Covid's Long Shadow Archives - ��ϳԹ�� News

Damage to Children’s Education — And Their Health — Could Last a Lifetime

Liz Szabo — Thu, 01 Jul 2021 09:00:00 +0000

Before the pandemic, 16-year-old Na’ryen Cayou had everything he needed. He had his own room. A partial scholarship to a boys’ prep school. A spot playing trombone in the marching band, performing in parades all over New Orleans.

Then covid-19 blew through the Big Easy like a hurricane, washing away nearly everything that helped him feel safe and secure. Schools shut down. His mom lost her job and couldn’t make the rent. Their landlord evicted them.

Na’ryen and his mom now live with his grandmother. His mom sleeps on one couch; he sleeps on the other. He spent half the school year in virtual learning rather than in class with friends. Although he has struggled with math and chemistry, his mother, Nakia Lewis, said there’s no money for a tutor.

“He went through a real deep depression,” said Lewis, 45, a single mother with two older daughters living on their own. “This is nothing anyone could have prepared them for.”

As Americans crowd into restaurants, line up at movie theaters and pack their bags for summer travel, people are understandably eager to put the pandemic behind them. Yet kids like Na’ryen won’t rebound quickly. Some won’t recover at all.

After more than a year of isolation, and experts say many of the youngest Americans have fallen behind socially, academically and emotionally in ways that could harm their physical and mental health for years or even decades.

“This could affect a whole generation for ,” said Dr. Jack Shonkoff, a pediatrician and director of the Center for the Developing Child at Harvard University. “All kids will be affected. Some will get through this and be fine. They will learn from it and grow. But lots of kids are going to be in big trouble.”

Many kids will go back to school this fall without having mastered the previous year’s curriculum. Some kids have disappeared from school altogether, and educators worry that more students will drop out. Between school closures and reduced instructional time, the average U.S. child has lost the equivalent of five to nine months of learning during the pandemic, according to

Educational losses have been even greater for some minorities. Black and Hispanic students — whose parents are more likely to have lost jobs and whose schools were less likely to reopen for in-person instruction — missed six to 12 months of learning, according to the McKinsey report.

Missing educational opportunities doesn’t just deprive kids of better careers; it can also In study after study, researchers have found that people with less education die younger than those with more.

Schools across the country were closed for an average of in spring 2020, and many provided little to no virtual instruction, said Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at the Seattle Children’s Research Institute. A study he co-authored found the learning that kids missed during that time could shorten an elementary school boy’s life by eight months and a girl’s by more than five months.

The total loss of life would be even larger when factoring in the loss of instructional time in the school year that just ended, Christakis said. “We’ve interrupted children’s education, and it’s going to have a significant impact on their health and longevity,” he said. “The effects will linger a very long time.”

Assaulted on All Sides

The double hit from the pandemic, which has millions of children and deprived them of classroom time, will be too much for some to overcome.

“Living in poverty, even as a child, has health consequences for decades to come,” said Dr. Hilary Seligman, a professor at the University of California-San Francisco. “Children in poverty will have higher risk of obesity, cardiovascular disease and diabetes.”

A growing body of research shows that poverty reshapes the way , altering both the and the . These changes can alter how children react to stress and reduce their and .

“Adversity literally shapes the developing brain,” said Shonkoff, of Harvard. “It affects your memory, your ability to organize information, to control impulses.”

Chronic stress in children can lead to persistent inflammation that damages the immune system, raises blood sugar and accelerates hardening of the arteries. The heart disease that kills someone in midlife can actually begin in childhood, Shonkoff said.

“What happens to children early on doesn’t just affect early language and school readiness, but the early foundations of lifelong health,” he said.

The pandemic took a toll on Nakia Lewis and her son, Na’ryen Cayou: She lost her job, his school shut down, and they were evicted. But Nakia recently started a new job and is looking for an affordable home. And Na’ryen found a part-time job at a food market and will start marching band practice this summer. (Kathleen Flynn)

More Kids Going Hungry

The pandemic has deprived millions of children of school-related services that normally blunt the harm caused by poverty.

From March to May 2020, students missed more than that would have been provided in school.

Children who experience even occasional “food insecurity” suffer two to four times as many health problems as other kids at the same income level, said Dr. Deborah Frank, director of the Grow Clinic for Children at Boston Medical Center.

