Three Ways of Looking at Children and the Coronavirus – The New Yorker

A good friend recently invited me to meet his spiritual guide via Zoom. The spiritual guide does energy work, which he claims requires no physical proximity and works based on principles of Christianity and quantum mechanics. After some introduction of his methods, the spiritual guide turned his attention to me, rotating a wooden bar in the air and snapping his fingers against his hand in order to confer on me protection from the novel coronavirus. I could see his living room behind him, and his wife joined from a separate device elsewhere in the apartment.

The procedure was brief, and shortly he pronounced me protected. Is the baby protected, too, Lord? he asked. There was a scant pause and then Amen, he said, the baby, too.

Humiliatingly, I started crying. I could not explain it in that moment, so I allowed my friend to believe that I cried because of the power of being conferred such protection. I exited the Zoom, thanking them both, and snapped my laptop closed.

The fact is I was crying because I know there is no way to guarantee safety for my baby, who, at thirty-seven weeks, rides in my uterus through the hospital daily, while I work as a pediatric hospitalist and the pandemic blossoms here in Texas. Nobody can say to meor to any parent, at this pointwhat exactly will protect the little bodies that pertain to us.

This has always been true, and more pointedly so for some parents than others. To have ever believed one could keep a child safe in this world is a marker of privilege, generally reserved for affluent white parents such as myself. Yet I have never been asked so often or so fruitlessly what specific formula might confer protection on the children: if they have playdates but only with one neighbor, if they go to the park and wash hands afterward, if they start school but in the school everyone wears masks.

I tell parents about the data that supports their hope to safely liberate children from home. Though it was initially reasonable to suspect that SARS-CoV-2 would behave like other respiratory viruses and use children as the little viral culture media which God created them to be, evidence is accumulating that, so far, children are not the primary drivers of this particular pandemic. They absolutely do get sick from it, and many, around one in two hundred in some studies, get so sick that they require I.C.U.-level care. But the most frightening manifestation of SARS-CoV-2 infection in childrenmultisystem inflammatory syndrome in children, or MIS-C, which often lands them in I.C.U.s but rarely seems to kill themremains rare.

I have my own fears about infection, however. So far, the diagnostic criteria for MIS-C require proof of current or recent infection with (or documented exposure to) the novel coronavirus. Most cases seem to be occurring two to four weeks after infection. But the inflammatory sequelae of other viruses, such as measles, herpes, and chicken pox, may occur years after infection. As many as one in twenty children infected with measles will develop pneumonia, and around one in a thousand develop encephalitis: swelling and inflammation of the brain. A much smaller percentage (two in a hundred thousand) will develop subacute sclerosing panencephalitis (S.S.P.E.) generally seven to ten years after measles infection. This slow, inflammatory scarring of the brain is fatal. Just as we do not yet know what, if any, long-term complications may lie in wait for children infected with SARS-CoV-2 in utero, we do not yet know if this virus will carry any super-delayed sequelae of childhood infection.

Sometimes I think that the habit of mind that most clearly separates experienced physicians from faith healers is not scientific rigor but prudence. We physicians have seen enough irremediable suffering to know the limitations of our art. We are acquainted with fortuna, the capricious force of destiny that deals suffering and healing without regard for our efforts. We promise to work through the night for our patients, to explain every step, to be at their sides no matter what. We do not, however, promise safety. Even when I am caring for a baby with a very routine respiratory infection, I do not promise parents that their child will recover. I say, Well help your baby by giving her the extra oxygen, and we will watch her very closely. If we see that shes getting sicker even with the oxygen, then well talk to the I.C.U. doctors about the next steps to keep her safe. I know a lot of science, but I also engage with fortuna and a level of magical thinking that would be more appropriate in a four-year-old; I cant escape the fear that some horror will befall any baby whom I promise an easy recovery.

In the case of the novel coronavirus, prudence tells me that I should be at least as worried about actual measles and S.S.P.E. as I am about theoretical risks of long-term sequelae of SARS-CoV-2. Worldwide, childhood-vaccination rates are declining and measles outbreaks are blossoming amid the coronavirus pandemic. I should also worry about children losing their parents or grandparents, missing meals, and falling behind in school. I should worry about kids whose learning disabilities will go undiagnosed without school screenings, L.G.B.T.Q. teens trapped in unsafe homes, and children traumatized from witnessing domestic violence. When my friends ask me how to keep their kids safe, though, they mean safe from infection. I refer them to the guidelines of the C.D.C.

I get the sense, though, that parents dont want my prudence; they want my blessing. They want to move out into the world under the glimmering umbrella of a pediatrician who has said, Amen, the child is safe.

Early in the pandemic, the number of children admitted to my hospital fell. Kids were staying home and avoiding the usual respiratory viruses that drive hospitalization; when kids did get sick, parents were likely avoiding the hospital for as long as possible.

With fewer sick kids, the service was dominated by trauma. We saw plenty of injuries related to neglect: kids burned from having poured gasoline on fires while unsupervised, or shot from playing with unlocked guns. Then there were the abuse cases: children with brain bleeds from abusive head trauma, or liver lacerations from being pummelled in the abdomen. Although my hospital has not published data on these cases, pediatricians across the country are worried that abuse is on the rise. Educators are often the people who detect early signs of child abuse and neglect; with schools closed and fewer cases of suspected maltreatment being reported, some doctors are seeing more severe trauma among children.

When a child comes in with an injury that could be from abuse, we pediatricians go looking for other injuries. We may do X-rays to look for evidence of old broken bones, or a scan of the head to look for bleeds. We may draw blood to look for evidence that the liver has been injured by blunt trauma. We look for characteristic bruises and patterned scars. Sometimes these investigations reveal a long history of physical abuse. These are the children who keep pediatricians up at night: kids whom we probably saw in the office or in the hospital for a so-called sentinel injuryan early, less serious injury that was caused by abuse but went unrecognized. In one study of infants hospitalized for serious physical abuse, just over twenty-seven per cent had a previous sentinel injury, and nearly forty-two per cent of those were reportedly evaluated by a physician.

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Three Ways of Looking at Children and the Coronavirus - The New Yorker