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."
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.
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 impact of 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 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 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."