Perhaps the only saving grace of the novel coronavirus is that it largely spares my pediatric patients from severe disease. But this pandemic presents a different sort of threat to children: The threat of being stranded should their parents fall ill.
Last week, a mother with worsening coronavirus infection brought her baby to my practice to be seen. The baby had been coughing, she said, her words muffled by the surgical mask that covered her mouth and nose. On her lap, the little girl squirmed as I checked her ears, nose, and lungs. Thankfully, she had no more than a cold.
“But what about me?” the mother asked. “It’s getting harder to take care of her. I can’t walk across the room without losing my breath. What happens if I get worse?” The baby smiled and played with the drawstrings on my protective gown. “No one will come near us. If I go to the hospital, she’ll have to come with me.” She closed her eyes, paused for several deep breaths, and turned to the side to cough.
She had spent time in hospital emergency rooms. She knew her daughter wasn’t coming with her.
After 25 years in this profession, I am used to solving all kinds of problems that we learned nothing about in medical school. But as the gravity of her situation slowly sank in, I realized with a sickening dread that there was no answer. She was not ill, but she was contagious. No one could care for her. Not the usual grandparent or aunt or uncle or friend or neighbor. Not even a foster parent. I did my best to express sympathy. But as the mother strolled her child away, I had never felt so helpless.
This outbreak is surging. At the height of it, the University of Pennsylvania forecast predicts that 2,079 people will be hospitalized in our area, and 300 more will be admitted each day. Household transmission is a significant source of spread. As the number of infected adults increases, so will the number of stranded children.
For those who are single parenting, COVID-19 infection is already particularly harrowing. They are sick and quarantined away from anyone who can care for them. The only help they are able to receive comes in packages delivered to their stoops. They have no choice but to care for their children while they themselves are weak, feverish, and exhausted. And the issue of child care adds insurmountable fear. They are constantly assessing their own breathing, wondering if they should call 911, hoping they can hold out and stay home, knowing their children have nowhere to go.
Some have suggested emergency group child care for families experiencing this crisis, where rotating caregivers would wear full personal protective equipment. This option may well be safe, but I shudder to imagine the trauma to a child, taken from his critically ill parent and dropped into a room of faceless strangers.
A far better option is to leave children with adults who have already had the disease and recovered. These could be friends or relatives, or in the worst-case scenario, they could be foster parents through the Department of Human Services. But this requires proof of immunity.
The FDA has recently approved an antibody test to identify those who have been infected and are now immune to COVID-19. But this test is in its earliest stages and supplies are limited. At the moment, it is intended for three potential uses: for using the serum of recovered individuals as treatment; for determining when infected health-care providers can safely return to the frontlines; and for assessing levels of immunity in communities so we can all go back to our lives.
We need a fourth use of this test. We need to know which adults can safely care for children whose parents are ill. We need this as soon as humanly possible. My patient needs this now.
The city of Philadelphia and health-care systems across the region are working furiously to prepare for the enormous demands this outbreak will place on our hospitals, as well as our economy. Adding this issue to the many they are grappling with further complicates matters. But imagine the EMTs, fully garbed in protective gear, entering my patient’s home and encountering the mother, critically short of breath, and her daughter, bright-eyed and playful. They are stopped in their tracks. Nowhere to go. It is an impossible moment. And it is avoidable.