Illustration of Francisco Alvarez
Illustration: John Jay Cabuay

The patients arriving in Francisco Alvarez’s emergency department at Valley Children’s Hospital in Fresno have changed: fewer sniffles and scrapes, far more serious symptoms. 

“We had to actually shift the way we were practicing because of COVID,” Alvarez says. “The kids are coming in sicker than before because there’s that delay – that fear of coming into an ER now.” 

Some have a condition called multisystem inflammatory syndrome in children (MIS-C), which can affect children with COVID. Symptoms of MIS-C include fevers, rashes, gastrointestinal issues, and even heart damage. MIS-C is rare, but Fresno has one of the highest per-capita case counts of the condition in the country. Alvarez, who works to improve care for acutely ill children, has already identified several with MIS-C. 

“It’s scary,” he says. “Before, a kid could come in with one to two days of fever and look pretty sick. You could give them medication. They could look a lot better. You could send them home. Now, if they have a COVID history, we really have to discern whether this is MIS-C. If it is, we need to get them treated because it can be fatal.” 

In December, the coronavirus spread faster in Fresno County than in any other metro area in the nation. To take pressure off other medical centers, Valley Children’s has even accepted some adult patients with COVID. In addition to his role as a nurse practitioner, Alvarez serves as a hospital supervisor, managing the high-stakes logistics of transport and care for COVID patients. 

It’s stressful work, but his time at UCSF prepared him for it. Administrators arranged for him to train at Valley Children’s because he hoped to work there. Many migrant farm workers live in Fresno, and Alvarez knew a lot of them struggle to navigate the health care system. He’d seen firsthand how overwhelming it could be; when he was 21, he lost his own father to cancer, just a few weeks after his diagnosis. 

“I try to recall how completely caught off guard we were,” Alvarez says. “I always try to make sure families know what to expect and get their questions answered. It helps being able to speak Spanish fluently, being able to reassure families that are very underserved.”

– Elizabeth Daube for UCSF Magazine

Read the Summer 2021 Issue