(CNN) More than a year into the pandemic, children's lives may be starting to look more normal as an increasing number of people get vaccinated and schools reopen. However, many children in the US are contending with the difficult reality that is irreparable: the loss of a parent from Covid-19. One result of the pandemic may be an ever-growing number of "Covid orphans."
A new model estimates that nearly 40,000 children have lost a parent to Covid-19, and black children have been disproportionately affected, according to a new research letter published Monday in the journal JAMA Pediatrics.
"The number of children experiencing a parent dying of Covid-19 is staggering, with an estimated 37,300 to 43,000 already affected," said the research letter, led by Rachel Kidman of the Program in Public Health at Stony Brook University. "Black children are disproportionately affected, comprising only 14% of children in the US but 20% of those losing a parent to Covid-19."
Kidman and coauthors estimated the expected number of affected children for each death from Covid-19, also known as the parental bereavement multiplier.
The model suggests that each Covid-19 death leaves 0.078 children aged between 0 and 17 parentally bereaved, representing a 17.5% to 20.2% increase in parental bereavement absent of Covid-19.
They point out that although the bereavement multiplier is small, it translates to large numbers of children who have lost parents.
"As of February 2021, 37,300 children aged 0 to 17 years had lost at least 1 parent due to Covid-19, three-quarters of whom were adolescents," says the research letter.
When the authors factored in excess deaths, they estimated that 43,000 children have lost a parent and looking at a natural herd immunity strategy which resulted in 1.5 million deaths "demonstrates the potential effect of inaction: 116,900 parentally bereaved children."
The authors note that the estimates rely on modeling, not survey or administrative data and do not include bereavement of nonparental primary caregivers. The study also doesn't quantify the number of children who have lost more than parent.
Kidman and co-authors suggest that "sweeping national reforms" are needed to address the pandemic fallout that will affect children. Children who have lost a parent will also need targeted support to help with grief. Establishing a national child bereavement cohort could also help through identifying children who have lost a parent and monitoring them to identify emerging challenges early. This would also make it easier to link these children to the local support systems they need and form the basis of a study on the long-term effects of losing a parent during the pandemic.
Losing a parent can have a long lasting effect.
A study published in 2018 from researchers at the University of Pittsburgh School of Medicine Department of Psychiatry that lasted for seven years followed children who had lost a parent and those who had not.
They found that there was increased incidence of depression and post-traumatic stress disorder in those who had lost a parent. Depression occurred mainly in the first two years after loss and in those aged 12 and younger. They also found increased rates of clinically significant suicidal ideation in children who had lost parents.
"What makes deaths from Covid more challenging than, say, if somebody passed away of old age, is that the deaths related to Covid may lead to child traumatic grief, which is different than just grief itself," according to Robin Gurwitch, a psychologist and professor at Duke University Medical Center, who was not involved in either studies.
Child traumatic grief is when the cause of death can be seen as something that is horrifying or terrifying, making it harder for children to get to the grief itself as they can't get through how the death happened.
Gurwitch also said that the sheer numbers of Covid deaths make things more challenging, as does that fact that the pandemic is still going on.
"God forbid, a child's parents died from a heart attack -- it's not that heart attacks don't continue to happen but they're not every day on the news, they're not every day in the stores, they're not every day related to making decisions about whether I can see my friends or go back to school or go to a funeral," Gurwitch said. "Covid has changed that. The normal activities related to death cannot happen, so a child that's lost someone right now, no matter what the circumstances, but particularly due to Covid, make it so much more challenging because all the things that I would normally do, I can't do, the family can't do."
Gurtwich said that children need to be able to talk about their loss, find ways to remember the parent who has died and receive the support and encouragement to talk openly about their loss. She also said that there are treatments for child traumatic grief available for children who need them. Many experts recommend consistent talk therapy for bereavement. If needed, medication to treat depression or anxiety can also help.
"We have to make sure that there's certain supports in place for children to do well with loss, with grief, with death," she said. "We have to be able to talk about it, we have to be able to help them find ways to remember the person that died. And we have to make sure that we keep those lines of communication open."
She also highlighted the National Child Traumatic Stress Network, which has a number of resources for helping navigate traumatic grief for children.