A hospitalized 8-year-old witnesses death. Her fear is part of a broader wave of pandemic trauma in kids

Brianna, 8, didn’t know death was going to come so close to her.

She was admitted to the pediatric intensive care unit (PICU) at Harbor-UCLA Medical Center in Torrance, California last January with multisystem inflammatory disorder in children, or MIS-C.  This illness is characterized by total body inflammation due to a misguided immune response to coronavirus.

Her mocha-hued skin was covered in a red blotchy rash. She had a fever, and was lying still because her muscles ached. Her heart wasn’t pumping as well as it should’ve. Tucked into the rumpled white sheets of her large hospital bed, she looked like a tiny pixie peeping out of a shirt pocket. 

Bri’s parents thought she had escaped COVID-19. They both had it in November 2020, but she stayed healthy and had tested negative for the virus at the time. Then, during the New Year holiday, she started having daily fevers and trouble breathing, which led to her hospitalization.

She promptly responded to treatment to dampen the inflammation, and by the next morning, she was smiling, chatty and coloring pictures on her hospital tray.

That evening, a 19-year-old woman was admitted to the PICU, for a heart problem (patients up to 21 are still admitted to the pediatric unit). Overnight the teen had a cardiac arrest, activating a “code blue.” Controlled chaos overtook the PICU – beeping alarms, doctors squawking orders, nurses scrambling for medications and respiratory therapists trying to squeeze oxygen into the young woman. Bri, meanwhile, took it all in.  

The teen died that night, and witnessing the stranger’s final moments traumatized Brianna. She became tearful and visibly anxious. She understood that the virus had irritated her heart and she said she was afraid she was going to die too. 

Brianna’s proximity to death during COVID is unique in some ways — for one, it was firsthand. But it was less unusual in another way, as the pandemic has made the abstract concept of death an omnipresent reality for Bri and hundreds of thousands of other kids.

An estimated 140,000 children younger than 18 in the U.S. have lost a parent or grandparent caregiver to COVID-19 by June 2021, according to a recent study in Pediatrics. Some kids have lost aunts, uncles, teachers, neighbors or family friends, but rarely have the children been immediate witnesses to death.

“When we realized that this (COVID-19) was a very unique grief, we knew we had to respond,“ Erin Nelson told me earlier this year. Nelson is founder and director of Jessica’s House, a nonprofit organization in Stanislaus County that works with grieving children and families. 

Due to COVID’s contagiousness, many people die without loved ones nearby. Missing those last goodbyes, saying “I love you” and end-of-life conversations can impede grieving, Nelson pointed out. Jessica’s House created a support group for families bereaving a COVID death.

As of October 19, more than 723,000 Americans have succumbed to COVID-19 and ethnic minorities have had disproportionally higher mortality rates. 

As a result, children of those communities have experienced higher rates of loss of a primary caregiver. Compared to non-Hispanic Whites, caregiver death rates per 100,000 children was 4.5 for American Indian/Alaskan Native, 2.4 for Black and 1.8 for Hispanic children.

But children who haven’t suffered a direct loss have been grieving other losses, including school closures, social connections to family and friends, and absence of emotionally supportive adults, who are coping with their own distress. Child health experts fear some of these adversities caused by the pandemic will have lifelong effects on children and adolescents.

In addition, lower socioeconomic neighborhoods have suffered higher burdens of COVID-19, losing more wage-earners (from death and unemployment) and ensuing increases in poverty and less affordable food and housing. 

“Most crisis events are not a single loss. It’s a cascade of losses,” said David Schonfeld, pediatrician and director of National Center for School Crisis and Bereavement at Children’s Hospital of Los Angeles.

He said most people think about grief following a death, but there is also grief in the wake of other losses — normalcy, feeling safe, time with friends and visiting extended family, to name a few. 

The American Academy of Pediatrics encourages adults to foster resiliency for children by being present, empathetic and nurturing. This includes helping the child identify their strengths and taking control of small things that are within their power. The group also encourages adults and children to practice mindfulness and other relaxation techniques and seeking help for mental distress.

“We can’t expect people to be over the crisis until the crisis is over,” Schonfeld said.

For Brianna, with reassurance from the medical team and child life specialists, she started to relax and as she continued to improve, her fear of dying waned. She was able to go home in a few days. How the experience will ultimately shape her life, only time will tell.

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