Children Are Not Small Adults

Playing a game of Candy Land with a tearful 12-year-old girl who lives in a pediatric long-term care facility (pLTCF) and has been isolated from her family at the onset of the COVID-19 pandemic, I consider the fact that protecting my patient from COVID-19 infection requires isolating her from her loved ones. An epic poem comes to mind. Homer’s Odyssey describes the plight of Odysseus and his perilous journey returning to his home kingdom of Ithaca. Due to uncontrollable circumstances including war and captivity, Odysseus is kept from his beloved homeland for years. On his eventual sea journey home he must sail between two sea monsters found on opposite sides of a narrow straight: the perilous whirlpool Charybdis and the six headed monster Scylla. As there is no escape without cost, Odysseus is forced to choose the lesser of the two evils; passing by Scylla, losing only a few sailors rather than risking the loss of his entire ship in the whirlpool. As a medical student rotating in a pLTCF at the onset of the pandemic, I recall many instances where physicians and facility leaders were forced to choose between the lesser of two evils while creating policies and best practices for resident children. Balancing the creation of an effective infection control policy with the negative effects of social isolation on resident children demonstrates one example: My patient was sad during the initial weeks of isolation from her family. Now, a year later and still isolated, I wonder if she and her family think that facility policies implemented to prevent COVID-19 infection have been worth the sacrifice.