Kids who don’t consistently eat nutritious meals are more likely to develop anemia, more likely to be hospitalized and more susceptible to lead poisoning, Frank said. They also are more likely to behave aggressively and suffer from hyperactivity, depression and anxiety.

The last well into adulthood, she said, increasing the risk of substance abuse, arrest and suicidal thoughts. “There’s going to be educational and emotional fallout that won’t disappear right away,” Frank said. “These kids have endured a year and a half of deprivation. You can’t sweep all that under the rug.”

Kids at the Breaking Point

Young people are already showing signs of strain.

The proportion of emergency room visits related to mental health among kids 12 to 17 , according to the Centers for Disease Control and Prevention.

Although overall haven’t increased during the pandemic, as many feared, teens are making more attempts. ERs treated 50% more adolescent girls and 4% more boys for in February and March 2021 than in those months the year before.

Diagnoses of obsessive-compulsive disorder have soared 41% among girls 12 to 18, according to a . Diagnoses of eating disorders have jumped 38% among girls and 5% among boys.

Many children separated from their peers during the pandemic have been depressed and anxious, said Dr. Lisa Tuchman, chief of adolescent and young adult medicine at Children’s National Hospital in Washington, D.C.

“Mental illness thrives in isolation,” Tuchman said. “The longer the behaviors and thoughts persist, the more entrenched they become and the harder they are to interrupt.”

Falling Behind in School

The loss of educational opportunities has been far more extensive than many realize. Although the majority of students were back in classrooms by the end of the last school year, most spent a large part of the year

And while some students thrive in virtual classes, studies generally find they provide an partly because students are less engaged. Just 60% of students consistently participated in distance learning, recent found.

Test scores show students have fallen behind in math and . And those scores likely underestimate the damage, given that some of the most vulnerable kids weren’t able to report to school for the exams.

An — including those who are homeless or in foster care — received no instruction during the past school year, either because they had no computer or internet access, had to leave school to work or faced other challenges, according to Bellwether Education Partners, a nonprofit that focuses on disadvantaged students.

Less-educated students can expect to earn less after they leave school.

Lost educational time will cost the average child in lifetime earnings, McKinsey concluded. Lifetime earning losses are predicted to be twice as great for Black and Hispanic students as for whites.

“Many of the teens I see have given up on school and are working instead,” said Dr. Sara Bode, a pediatrician at Nationwide Children’s Hospital in Columbus, Ohio. “It’s helping their families in the short term, but what does it mean for their future?”

Learning From Katrina

Experience with and suggests that even relatively short interruptions in education can set children back years, said McKinsey analyst Jimmy Sarakatsannis, co-author of a 2020 report, “”

When Hurricane Katrina devastated New Orleans in 2005, for example, it disrupted the education of .

Katrina left . Although New Orleans students missed an average of of learning, children wound up two years behind peers not affected by the hurricane, said Douglas Harris, professor and chair of economics at Tulane University.

Na’ryen Cayou was just 2 months old when Katrina submerged his house, leaving the family homeless. He contracted whooping cough in an emergency shelter, the first of four moves in eight months. His sister, O’re’ion Lewis, then 4, didn’t attend school at all that year. When she finally began prekindergarten at age 5, the other kids “were already ahead of her,” mom Nakia Lewis said. For a time, teachers even mislabeled O’re’ion as having dyslexia. It took five years — from prekindergarten until fourth grade — before she finally caught up with her peers, Lewis said.

It will be years before researchers know how far behind the pandemic will have left American kids.

After Katrina, 14% to 20% of students never returned to school, . “As kids fall further behind, they feel hopeless; they don’t engage,” said Sarakatsannis, one of its authors.

Under normal circumstances, high school students who miss more than 10 days of school are 36% more likely to drop out. Based on the number of absences during the pandemic, dropout rates could increase by 2% to 9%, with up to 1.1 million kids quitting school, Sarakatsannis said.

Communities need to find ways to repair the damage children have suffered, said Dr. Gabrielle Shapiro, chair of the American Psychiatric Association’s Council on Children, Adolescents and their Families. “How we behave as a society now will determine the depth of the impact on the younger generation.”

Nakia Lewis is hoping for better days.

O’re’ion is now 20 and studying nursing at community college. Although her classes were virtual last year, she expects to attend class in person in the fall.

Lewis recently landed a job as a manager at a Shoney’s restaurant and is looking for an affordable home. She looks forward to reclaiming her furniture, which went into storage — at $375 a month — when she was evicted.

