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By Katie Dukes
At least 3,626 children across North Carolina — mostly students of color — are currently coping with the death of a caregiver due to COVID-19. Schools will bear responsibility for supporting children who’ve experienced this loss as they learn and grow over the next two decades.
Research published in October in the journal Pediatrics revealed the high toll caregiver deaths are taking on children nationwide, particularly Native American, Hispanic, and Black children. The researchers used fertility, household composition data, and COVID-19 and excess death rates to estimate what they termed “COVID-19-associated orphanhood.” They estimated at least 1,855 children in North Carolina lost a caregiver between April 1, 2020 and June 30, 2021.
Updated estimates now put this number even higher.
A new report published in December by the COVID Collaborative used a similar methodology to expand on the previous estimate, including deaths from January 2020 through mid-November 2021. That study estimated 3,626 children have lost caregivers in North Carolina.
For the purposes of both studies, “caregivers” are parents, custodial grandparents, or grandparents who live in the same household as the children and provide for at least some of their basic needs. The death of any caregiver can have negative impacts on the learning and health outcomes of children over the course of their lives.
Children who’ve lost caregivers are more likely to experience mental health problems and lower self-esteem. They’re also at higher risk of suicide, violence, sexual abuse, and exploitation. Additionally, this type of loss is associated with shorter schooling.
Undercounting caregiver deaths
In the original research paper and in subsequent interviews, the researchers acknowledge their methodology likely resulted in an undercount of the true number of children experiencing caregiver death. This is due in part to the period they studied.
From April 1, 2020 to June 30, 2021, North Carolina recorded almost 14,000 COVID deaths. In the six months since the study’s completion, more than 5,000 additional deaths have been reported. There are also many children who live with aunts, uncles, or other guardians whose deaths would not have been included in either study’s methodology.
While the more recent study includes those additional deaths, the likelihood of undercounting is still present, in part because states such as North Carolina are months behind in processing death certificates.
According to Summer Tonizzo, a representative from the N.C. Department of Health and Human Services, the transition from a paper system to a digital database for tracking death certificates means “there can be 3 to 5 month delay from the date of death before that death record is included in [State Center for Health Statistics] data files.” This means some of the data used by researchers to estimate the number of caregiver deaths is out of date.
Susan Hillis, a CDC COVID response researcher and lead author of one of the studies, said that’s why her top priority for addressing this crisis is getting an accurate, timely accounting of how many kids have experienced the death of a caregiver and who those children are.
In response to learning about North Carolina’s death record delays, Hillis stressed, “The estimate of the number of children affected will only be as good as your death estimates.”
In general, Hillis says it’s reasonable to estimate that for every four COVID-19 deaths, one child is orphaned.
North Carolina’s death toll is rapidly approaching 20,000. By Hillis’s broad estimation, there may be as many as 5,000 children experiencing COVID-19-associated orphanhood.
That’s approximately one of every 462 children across the state.
The maps below can help stakeholders begin to predict where those losses have occurred. By comparing county COVID-19 death rates with the proportion of the population under age 18 in each county, it’s possible to find counties where both of those rates are high. These counties likely have higher proportions of children who’ve experienced caregiver loss.
Regardless of where those children are across the state, researchers predict the racial and ethnic disparities seen among COVID-19 deaths will be reflected in caregiver deaths as well.
Racial and ethnic disparities
The inequitable distribution of caregiver deaths across racial and ethnic categories is of particular concern given that students of color already face greater risk of exposure to Adverse Childhood Experiences (ACEs) due to various forms of structural inequality. The CDC defines ACEs as “potentially traumatic events that occur in childhood (0-17 years),” including “aspects of the child’s environment that can undermine their sense of safety, stability, and bonding.”
The best available data indicate that in North Carolina, the Hispanic population is 9.8%, but Hispanic children make up 21.1% of children who’ve lost caregivers due to COVID-19. Non-Hispanic American Indian or Alaskan Natives are 1.6% of the population, but 5.1% of children who’ve lost caregivers. Non-Hispanic Blacks are 22.2% of the state’s population, but 38.1% of children who’ve lost caregivers. Combined, these groups make up just 33.6% of the state’s population, but 64.3% of children experiencing caregiver death.
Jim Johnson, a professor at UNC’s Kenan-Flagler Business School who studies inequality, suspects communities haven’t begun to process the magnitude of the impact of COVID deaths.
“I don’t think there are a lot of conversations about loss,” he said. “I think the circumstances, particularly in low-wealth families, are so overwhelming that oftentimes people don’t want to talk about those issues.”
Tripp Ake, a psychologist at Duke University Medical Center with more than 20 years of experience treating childhood trauma, agrees.
“We’re still getting our minds wrapped around how this pandemic has impacted the functioning of our kids and the ability of caregivers to be able to support them,” he said. “I think so much of this does fall to schools.”
Impact on education
Historically, schools have been responsible for providing significant mental health support to children experiencing trauma and ACEs, including the deaths of caregivers. But likely never in the history of the state’s education system have so many children lost caregivers in such a short amount of time. This will present unique challenges for a generation.
For nearly two years, all of North Carolina’s students have been exposed to the ongoing stress and uncertainty of the pandemic.
Jay Pearson, Associate Professor at Duke University’s Sanford School of Public Policy, says this is of particular concern when it comes to students of color.
“The set of conditions that many kids of color are contending with in their homes and immediate social environments are such that it leaves very little space for the kinds of primary socialization that ideally prepares them to perform well in school,” Pearson said.
Typically, the presence of a caring adult in the life of a student can compensate for exposure to various forms of stress. Children who’ve lost caregivers will likely rely more heavily on teachers and other adults in their lives for the social and emotional support needed to develop healthy brains and bodies, which can impact their entire lives.
In an interview with the Hechinger Report, Cynthia Osborne, director of the Prenatal-to-3 Policy Impact Center at the University of Texas at Austin, explained, “We will see kids show up to kindergarten feeling less secure, needing more assistance and more services. But we will also see this for decades to come. We will see teenagers who have not been able to kind of reach that level of executive functioning they need to make better choices.”
The COVID Collaborative provides a series of recommendations for policymakers and schools, including developing a coordinated strategy to identify children who’ve lost a caregiver, plus the expansion of grief-competence at schools, access to high-quality early childhood programming, integration of social and emotional development and evidence-based mentoring in academic learning, and access to mental health care in schools.
To that end, the recently passed state budget does include funding to ensure that each district in the state has at least one school psychologist, an almost $9.7 million grant program “to support students in crisis, school safety training, and safety equipment in schools,” and salary supplements for school psychologists, speech pathologists, audiologists, and school counselors. There are no plans for specifically addressing the needs of students whose caregivers have died.