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Norfolk — Umiyah Rice-Cummings sat with her family at TGI Friday’s, but refused her dinner.
Not even dessert could tempt the 10-year-old.
When she complained of a fever and headache the next day, Aug. 15, her mother took her to an urgent care clinic. She and Umiyah’s stepfather had had COVID-19 a couple of weeks earlier, and they feared she had contracted it.
She tested negative twice over the next six days, but her fever kept spiking. Because her pediatrician didn’t have any appointments available, they made a second trip Aug. 19 to the same clinic. She received IV fluids for dehydration, and they left.
“The next morning, about 2 a.m., my mommy senses kicked in, and I just felt like something was wrong,” Tiesha Rice remembered. “As soon as I walked into her room, she was throwing up.”
Umiyah barely had the energy to leave the house. They eventually drove the 50 miles from Yorktown to Children’s Hospital of The King’s Daughters in Norfolk.
She would remain there for 10 days, nearly half of that time in intensive care.
More children were hospitalized for COVID-19 last month than during the pandemic’s January peak, when the facility treated 23. Umiyah was one of 39 in August. September already outpaced it — 30 hospital admissions as of Wednesday — with half the month remaining.
The increase has come as a shock to many who interpreted the summer lull as a sign the public health crisis was on its way out. In June, CHKD had just nine patients with coronavirus infections, four of whom tested positive but were admitted for other reasons.
It’s a nationwide trend, especially in the South, as the more contagious delta variant steers the latest surge. Children are making up an increasing share of new cases, in part because vaccines are not allowed for anyone under age 12.
Though health experts say children are still likely to be asymptomatic or experience only mild symptoms, nearly 1,000 juveniles have been hospitalized for the disease statewide. More than a third live in Hampton Roads.
This surge is what pediatricians are calling the “third wave” for children. CHKD had 1,263 positive COVID-19 tests across all of its medical providers in August. That surpassed their previous high of 1,216 tests systemwide in January.
Parents throughout the region were alarmed last month when Schwanda Corprew, a Norfolk teen, died at home from coronavirus complications. She’s one of 11 Virginians 19 or younger whose life was cut short by COVID-19.
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As of Sept. 9, nearly 5.3 million children in the United States have tested positive for the disease since the onset of the pandemic.
Almost half a million were added in the previous two weeks — the worst for juvenile cases since the pandemic began, according to the American Academy of Pediatrics and Children’s Hospital Association. Children have represented about 15.5% of all U.S. cases, but during the week ending Sept. 9, children made up 29% of reports.
Dr. Laura Sass, CHKD’s medical director of infection prevention and control, said the new wave has changed the game. At the only freestanding children’s hospital in Virginia, more COVID-19 patients have required intensive care, and they are using more medications to treat them. None needed a ventilator last month, but many have been on other kinds of breathing support.
Clinical studies are trying to get to the bottom of whether the delta variant causes more severe disease in children or if more happen to be getting sick simply because they’re unvaccinated.
“Because we have so many people who are older who are more at risk who are vaccinated, that does change some of that proportion of who’s getting hospitalized,” said Dr. Lillian Peake, director of epidemiology for the Virginia Department of Health. “But that doesn’t mean that (children) are necessarily at more risk right now.”
Though many states are seeing an uptick in pediatric COVID-19 hospitalizations, that was not what unfolded in Israel and the United Kingdom when they confronted delta. Dr. Danny Avula, state vaccine coordinator, said public health officials need to determine whether the dramatic increase is a product of exposure.
“Because compared to last summer, your kids were on lockdown, camps were canceled, schools were closed, and there just wasn’t as much opportunity for infection?” he posed during a call with reporters in August.
The disease usually looks the same in children as in adults: fever, cough, difficulty breathing and runny nose. Some patients have vomiting, diarrhea and stomach pain.
But what often complicates pediatric diagnoses is that doctors are also seeing a large number of other respiratory viruses, such as respiratory syncytial virus, or RSV, and parainfluenza, which normally circulate in the winter. All can have similar symptoms.
A common misconception is that the coronavirus only threatens children who have other health conditions. Some of the hospital’s young patients had no other medical issues.
One thing they did have in common, Sass said: All hospitalized COVID-19 patients last month were unvaccinated, including those old enough to get the shots.