She said she’s relieved that Na’ryen’s mood has improved. He found a summer job working part time at a food market and will begin marching band practice this summer.

“He is happy and I’m happy for him,” Lewis said. “Now I just have to worry about everything else.”

[Correction: This article was revised at 7:15 p.m. ET on July 2, 2021, to correct the name of Children’s National Hospital.]

Before the pandemic, New Orleans teenager Na’ryen Cayou played trombone in the marching band at a boys’ prep school, performing in parades all over the city. Then schools shut down and he spent half a year in virtual learning. This summer, though, he’ll begin band practice again. (Kathleen Flynn)

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Black and Hispanic Americans Suffer Most in Biggest US Decline in Life Expectancy Since WWII

Liz Szabo — Thu, 24 Jun 2021 09:00:00 +0000

Although James Toussaint has never had covid, the pandemic is taking a profound toll on his health.

First, the 57-year-old lost his job delivering parts for a New Orleans auto dealership in spring 2020, when the local economy shut down. Then, he fell behind on his rent. Last month, Toussaint was forced out of his apartment when his landlord — who refused to accept — found a loophole in the

Toussaint recently has had trouble controlling his blood pressure. Arthritis in his back and knees prevents him from lifting more than 20 pounds, a huge obstacle for a manual laborer.

Toussaint worries about what will happen when his pandemic unemployment benefits run out, which could happen

“I’ve been homeless before,” said Toussaint, who found a room to rent nearby after his eviction. “I don’t want to be homeless again.”

With falling in the U.S., many people are eager to put the pandemic behind them. But it that won’t easily heal. In addition to killing in the United States and afflicting an estimated 3.4 million or more with , the pandemic threatens the health of vulnerable people by the , and It will, almost certainly, cast a long shadow on American health, leading millions of people to live sicker and die younger due to increasing rates of , and .

In particular, it will exacerbate the discrepancies already seen in the country between the wealth and health of Black and Hispanic Americans and those of white Americans. Indeed, new research published Wednesday in the BMJ shows just how wide that gap has grown. Life expectancy across the country from 2018 to 2020, the largest decline since 1943, when American troops were dying in World War II, according to the study. But while white Americans lost 1.36 years, Black Americans lost 3.25 years and Hispanic Americans lost 3.88 years. Given that life expectancy typically varies only by a month or two from year to year, losses of this magnitude are “pretty catastrophic,” said Dr. Steven Woolf, a professor at Virginia Commonwealth University and lead author of the study.

Over the two years included in the study, the average loss of life expectancy in the U.S. was nearly nine times greater than the average in 16 other developed nations, whose residents can now expect to live 4.7 years longer than Americans. Compared with their peers in other countries, Americans died not only in greater numbers but at younger ages during this period.

The U.S. in 2020, when there were roughly 522,000 more deaths than normally would be expected. Not all of these deaths were directly attributable to covid-19. Fatal and both increased in 2020, at least partly fueled by delayed treatment or lack of access to medical care, Woolf said. More than put off during the early months of the pandemic, when hospitals were stretched thin and going into a medical facility seemed risky. Without prompt medical attention, heart attacks can cause congestive heart failure; delaying treatment of strokes raises the risk of long-term disability.

Much of the devastating public health impact during the pandemic can be chalked up to economic disparity. Although stock prices have recovered from last year’s decline — and have recently hit all-time highs — financially, especially . In a , economic analysts at McKinsey & Co. predicted that, on average, Black and Hispanic workers won’t recover their pre-pandemic employment and salaries until 2024. The lowest-paid workers and those with less than a high school education may not recover even by then.

And while federal and state relief programs have cushioned the impact of pandemic job losses, 11.3% of Americans today live in poverty — compared with . A , which has helped , expires June 30. Without protection from evictions, “millions of Americans could fall off the cliff,” said Vangela Wade, president and CEO of the Mississippi Center for Justice, a nonprofit advocacy group.

Being evicted erodes a person’s health in multiple ways. “ and and this pandemic has said Dr. Otis Brawley, a professor at Johns Hopkins University who studies health disparities. “The effect of this pandemic on chronic diseases, such as cardiovascular disease and diabetes, will be measured decades from now.”

recently have had trouble putting food on the table. The — which is usually more expensive than salty, starchy fare — can cause both short-term and long-term harm. People with low incomes, for example, for low blood sugar toward the end of the month, when they run out of money for food.

