Aug. 20 was a good day in the pediatric intensive care unit at Children’s Hospital New Orleans. Carvase Perrilloux, a two-month-old baby who’d come in about a week earlier with respiratory syncytial virus and COVID-19, was finally ready to breathe without the ventilator keeping his tiny body alive. “You did it!” nurses in PPE cooed as they removed the tube from his airway, and he took his first solo gasp, bare toes kicking.
Downstairs, Quintetta Edwards was preparing for her 17-year-old son, Nelson Alexis III, to be discharged after spending more than two weeks in the hospital with COVID-19—first in the ICU, then stabilizing on an acute-care floor. “Fortunately, he never regressed,” Edwards says from outside Nelson’s room, the door marked with signs warning of potential COVID-19 exposure inside. “He’s progressing, slowly but surely.”
The nurses and doctors who care for the sickest patients at Children’s Hospital New Orleans (CHNO) have to take the good where they can take these days. On Aug. 6, Louisiana Governor John Bel Edwards announced that more than 3,000 children statewide had been diagnosed with COVID-19 over just four days. That same week, about a quarter of Louisiana children tested for COVID-19 by the state’s most extensive health system turned out to have the virus. Medical workers line a hall at Children’s Hospital New Orleans. The hospital has hired about 150 new nurses to help manage high patient counts.
Kathleen Flynn for TIME
Seventy young patients ended up in treatment at CHNO during the 30 days ending Aug. 23. Before this summer, the hospital had never had to care for more than seven COVID-19 patients at a time, and usually fewer than that; on any given day in August, that number has been at least in the mid-teens, enough that the facility had to call in a medical strike team from Rhode Island to help manage the surge.
CHNO isn’t alone. The extra-transmissible Delta variant has ushered in a new chapter of the pandemic. For the first time, pediatric hospitals are struggling to treat the number of young patients developing severe cases of COVID-19. A record high of more than 1,900 children was hospitalized nationwide on Aug. 14—and unlike during previous spikes, infections have so far been clustered mainly in states with low vaccine coverage, meaning hospitals in under-vaccinated states like Louisiana, Florida, Tennessee, Alabam, a and Texas are drowning. “Our hospital system across Alabama is beyond capacity. Last week we had net negative ICU beds, and that’s pediatric and adult together,” says Dr. David Kimberlin, co-director of the division of pediatric infectious diseases at Children’s of Alabama. “Doctors are doing CPR in the back of pickup trucks.”
This grim scenario may seem shocking, given one of the pandemic’s long-standing silver linings: that children, for the most part, are spared from the worst of COVID-19. About 400 children nationwide have died from COVID-19 since the pandemic began, and most pediatric hospitals have seen no more than a handful of patients at a time—which makes the current surge in the South and parts of the Midwest especially unnerving.
There is no evidence that the Delta variant is causing more severe disease than previous strains, says Dr. Sean O’Leary, vice-chair of the American Academy of Pediatrics (AAP) committee on infectious diseases. Less than 2% of children who have caught COVID-19 during this wave landed in the hospital—roughly the same percentage as during earlier phases of the pandemic, according to a TIME analysis of AAP and U.S. Department of Health and Human Services data. An even smaller percentage of children die from the disease, though some have developed complications like the inflammatory condition MIS-C. Two-month-old Carvase Perrilloux undergoes an extubation procedure, taking him off of the ventilator that has been keeping him alive.