Below is the full text of a letter sent to Covid Stories Archive describing the experiences and issues witnessed by a pediatrician during the Covid era. The letter has been edited slightly to protect anonymity. Please contact Covid Stories Archive if you would like to use or reproduce this essay, in whole or in part, for your research or writing. Also, please consider sharing your own stories for preservation in our archive.
5/24/2022
I am a pediatrician and have been practicing for more than 25 years. I’m also a mother. I’ve been deeply affected by the harms of the response to the pandemic professionally and personally.
Many people have written about everything I’ve experienced more eloquently than I can. I decided just to list some of the things that have surprised me the most since March 2020.
- Less curiosity and desire to seek out primary source medical information than I would have expected in physician colleagues.
- Unwillingness of institutions to advocate for children when politically risky-especially pediatric professional societies and children’s hospitals.
- Willingness of parents to participate in restrictions that hurt their children
- Physicians comfortable expressing contempt for patients who make different medical decisions from MD recommendations
- Fear of exposure to viral illness interfering with interactions between patient and MD, which seems worse in younger than older doctors, and has thankfully not been an issue in my practice.
- Compliance of young people-in masking, following rules, etc. This is one of the most alarming problems in my opinion, because it’s developmentally abnormal. Adolescents and young adults are supposed to rebel, and see themselves as immortal and smarter than adult authority figures, but they have typically been very eager to follow the rules. I consider this to be a harm against young people through coercive social pressure applied by adults, not a character flaw of young people. I worry that it may become a habit of character that persists.
- Inversion of seemingly every principle of medical ethics-autonomy, informed consent, avoiding paternalism, cultural respect
- Use of clinical information solely for non- clinical purposes. Mass testing at universities is an example. At [local university name redacted], students were required to be tested several times/week last year. Some students had hundreds of negative PCR tests during the 20-21 academic year. Classes were online, dining halls closed, activities canceled, students not allowed to visit other students’ dorm rooms. The test results were tallied for public health or political purposes, and didn’t provide individual benefit.
- Callousness toward hurting children with testing, esp the youngest and disabled non-verbal children. I am doing nasal swabs on minimally sick children every day, frequently for an administrative rather than medical purpose, or to reassure an adult relative who might be exposed to them, such as a grandparent.
- Acceptance of the idea that causing discomfort in children is tolerable because each individual instance of discomfort-eating outside, wearing a mask, etc is mild. It’s considered OK to hurt kids if it’s only a little at a time.
- Lack of concern by medical professionals about illogical vaccine reasoning: mass vaccinating a low risk population, vaccinating immune children, incomplete safety data and no expectation of long term efficacy of the vaccine.
- We [as a profession] are providing advice to families based on CDC guidelines that do not make sense medically. Prolonged quarantine of healthy household contacts of children with Covid is one example, as is vaccinating children immediately after recovery from Covid illness. This is very difficult to navigate because most parents expect advice based on standard guidelines, doctors in the practice have varying desire to adhere to all guidelines, etc. Nurses are giving advice that is based on rules but that cannot be reasoned from medical principles.
- My [medical practice] partners are aware that we have different opinions about Covid restrictions, and we have been able to maintain collegial relationships despite that. Because we share office space however, I find myself trying to avoid phone conversations in which I will say things to families with which my partners may not agree (such as that I support a family’s decision to hold off on vaccinating their child) when they are in the room. That is not something they have asked me to do, but is evidence of my sense of isolation, and is a new experience for me.
- Huge increase in anxiety and depression in patients, which was in progress before the pandemic but worse now. This isn’t surprising, just difficult and draining to see. Helping the children and their families is rewarding. I’m often providing psychiatry and counseling services because of the difficulty accessing additional services. Many children are taking psychiatric medications that may not have been prescribed if their lifestyle had not been disrupted.
- Academic failure. Subset of high-achieving girls > boys in middle school and high school failing multiple classes. Social interactions in school seem to be more important in girls than boys for academic success, at least more important than I realized. This is better this academic year than last year since kids are attending school in person. In addition to overt school failure, general academic decline, with teachers saying their students are 2 years behind academically and behaviorally in the classroom. Children also lost executive function skills, such as ability to meet deadlines and complete tasks, after having expectations lowered significantly for a prolonged time.
- Weight gain in many children, as is predictable when children are home and more sedentary. A more surprising change in weight was weight loss, especially in boys. More boys than girls seem to have their appetite driven by activity, and some stopped eating enough and lost weight (failed to thrive) when not doing normal activities. Some were so engrossed by video games that they didn’t eat meals and lost weight as a result.
- Eating disorders, some requiring inpatient treatment. I hadn’t seen severe eating disorders in recent years, but have had several patients admitted during the pandemic. I wouldn’t have predicted that particular issue happening so often.
- Children with developmental disabilities did not receive normal services, such as speech therapy and treatment for autism, in a timely way. This resulted in delayed diagnosis for some, which is well known to affect long term prognosis. For children with severe disabilities, many received no educational services at all for over a year because they could not participate online. This problem was worse for children in less affluent families. Children still receive speech therapy masked and from masked therapists when in person, despite the obvious decrease in quality when mouths aren’t seen. I am unaware of professional societies for pediatric speech therapists publicly lobbying against these restrictions, and that’s surprising to me.
- Severe anxiety in some parents about the social consequences of their child getting sick with Covid.
- Intense social pressure to follow Covid avoidance rules. This included a willingness to encourage children to end friendships with unvaccinated children or not allow them to interact outside of school. The social pressure to vaccinate children on families who would prefer not to do that has been severe. Multiple families told me that they decided to go ahead with vaccination, despite misgivings about necessity or safety, for the sake of allowing their children to have a normal social life.
- Families who have been hesitant about vaccines generally, and who I’ve encouraged to progress through the standard vaccine schedule through lots of conversation and patience, getting the Covid vaccine for same children on the first day possible. This includes one family for whom the Pfizer Covid vaccine may be nearly their children’s only vaccine! That’s a surprise.
- Lack of knowledge about medical treatment for Covid illness among adults. I’ve counseled parents of patients about how to access treatments like monoclonal antibodies if they are sick, and it’s often the first time they’ve heard about this treatment.
- There are so many really smart, funny and courageous people in the world who I have only encountered as a result of seeking out information about the pandemic on social media. This is definitely a positive for me and makes me optimistic about the future (although I’ve wasted too much time on the internet as a result!)
- Most families of my patients really do want to hear my opinion about the situation. We get masks off in most rooms, though some families prefer not to take them off. When we talk about the reality of Covid illness risk in children, many are legitimately surprised and relieved. I’m surprised they are surprised.
I’m grieving the loss of respect for my profession. I’m proud that relationships in my practice are strong enough to sustain our collegiality despite differences of opinion. I am deeply saddened by the suffering I’ve seen in my patients and their families, as well as in my own children. I wish I had done more to successfully advocate for children, but take comfort that I’m advocating in a small way to the best of my ability with each family I meet.
I’m very thankful that Covid Stories will provide a way for people to read authentic accounts of this time in the future.
Sincerely,
[Redacted]
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