The 12-year-old girl had no bruises on her body. She was not malnourished, according to prosecutors. She had just eaten before her mother found her unconscious in late August in their home in rural Georgia.
But she had a lice infestation so severe that the doctors who treated her the day she died said it was enough to kill her, according to an agent with the Georgia Bureau of Investigation who described the finding in court last week.
The unusual conclusion that lice could have killed a child raised doubts among some doctors and scientists. But child welfare specialists said the details of the case underscored deep concerns about how the coronavirus pandemic has cut many children off from teachers, counselors and doctors who could report possible signs of neglect or abuse, especially as families struggle with the economic crisis.
The girl, Kaitlyn Yozviak, died on Aug. 26. Her cause of death was listed as cardiac arrest and the secondary cause as severe anemia, the result of repeated lice bites that lowered her blood iron levels, said Brent Cochran, senior assistant district attorney for the Ocmulgee Judicial Circuit, which covers Ivey, the town of fewer than 1,000 people where Kaitlyn lived.
The girl’s parents, John Joseph Yozviak, 38, and Mary Katherine Horton, 37, were arrested and charged with second-degree murder and cruelty to children in the second degree. Under a Georgia law passed in 2014, charges of second-degree murder can be brought against someone if there is evidence that a child died under that person’s care because of negligence.
Ms. Horton’s lawyer declined to comment. Mr. Yozviak’s lawyer, Keri Foster Thompson, said he was innocent and “devastated and heartbroken.”
“The evidence will ultimately show that Mr. Yozviak was a loving and devoted father,” she said.
A grand jury will decide whether the case should go forward, Mr. Cochran said, and prosecutors will “continue to reassess the appropriateness of the current charge” as they learn more.
Medical examiners are expected to determine the official cause of death, he added.
Body lice can carry potentially deadly bacteria, but head lice need a live host to keep feeding on blood, said Alejandra Perotti, a professor of invertebrate biology at the University of Reading in England, who has studied how lice and mites can help determine the cause of death.
“That lice would kill you is an exaggeration,” Dr. Perotti said.
Severe lice infestations are characterized by a heavy presence of lice eggs, known as nits, on single strands of hair.
Such infestations are very common in cases of children and older people who are neglected by caretakers or relatives, Dr. Perotti said.
“A severe louse infestation on a person who died typically coincides with serious neglect and as a consequence of this neglect, a general deteriorating health condition,” she said.
There have been a handful of cases of children with severe lice infestations who were hospitalized for low levels of anemia, said Dr. Mary Groll, a pediatrician and professor of health sciences at North Central College in Naperville, Ill. But, she said, “I don’t know of any deaths from it.”
It is possible a child could suffer a fatal arrhythmia if hemoglobin levels fell precipitously, she said.
But before concluding that the lice alone were the cause, a doctor would need to know if there were other factors, like a diet of processed foods or menstruation, Dr. Groll said.
Mr. Cochran, the prosecutor, said the lice had been a “problem for three years on an on-again, off-again basis.”
Ms. Horton, the child’s mother, also had lice and told investigators her daughter had not bathed in a week and a half, he said.
“It’s very sad,” Mr. Cochran said.
Mr. Yozviak and Ms. Horton, who have remained in detention, went before Judge Brenda Trammell of the Wilkinson County Superior Court last week. She ruled the case should go to a grand jury.
During the hearing, a state investigator testified that their home was “very unclean” and that lice were still visible on the child’s bed, Mr. Cochran said.
Under Georgia law, prosecutors do not need to prove intent or that the lice were the cause of death to secure a murder conviction, said Bridgette Baldwin, a professor of law at Western New England University.
“They have to prove a failure of the parents to live up to the duty of care that was owed to the child,” she said. “Based upon the fact that the lice was untreated, they have enough to show negligence.”
In Georgia, the number of calls about possible abuse cases has dropped 50 percent since schools shut down in March, said Tom Rawlings, the director of the State Division of Family and Children Services.
“One of the biggest fears that I and other child welfare folks around the country have is this kind of case,” he said.
Kaitlyn’s family had a history with the department. Before Kaitlyn was born, Ms. Horton’s two sons were placed permanently with their maternal grandmother, Anna Horton.
The elder Ms. Horton said child services had found unsanitary living conditions at her daughter’s home.
Mr. Rawlings said the state became involved again two years later, when Kaitlyn was born. Hospital officials called the agency because Ms. Horton had decided not to give her up for adoption, as she had planned, and lacked items such as a car seat and formula.
The agency was also called in 2018 to investigate a report that Kaitlyn had been struck by a car. The report was unfounded, but social workers found the home filthy, with “cat urine everywhere,” Mr. Rawlings said.
Kaitlyn was placed with a relative for six days and the couple thoroughly cleaned the house, Mr. Rawlings said. Social workers followed up with the family’s doctor and a school counselor, who reported that they had never seen signs of chronic abuse and that Kaitlyn was doing well in school, he said. She returned home.
Kaitlyn’s family moved recently and she had switched schools just before the pandemic, Mr. Rawlings said.
He said that had schools not shut down, the child’s condition may have been noticed by a teacher or school employee who could have called state.
Anna Horton said she was trying to cope with the loss of a granddaughter she had hardly known and the arrest of her daughter, from whom she has been estranged for more than a decade.
She said she had held Kaitlyn once, when she was a baby, but had never seen her again. She said she wished her daughter would have called her for help.
“The shock was overwhelming,” she said. “I’ve lost two people in the space of a minute.”
Jack Begg contributed research.