WHEELING, W.Va. — When their daughter was diagnosed with severe autism, Heather and Brandon Murray realized they’d have to protect her in ways they hadn’t with their other two children. They never left her alone. They raised the locks in their house beyond her reach, so she couldn’t get outside and hurt herself. They stuck a sign onto the back of their car: “In an emergency situation, please be aware child may . . . have no awareness of danger.”

But it was the family who was unaware of the danger posed this winter, as the worst flu season in a decade hospitalized at least 23,000 people, killed thousands — including at least 114 children — and by the time it passes, probably will have hit poor families like the Murrays the hardest.

Even when Eden, who normally exploded with energy, stayed in bed all day one Saturday in January, the Murrays weren’t particularly concerned. Maybe she was just tired from school, family members said.

The next day Eden, 6, hadn’t improved, so Brandon took her to the local urgent care center. The doctor prescribed some antibiotics, and Brandon, 42, who made $10 an hour working for a local disability service provider, took her back home, telling the family the doctor had said she was “supposed to be okay.”

Not sure how to feel about the “supposed” part of that sentence, the family went to sleep. Brandon woke up at 6 a.m. and went to check on Eden, who because of her condition slept in a crib in their room. In the darkness, however, he could see she wasn’t breathing, and he screamed in panic.

Thinking an ambulance would take too long, and telling himself it wasn’t too late — that it couldn’t be too late — he carried her downstairs. He drove to Wheeling Hospital, came to a fast stop, and ran inside with her.

Hours later, after the doctors had come and gone, after everything had happened, he pulled out his phone. “O god,” he wrote on Facebook. “I need a friend so bad.”

“I can’t believe this is happening,” Heather, 41, wrote on her own Facebook page.

Their daughter was gone, but the worrying was just beginning.

Barriers to vaccination

Although the Centers for Disesase Control and Prevention does not collect data on flu hospitalizations and deaths by income, recent research has begun to show influenza does not attack all demographics equally. People who live in low-income communities are not only only more likely to contract influenza and end up in the hospital, but are also more likely to experience symptoms resulting in intensive care unit admissions and even death.

One study, published in 2016 in the CDC’s Morbidity and Mortality Weekly Report, found that a neighborhood’s poverty rate was deeply associated with the effects of the flu — across all regions, races and ages. Another study, this one rooted in Tennessee, determined that poverty was related to the influenza hospitalization rate, as well as its prognosticators: female-headed households, neighborhood density, and crowded housing. Then a third study, published last November, confirmed the findings.

“The ‘why’ is much more difficult,” said Kimberly Yousey-Hindes, author of the study in the CDC journal and a lecturer in epidemiology at the Yale School of Public Health. There are hypotheses: The poor often have a lower baseline of health and usually live in more crowded homes and neighborhoods. Research has also shown they are less likely to get flu shots, which, for children on Medicaid, are funded through a government program called Vaccines for Children. For adults in some states, including West Virginia, the shot is covered by Medicaid. But the decision to skip the flu vaccine, experts say, appears to be as much about the difficult realities of poverty as it is about access to vaccines and health care.

“We hear from a lot of families that, ‘I wish I could have come sooner, but I was afraid I would lose my job,’ ” said Marcee White, a doctor with Children’s National Health System, who treats patients in the poorest parts of Washington. “That’s a true fear of families living in poverty — taking that time off, especially when you have influenza, which can be a long illness.”

Or it can move with an unforgiving quickness, and families are left struggling to understand what had happened. “Surreal,” said Tameka Stettler, whose 3-year-old granddaughter in Muncie, Ind., died last month of the flu. The family had been on food stamps and Medicaid, and since the girl’s death, Stettler had begun thinking that she had received inadequate medical care because she was poor. How else to explain what had happened? The child was fine days ago. Now she was gone?