In the long term, food insecurity is associated with an increased risk of , , and

“Once the acute phase of this crisis has passed, we will face an enormous wave of death and disability,” said Dr. Robert Califf, former commissioner of the Food and Drug Administration, who wrote about post-pandemic health risks in in Circulation, a medical journal. “These will be the aftershocks of covid.”

Less Wealth, Poorer Health

American health was poor even before the pandemic, with 60% of the population suffering from a , such as obesity, diabetes, high blood pressure or heart failure. These four conditions were associated with nearly two-thirds of hospitalizations from covid, according to a February study in the

Deaths from some chronic diseases began rising in lower-income Americans in the 1990s, Woolf said. That trend was exacerbated by the Great Recession of 2007-09, which undermined the health not just of those who lost their homes or jobs but . Still, the Great Recession, and its resultant health effects, did not affect all Americans equally. Black people in the U.S. today control less wealth than they did before that recession, while the security between Black and white Americans has widened, according to a Nonprofit Quarterly article published last year. And the unemployment rate among Black workers .

Researchers have developed a better understanding in recent years of how — such as that caused by poverty, job loss and homelessness — leads to disease. Unrelenting stress causes that can damage blood vessels, the heart and other organs.

Research shows that people with low incomes live than those who are financially secure. The richest 1% of Americans than the poorest 1%.

People who are poor tend to ; have such as , and ; and are more likely to become .

The stress of the pandemic also has led many people to , and increasing the risk of chronic disease. Fatal drug overdoses from October 2019 to October 2020.

Jennifer Drury, 40, has struggled with substance abuse, particularly prescription painkillers, since her 20s. She blames the isolation and stress of the pandemic for causing her to relapse — and leading several of her friends to fatally overdose.

“Idle time is not good for addiction,” said Drury, who fell behind on rent and was evicted from her previous home. She said drug dealers are never far away, especially at the New Orleans motel where she and her husband are now staying. “Drug dealers don’t care about pandemics.”

Women Losing Ground

The , which provides $1.9 trillion in pandemic relief, was designed to help displaced workers and cut child poverty rates in half. The actual benefits of the law may prove less sweeping.

Twenty-five states have opted to , citing concerns that such generous benefits pay people more to stay home than they can earn by working.

Many women say they would like to return to work but have no one to take care of their children. and others have reduced the number of children they serve.

The concluded that “economic recovery depends on child care availability.” A March report from the estimates “women have lost a generation of labor force participation gains,” which could leave them and their children financially disadvantaged for years.

Ruth Bermudez is one of who have left the workforce in the past year. Bermudez, who was laid off from her job as a behavioral health caseworker in New Orleans last year, said her child care needs have prevented her from finding work. The care of her 6-year-old daughter became her full-time job after the pandemic closed schools.

Although her daughter has returned to class, Bermudez said school shutdowns due to covid outbreaks have been frequent and unpredictable.

“I had to be the teacher, the lunch lady, the school bus driver, all at one time,” said Bermudez, 27. “It is exhausting.”

Life-Altering Evictions

James Toussaint had just two weeks to find a new place to live after a judge ordered him evicted. His family was unable to take him in.

“I’ve got family, but everybody has their own issues and problems,” said Toussaint, who had to throw away all his clothes and furniture because they had become infested with bedbugs. “Everyone is trying their best to help themselves.”

Toussaint is now renting a room in a boarding house with no kitchen and a shared bathroom for $160 a week. He’s had to buy cleaning supplies with his own money in order to sanitize the bathroom, which he said is often too dirty to use.

Sharing communal space is often unsanitary and increases the risk of being exposed to the coronavirus, said Emily Benfer, a visiting professor at Wake Forest University School of Law. Even moving in with family poses risks, she said, because it’s impossible to isolate or quarantine in crowded homes.

Benfer co-wrote that found covid infection rates grew twice as high in states that lifted moratoriums on evictions, compared with states that continued to ban them. About have fallen behind on rent — double the rate before the pandemic.

Toussaint’s annual lease expired during the pandemic, leaving him to rent on a month-to-month basis. While some states require landlords to show “just cause” for eviction, Louisiana landlords can evict tenants for any reason once their annual lease has expired.

Property owners have filed for during the pandemic in just the five states and 29 cities tracked by Princeton University’s Eviction Lab. A growing body of evidence shows that eviction is , causing that increases the risk of death. Studies show that evicted people are more likely to be in poor general health or have mental health concerns

“This singular event alters the course of one’s life for the worse,” Benfer said. “If we don’t intervene” to prevent mass evictions when the moratorium ends, “it will be catastrophic for generations to come.”

