Andrew Malekoff

Although it appears as if headline news regarding the pandemic has ebbed, a recently released global study found that 10.5 million children lost a parent or secondary caregiver, such as a grandparent, due to COVID-19.

The study, conducted through a partnership among the World Health Organization, World Bank, Centers for Disease Control and Prevention, Imperial College London and others, includes deaths from January 2020 through May 2022.

Lead author Susan Hillis, a former CDC epidemiologist who is now at the University of Oxford, called the findings “heartbreaking and disturbing.”

She added, in a Sept. 6 report in the Washington Post, “When you have deaths of this magnitude, certainly without help you can weaken the fabric of a society in the future if you don’t take care of the children today.”

Hillis and her co-authors concluded that “while billions of dollars are invested in preventing COVID-19-associated deaths, little is being done to care for children left behind.”

The devastating consequences for children may include, “institutionalization, abuse, traumatic grief, mental health problems, adolescent pregnancy, poor educational outcomes and chronic and infectious diseases,” they said.

Among the 10.5 million children who lost one or both parents or caregivers worldwide, there are 4.2 million in Southeast Asia, 2.5 million in Africa, 1.5 million in the Americas, 1.5 million in the Eastern Mediterranean region and 500,000 in Europe.

In the United States, roughly 250,000 children lost one or both parents. While some nations are taking the initiative to address these shattering losses with steps to support bereaved families, the U.S. has fallen behind in this effort, according to social epidemiologist Rachel Kidman.

Kidman, who has studied the long-term impacts of the HIV-AIDS epidemic on children, concluded: “I’m not seeing any concerted efforts or even a lead by the federal government to address the needs of these children.”

University College London Psychologist Lorraine Sherr pointed to the overwhelming economic consequences of this degree of bereavement, particularly in circumstances where the deceased caregiver was the family’s primary wage earner. “A family’s loss of income can put kids at a higher risk of food and housing insecurity,” she noted.

Joe Kita, reporting for WebMD on Aug. 18, wrote that “Minority children [in the U.S.] have been disproportionately affected. American Indian kids are four times more likely to have lost a parent or primary caregiver to COVID-19, Blacks and Hispanics 2.5 times, and Asians 1.6 times. In all, 1 in every 340 children in the U.S. lost a parent or other caregiver to COVID-19.”

This information led the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association to jointly declare a national state of emergency in children’s mental health.

Two prominent psychiatrists Asim Shah, MD, professor at the Menninger Department of Psychiatry at Baylor College of Medicine in Houston and Warren Y.K. Ng, MD, professor of psychiatry at Columbia University in New York defined six distinct challenges that must be kept in mind when counseling bereaved children. They are:

Trauma. Many of these kids have been through “the equivalent of war,” with what they have observed and endured. “How do kids deal with trauma?” Bessel van der Kolk, MD, who has spent his professional life studying how children and adults adapt to traumatic experiences put it this way, “It all depends on quality of their attachment system…the attachment system trumps the trauma system.” In other words connections count – in the family, school and community.

Stigma. For families living in high-density population circumstances, where everyone knows everyone else’s business, Dr. Ng says, “people were ostracized for having COVID. It’s like they had a big red C on their door, warning neighbors to stay away.”

Blame. If a child comes home with a virus that, in due course, led to the death a parent or caregiver, that reality can seriously erode one’s mental health. “The memory is a cruel and persistent reminder that you may be responsible,” according to Dr. Ng, “and that can have devastating effects.”

Lack of closure. “The trauma people had at that time is just unimaginable,” Dr. Shah says. “Consider you’ve just lost a loved one: You cannot see them, you cannot go to their funeral and you cannot even come close to their dead body. It was treated like a contaminated fixture. All those things combined to multiply the trauma.”

Some may say this is past history, and to let sleeping dogs lie.

However, it is a present reality for those who directly experienced it and have not had adequate opportunity to process the loss.

Financial insecurity. The United Hospital Fund report for New York State found that 50% of children who lost a parent or caregiver were likely to enter poverty, with 23% at risk to enter foster or kinship care. “These compounding factors add to the level of distress these kids may experience,” Ng says. Furthermore, as indicated above, such dislocation disrupts the attachment system that is so vital for children.

Ongoing reminders. Susan Lechuga, who moved to California shortly after her husband’s death, to be closer to family, described the situation she encounters daily in the Web MD report. “Even though my husband died a year and a half ago,” says Lechuga, “every single day my children are hearing about what killed their dad. If he had died in a car accident, I wouldn’t have to worry about turning on the TV and hearing there were 2,598 car accident deaths today. But if I turn on [the TV], I can guarantee you that in 10 minutes there’s going to be something about COVID.”

To date, no government program is specifically geared to help children who lost a parent or caregiver to COVID-19. However, there are resources available.

New York Life’s Grief-Sensitive Schools Initiative provides information on tangible resources for grieving children and their families, as well as training, practical tools and a connection to a network of supportive services: https://www.newyorklife.com/foundation/bereavement-support/grief-sensitive-schools-initiative

The National Alliance for Children’s Grief, whose vision it is “for no child to have to grieve alone…[and to] have the support and resources they need to positively adapt to a loss in their lives.” The NACG is a nationwide network that promotes critical resources to advance the mental, emotional and physical health of grieving children and their families. https://childrengrieve.org/about-us/

As Dr. Ng states, support “starts with family [and] then there’s their faith-based community, their pediatrician or primary care doctor, their school and its health services, and finally the community mental health services and treatments that are available if needed.”

If you have a child who is grieving and needs support, please reach out to one of these local or national resources. When grief goes underground, it is likely to surface in ways that will be exceedingly more problematic in time.