An 11-day-old, full-term girl is brought by ambulance to a community hospital after 24 hours of poor feeding, and an episode of cyanosis and unresponsiveness at home.

The infant’s mother had received routine prenatal care with an unremarkable infectious screening prior to delivery. The infant was born vaginally with normal Apgar scores. She had neonatal jaundice and briefly required phototherapy. She had been exclusively breastfed and left home only to go to the pediatrician’s office. The infant’s parents deny the presence of cough, rhinorrhea, rash, vomiting, diarrhea, abdominal distention, or abnormal movements. Parents had not experienced any COVID-19 symptoms. The infant’s parents were born in the Philippines and Malaysia and had recently lived in Hawaii and Arizona before moving to Northern California.

In the emergency department, the rectal temperature is 94.6°F (34.8°C). The infant has tachypnea with increased work of breathing and oxygen saturation of approximately 75%, prompting intubation. An...

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