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A crisis of childhood grief

The number of American kids whose caregivers have died in the pandemic has surpassed 140,000.

Maxine Beltran and her daughter, Natasha, at the playground near their apartment in the Bronx. Natasha lost her father to Covid-19 early in the pandemic, and is one of 140,000 children who’ve lost a primary caregiver to the disease.
Photographs by Sara Naomi Lewkowicz for Vox

Part of the Family Issue of The Highlight, our home for ambitious stories that explain our world.

Julian Peña was hospitalized with Covid-19 in early 2020, when the pandemic first hit New York City. His daughter, Natasha Beltran, couldn’t visit him in the hospital, couldn’t hug him or hold his hand. Her mom, Maxine Beltran, remembers the excruciating back-and-forth calls from the ICU.

From the other end of the phone line, Natasha and Maxine witnessed the terrible ups and downs of the disease as it tore through Julian’s body. One day, a nurse would inform them that Julian was doing better, laughing, making progress. The next, he would worsen. And then, one day, they got the news they had been dreading: He was not going to get better. It was time to remove him from the ventilator and let him go.

Natasha was 10.

After her father died, the girl cried for four or five days straight, Maxine remembers. “She couldn’t believe it.”

In the weeks and months that followed, Natasha’s grief took many different forms, from nonstop questions about her father’s youth to sorrow and pain at seeing other parents pick up their kids from school. Mourning comes in waves for Natasha, Maxine, 34, said. “It goes up and down, but it keeps on coming.”

Through all those ups and downs, Natasha’s mom has been her rock. On a recent afternoon at their apartment in the Bronx, the two laughed and cried together as Natasha cuddled Cocó, one of her two guinea pigs. Their living room is full of family photos, each with a special story — one, Natasha remembers, is from her seventh birthday, when her mom woke her up by singing a silly song in her ear. The two have such a strong rapport that when they’re together, it can feel like no one else is in the room.

Maxine Beltran and Natasha FaceTime with relatives from their apartment. The two have faced a series of woes as they adjust to life without Julian Peña, Natasha’s father.

Over the past 20 months, Julian’s death has sent the two of them on an odyssey they never expected — one that, at times, threatened to tear them apart, too. Their story is one of all too many. Across the country, more than 140,000 kids, like Natasha, have lost a parent or other primary or secondary caregiver to Covid. Natasha’s story provides a glimpse at how institutions such as schools, hospitals, and governments have struggled to respond to the needs of children and families left bereft by the pandemic.

International research prior to the Covid-19 era has shown that “kids who experience a parental death are more likely to suffer from depression or drop out of school,” said Rachel Kidman, a social epidemiologist who has studied bereaved children. “They also exhibit greater suicidality.”

That’s in relatively normal times — kids who have lost parents to Covid have also had to mourn without a lot of the social supports they’re used to. “They didn’t have friends checking in on them. They didn’t have neighbors dropping by with food. They didn’t have proper funerals,” Kidman said. “I worry that the psychological impact on these kids is going to be even greater.”

Experts and advocates fear that the impact of parental death on children is falling by the wayside as policymakers focus solely on preventing and treating Covid — a crucial goal, but one that they argue can’t be pursued in isolation. They worry that without a concerted effort now to help the children who’ve lost loved ones to a terrifying new virus in the midst of an unprecedented global crisis, a generation of kids will grow up with mental and emotional trauma that could affect them for the rest of their lives.

As Maxine puts it, “this is a ticking bomb.”

The numbers alone are staggering. One in 500 children in the US has lost a parent or caregiver to Covid, according to a Centers for Disease Control and Prevention study published last month. One in every four Covid deaths leaves yet another bereaved child behind.

The deaths are not evenly distributed. American Indian or Alaskan Native children are 4.5 times more likely than white children to have lost a caregiver, Black children 2.4 times more likely, and Hispanic children nearly twice as likely, per the CDC study. That means that without support, Native, Black, and Hispanic communities are likely to bear the brunt of the long-term effects of childhood bereavement, from depression to problems at school, as well.

No crisis in recent memory has produced this much loss in such a short period. “We haven’t really had an experience of mass bereavement here in the US in the same sense,” Kidman said. “And we’re not done.”

Even with the delta surge receding, hundreds of Americans are still dying of Covid every day. Those deaths are also skewing younger, with news outlets across the country reporting the deaths of pregnant people and young parents who leave children behind. Those children find themselves at the center of the ongoing war between public health experts and vaccine skeptics, with their private grief becoming part of a public push for others to get the shot — even though it’s too late for the ones they loved.