It’s a question that still haunts Rebecca Hendricks, even three years after the death of her daughter, Scarlet. Their life had then been chaotic. The family had just spent eight months in a motel, living on food stamps, insured by Medicaid, and Hendricks had recently started her first job in what seemed like forever. She didn’t think about flu vaccinations — because she had so much going on, because she wanted to succeed at her job, because why would she ever worry about the flu? She didn’t know anyone who’d ever gone to the hospital for it, let alone died of it.

Scarlet, 5, was sent home from kindergarten on a Wednesday. Thursday, they were racing from the car to the door of Hendricks’ dentist. Friday, she went into the hospital. Three hours later, she was dead.

“I didn’t take my daughter to the doctor’s,” Hendricks said, still unable to forgive herself. “I didn’t want to wait in the emergency room for six hours just for them to tell me that, ‘It was just a virus and it needed to run its course.’ ”

The guilt, the shame, the powerlessness — all of it led her to start a grass-roots group called the End-Fluenza Project and to seek out mothers like herself, one of whom she found at the end of January, living on the other side of the country, in a poor neighborhood, in a poor town, in a poor state.

“From one flu mom to another,” Hendricks wrote to Heather Murray that day. “I, too, lost my babygirl to flu.”

An unexpected disease

What Murray believed she could have done differently: She could have gotten Eden, who had Medicaid, a flu vaccination, but didn’t. She could have paid closer attention to her daughter’s condition, but didn’t do that, either. “I could have taken it more seriously,” she was saying again. “What could I have done differently that would have changed the outcome of everything?”

And so she sat, on the seventh floor of Pittsburgh’s Allegheny General Hospital on a recent afternoon, with no answer to that question, staring blankly at the culmination of that “everything.”

Two days after Eden died, when Brandon had been inconsolable with grief, he had a stroke. Now his wife looked at him in the hospital bed, still recovering after surgery to remove the right side of his skull to ease the swelling in his brain. The left half of his body was now mostly paralyzed, and he could scarcely communicate.

She wanted so badly to believe he could recover soon, but knew she would probably be visiting hospitals and rehab centers for the foreseeable future — another worry in a life that was quickly becoming defined by them. She had never thought of herself as hypochondriac, because she never knew anyone whose common cold had turned into something worse. But since her daughter’s death, she had been thinking of sickness and germs all the time, sharing news stories on Facebook.

“Why the flu can kill a healthy person so quickly,” one said.

“Child dies from the flu virus,” said another.

“New victims in deadly flu epidemic,” said another.

She had seen a television news story about a Texas woman who had gotten the flu twice and was near death. Could that happen to her family? The entire family had already had the flu that year, shortly before Eden got sick, but maybe it wasn’t done with them yet.

So she rarely allowed the kids out of the house, fearful a return to school could allow another flu strain into the house. She had all but stopped having visitors over. And when she left the hospital, she always made sure to lather her hands in antibiotic foam.

After several hours with Brandon, she stepped into an elevator. It was crowded with people. She squeezed into the back. “The sickness,” she said, wincing. “I need a mask.”

'I'm just so paranoid now'

She barely slept that night from the worry. Her two other kids had come down with some sort of illness, and there had been some vomiting, and she didn’t know whether she should take them to the hospital or wait to see whether they felt better in the morning. It had been late when she got them down, and later still when she’d gone to bed, and near morning when she finally fell asleep.

Now it was hours later, getting on toward midday, and the house, in a neighborhood packed with houses along streets pockmarked with holes, was sealed. The blinds were drawn. A purple blanket was draped across the front-door window.

Inside, Heather picked up her phone. She got on Facebook, where the night before she had shared another post about the flu, and got off. “I’m just so paranoid now about everything,” she said, trying to get herself together. It was nearly the weekend, and she wanted to get her daughter back in school at the beginning of the next week. They couldn’t always be scared of the flu. Something had to be done.

But today was not the day for it, so she canceled her only appointment and remained inside her house, closed off from everything, waiting for the flu season to pass.