Smith started having second thoughts about school closures in the fall of 2020. Unlike in the early days, his hospital, by that point, had plenty of tests. Kids didn’t seem to be getting very sick from COVID, and they appeared to have no greater risk of spreading it than everyone else. “This idea that kids were going to be these crazy vectors was no longer being borne out,” he says.

Then, he began to see kids come into the hospital with mental-health emergencies at alarming rates. Kids were having panic attacks and trying to kill themselves; some were saying they were stressed out because they couldn’t see their friends. What he saw mirrors national trends: 37 percent of high schoolers have experienced poor mental health during the pandemic, according to a CDC survey.

But as in other parts of the country, pediatric psych wards in Northern Virginia were so full that the kids would remain in the ER for three or four days while the doctors tried to find an open psychiatric bed. “They were just sitting in an ER room,” Smith told me. A social worker would stop by each day to check on them, and someone would roll a TV console from room to room. In the summer of 2020, he started to see younger and younger kids involved in shootings and stabbings. (Gun violence among kids younger than 17 spiked nationally in 2020.)