“It makes people feel better when they can say, ‘Oh well, they got so sick because they had X, Y and Z,’ you know, ‘They have asthma, they have cancer, they are obese,’” she said. “You are at greater risk to get sicker if you have some of those underlying conditions, very similar to what you see in adults. But that is not always the case.”
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On Aug. 20, Umiyah was declining fast.
An ultrasound found heart inflammation. One of her valves was leaking.
She pleaded for her doctors and family not to let her die.
Rice, who had been holding Umiyah’s hand since she entered the hospital, had to leave the room. She didn’t want to abandon her daughter, but she also didn’t want to upset her more with tears.
“To hear your child say that ...” Rice said, her voice cracking.
Umiyah’s stepfather tried to explain her reaction to the doctors: The two are like mother-daughter soulmates, he said.
Around 4 a.m. Aug. 21, doctors diagnosed Umiyah with Multisystem Inflammatory Syndrome in Children, or MIS-C, a rare but serious complication of COVID-19 that can be deadly. Though she had never shown coronavirus symptoms, her bloodwork came back from the lab positive for COVID-19 antibodies.
MIS-C affects various parts of the body and may cause problems with a child’s heart and other vital organs.
Around the world, a relatively small number of children and teens have died from the condition, but at least 83 in Virginia have been hospitalized for it. That could be an undercounting, as earlier reporting by The Virginian-Pilot found that many more patients at CHKD had been treated for the syndrome but didn’t meet the CDC’s narrow definition.
Most children with the syndrome get sick about 4-6 weeks after exposure to the coronavirus. They have a fever lasting several days and symptoms such as irritability, abdominal pain, diarrhea, vomiting, rash, conjunctivitis, lack of appetite, red or cracked lips, red or bumpy tongue and swollen hands and feet.
Some medical experts have likened it to other hyperinflammatory conditions, including Kawasaki disease and toxic shock syndrome.
Though Umiyah never showed signs of the coronavirus, she had contracted it at some point, possibly even before her mother and stepfather, doctors told Rice.
Children with the syndrome are counted as COVID-19 cases by the state and hospital.
Rice said CHKD medical staff asked if she had been vaccinated. They wanted to know if her illness in July was a so-called “breakthrough case.”
Since vaccines became available, Rice said she was reluctant to get inoculated. She believed early adopters were essentially guinea pigs. Then, when she started to come around to the idea, it was more a matter of procrastination.
She still had doubts. She heard of someone who died after getting a shot, and she worried she’d have a bad reaction. She knew someone vaccinated who had still gotten severe COVID-19. Other people, incorrectly, told her the vaccine “only” keeps you from dying.
Despite being asked whether she had gotten the shots, Rice said none of the hospital staff told her she should get vaccinated. Even after battling her own case of COVID-19 with pneumonia and watching her daughter become gravely ill, she’s still not sure whether she’ll get the shots, she said.
Vaccination of all eligible family members is the best way to protect children who are too young to get shots themselves, Sass said. It’s also the way to slow down the virus from mutating into worse strains, like this delta variant.
“The virus wants to live, and so that’s why it changes over time, just like any other virus does,” Sass said. “By getting immunized, that helps with that.”
The pediatric academy has called on the Food and Drug Administration to speed up efforts to allow vaccines for children ages 5 to 11. In a letter Aug. 5, Dr. Lee Beers, president of the academy, wrote that the higher proportion of cases in this age group could be fueling the continued spread of the disease.
“Millions of children have been negatively impacted by missed schooling, social isolation, and in too many cases, the death of parents and other caregivers,” he said.
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Umiyah was discharged from the hospital Aug. 29, the day before she was supposed to begin middle school.
She’s home, recovering. She has follow-up appointments to check her vital organs. But she also has other issues: Balance problems and occasional trouble with memory.
Little is known about the long-term consequences of COVID-19 in children. Like adults, some are facing long-haul symptoms, and it’s unclear what impact MIS-C may have. The academy has said there is an urgent need to collect data on longer-term impacts on children, including ways the virus may harm their physical, emotional and mental health.
After a difficult 1½ months, Umiyah’s family is trying to get back to some semblance of normal. With all of their illnesses, Rice hasn’t made much income. She normally drives for Uber and styles hair when she’s not attending hair school at night.
“Everyone is under-educated on this because the focus has been on elderly people,” she said. “A lot of people, I hate to say it, but it has to be somebody that they know for them to believe it.”
Elisha Sauers, 757-839-4754, elisha.sauers@pilotonline.com