Even the CDC estimates don’t capture the full scope of what children have lost. When Patrick Patoir, a New York City transit worker, died of the disease in March 2020, he left behind not just his own adult children but also his brother’s three boys, for whom he was an important caregiver and role model. Patoir helped raise the boys, said their mother, Odessa Evelyn, and also encouraged his brother to stay involved, “in terms of, even though you’re not together with their mother, you have to be a father to your children.”

His innate kindness helped him to be “more than an uncle” to her boys, Evelyn said. When he died, their father, who worked alongside Patoir at the MTA, entered a deep mourning. “So he wasn’t able to be there for them,” Evelyn said. “They lost their uncle, but in a way, they lost their father, too.”

Natasha plays with her pet guinea pig. For kids, the loss of a caregiver can reverberate across every aspect of life, affecting everything from sleep to school to their relationships.

For kids, the loss of a caregiver can reverberate across every aspect of life, affecting everything from sleep to school to their relationships with other family members. Some kids may fear that because one person they loved has died, someone else will die, too, said David Schonfeld, director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles. Others may experience guilt: Both children and adults “often wonder what they did, didn’t do, should have done, or might have done to change the outcome,” Schonfeld said.

Loss during a pandemic, one that’s caused by a novel and terrifying virus and that upends every aspect of daily life, can intensify all of those feelings. Kids may worry that they inadvertently caused their loved one’s death by exposing that person to Covid. They may even go to extremes to isolate themselves and avoid the virus in fear of the same thing happening again. Fear-based messaging around Covid, such as the idea that an unvaccinated grandchild could wind up killing their grandparents, can increase the psychological burden on kids. “Then when the grandparents die, of course people are going to feel guilty,” Schonfeld said.

Children’s grief has been complicated even more by the fact that the ordinary rituals of mourning have been interrupted or delayed. Evelyn’s sons, now 10, 11, and 12, weren’t able to attend a funeral for their uncle because he died at the height of Covid’s first wave. Two weeks after his death, her youngest son asked, “How come he died and there’s no funeral? So, like, that means he didn’t die?”

“In their mind, it’s like after the virus is over, they’ll be able to see him again,” Evelyn said.

For Natasha, Covid meant not being able to visit her father’s grave for more than a year after his death. Julian, who was separated from Maxine when he died, was buried in Florida, where he was from. At the height of Covid’s first wave in spring 2020, it didn’t feel safe for Maxine and Natasha to travel there. “We didn’t really pay respects to him the same as we would” in a normal year, Maxine said. “We didn’t get to say the last goodbyes.”

Maxine displays a photo of Natasha with her father, Julian. Natasha’s father died of Covid-19 early in the pandemic. In part because of travel restrictions, they could not visit his grave for a year. “We didn’t get to say the last goodbyes,” Maxine notes.

When Maxine and Natasha finally made the trip to Julian’s gravesite in May 2021, a heavy weight of loss hit Natasha all at once. It wasn’t just her dad. Natasha also missed her grandmother, her family dog, and her old elementary school in Florida, where she used to live, and which helped inspire her dream to become a teacher.

Leaving Florida was wrenching. “My dad is there, my dad’s grave — everything, including him, that I loved — was there,” Natasha said. “And I wanted to be there.”

Those feelings came to a head at an end-of-year celebration at Natasha’s school back in New York. “She was seeing all these parents with their children,” Maxine said. Natasha started crying and saying, “I want to go with my father.”

Maxine interpreted that to mean that Natasha missed her dad and wished she could be with him again. But school officials believed Natasha was suicidal. The school counselor told Maxine she needed to get Natasha a therapist right away, Maxine said. She was taken aback.

“You cannot just tell me to go and get a therapist,” Maxine remembers saying. “You need to provide me the resources, because getting a therapist in New York is not easy.” She wasn’t sure if her insurance would cover it, or if she could afford it. Money was especially tight without Natasha’s dad around to help support her. “I am not a rich person,” Maxine said.

When Maxine told the counselor all this, “she got upset at me,” Maxine said. “She said, well, if you don’t look for a provider, I’m going to have to report you.”

“You do whatever you have to do to save your job,” Maxine responded. “So she reported me to ACS” — the New York City Administration for Children’s Services.

When contacted for comment, Natasha’s school referred a reporter to the New York City Department of Education, which said schools cannot legally comment on specific cases.

“Schools wrap their arms around students when they’re going through crisis — especially when a tragedy strikes their family — and children receive supports like mental health services, one-on-one time with guidance counselors and more,” Nathaniel Styer, the department’s deputy press secretary, said in an emailed statement. “Our staff take their responsibility as mandated reporters for child welfare very seriously and only make reports when there are serious concerns for the child’s welfare.”

