“It’s been surreal this past month,” Evelyn Obregon, a pediatric resident at the University of Florida Shands Children’s Hospital, told me. “I’ve never seen this many COVID-positive cases.” Her state is consistently reporting among the highest numbers of pediatric coronavirus cases in the country. Obregon has grown accustomed to treating about five kids with COVID-19 a night; last year, a more usual number was one. In mid-July, she treated a 2-year-old gripped with fever and dehydration. “I was shocked,” she told me. “I had never seen a toddler getting infected like this before.” Her patients are only getting younger, sometimes just weeks old. Most of her patients, she said, are from unvaccinated families.

In recent weeks, Arkansas Children’s—the only pediatric hospital system in Arkansas, where vaccine uptake has been especially sluggish—has admitted far more children than at any other point in the pandemic, Jessica Snowden, the hospital’s chief of pediatric infectious disease, told me. “All of them are unvaccinated.” Last year, she said, she and her colleagues considered it a bad day when they had five to seven kids with COVID-19 in their hospital. Now they’re routinely caring for 20 or 30, nearly half of whom are under 12.

Many of Arkansas Children’s new COVID-19 patients are also much more ill than before. They’re coming in with wrecked lungs, struggling to breathe; they’re not bouncing back with typical youthful resilience, despite having been very healthy before. “This COVID surge, I’ve never seen anything like it,” Linda Young, a respiratory therapist who’s been on the job for 37 years, told me. “It’s the sickest I’ve ever seen children.” It’s become common for more than half of the kids in the ICU to be on ventilators. A few have been in the hospital for more than a month. “We are not able to discharge them as fast as they are coming,” Abdallah Dalabih, a pediatric critical-care physician, told me. Some parents, Snowden said, are in disbelief. “Many people didn’t believe kids could get this thing,” she said.