to consider more aggressive action in stopping the latest surge in COVID cases caused by the more contagious Delta variant.

Hospitalizations have quadrupled in Tennessee since July 4, and fewer of them are elderly, since they have the highest vaccination rates.

“These patients are skewing younger this time,” says Dr. Katrina Green, who works in emergency departments in Nashville and Lawrenceburg. “The problem is that we’ve stalled out on our vaccinations for younger people.”

The state suspended outreach efforts for several weeks over concerns from some Republican legislators that teens were being coerced into getting COVID shots, against their parents’ wishes. Those efforts have resumed. But school starts for most kids in the next two weeks, and children under 12 are the only people left who still don’t have an option to vaccinate.

Data kept by the American Academy of Pediatrics says 43 states have now reported fatal cases in kids, with a total of 349 compared to 76 pediatric deaths at the same time last year. Dr. Vidya Bansal, a Nashville pediatrician, says this is not the same set of circumstances when Tennessee school children got out for the summer.

“We need to shift our focus from when it was going on last year when it was ‘rare’ in children to what is going on right now,” Bansal says.

She and others are encouraging the state to require universal masking in schools, as newly recommended by the Centers for Disease Control and Prevention. Gov. Bill Lee said a week ago he’s leaving the decision up to local school districts. And nearly all schools are only planning to make masking optional, including Metro Nashville Public Schools.

COVID cases in Tennessee have been steadily rising all month but shot up by more than 2,000 on Tuesday, according to health department data.