What happened next was a months-long process that required Maxine to prove she was a good mother to her child. Over the next 60 days, caseworkers from ACS visited the house, asking Natasha questions and looking in the fridge. Seeing “random people knocking on your door, and then you have to let them in” was terrifying for Natasha, Maxine said.

The first time a caseworker visited their home, “I started crying,” Natasha said. “I was saying, ‘Mommy, I don’t want to lose you.’”

The two had long been inseparable. They share clothes and tease each other constantly — on a recent afternoon, Natasha grabbed her mom’s phone and proceeded to DM Lizzo from it.

They also share interests. When Maxine was learning organic chemistry for nursing school, Natasha got interested, too. And when Maxine is feeling sad and missing her dad, her mom is the one who can comfort her. “My mom is like my best friend,” Natasha said.

Maxine was urged to get therapy for Natasha but did not know if she could afford it or where to turn. Her hesitance set off an odyssey for the family.

During the investigation, Natasha was scared to even go to the park for fear of somehow jeopardizing the ACS case, she said. Maxine had to delay her application to nursing school because of the open investigation. She was glad, she recalls thinking, that all of it was happening in the summer, so at least Natasha could sleep in after long nights spent crying.

Finally, ACS determined that Natasha was safe with her mom and closed the case. And then, at the very end of the investigation, someone mentioned Children’s Village, a New York-based nonprofit that supports families with therapy, mentoring, and more.

Maxine wondered why such a resource was only coming up now, after months of pain for her and Natasha. “Why doesn’t the school have this phone number?” she recalled thinking. “Why are they calling ACS?”

Still, it was better late than never, because Children’s Village introduced Natasha and Maxine to Miss Yolanda.

Yolanda Elcock is a family functional therapist, but to the Beltrans, she’s been much more than that. She comes once a week to the family’s apartment in Kingsbridge, a picturesque neighborhood of the Bronx with rolling hills and oak trees, and they just talk. She and Natasha practice coping skills like mindfulness and turning a negative into a positive. Sometimes they work on difficulties in Natasha’s daily life, like the bullying she experiences at school.

“When she feels sad, she’s withdrawn,” Yolanda said. “She’s by herself. And that’s when they pounce on her.”

Yolanda uses role-playing to help Natasha respond to bullies — “I’m the bully,” she’ll say. “What are you going to say to me?”

Sometimes Natasha talks about happier things, like her excitement over Halloween. Costumes are a big deal for the Beltrans — Natasha has already dressed up as Frida Kahlo and Rep. Alexandria Ocasio-Cortez, and this year, she went as a suffragette.

While Yolanda helps Natasha, she’s working with the adults in Natasha’s life, too. She’s in regular contact with Natasha’s school, making sure they’re responding to bullying and any other issues Natasha faces. She also coordinates between the school and Natasha’s outside therapist — she sees one now, in addition to Yolanda. “Now, everyone is working together,” Maxine said. “Everyone is on board.”

Maxine Beltran poses for a portrait in the Bronx. Today, she is gearing up for nursing school while working part time and caring for her child.

Nonprofit organizations like Children’s Village have stepped up across the country to help kids and families dealing with loss. Odessa Evelyn, for example, was able to get after-school care for her sons through the group Children of Promise, which typically works with kids affected by mass incarceration. The group has also dropped off hot meals, and even milk for the boys. “If I feel like I need something, I can always call them,” Evelyn said.

But often, families, schools, and others who work with mourning kids aren’t aware of the available resources. Yolanda, for example, says she hasn’t received many calls to work with bereaved children, even though more than 34,000 people have died of Covid-19 in New York City. “The fact that I don’t have many on my caseload should be an issue, because we know that many, many, many, many people have passed away from this,” she said.

Research by the New York Life Foundation before the pandemic found that only 7 percent of teachers were trained in handling bereavement, and a 2020 New York Life survey found that just 15 percent of educators said they felt very comfortable addressing the emotional needs of students dealing with the pandemic, including grief.

While the experiences of grieving kids are getting increased attention, they haven’t gotten the same kind of coordinated, high-profile policy response that federal and state governments have brought to other aspects of the pandemic, such as vaccine delivery. “I haven’t seen a concerted effort to respond to the needs of these children,” Kidman, the epidemiologist, said.

The result is that when children are mourning, the adults in their lives don’t always know where to turn. Sometimes educators, at a loss for how to help a child who may not be participating in school, may consider calling child protective services because nothing else is helping — especially if the family has declined offers of support. “They want to rescue these kids,” Schonfeld said. “They want to try and save them from the situation.”

