More kids under 5 than ever are sick with COVID: Take a rare look inside a pediatric ICU

People tend to think the coronavirus is mild in kids — and most of the time, it is.

But when it's not, it can be downright scary.

Since Christmas, the number of hospitalized children aged 4 and under infected with COVID-19 has reached the highest levels since the start of the pandemic.

Little kids in this age group can’t do anything to prepare their immune systems to fight the highly contagious omicron variant of the coronavirus; the vaccine is not yet available to children under 5.

On Friday, Pfizer postponed its application to the Food and Drug Administration to expand the use of its COVID vaccine for children ages 6 months to 4 years — a setback for parents who'd hoped a vaccine for very young children might be approved soon.

For young kids who get very sick, the pediatric intensive care unit is their last and best hope.

Because of patient privacy protections and also the need to isolate COVID patients, few people know what it's like inside a pediatric COVID ward. TODAY Parents was able to spend time, with many precautions, in the Intensive Care Unit (ICU) of Seattle Children's Hospital to tell these stories. Here's what we saw.

Bonnie's story

This is Bonnie.

That photo was taken when Bonnie finally started feeling better after 12 rough days at Seattle Children’s Hospital. Just a few days earlier, the normally healthy and exuberant 3-year-old looked like this.

“Her skin was so tight. Everything was tight — her hands, head, belly, all the way down to her toes,” said Bonnie’s mom, Cassandra Wesley, 31, of Wapato, Washington. “They said her kidneys weren’t working and she kept retaining fluid and her body wouldn’t get rid of it. That was the worst point for me. She couldn’t barely open her eyes, she was so puffy.”

Typically a little dynamo who loves to climb furniture and catapult herself across the room, Bonnie became lethargic and unresponsive as COVID tore through her family.

“I was diagnosed on New Year’s Day and I got pretty bad — I couldn’t get out of bed, couldn’t walk, had a hard time breathing, I was dizzy,” Wesley, a mom of five, told TODAY. “The rest of the kids started getting it one day after another … and then Bonnie, she started just sleeping. She wasn’t really waking up. She’d come out to get a drink or two, but she wouldn’t even eat. She would go right back to sleep.”

On Jan. 17 — Martin Luther King Jr. Day — Bonnie was airlifted from her hometown near Yakima in Washington state to the ICU at Seattle Children’s Hospital.

“She became critically ill with less common but known complications of COVID-19 infection, including kidney injury, cardiac dysfunction, pneumonia and bacterial infection,” said Dr. John McGuire, chief of Seattle Children’s Hospital’s Division of Pediatrics Critical Care Medicine. “Her case is an example of how COVID-19 can cause serious life-threatening illness even in otherwise healthy children.”

A rare tour of the hospital

On a weekday in late January, McGuire led a rare tour of the normally locked-down COVID wings at Seattle Children’s Hospital for TODAY Parents. He wanted to do it because he wanted other parents to see what he’s been seeing.

The tour began on a non-ICU floor where hospital workers have been scrambling to transform rooms into special isolation units for COVID patients.

“We started out with just these six rooms here, and we thought we’d be OK with that,” McGuire explained, gesturing to a tidy hallway. “Right now, though, we have 22 patients on this floor with COVID. Last week we had more than that. We’ve had to extend into other areas to make more room.”

This COVID unit feels quiet and calm — in part because all patients’ doors must remain firmly closed. Before entering the rooms to care for sick kids, health care workers don so much personal protective equipment (PPE) that they look like they’re preparing for a spacewalk.

McGuire stopped to chat with charge nurse Julia Smock. Smock has worked as a registered nurse at Seattle Children’s for more than 30 years, and she said she’s been shocked by the number of young COVID patients.

“It’s a LOT,” she said. “Once omicron hit, we’ve been full the entire time.”

Together, Smock and McGuire described the two categories of COVID symptoms that hit young patients the hardest: respiratory and gastrointestinal. They often see kids struggling with congestion, wheezing, coughing, fast breathing and difficulty breathing.

There’s also been an uptick of tiny babies and unvaccinated teenagers at the hospital with COVID.

“Young ones under 2 to 3 months come in with dehydration and not eating and vomiting as their main symptoms,” McGuire said. “Some of the kids have been under a month of age — which is really scary for families with newborns.”

According to McGuire, of the 818 COVID patients treated at Seattle Children’s since the start of the pandemic, many have had bad headaches. Some have had seizures. A handful have had strokes. Two have died.

Doctors are confounded by the kids who return to the hospital with multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition that can emerge about three to four weeks after patients recover from COVID.

“The good news about MIS-C is we’ve been participating in long-term follow-up,” McGuire said. “Although kids get pretty sick with it, they do recover.”

Smock noted that some of her young patients come to the hospital for a host of other reasons — and then learn that they also happen to have COVID.

“But then some of them are coming in super-super sick just with COVID,” she said. “We were used to that with the adult population, but to have our little kids get so, so sick with COVID? It’s been very scary for us.”

