ANCHORAGE, Alaska (AP) — Severe child abuse cases in Alaska have increased significantly at times during the coronavirus pandemic, experts said.

As students return to classrooms, child welfare advocates are assessing the impact of the pandemic on child abuse, Alaska Public Media reported Wednesday.

Visits by one clinic to children in need of hospitalization for severe injuries because of suspected abuse skyrocketed by 173% in the last year. The number was initially reported as 220% but didn’t include four cases that were added later to the 2019 count, Mike Canfield, a spokesperson for Providence Alaska Medical Center in Anchorage, said Friday.

“This absolutely reflects an increase in serious physical abuse and neglect cases,” said Barbara Knox, the medical director of the clinic, Alaska Child Abuse Response and Evaluation Services.

Knox found an alarming change while evaluating 2020 child abuse data for the clinic, known as Alaska CARES, at Providence.

“The cases that are presenting are presenting inpatient, and it’s the big and the bad,” Knox said. “A serious uptick in cases of abusive head trauma, serious physical abuse.”

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Reports to the state Office of Children’s Services decreased by up to 30% in some months of 2020, while evaluations by Alaska CARES slightly decreased compared to 2019.

The lower reporting rate and the spike in severe cases is likely because of a combination of factors — including increased isolation, stress from family financial instability and school closures, Knox said.

The children’s services office has seen the number of children in foster care grow, with children staying in foster care for longer periods.

Kim Guay, acting children’s services director, said the pandemic “sent us for a loop.”

Family courts shifted to virtual operations, social workers’ ability to do home studies and home visits were disrupted and the pandemic increased the difficulty of investigating suspected abuse, especially in rural areas, Guay said.

Elizabeth Congdon-McGee, acting executive director of the Alaska School Counselor Association, said that as school staff prepare for in-person learning, “the mental health and the trauma is going to be coming in our doors full force.”

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“Because we don’t know what has been in our kids lives. We see them on a screen, but we don’t know what’s behind that screen,” Congdon-McGee said.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some — especially older adults and people with existing health problems — it can cause more severe illness, including pneumonia, and death.

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This version corrects that family courts shifted to virtual operations, they didn’t close.