Eviction’s harms can be measured at every stage of life:

When pregnant women are evicted, their newborns are more likely or and have a Women who are evicted are more likely to Benfer said.

Kids who are evicted are at greater risk of from substandard housing, Benfer said. They’re also

Evicted adults report worse mental health and are more likely to be hospitalized for a mental health crisis, . They also have higher mortality rates from suicide. Although the causes of addiction are complex, research shows that counties with higher eviction rates have significantly higher rates of drug- and alcohol-related deaths.

People who are evicted often move into substandard housing in neighborhoods with higher crime rates. These homes are sometimes plagued by mold and roaches, lack sufficient heating, or have plumbing that doesn’t work. Landlords have no incentive to make repairs for tenants who are behind on their rent, Benfer said. In fact, tenants who request repairs or report safety hazards risk eviction.

Although middle-class Americans take their kitchens for granted — and rely on them to cook healthful meals — more than 1 million homes lack complete kitchens, according to the

New Orleans doesn’t require that rental units include stoves, said Hannah Adams, also a lawyer with Southeast Louisiana Legal Services. Toussaint’s new room is equipped with a microwave and small refrigerator, but no sink, oven or stove. He washes dinner dishes in the bathroom. His landlord doesn’t allow residents to have electric hot plates, so most of his meals involve cold cereal, deli sandwiches or meals he can heat in the microwave. His doctor has urged Toussaint, who is borderline diabetic, to lose weight, eat less salt and starch, and stop smoking.

Toussaint, who lived on the street for two years, said he’s determined not to return there. He hopes to apply for disability insurance, which would provide him with an income if his arthritis prevents him from finding steady work.

Woolf said he hopes Americans won’t forget about the suffering of people like Toussaint as cases of covid decline. “My worry is that people will feel the crisis is behind us and it’s all good,” Woolf said. His research connecting four decades of declining economic opportunity with falling life expectancy shows “we are in really big trouble, and that was true before we knew a pandemic was coming.”

The pandemic doesn’t have to doom a generation of Americans to disease and early death, said Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation. By addressing issues such as poverty, racial inequality and the lack of affordable housing, the country can improve American health and reverse the trends that caused communities of color to suffer. “How the pandemic will affect people’s future health depends on what we do coming out of this,” Besser said. “It will take an intentional effort to make up for the losses that have occurred over the past year.”

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The ‘Grief Pandemic’ Will Torment Americans for Years

Liz Szabo — Wed, 02 Jun 2021 09:00:00 +0000

Cassandra Rollins’ daughter was still conscious when the ambulance took her away.

Shalondra Rollins, 38, was struggling to breathe as covid overwhelmed her lungs. But before the doors closed, she asked for her cellphone, so she could call her family from the hospital.

It was April 7, 2020 — the last time Rollins would see her daughter or hear her voice.

The hospital rang an hour later to say she was gone. A chaplain later told Rollins that Shalondra had died on a gurney in the hallway. Rollins was left to break the news to Shalondra’s children, ages 13 and 15.

More than a year later, Rollins said, the grief is unrelenting.

Rollins has suffered panic attacks and depression that make it hard to get out of bed. She often startles when the phone rings, fearing that someone else is hurt or dead. If her other daughters don’t pick up when she calls, Rollins phones their neighbors to check on them.

“You would think that as time passes it would get better,” said Rollins, 57, of Jackson, Mississippi. “Sometimes, it is even harder. … This wound right here, time don’t heal it.”

With nearly — now a leading cause of death — researchers estimate that more than , including children who have lost a parent.

The pandemic — and the political battles and economic devastation that have accompanied it — have inflicted on mourners, making it harder than with a typical loss, said sociologist Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care.

The scale and complexity of pandemic-related grief have created a public health burden that could deplete Americans’ for years, leading to more depression, substance misuse, suicidal thinking, sleep disturbances, and impaired immune function.

“Unequivocally, grief is a public health issue,” said Prigerson, who lost her mother to covid in January. “You could call it the grief pandemic.”

Like many other mourners, Rollins has struggled with feelings of guilt, regret and helplessness — for the loss of her daughter as well as Rollins’ only son, Tyler, who died by suicide seven months earlier.

