More than 140,000 children in the United States have lost a parent or grandparent to COVID-19. In Washington, researchers estimate 1,428 children have suffered such a loss.

The findings are part of a peer-reviewed study set to be published in Pediatrics, the official journal of the American Academy of Pediatrics.

The study analyzed death data from April 1, 2020, through June 30, 2021, missing the devastation of the delta surge this fall.

“COVID is real, and its impact on families is real, and as members of the family pass away because of COVID, be it your grandmother or mother, there’s an impact to the child,” said Dr. Michael Barsotti, president of the Washington Chapter of the American Academy of Pediatrics.

He has not yet read the report, but as the chief administrator at Providence Sacred Heart Children’s Hospital in Spokane, he knows the effect on kids.

Andie Daisley also has seen how COVID-19 losses hurt children through her work as a child-life specialist at Sacred Heart.

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Daisley is tasked with helping kids who are sick or get injured understand what happened. The process can help reduce their trauma. Daisley said a lot of her work and the work of her team has been helping children cope with the aftershocks of COVID-19.

“It’s new heights of loss and new heights of families feeling lost in navigating how we talk to children about this since it’s on such a widespread scale,” Daisley said.

The child-life specialists are having to coordinate referrals for adult patients’ families more than ever before, Daisley said, noting that they had to order more materials to hand out to families as the community loses so many people to the virus.

There have been 895 deaths due to COVID-19 in Spokane County residents since the pandemic began.

More on the COVID-19 pandemic

Coping and finding resources

When a child loses someone close, their emotions could be all over the place, said Dr. Kira Mauseth, co-leader for the Department of Health’s behavioral health strike team.

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The most important thing is to tell them the truth.

“It is very important not to hide from kids or lie to them about what has happened,” Mauseth said. “It’s very important to provide developmentally appropriate information about the reality of what has happened to the child and youth.”

The reason this is so important, Mauseth said, is that adolescent brains still are developing, and they don’t have the reasoning ability and neurological resources that adults have to cope with loss. In the absence of truth, children might blame themselves or unnecessarily add themselves to the narrative they create about the death.

Daisley’s job is to work with families through their children’s emotions. Daisley said she explains to families that their child’s behavior, especially for school-aged children, could vary. But they need to be told the truth in a developmentally appropriate way as well as be given space to express themselves.

“We really, as child-life specialists, want to honor the voice of the child because so often children are underestimated and passed over in decision-making,” Daisley said.

This means that a child might want to come to the hospital to say goodbye to a family member, then get to the door and change their mind. Processing a loss and a trauma like losing a caregiver is going to take time, and a child-life specialist, like Daisley, is preparing the family for what happens once they leave the hospital.

She gives families resources and lets kids know it’s OK to feel all sorts of emotions from anger and sadness to happiness in the coming days and months. Emotions are normal after the death of a loved one, she said, adding there’s no need to rush through those feelings. With COVID, Daisley is seeing the repetitive and broad effect the pandemic has had on families.

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“I don’t think we can even conceptualize, as devastating as it feels to live every day in this COVID world, I don’t think we know yet how far-reaching this collective loss and grieving as a community will be,” Daisley said.

COVID deaths deepen inequity of pandemic

The study analyzed multiple datasets, including COVID-19 mortality data, as well as race and ethnicity data. Researchers found disparities among the children and teens most affected by the death of a caregiver from the virus.

“We estimate white children account for 35% of children who lost primary caregivers, whilst white persons represent 61% of the total (U.S.) population,” the study says. “In contrast, children of racial and ethnic minorities account for 65% of children losing primary caregivers, compared to 39% of the total population.”

This is in line with how COVID-19 has disproportionately affected people of color throughout the pandemic.

In Washington, Native Hawaiians and Pacific Islanders have the highest age-adjusted case rate and are seven times more likely to be hospitalized for the virus than white Washington residents.

Hospitalization rates for the virus are four times higher for Hispanic Washington residents than white Washington residents.

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“The pandemic has exacerbated the underlying and persistent inequities among historically marginalized communities and those disproportionately impacted due to structural racism and other forms of systemic oppression,” according to a Washington Department of Health COVID race and ethnicity data report.

WSU College of Medicine Professor Dr. Pablo Monsivais and his colleagues studied social determinants of health, including socioeconomics, access to health care and other factors that impacted how vulnerable people were to the virus earlier in the pandemic. From household to workplace, myriad inequities that existed before the pandemic were exploited by it, and family members who survive those the virus took will carry that trauma with them.

“The pandemic has hit minority populations harder than others for reasons like social determinants of health, occupations, health care and other aspects that put people at greater risk for exposure, and also just having a lot of existing health disparities makes those communities more vulnerable to complications and deaths from infection,” Monsivais said.

Accessing resources

As kids and teens learn to process the trauma that comes with losing a loved one, help can be hard to come by.

Mauseth said she hasn’t seen data directly connecting youth losing caregivers to needing more help, but logically, it would make sense.

The pandemic has impacted mental and behavioral health in adults and teens since early 2020, and even during the summer, kids and teens needed more behavioral and mental health support than during a typical pre-pandemic summer.

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Mauseth said she and her colleagues did not see a typical “summer slump” in adolescents seeking mental health resources. On top of that, kids are now back in school experiencing the potential instability of COVID exposure and being sent home to isolate.

“In many ways, the experience of this school year — from a disaster psychology lens — this school year is harder than last year because it’s really unpredictable,” Mauseth said.

Emergency department visits for behavioral health needs in youth in Washington appear to be down from this time last year, but Mauseth said outpatient services and demand remain high. October and November are typically high-demand months for mental health help across the state.

“We’re concerned about what that will look like in terms of overloading an already overloaded system,” Mauseth said.

Gov. Jay Inslee declared a state of emergency for children and youth mental health in March, and he has yet to rescind that proclamation.

At Sacred Heart, the pediatric emergency department has seen about double the patients seeking care for a behavioral heath or psychiatric need in the past 18 months, Barsotti said.

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Mauseth encouraged families to talk to their health care providers if they are interested in seeking further behavioral health help. She encouraged families to make contingency plans in case someone tests positive for COVID-19 and prepare for how children would be able to cope with inevitable changes the rest of the year could bring.

Data hard to find

Finding data that validates the figures in the Pediatrics study is challenging at a state level, but that is in part due to how the system works.

The Division of Children, Youth and Families tracks data on children who enter the state’s foster care system after the death of a caregiver, but this happens only in extreme scenarios, when children are left without guardians and have no relative to care for them.

The division has not seen an increase in children who have entered the state’s care due to the death of a caregiver during the pandemic.

The Department of Health is not tracking statistics that would show how many children lost a caregiver due to COVID either, and even in the county court system, those figures are not apparent.

Only if a family member formally applies for custody of the child, through the family court facilitator, would the court system know about a change in custody for the child.

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What’s important, experts say, is recognizing the far-reaching consequences of COVID-19 for those who experience the trauma on children who lose loved ones.

“I think what’s important about this report is the loss of a parent or caregiver is a form of trauma that has lifelong consequences,” Monsivais said. “And these are consequences felt for the lifetime of the child or kids who are affected.”

Arielle Dreher’s reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community.