A plea from the last line of defense for our children

There are seven of us, all women, all physicians, who take care of the sickest children in the nation in Pediatric Intensive Care Units (PICUs) in the Midwest, the East Coast, the West Coast and the South. Some of us work in community hospitals, and some of us work at nationally rated hospitals, the kind everyone knows.

We have an intense bond that has formed over the last year and a half, even though most of us have never met in person. We initially connected on Twitter and have supported each other virtually as the pandemic has kept us separated yet living a shared experience. We discussed mask mandates and how our local communities are responding to the pandemic. We rejoiced when the COVID-19 vaccine was approved, and we discussed how and when we could get it for ourselves, our colleagues and our patients.

We celebrate each other’s victories and mourn when things do not go the way we had hoped.

Over the last year and a half, we noticed something: Our group is an unintentional microcosm of pediatric providers throughout much of the nation. When we talked about vaccines, we saw that they were not distributed equitably, not here, and certainly not worldwide. Some of our units were eerily quiet during the winter, because our communities supported vaccines, mask mandates and social distancing, and some saw numbers rise and hopes plummet, because some of us work in areas where many people denied the dangers of COVID-19.

Recently, we noticed that things have been changing. While we had seen decreases in COVID-19 cases over the spring, cases began rising dramatically in many areas as the summer wore on. Some of us are now admitting kids with COVID-19 who are extremely sick, who need advanced life support measures like ventilators and heart-lung machines at rates much higher than earlier in the pandemic.

According to the CDC data tracker, in the beginning of June 2021, there were about 16 cases per 100,000 children ages 5-11; by the end of August 2021, there were 171 cases per 100,000 for the same age group. There were similar trends in every age group. More kids who are infected with COVID-19 are being hospitalized, likely because the delta variant is more infectious and more virulent. We see that reflected in the experiences of our own small group.

PICUs in some areas became full, and we started using connections to find placements for kids who needed critical care but whose local hospitals were out of space. But this was not true everywhere. While a unit in Kansas City was overwhelmed with patients, a unit in Chicago had not seen a COVID-19 patient in the PICU in six weeks. Our own experiences mirrored the inequities in the COVID-19 disease burden throughout the country.

Vaccine rates also vary dramatically between areas. While the FDA recently approved the Pfizer-BioNTech COVID-19 for those ages 16 and older, with an emergency authorization use for those ages 12 to 15, younger children are not eligible. The vaccination rate in the 12-18 age group is rising, with 50-60% of eligible children receiving at least one dose, according to the CDC.

In a society where children under age 12 are not yet eligible for vaccination, we call on all adults to protect them. They need to go to school, but they need to do so safely. They need to live and thrive in communities that value their health, that take basic safety measures that will allow children to live as normally and as safely as possible. They need to wear masks in schools, in stores, when visiting friends. They need to continue seeing their pediatricians on a regular basis and get, on time, their shots for vaccine-preventable illnesses, such as measles, mumps, polio and rubella.

As pediatricians, we hear and speak out against dangerous misinformation, and we see the fear in our patients and families as the pandemic has worsened again. All of us have had conversations with friends and family about the pandemic. Many of us have lost loved ones to COVID-19.

We also hear the anger. One of us could not add her name to this piece for fear of the potential consequences.

We are extremely worried about the coming months because the system is already stretched.

Nationwide, there are only 5,400 PICU beds in the country. Two years ago, pre-COVID-19, there were times when there was not a single PICU bed in all of Chicago. We continue to care for children with cancer, with heart disease, with asthma or trauma.

The PICU is the last line of defense for children, but the system is not designed to take on this magnitude of preventable illnesses. This is what haunts us: the reality that we might not be able to care for every child who needs us. We are pro-vaccine, pro-masks and pro-child.

We are eight pediatric intensive care doctors standing together and asking you to stand up to protect children.