“I was there to see my mom close her eyes and leave this world,” said Rollins, who was first interviewed by KHN a year ago in a story about covid’s disproportionate effects on communities of color. “The hardest part is that my kids died alone. If it weren’t for this covid, I could have been right there with her” in the ambulance and emergency room. “I could have held her hand.”

The pandemic has prevented many families from gathering and holding funerals, even after deaths caused by conditions other than covid. Prigerson’s research shows that families of patients who die in hospital intensive care units are seven times more likely to develop than loved ones of people who die in home hospice.

The polarized political climate has even pitted some family members against one another, with some insisting that the pandemic is a hoax and that loved ones must have died from influenza, rather than covid. People in grief say they’re angry at relatives, neighbors and fellow Americans who failed to take the coronavirus seriously, or who still don’t appreciate how many people have suffered.

“People holler about not being able to have a birthday party,” Rollins said. “We couldn’t even have a funeral.”

It’s been more than a year since Cassandra Rollins’ daughter Shalondra died of covid-19, but Rollins says the grief is unrelenting. In April of last year, just an hour after an ambulance took Shalondra away, the hospital called to say she was gone. Rollins is now raising Shalondra’s two teenage daughters. (Imani Khayyam)

Indeed, the optimism and has blinded many Americans to the deep sorrow and depression of those around them. Some mourners say they will continue wearing their face masks — even in places where mandates have been removed — as a memorial to those lost.

“People say, ‘I can’t wait until life gets back to normal,’” said Heidi Diaz Goff, 30, of the Los Angeles area, who lost her 72-year-old father to covid. “My life will never be normal again.”

Many of those grieving say celebrating the end of the pandemic feels not just premature, but insulting to their loved ones’ memories.

“Grief is invisible in many ways,” said Tashel Bordere, a University of Missouri assistant professor of human development and family science who studies bereavement, particularly in the Black community. “When a loss is invisible and people can’t see it, they may not say ‘I’m sorry for your loss,’ because they don’t know it’s occurred.”

“You would think that as time passes it would get better. Sometimes, it is even harder. … This wound right here, time don’t heal it.”
Cassandra Rollins, of Jackson, Mississippi

Communities of color, which have experienced disproportionately and from covid, are now carrying a heavier burden.

Black children are more likely than white children to lose a parent to covid. Even before the pandemic, the combination of higher infant and maternal mortality rates, a greater incidence of chronic disease and shorter life expectancies made Black people a close family member at any point in their lives.

Rollins said everyone she knows has lost someone to covid.

“You wake up every morning, and it’s another day they’re not here,” Rollins said. “You go to bed at night, and it’s the same thing.”

A Lifetime of Loss

Rollins has been battered by hardships and loss since childhood.

She was the youngest of 11 children raised in the segregated South. Rollins was 5 years old when her older sister Cora, whom she called “Coral,” was stabbed to death at a nightclub, according to news reports. Although Cora’s husband was charged with murder, he was set free after a mistrial.

Rollins gave birth to Shalondra at age 17, and the two were especially close. “We grew up together,” Rollins said.

Just a few months after Shalondra was born, Rollins’ older sister Christine was fatally shot during an argument with another woman. Rollins and her mother helped raise two of the children Christine left behind.

Heartbreak is all too common in the Black community, Bordere said. The accumulated trauma — from violence to chronic illness and racial discrimination — can have a weathering effect, making it harder for people to recover.

“It’s hard to recover from any one experience, because every day there is another loss,” Bordere said. “Grief impacts our ability to think. It impacts our energy levels. Grief doesn’t just show up in tears. It shows up in fatigue, in working less.”

Rollins hoped her children would overcome the obstacles of growing up Black in Mississippi. Shalondra earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs. Shalondra, who had been a second mother to her younger siblings, also adopted a cousin’s stepdaughter after the child’s mother died, raising the girl alongside her two children.

Rollins’ son, Tyler, enlisted in the Army after high school, hoping to follow in the footsteps of other men in the family who had military careers.

Yet the hardest losses of Rollins’ life were still to come. In 2019, Tyler killed himself at age 20, leaving behind a wife and unborn child.

“When you see two Army men walking up to your door,” Rollins said, “that’s unexplainable.”

Tyler’s daughter was born the day Shalondra died.

“They called to tell me the baby was born, and I had to tell them about Shalondra,” Rollins said. “I don’t know how to celebrate.”

