William A. Haseltine Ph.D.

Best Practices in Health

A Troubling Tale of Two Children in the Time of COVID-19

A story that exposes the troubling gaps in care for children in America.

Posted Apr 09, 2020

This week, I heard a disconcerting story from a friend of a friend in Boston who was diagnosed with COVID-19. She is just a teenager, but one who has suffered since early childhood from chronic asthma. Just over a week ago, she started experiencing the symptoms all of us with underlying conditions have come to dread—chest pains, difficulty breathing, and a dry, hacking cough that would not disappear. 

Initially, because there was no fever, she and her parents tried to manage the symptoms at home, hoping it may just be a regular cold or a mild flu and not a more serious case of COVID-19. But when one of her high school friends texted to say she had recently tested positive for COVID-19, they felt they had no choice but to be tested and seek proper care.

Her mother drove her to her physician’s office where, after a clinical examination, the doctor said there was little doubt that she was positive for COVID-19—but there were no tests available to confirm the diagnosis. Instead, the young girl was given acetaminophen, a prescription for more asthma pumps, and told to go home and rest. Both mother and daughter were distraught and confused, left to manage a potentially lethal disease on their own, with the risk of the infection spreading to the rest of the family, some of whom have underlying conditions of their own, highly likely.

Meanwhile, nearly 10,000 miles away in Singapore, one of my colleagues and her 6-year-old daughter were struggling with a similar challenge. Her daughter woke one morning with a slight wheezing in her chest, not particularly alarming since the young girl was just getting over a mild cold and—much like the teenager in Boston—she suffered from asthma. Wheezing was to be expected. Still, they called a nearby walk-in clinic and within the hour, they were sitting in front of a local physician. After running through their daughter’s medical history, including her history of asthma and her recent illness, the doctor referred her to the emergency department of the National University Hospital to verify that her asthma was under control and to swab her for COVID-19.

At the emergency room, they were, once again, seen quite quickly, since most people in Singapore have been heeding warnings not to overcrowd ERs. The emergency room physician said the wheezing wasn't severe, but they would have her take a few rounds off an inhaler and if her condition didn't stabilize they would take a chest x-ray. The doctor isolated them in a separate room to avoid the risk of further infection in case she eventually tested positive for COVID-19. 

A few hours and many Peppa Pig episodes later, her daughter’s condition had stabilized. The doctor swabbed her throat to test for COVID and gave her steroid medications to take home in case her symptoms were to return or worsen. They also sent her home with a legally enforceable medical leave, which meant she was not allowed to leave the house for five days. The next morning, to my colleague’s great relief, they received a call that the test results were negative

While I was comforted to hear my colleague’s good news, the moment was bittersweet. Here are two cases of vulnerable young children at risk of COVID-19, both of them being treated in highly developed nations. In one, the child is tested, cared for, and quarantined immediately, steps that ensure not only her safety but the safety of those around her. In the other, there are no tests, there is no knowing whether there is an infection, and there are no safety protocols in place to break the chains of transmission.

What a troubling state of affairs for those of us here in the United States and our children. Without tests available to all those at risk of infection and without mandatory quarantine orders to prevent further spread, we stand no chance against this disease. Instead, we set the stage for an endless wave of infections that will befall us for months, years, or perhaps for generations to come.