Walking into the COVID ward in the children’s hospital, those words seemed etched on an invisible wall, a wall that I wanted to choose to stay behind. It was a wall I could stay behind for the first couple months of the pandemic where multiple studies touted how children weren’t getting sick, and my hospital had seen very few mild cases of the virus in children manifesting from a fever in infants to asymptomatic infection in teenagers. Even when I had seen cases of multisystem inflammatory syndrome in children (MIS-C), the heart condition that affects children with coronavirus, I had been able to point to studies that showed how few children were affected. But it was my turn to be the attending physician on the COVID ward that day, so I was forced to push through that invisible wall to the other side where children affected by coronavirus waited.
My first patient had been transferred out of the pediatric ICU, where he had been on high flow nasal cannula (a non-invasive ventilator) and had received Remdesivir and steroids for pneumonia caused by the virus. His mother could not be with him because she, too, has coronavirus. I call her on the phone. She has so many questions: “How will the virus affect his lungs in a year, in two years, as an adult?” “Will he have any heart damage?” “How long will we have to give him blood thinners?” At first, I simply say, “I don’t know.” Finally, I say, “No one knows. I wish that we knew.” The mother says, “But I thought that coronavirus didn’t affect children.”
My second patient I had first met in the emergency room when she was breathing like she had just finished a marathon though she was lying in bed. I had placed her on high flow nasal cannula and sent her to the ICU where she had received all the things my first patient received, the things we normally use for adults because coronavirus doesn’t affect children. Her mother also had COVID but had begged the hospital to allow her to stay with her sick child.
My third patient, like the first, was alone in his room. His mother had COVID, and his father was in the ICU with COVID. He huffed and puffed, struggling with COVID pneumonia, and bravely told me he could learn how to inject himself with blood thinners since his parents were also sick. He can inject himself, alone, at home, because COVID doesn’t affect children.
My fourth patient was being transferred out of the children’s ICU. She had been there for two weeks and had received convalescent plasma (antibodies from patients who had recovered from COVID), Anakinra (an inhibitor of a chemical that is released during the body’s inflammatory reaction to the virus), steroids, and Remdesivir. She is on multiple forms of insulin now and may develop diabetes because COVID doesn’t affect children. She had been intubated (with a tube down her throat that was connected to a ventilator) but was now on high flow nasal cannula and able to speak. She repeated, “mama?”, over and over again. Her mother was also recovering from COVID, and her father was in the ICU with COVID. “Mama” would not come that day because COVID doesn’t affect children.
I continue rounding on my other COVID patients, recalling an article that I’d just read about how coronavirus didn’t affect the 17,000 children infected with it in Florida because coronavirus doesn’t affect children.
In John Barry’s, The Great Influenza, he comments that “the biggest problem [of a pandemic] lies in the relationship between governments and the truth.” He talks about how politicians have a duty to tell the truth to the public and how covering up the truth actually leads to more fear, not less. But as a physician, I wonder, are we also willing to tell the truth? It is especially hard during these times, when each scientific study’s results seem to contradict the next. It is especially hard when we have to admit as physicians that we don’t know, that no one knows. It is hard when we have to admit that our hypothesis may be wrong. But in admitting that a hypothesis may be wrong, there is a way forward for discovering the truth. Looking at my own healthy children, there is a part of me that still clings to the idea that coronavirus doesn’t affect children, but as the physician on the COVID ward today, I know I need to allow for the possibility that maybe, just maybe, that hypothesis is wrong.
The author is an anonymous physician.
Image credit: Shutterstock.com