Cassandra Rollins’ son, Tyler, killed himself at age 20 in 2019, leaving behind a wife and an unborn child. Tyler’s daughter was born in 2020, on the day Rollins’ daughter Shalondra died of covid-19. (Imani Khayyam)

Shalondra’s death from covid changed her daughters’ lives in multiple ways.

The girls lost their mother, but also the routines that might help mourners adjust to a catastrophic loss. The girls moved in with their grandmother, who lives in their school district. But they have not set foot in a classroom for more than a year, spending their days in virtual school, rather than with friends.

Shalondra’s death eroded their financial security as well, by taking away her income. Rollins, who worked as a substitute teacher before the pandemic, hasn’t had a job since local schools shut down. She owns her own home and receives unemployment insurance, she said, but money is tight.

Makalin Odie, 14, said her mother, as a teacher, would have made online learning easier. “It would be very different with my mom here.”

The girls especially miss their mom on holidays.

“My mom always loved birthdays,” said Alana Odie, 16. “I know that if my mom were here my 16th birthday would have been really special.”

Asked what she loved most about her mother, Alana replied, “I miss everything about her.”

Grief Complicated by Illness

The trauma also has taken a toll on Alana and Makalin’s health. Both teens have begun taking medications for high blood pressure. Alana has been on diabetes medication since before her mom died.

Mental and physical health problems are common after a major loss. “The mental health consequences of the pandemic are real,” Prigerson said. “There are going to be all sorts of ripple effects.”

The stress of losing a loved one to covid increases the risk for , also known as , which can lead to serious illness, increase the risk of domestic violence and steer marriages and relationships to fall apart, said Ashton Verdery, an associate professor of sociology and demography at Penn State.

People who lose a spouse have a roughly over the following year, a phenomenon known as the Similar risks are seen in people who lose a child or , Verdery said.

Grief can lead to a temporary condition in which the heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively, Verdery said.

From final farewells to funerals, the pandemic has robbed mourners of nearly everything that helps people cope with catastrophic loss, while piling on additional insults, said the Rev. Alicia Parker, minister of comfort at New Covenant Church of Philadelphia.

Cassandra Rollins leans on daughter Shalondra’s car outside Rollins’ home in Jackson, Mississippi. Shalondra, who earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs, died of covid-19 in April 2020. (Imani Khayyam)

“It may be harder for them for many years to come,” Parker said. “We don’t know the fallout yet, because we are still in the middle of it.”

Rollins said she would have liked to arrange a big funeral for Shalondra. Because of restrictions on social gatherings, the family held a small graveside service instead.

Funerals are important cultural traditions, allowing loved ones to give and receive support for a shared loss, Parker said.

“When someone dies, people bring food for you, they talk about your loved one, the pastor may come to the house,” Parker said. “People come from out of town. What happens when people can’t come to your home and people can’t support you? Calling on the phone is not the same.”

While many people are afraid to acknowledge depression, because of the stigma of mental illness, mourners know they can cry and wail at a funeral without being judged, Parker said.

“What happens in the African American house stays in the house,” Parker said. “There’s a lot of things we don’t talk about or share about.”

Funerals play an important psychological role in helping mourners process their loss, Bordere said. The ritual helps mourners move from denying that a loved one is gone to accepting “a new normal in which they will continue their life in the physical absence of the cared-about person.” In many cases, death from covid comes suddenly, depriving people of a chance to mentally prepare for loss. While some families were able to talk to loved ones through FaceTime or similar technologies, many others were unable to say goodbye.

Funerals and burial rites are especially important in the Black community and others that have been marginalized, Bordere said.

“You spare no expense at a Black funeral,” Bordere said. “The broader culture may have devalued this person, but the funeral validates this person’s worth in a society that constantly tries to dehumanize them.”

In the early days of the pandemic, funeral directors afraid of spreading the coronavirus did not allow families to provide clothing for their loved ones’ burials, Parker said. So beloved parents and grandparents were buried in whatever they died in, such as undershirts or hospital gowns.

“They bag them and double-bag them and put them in the ground,” Parker said. “It is an indignity.”

Coping With Loss

Every day, something reminds Rollins of her losses.

April brought the first anniversary of Shalondra’s death. May brought Teacher Appreciation Week.

Yet Rollins said the memory of her children keeps her going.

When she begins to cry and thinks she will never stop, one thought pulls her from the darkness: “I know they would want me to be happy. I try to live on that.”

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