Barbara Luna was planning a first movie outing with her toddler son this summer thinking the worst of the coronavirus pandemic had passed. Instead, she spent several days in early August at her 4-month-old daughter’s bedside, “absolutely terrified.”

Three viruses simultaneously attacked her baby — COVID-19, respiratory syncytial virus (RSV), and rhinovirus — as Isabella was admitted to North Central Baptist Hospital, where Luna works as a nurse.

Isabella, 4-months, is photographed while hospitalized for a variety of viruses including COVID-19. Credit: Courtesy / Barbara Luna

The infant was fitted with nasal tubes to deliver oxygen, making breastfeeding difficult, and a catheter was inserted in her hand, the one she used to suck her thumb and comfort herself.

“She was looking at me and [would] just grunt and gasp, and she didn’t understand what was happening,” Luna said. “She would look at me, like, ‘Mommy, help me.'”

Now recovering at home with a lingering cough that doctors said may last for several more weeks, Isabella is one of a growing number of children contracting COVID-19 and developing symptoms serious enough to land them in the hospital, struggling to breathe.

San Antonio hospitals

In addition to the increase in children with COVID-19, doctors are reeling from a surge in cases of childhood RSV, an illness that was uncommonly absent during last fall and winter but is now stressing hospitals increasingly overwhelmed with a surge in COVID-19 cases.

Nationwide, data from the Centers for Disease Control and Prevention show that last week about 1,800 kids were hospitalized with COVID-19, a 500% increase in the rate of such hospitalizations for children since early July. 

Exactly how many children are hospitalized with the virus in local hospitals is unknown. The San Antonio Report has been requesting a breakdown of hospitalized COVID-19 patients by age from the San Antonio Metropolitan Health District and the Southwest Texas Regional Advisory Council (STRAC) since July 26.

Metro Health has stated that through most of the pandemic, 1% of all COVID-19 hospitalizations were children. On Thursday, Metro Health Director Claude Jacob said that out of 212 new hospital admissions , 22 were pediatric patients. But a Metro Health spokesman clarified Friday that the total number of pediatric COVID-19 cases currently in local hospitals was 22 out of 1,382 total people hospitalized.

A father walks with his child from the Children’s Hospital of San Antonio. Credit: Scott Ball / San Antonio Report

One San Antonio physician described hospitalized infants and newborns whose rib cages and abdomens contract with every breath, and teenagers who have a significant cough. The worst cases require supplemental oxygen.

Cases could skyrocket

The danger in this rising number of cases, said Dr. Deena Sutter, a pediatric infectious disease specialist working in the Baptist Health System, goes beyond having enough beds to care for pediatric intensive care patients, which is already a possibility.

Sending unvaccinated kids to schools without face masks is a “recipe for absolute disaster,” she said.

“When we have a virus that normally does not circulate in the summer, filling up the ICU beds, and you start seeing a trend toward older children, and some younger children, becoming very ill to COVID and requiring intensive care, that’s when you start really worrying that you’re going to run out of space, and run out of resources for pediatric patients,” Sutter said.

With many schools back in session, and the vaccination rate for Bexar County children age 12-18 at only 39%, COVID-19 cases among all ages could skyrocket as kids unwittingly take the virus home to others — especially those most vulnerable to the disease, Sutter said.

Castle Hills Elementary, which began school on July 19, reported 22 cases last week and three rural Texas school districts have closed amid rising cases.

Though most kids infected with COVID-19 have very mild or no symptoms of the virus, some land in the hospital.

Dr. Junda Woo, medical director for Metro Health, said in testimony Monday during a court hearing on the city’s mask mandate that local hospitals weren’t prepared for the double whammy of RSV and COVID-19. “We’re adding an additional burden to hospitals that were already bursting at the seams,” she said.

Everyone is at risk

“The pediatric cases are what’s going to drive the cases in the community,” Sutter said. “Obviously as a pediatrician, I’m concerned about the kids … but everybody has a cousin, an aunt, an uncle, a friend, a grandma” who could be infected. 

