Ten months after James Vance, a former Marine and retired police officer in Princeton, W.Va., died of COVID-19, his two young children are still reeling from his death.

Julia, 12, a middle-schooler who used to do everything with her father, is withdrawn. Her sister, Jamie, 7, still talks about him in the present tense. As for Mom, Jerri, a third-grade teacher, she is struggling to keep up with bills and maintain a sense of normalcy for her daughters while still processing the devastation of losing the love of her life.

“All three of us are in therapy,” Jerri Vance said. “Every time we go out, everything is about COVID. We have to see that daily and deal with people who say it isn’t real when it’s beyond real to us.”

Throughout the pandemic, public health experts and other observers have often noted that children have been largely spared the worst because they are less likely to develop severe illness from the virus. The fact that many of the dead are parents or caregivers has been largely left out of the conversation.

A new study published Thursday in the journal Pediatrics attempts to quantify the vast hole left by these deaths, estimating that roughly 140,000 children under 18 may have lost parents or caregivers from March 2020 to June 2021 due to COVID-19 or other causes classified as pandemic related. Those numbers take into account both official COVID deaths and deaths from other causes, such as homicides and drug overdoses, beyond those expected in a typical year before the pandemic.

The consequences are life-changing: Losing a parent or other primary caregiver is one of the most stressful things that can happen in a child’s life, putting them at risk of a trajectory of depression and post-traumatic stress, as well as physical manifestations of grief, such as heart problems.

The data also reveal vast disparities by race and ethnicity — even more skewed toward an overrepresentation of minority communities than COVID deaths. In the United States as a whole, 1 out of 500 children lost at least one parent/caregiver. But for American Indian children, it’s 1 out of 168; for Black children, 1 out of 310; for Hispanic children, 1 out of 412; for Asian children, 1 out of 612; and for white children, 1 out of 753. The highest burden of death has occurred along the U.S.-Mexico border, in the South and in tribal areas.

Susan Hillis, a Centers for Disease Control and Prevention researcher and lead author of the study, said she has been lying awake at night worrying about the magnitude of the problem. “It’s disturbing to think about how for every four COVID deaths, one child is left behind,” Hillis said. “This is a crisis.”

Hillis and her co-authors, along with religious and tribal leaders, parent groups, grief support therapists and others, are calling on states and the Biden administration to do more to support these children. They are urging a comprehensive response that includes financial assistance, mental health services, education, insurance and increased resources for the foster-care system.

Pamela Addison, 37, of Waldwick, N.J., who is raising two young kids on her own after her husband died of COVID, started a Facebook group to try to bring attention to the issue and offer support for other parents facing the same loss.

“I feel like these kids are so forgotten,” she said. “We need to acknowledge this is happening and the consequences of these children losing a lifetime with their parents.”

Aftereffects

Mass-casualty events in history have been shown to have a domino effect on children. Following World War I, studies showed that children whose soldier fathers died before or after their birth appeared to have decreased life spans. The more than 3,000 children who lost parents in the Sept. 11 terrorist attacks still talk about the impact it has had on their lives.

“When a death is sudden and unexpected — which COVID is by its nature — there’s a lot of uncertainty, and that can put children at risk for many different health consequences,” said Komal Sharma-Patel, a clinical psychologist at Children’s National Hospital, who has been working with children who have lost parents due to COVID-19.

Addison is desperate to protect her two young children from those outcomes.

Shortly after her husband, Martin, a speech pathologist, died of COVID early in the pandemic last year, her daughter stopped eating and began screaming at odd times, like when Addison would touch the night light. Elsie was only 2 at the time, and when mother and child began to work with a therapist, Pamela Addison realized it was Elsie’s way of communicating her loss. It had been her papa who would tuck her in and turn off the night light.

“She was sad all the time,” Addison recalled. Today, Elsie, who is 3½ and can speak, continually tells Addison to “be healthy” — expressing fears of losing her other parent.

Addison also worries about her younger son, Graeme, who was only 6 months old when his father died. For now, he is content to kiss his father’s picture good night, but she wonders about the questions he will ask when he gets older.

Kate Kelly’s dad, a stage and sound manager at a church, died at age 54 in Atlanta. He experienced a blocked artery but was unable to get treated in time due to hospitals being full of coronavirus patients. Kelly, 16, said she’s trying to deal with the anger she feels about his death.

“It makes me mad. That was my dad. He went to urgent care, but he didn’t get the help he needed. He was looked at as less important because it wasn’t COVID,” she said.

Kelly, a high school sophomore and a middle child, says her sisters are not coping well with the Jan. 23 death either: “I can tell my little sister — I don’t think she completely understands it. I’m pretty sure she’s still in the denial phase. My older sister, she’s really struggling because she was really close with my dad, but she’s trying to put on a brave face.”

Community support

In areas hit hard by the pandemic, the loss of so many parents has raised questions about how to preserve traditions, culture and community when supporting their children.

Whitney Gravelle, president of the Bay Mills Indian Community in the Upper Peninsula of Michigan, said she worries that the loss of so many elders and parents will impact not just today’s children but future generations, especially for small Indigenous communities like hers. She said she’d like to see more counseling about loss due to COVID integrated into programs for at-risk children.

“In native communities, this is an extension of intergenerational trauma that has been inflicted from forced removal from our lands up through present day,” she said.

In Dallas, Aaron Blake Sr., a bishop who has been working with children orphaned by COVID, said he broke down in tears when he saw data on parent and caregiver deaths from COVID-19 at a recent meeting with other Christian leaders.

He recounted the story of two children, whose young, single mom recently died of COVID. The pair seemed destined for foster care. But the school district, social workers and community groups were able to locate the father, who had not previously been involved in the children’s care and did not even have beds for them, and work with him to provide a home for the children.

“We want to help these kids stay within their families so we don’t see a loss of community,” Blake said.

He said he also worries that the impact of the loss of grandparents, even if they are not legally a child’s caregivers, is not being fully recognized, and believes more must be done to figure out ways to provide that same sort of guidance to youths who may have lost these loved ones.

“In communities of color — Black and Brown — the matriarchs and patriarchs are grandmothers. They are the major stabilizers and voices in these homes,” Blake said. He said his church is working with health departments and school systems to see if there is a way to figure out how many children may have been living in the same home as an elderly relative who died.

“If we can identify these kids,” he said, “then we can help them.”

The Washington Post’s Magda Jean-Louis contributed to this report.