In late August, Megan McCabe found herself at Primary Children’s Hospital in Salt Lake City, holding her 2-year-old daughter still while doctors sewed a dialysis line into her neck.

A week earlier, the girl, Charlotte, had been playing with her brothers at their home in Nampa and was jumping off the kitchen counter into her father’s arms. Now, pediatric specialists were readjusting a line to help her liver stabilize. The girl had tested positive for COVID-19 just days before, and her condition deteriorated rapidly as her liver failed and abdomen swelled.

Charlotte was one of the 243 Idaho children who have been hospitalized with COVID-19 so far during the pandemic. While serious pediatric infections are rare, they do exist, and Megan McCabe hopes Charlotte’s story will encourage others to realize the risks COVID can pose to children.

An unexpected illness and rapid decline

On a Saturday in late August, Charlotte started throwing up. The family thought it was a stomach bug until the toddler, who was healthy and had no pre-existing conditions, started acting listless.

On Monday, the McCabes took her to urgent care, where health care workers told them to take her to the emergency room at Saint Alphonsus in Nampa. There, Charlotte tested positive for COVID.

The hospital transferred her to St. Luke’s in downtown Boise, which has more pediatric beds. Doctors ran more tests, and Megan stayed with Charlotte at the hospital overnight while her husband stayed with the couple’s older children at home.

Around 2 a.m., a doctor came into Charlotte’s room to talk to Megan.

“When she came in you could just tell, OK, this is not good,” she said.

The physician informed Megan that Charlotte’s liver levels were “through the roof,” and the girl needed to be transferred to another hospital. They gave Megan the choice of California or Utah; Megan chose Utah’s Primary Children’s Hospital in Salt Lake City, as it would be a shorter drive for Cliff.

Two hours later, Megan and Charlotte were in an ambulance on the way to the Boise airport, where St. Luke’s has a small airplane. By 5 a.m., they had landed in Salt Lake City, and Charlotte was soon admitted to Primary Children’s.

Upon arrival, Charlotte’s liver was in such bad shape that physicians told Megan the toddler would need a transplant.

“That was in our head: Our daughter is getting a liver transplant,” Megan said. But to even get on the transplant list, Charlotte would have to first test negative for COVID. Liver transplants are also hard to come by, so Megan was mentally preparing for a multi-month stay in the hospital at minimum.

In the meantime, doctors focused on keeping Charlotte alive. Her brain had begun to swell from high ammonia levels, a side effect of her liver’s inability to process waste. Cliff drove to Salt Lake City to be with Megan and Charlotte while Megan’s mom cared for the boys.

They made the difficult decision to give her dialysis, a procedure that carries a high risk of infection, especially when the patient is already weak. Charlotte spent a day on dialysis, which Megan says was just what her body needed to start recovering.

But the treatment wasn’t without difficulty. At one point, Megan says, doctors had to readjust a line running from Charlotte’s neck to a vein near her heart.

“They had to sew the line in since it’s such an important line,” Megan said. “They don’t want it moving.” According to Megan, the adjustment happened so quickly that they didn’t give Charlotte numbing medication. “Cliff and I had to hold her down while they stitched it back into her neck,” she said.

Rare but not impossible

Charlotte’s extreme illness due to COVID-19 is rare among children. Throughout the pandemic, the most children hospitalized at any given time was 15, on Oct. 2, and so far, the state hasn’t recorded the deaths of anyone younger than 18.

Children are much more likely to experience the loss of a parent than they are to be hospitalized themselves, with one research paper estimating about 500 children in Idaho have lost a primary caregiver, according to the Idaho Capital Sun.

But while few children have become critically ill, that number isn’t zero. As of Friday, the Idaho Department of Health and Welfare has reported 33 cases of multisymptom inflammatory syndrome in children, a painful condition in which an overstressed immune system attacks a child’s organs, skin and muscles.

In late September, hospital officials told Idaho reporters that they were seeing an increase in pediatric hospitalizations, as well as stillbirths among COVID-positive mothers. This week, Kootenai Health in Coeur d’Alene posted a story about a COVID patient who celebrated his 10th birthday while being hospitalized for COVID complications.

“The one thing we really learned about COVID is it affects people differently,” Megan said. While COVID causes blood clots in some patients, Charlotte’s blood had trouble clotting. And though most children don’t get severely ill, Charlotte did.

Miraculously, after dialysis, Charlotte began to improve. Her liver levels dropped, and she gradually became more alert. When she was in pain and unhappy, she would thrash, scream “No!” and try to stop nurses from poking and prodding her – difficult for Megan to see, but proof Charlotte was getting healthier and less lethargic.

After a few days, the little girl was able to sit up in bed, eat macaroni and cheese, and let her mom brush her hair. Healthcare workers at Children’s Primary marveled at the bounce-back, and one nurse referred to Charlotte as “my little anomaly.”

“When we got there, we did not think we were coming home with our child,” Megan said. “We just did not have hope.” Their best-case scenario involved waiting several months for a liver transplant, but on Sept. 1, a week and a half after Charlotte first went to the emergency room in Nampa, she was discharged from the hospital in Salt Lake City.

Physical, emotional scars linger

While Charlotte was able to come home, the physical and emotional scars are still healing. At first, the toddler would wake up screaming “No, no,” in the middle of the night, Megan said. She also got upset when she saw the signs of where the needles and lines were inserted.

“She had so many holes in her arms and bruises, and she could see them. That was a really big trigger,” Megan said.

While those spots slowly healed over the last few weeks, Charlotte still doesn’t want her parents to look at her neck, or brush her hair near where the dialysis line was placed. She still wakes up in the middle of the night looking for reassurance.

The episode has had other ripple effects on the family. Because they don’t yet know how Charlotte would handle more COVID exposure, the McCabes decided to homeschool their oldest children this year.

While Megan is starting to recover emotionally, she still avoids social media. The family documented Charlotte’s hospital stay and recovery on Facebook, and while the vast majority of comments were supportive, some people who left replies were COVID skeptics.

“We had people telling us, ‘Well no, your daughter’s liver failure is not from COVID. COVID doesn’t cause that,’” Megan said. “It was so frustrating to hear those comments and see this, because you’re not a doctor.”

There was one bright spot: Charlotte’s story also convinced others to take the virus more seriously.

“We had friends and people we don’t even know reach out to us and say, ‘We got vaccinated after seeing pictures of Charlotte,’” Megan said.

Ultimately, Megan hopes no other family has to go through the same experience.

“It’s such a traumatic experience, watching your child go through that and thinking you’re not going to be coming home with them,” she said.