When Jasmine Cadavid's parents took her to the emergency room near their Abingdon home nearly two weeks ago, the normally playful 2-year-old was lethargic, feverish and struggling to breathe.
She not only had swine flu, but her right lung was so filled with fluid from pneumonia that it was getting no air. Soon she was headed to an intensive-care unit at the University of Maryland Hospital for Children, where doctors scrambled to halt the damage; she's still in the hospital, recovering, today.
Doctors still can't say why Jasmine got so sick, but what happened so quickly to her young lungs is a subject of intense interest for doctors nationwide who are seeing the same pattern in a small number of children severely sickened by swine flu.
Young people have been disproportionately hit. So far, two children in Maryland and 114 across the country have died from the H1N1 strain - about the standard toll for an entire year of seasonal flu. Half of the approximately 20,000 people hospitalized have been under 18.
The reasons remain something of a mystery. Doctors and researchers believe young people lack immunity to the H1N1 strain because it has not been seen in a couple of generations. Their lungs also seem to respond in a way that's different, and may trigger more damage, than in adults. That might make them less able to ward off secondary infections such as pneumonia, the most common complication.
Health officials stress that cases like Jasmine's are uncommon. There have been millions of cases of swine flu, and the vast majority of children and adults get better at home within a week without so much as a prescription. Two-thirds of those hospitalized had underlying health problems.
But a small number of cases have proceeded much like Jasmine's - making seemingly healthy young people severely ill - and it is the unpredictability of those cases that researchers and clinicians are studying closely so they can better prepare for the next pandemic.
"I hope they learn from Jasmine, because no one should have to go through this with their child," said Jacqueline Cadavid, who hopes to take her daughter home this week.
The little girl who likes to play with her two bigger sisters got sick Oct. 15 and her parents took her the next day to the doctor, who did what most doctors would do. He sent her home with ibuprofen for the fever.
Jasmine did get a little better. But a few days later she got worse, said her father, Fred Cadavid.
That's a sign that a secondary infection has begun, doctors say. And when her breathing became labored, her parents took her to the emergency room at Upper Chesapeake Medical Center, which sent her to intensive care at Maryland.
There, Dr. John Straumanis, head of the Hospital for Children's pediatric intensive-care unit, put her on antibiotics and oxygen and inserted a tube to remove the infected fluid from her lungs. A full 8 ounces of fluid was drained the first day.
"It's amazing what this flu can do," said Fred Cadavid, who has been alternating eight-hour shifts with his wife to make sure Jasmine is not alone. "Within two or three days, it can take a healthy kid and put them in the hospital. It's been very stressful."
The Cadavids do not know where Jasmine, who is cared for at home by her mother, caught the flu, and why neither they nor their other children, ages 4 and 7, have gotten sick.
Neither does Straumanis. About the pneumonia, he said: "It's luck, bad luck. Organisms are in the environment. Washing your hands isn't going to stop them."
He said the lungs become inflamed as the body's immune system works to fight off flu. In children, the temporary lung damage can be worse because their systems work harder than adults'. Respiratory troubles can become so bad that patients need to be put on a ventilator.
When the lungs are vulnerable, secondary infections can strike. Various bacteria, including Streptococcus pneumoniae and Staphylococcus aureus, are to blame. They live in the nose and throat and on the skin and can cause infections in the lungs, or pneumonia. The infection can be treated with antibiotics, though some have become resistant.
Jasmine's infection in her right lung, which did respond to antibiotics, never completely stopped her from breathing because her left lung was largely unaffected.
"It's a harder question about why some kids do fine and some get sicker," said Straumanis, who said he's at least 50 percent busier in the pediatric unit because of swine flu. "But most kids are fine in a few days."