Deciding who gets into the ICU

Hospital workers were hoping the Pfizer vaccine could become available for kids under 5 by the end of February; but on Feb. 11, Pfizer opted to delay its approval request, leaving the future of an under-5 vaccine murky once again.

Parents’ reception to vaccinating their 5- to 11-year-olds has been tepid at best. Nationally, just 18.8% of children in that eligible age group are fully vaccinated, and 28.1% have gotten one dose, according to a recent report by the Kaiser Family Foundation based on federal data.

Those percentages are somewhat higher in Washington state — but even so, the influx of sick kids has stunned health care workers at Seattle Children’s.

“The ask is every day, every shift, for people to work overtime,” said ICU nurse Cindy Sloan, straining to be heard over the incessant ding-ding-ding-ding of urgently beeping hospital equipment. “We’re short every day. Staff is now getting sick, and staff is tired.”

As a risk nurse, it’s Sloan’s job to help evaluate sicker patients who might need to transfer to the ICU.

“It sort of feels like I move from one bedside to another putting out fires,” she said. “I’m trying to figure out how to prioritize the kids who need an advanced level of care because resources have been so limited.”

“How’s it going today, Cindy?” Dr. McGuire asked Sloan during the tour of the non-ICU COVID ward.

At that moment, Sloan was tense. She needed to move a teenage COVID patient to the ICU.

“Beds are tighter right now,” Sloan said, her blue eyes anxious above her mask. “My goal as a risk nurse is to have her in the ICU or the right place for her care within 60 minutes. We decided this morning that she needed ICU care at about 9:30 — and it’s now almost 1:30.

“I think we finally found a bed for her, though. I hope so.”

Inside the pediatric ICU

The ICU rooms are spacious and bright, with large windows looking out onto Douglas firs and other evergreen trees. Engineered with airborne diseases in mind, the “negative pressure” rooms suck air inward so that even if the door is opened, the coronavirus can’t escape.

Each room contains an extra bed for one parent or caregiver who must commit to staying isolated with a COVID-positive child.

“The visitation restrictions during this pandemic have been one of the absolutely hardest things,” McGuire said, noting that pediatric hospitals have been a little more permissive than adult wards. “It’s just absolutely necessary that children have someone with them.”

“If a child has a four- to five-day hospital stay, 24 hours a day, that’s exhausting for the one parent,” McGuire acknowledged.

Wesley, Bonnie’s mom, has been exhausted for weeks now. As Bonnie’s kidneys were failing in the ICU, Wesley would turn on “Frozen” and “SpongeBob SquarePants” to try to distract her 3-year-old while she choked down her own fears.

“I kind of felt like I was holding my breath all the time,” Wesley said. “I didn’t really talk about it to anyone. … It’s just hard to understand if your child might not make it.”

'Absolutely no immune system'

Just down the hall from Bonnie’s room, workers wheeled Katherine Abud into an ICU room. Abud — the teenage COVID patient who had risk nurse Sloan so worried — said she doesn't know when she might be able to leave the hospital.

The 17-year-old resident of Auburn, Washington, has been living with sickle cell disease, a red blood cell disorder, all her life. Her situation was so dire that she underwent a bone marrow transplant in June 2021.

“The transplant was my last option — my last resort. I did it to save my life,” Abud said. “It essentially removed all my childhood vaccines from my body, and it also means I have absolutely no immune system. It’s like my body is starting over.”

Abud, who spoke to TODAY with permission from her parents, said that because of her bone marrow transplant, she couldn’t get the COVID vaccine — and because of the state of her immune system, her body has had a hard time fighting COVID. She said she’s been COVID-positive since December, when she caught the coronavirus in a medical setting.

Throughout the pandemic, parents of kids like Abud with medically complex health problems have had to weigh the need to seek care for their children against the risk of exposing their kids to the coronavirus. Parents told TODAY that their routine hospital and clinic visits have started to feel like terrifying games of COVID roulette.

After everything she’s been through, Abud begged people to wear masks in public, wash their hands often and take other safety measures during the pandemic.

“Please make an effort,” she said. “I see what my parents are going through. I see their tears. I see the heartbreak that’s in my household. Please be safe, because you don’t know the heartbreak you might be causing a parent.”

A homecoming, at last

On Feb. 2, after 17 days at Seattle Children’s, 3-year-old Bonnie finally got to go home, hug her dad and play with her siblings again.

Dr. McGuire said Bonnie is making a full recovery, and her life should soon return to what it was before her COVID-19 infection — but, because she experienced acute kidney injury, she could be at risk of other kidney problems later in life.

“She will need longer-term follow-up and (to) have her kidney function monitored,” McGuire added.

Wesley said she realizes her daughter could face long-term health effects. As they were being released from the hospital, though, the tired mom kept her mind focused on one thing:

“She is so happy right now.”

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