Such services, though, are not geared toward helping a grieving child. ACS is “just going to be concerned if you have scars on you or if there’s food in the fridge,” Yolanda said. “They’re not really going to assess your mental state.”

Maxine is overcome with emotion and unable to speak while discussing the death of Natasha’s father.
Natasha holds a photo of a note reading “Happy Father’s Day” that she wrote for Julian Peña. It was buried with him.

Removing children from remaining family members poses additional problems. “Keeping children with families is critical,” Kidman said. “They are best placed to care for these children, and what we should really be doing is making sure they have all the support that they need.”

That means not only offering therapy and other help to children, but also making sure their families have all their needs met — including the basics like food, shelter, and money to pay the bills. Research from the HIV epidemic shows that cash benefits to families can improve educational outcomes and lessen anxiety and trauma in bereaved children. “Just that financial safety net is really important,” Kidman said. The expanded child tax credit signed into law by President Biden provides some of this safety net, but its future is in doubt as Democrats in Congress hammer out an infrastructure package.

Beyond monetary support, bereaved kids need their teachers, doctors, and other adults in their lives to be trained in recognizing and responding to their needs. The National Center for School Crisis and Bereavement offers such training and has worked with school systems from New York City to Miami since the pandemic began, but it’s not enough, Schonfeld said. “We also have to give resources to schools so that they can invest what it takes to help their educators learn these things.”

That’s particularly true since teachers are stretched thin during the pandemic, dealing with the challenges of quarantines and school interruptions, and often experiencing loss and trauma themselves. Ideally, Schonfeld said, bereavement training would be incorporated into schools of education so that teachers wouldn’t have to take time out of their daily work to learn the skills they need.

Setting any of these changes in motion, though, would require a firm commitment, both from lawmakers and in American culture at large, to prioritize the needs of bereaved children. Individual school systems are taking steps to support kids’ mental health — in April, for example, New York City announced a plan to hire more than 600 new social workers, family support workers, and psychologists to work in the city’s schools. The district has also trained 75,000 staff members in recognizing and responding to signs of trauma in students.

But experts are calling for a coordinated response to grief at the national level. One way would be to have “a dedicated office that is attended to the needs of children affected by Covid,” including those who have lost a caregiver, Kidman said. More broadly, “we have to figure out how we can respect bereavement support and see it as a legitimate need,” Schonfeld said.

“I don’t think we can wait and see what happens to kids and then respond,” Kidman said. “We need to have the resources and support to respond to kids’ needs right now. Because I think if we don’t, there are going to be long-term repercussions.”

Natasha is still raw with sorrow over her father. When she talks about the good times they shared, like going to superhero movies together and sending silly selfies back to Maxine, her voice gets quiet and she starts to cry.

“My dad was the best dad I’ve ever met,” she says. “I never met anybody like him.”

But when she talks about what happened to her this summer with the ACS investigation, and what she wishes would have happened instead, her words come out strong and clear. “The better thing to do is talk to the kid or call their mom,” she said. “Nobody ever asked my mom how I was feeling.”

These days, Natasha and her mom are both looking to the future. Maxine is gearing up for nursing school while working part time and caring for her child. Above her desk in the living room, she has an inspiration wall, with portraits of Kahlo and Ocasio-Cortez, as well as Michelle Obama and Ruth Bader Ginsburg. “That’s what keeps me going,” she says.

Natasha is starting a new after-school program focused on writing and reading, and she’s especially excited about the field trips. “Maybe they’re going to take me to libraries or museums,” she said. “Maybe one day we’re going to meet a writer.”

With Miss Yolanda’s help, Natasha is also planning to speak soon with a group of other children who have lost their parents to Covid and other illnesses. As hard as it is to talk about the loss, she and her mom are eager to share their story if it helps other kids — or if it helps adults respond better to the needs of grieving kids. Maxine worries that without better awareness of children’s grief, other families will experience what she and her daughter went through, nearly being separated at the worst possible moment. “Thousands of kids have lost their parents,” she said, leaving others like her struggling to address the particularly wrenching, unexpected nature of loss during Covid. “I cannot be the only one.”

Through it all, from loss to fear to healing, Maxine is helping keep the memory of Natasha’s dad alive. As the two cuddle on the couch, Maxine ruffles Natasha’s wavy black hair. “Every little piece of your hair was from your dad,” she told Natasha. “He left you all of that. You want to feel your dad? It’s right here.”

Anna North covers American work and family life for Vox. She is the author of the novel Outlawed.

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