We saw this coming. Pediatricians sounded the alarm as cases of viral upper respiratory infections poured into our emergency departments, wards, and pediatric intensive care units (PICUs) earlier this summer. We warned citizens and lawmakers about what might happen if we sent our children back to school without reliable mitigation efforts in place. As a mother to three young children, I was worried.
Our predictions were particularly concerning in South Carolina, where despite the nightmare in our hospitals, only 57% of eligible residents have received at least one COVID-19 vaccine. A school-based pediatrician even published an op-ed on August 8 begging parents to mask-up and vaccinate in order to protect our unvaccinated children during the upcoming school year. I was hopeful.
Unfortunately, South Carolina Gov. Henry McMaster decided that the CDC, the Department of Health and Environmental Control, and the American Academy of Pediatrics wouldn’t dictate policy. He wrongly proclaimed that “personal responsibility and common sense” would be the way out of this crisis. By using a budget proviso, the South Carolina legislature effectively prohibited public schools from mandating masks. As fierce advocates for children, pediatricians volleyed. We lobbied our legislators, wrote letters, attended school board and city council meetings. Days before school began, over 1,000 South Carolina physicians united to sign a petition to urge McMaster to repeal his mandate. We thought our community would come together to protect our most vulnerable children. I was naive.
Our pediatric battle cries could not overcome the growing fervor in the community. By mid-August, my hopes for a sensible return to school were gone. I watched in abject horror as my PICU mentor was spit on at a local school board meeting after she contradicted the false notion that children do not get sick from COVID-19. Her entire life dedicated to trying to save the sickest children in South Carolina, and her expertise was discarded in favor of conspiracy and ideology. I then watched a prominent community pediatrician defamed across social media for having the audacity to suggest that universal mask mandates and vaccines might save lives. Seeing the vitriol aimed at my colleagues damaged my psyche in a way that was surpassed, only by the fear I felt in sending my children back to school. I felt dejected.
I was far from alone. Frazzled group chats sprung up among fellow pediatricians about alternative plans for schooling and daycare. Taking inventory of our losses, we wondered how long it would be before our children were sick, before they unknowingly made others sick, before entire school districts reverted to virtual learning, before we either couldn’t work due to quarantine and isolation or were expected to work overtime to support a community that couldn’t be bothered to do the most basic preventive tasks: vaccinate, isolate, and wear masks to protect vulnerable citizens. I felt abandoned.
As a pediatric fellow raising three children and fully dependent on our dual-income family, there were no good options. Nannies and private schools (where ironically masks are mandated) were well beyond our means. Home-school “pods” were logistically impossible without giving up my fellowship in developmental pediatrics, a desperately undermanned subspecialty. With great hesitation, my husband and I (both fully vaccinated) took deep breaths and sent our babies into their public-school classrooms on August 18 — with masks on their faces, but no mandates for their peers. I hoped for the best, but felt completely helpless.
When all three of my too-young-to-be-vaccinated children were quarantined due to a COVID-19-positive close contact, 3 short days after school began, I tried to remain calm. I took a deep breath, texted my program directors about work-from-home options, then picked up homework packets and began to tackle my additional role as “teacher.” By day 5 of quarantine, my husband felt like he was hit by a train and my 22-month-old toddler was febrile to 103 degrees. Afternoon COVID-19 tests for the whole family confirmed what I suspected, my husband and all three children were infected with COVID-19. As I processed the news, and thought about how hard we worked to prevent this, I grew livid.
While I know that most children who get COVID-19 will probably be OK, my combined pediatrician and parent anxiety overwhelmed me and I spiraled into worst-case scenarios. As my 5-year-old told me that her dinner tasted funny, I thought of the healthy 5-year-old in Georgia who died of pneumonia and a stroke. As my 8-year-old begged to break out of isolation, I remembered the first pediatric COVID-19 death in North Carolina last year; an 8-year-old girl who loved the beach, just like my daughter. One of my biggest challenges as a pediatric resident was not imagining my children in every trauma, every preventable firearm injury, every drowning, every set of compressions, every child treated for multisystem inflammatory syndrome in children (MIS-C) that needed emergent extracorporeal membrane oxygenation, every heartbreaking outcome, every child that didn’t go home. The thought of being the mother who left the hospital without my baby, broke me on more than one occasion. Maybe I’ve just seen too much, but I am terrified.
Now, on day 4 of isolation, I am grateful that my husband can breathe, my baby’s fever is gone and my girls remain asymptomatic. But elsewhere in South Carolina, there are 33 children hospitalized for COVID-19. Seven are in critical care and three are on a ventilator. While my children are statistically likely to continue healing without complication, there are 454 children who have died from this virus in the U.S., an estimated 1.5 to 2 million children who have lost a caregiver worldwide, too many babies being born at the edge of viability because their unvaccinated, pregnant mothers are dying in ICUs, and many more children who are struggling with post-COVID-19 morbidities. As a mother and pediatrician, I wonder, exactly how much child death and devastation is acceptable? How much harder do we have to fight? All I know for sure is that I am equally heartbroken, burned-out, and angry.
The severity of this wave, and its effects on children, were largely preventable.
Shawna McCafferty, MD, is a U.S. Navy Veteran and a pediatrician in Charleston, South Carolina.