The 12-year-old girl had no bruises on her body. According to the prosecutor, she was not malnourished. She had just eaten before her mother found her passed out in their home in rural Georgia in late August.
But she had such a severe lice infestation that the doctors treating her the day she died said it was enough to kill her, according to a Georgia Bureau of Investigation agent who described the finding in court last week.
The unusual conclusion that lice could have killed a child cast doubt on some doctors and scientists. However, child welfare professionals said the details of the case underscored deep concern about how the coronavirus pandemic has cut off many children from teachers, counselors and doctors who may report possible signs of neglect or abuse, especially as families grapple with the economic crisis .
The girl, Kaitlyn Yozviak, died on August 26th. Her cause of death was listed as cardiac arrest and the secondary cause as severe anemia, which was due to repeated lice bites that lowered her blood-iron levels, said Brent Cochran, assistant district attorney for the Ocmulgee Judicial Circuit, which covers Ivey, the city with less than 1,000 people Kaitlyn lived in.
The girl's parents, John Joseph Yozviak, 38, and Mary Katherine Horton, 37, were arrested and charged with second degree murder and second degree cruelty to children. A 2014 law passed in Georgia allows a person to be charged with second degree murder if there is evidence that a child died of negligence while that person was in their care.
Ms. Horton's lawyer declined to comment. Mr. Yozviak's attorney 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 to move the case forward, Cochran said, and prosecutors will "continue to review the adequacy of the current charges" as they learn more.
Medical investigators are expected to determine the official cause of death, he added.
Body lice can transmit potentially deadly bacteria, but head lice require a live host keep feeding on blood, said Alejandra Perotti, a professor of invertebrate biology at the University of Reading in England, who has been studying how lice and mites can help determine the cause of death.
"Those lice would kill you is an exaggeration," said Dr. Perotti.
Severe lice infestation is characterized by a strong presence of lice eggs, called nits, on individual strands of hair.
Such infestations are very common in children and the elderly who are neglected by janitors or relatives, said Dr. Perotti.
"Severe lice infestation in a deceased person is usually associated with serious neglect and, as a result of that neglect, overall health deteriorates," she said.
There have been a handful of cases of severely lice infested children admitted to hospital for mild anemia, said Dr. Mary Groll, pediatrician and professor of health science at North Central College in Naperville, Illinois. But she said, “I don't know of any deaths. "
It is possible for a child to have a fatal arrhythmia if hemoglobin levels drop sharply, she said.
But before concluding that the lice are just the cause, a doctor needs to know if there are other factors, like a processed food diet or menstruation, said Dr. Resentment.
Mr Cochran, the prosecutor, said the lice had "been a problem for three years, over and over again".
Ms. Horton, the child's mother, also had lice and told investigators that her daughter hadn't bathed in a week and a half, he said.
"It's very sad," said Mr. Cochran.
Mr. Yozviak and Ms. Horton, who have remained in custody, went before Judge Brenda Trammell of Wilkinson County Superior Court last week. She ruled the case should go to a grand jury.
During the hearing, a state investigator testified that her home was "very unclean" and that lice were still visible on the child's bed, Cochran said.
Under Georgian law, prosecutors don't have to prove that the lice were the cause of death in order to win a murder conviction, said Bridgette Baldwin, professor of law at Western New England University.
"You have to show that the parents are not doing the due diligence that was due to the child," she said. "Due to the fact that the lice were left untreated, they have enough to show negligence."
In Georgia, calls for possible abuse cases have fallen 50 percent since schools closed in March, said Tom Rawlings, director of the state's Department of Family and Children's Services.
"One of the biggest fears that I and other children across the country have about this type of case," he said.
Kaitlyn's family had a history with the department. Before Kaitlyn was born, Mrs. Horton's two sons were permanently housed with their maternal grandmother, Anna Horton.
Elderly Ms. Horton said childcare found her daughter's living conditions unsanitary.
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 put her up for adoption as planned, and items such as a car seat and formula were missing.
The agency was also called in in 2018 to investigate a report that Kaitlyn had been hit by a car. The report was unfounded, but social workers found the house filthy, with "cat urine everywhere," said Mr Rawlings.
Kaitlyn was placed with a relative for six days and the couple cleaned the house thoroughly, Mr. Rawlings said. Social workers reached out to the family doctor and a school counselor, who reported they had never seen signs of chronic abuse and that Kaitlyn was doing well in school, he said. She returned home.
Kaitlyn's family recently moved and they had switched schools just before the pandemic, Mr. Rawlings said.
He said that if the schools hadn't closed, the child's condition may have been noticed by a teacher or school employee who could have called the state.
Anna Horton said she tried to cope with the loss of a granddaughter she barely knew and the arrest of her daughter, from whom she has been estranged for more than a decade.
She said she held Kaitlyn once when she was a baby but never saw her again. She said she wished her daughter had called her for help.
"The shock was overwhelming," she said. "I lost two people in a minute."
Jack Begg contributed to the research.