Schoolchildren are at particular risk, but children in day care settings, where masks aren’t feasible and young children readily spread germs, are even more exposed to a virus spread.

Luna suspects her daughter was exposed to COVID-19 at her day care. Her 2-year-old son, Alexander, also was sick with a fever and cough.

“Even though I feel like our day care takes all the precautions … it still just takes one child coming from a home where they were exposed,” she said. “For us, them not being in day care isn’t an option right now. But every day I drop them off, it’s very difficult.”

Barbara Luna, a nurse at North Central Baptist Hospital, spent several days at the bedside of her four-month-old daughter, Isabella, as she fought COVID-19, respiratory syncytial virus (RSV), and rhinovirus. Her son, Alexander, also was sick with a fever and cough.
Barbara Luna, with her 4-month-old daughter, Isabella, and her 2-year-old son, Alexander. Credit: Nick Wagner / San Antonio Report

At work in the hospital, Luna is caring for patients with COVID-19, and that, too, is a strain. She said North Central Baptist has a high volume of such patients now — both adults and children.

“The most difficult part is how emotionally challenging it is for my nurses,” she said. “It’s very hard for them to go home every day and know that their patient might not be here when they get here the next day.”

Luna and her husband were able to be with their daughter in the hospital; the policy for adult COVID-19 patients allows only end-of-life visits. But last year, there were times when Luna had to hold her cell phone to a dying patient’s ear so families could say their farewells.

There’s another difference in the latest surge, Luna said. “Before, we kind of felt like our children were safe … and we definitely weren’t dealing with RSV at the same time.”

‘Crazy resurgence’

For pediatric pulmonologist Dr. Kelly Smith, who treats lung diseases at Methodist Children’s Hospital, the unforeseen wave of patients sick with a variety of viruses began in May. 

“Once people started going back to school and back to work and masks started coming off, we saw this crazy resurgence of viruses,” he said. “[There are] like 10 different viruses going around right now.”

Smith didn’t see a single case of RSV last winter, a rarity. “But now this summer it’s just off the charts,” he said. 

Meanwhile, severe COVID-19 cases are up among children. Of the 25 patients in the hospital’s pediatric ICU on Aug. 13, five were COVID-19 cases and the unit was almost full. Two kids were on ventilators.

While previous surges may have resulted in three or so cases in the hospital at a time, this time around, Smith is treating more than a dozen.  

Though some of the children have underlying health conditions that make them more susceptible to the coronavirus, such as obesity or asthma, some of the worst cases Smith has treated were in previously healthy children. 

“That’s actually probably one of the most unnerving parts of this,” he said. “A lot of the kids that we’ve seen who get COVID and end up in the hospital are just normal, otherwise healthy kids. That’s probably what bothers me the most about it.”

Smith is now seeing kids who have recovered from the worst symptoms of COVID-19 left with long-term lung problems. “They became long-haulers,” he said. “They can’t play soccer, can’t be the midfielder on the soccer team … because they can’t breathe like they used to.”

There’s no good way to predict who is going to get sick or suffer long-term effects of the virus, he added. And because children younger than age 12 can’t yet be vaccinated, “they’re all kind of at risk for the unknown. I think it’s the scariest part for most parents.”

Protecting with a vaccine

Luna was vaccinated early on and never contracted the virus that threatened her daughter’s life. She’s pleading for others to do the same, saying the recent surge has taught everyone so much about the need to protect the youngest members of the community.

“Get this done,” she said. “You want to go into this knowing you did everything you could.

“As a parent, you would do anything for your child. You would do anything to protect them.”

Reporter Jackie Wang contributed to this report. This article has been updated to clarify the number of pediatric patients hospitalized with COVID-19.

Shari Biediger

Shari Biediger is the development beat reporter for the San Antonio Report.