Then covid-19 blew through the Big Easy like a hurricane, washing away nearly everything that helped him feel safe and secure. Schools shut down. His mom lost her job and couldn’t make the rent. Their landlord evicted them.

Na’ryen and his mom now live with his grandmother. His mom sleeps on one couch; he sleeps on the other. He spent half the school year in virtual learning rather than in class with friends. Although he has struggled with math and chemistry, his mother, Nakia Lewis, said there’s no money for a tutor.

“He went through a real deep depression,” said Lewis, 45, a single mother with two older daughters living on their own. “This is nothing anyone could have prepared them for.”

As Americans crowd into restaurants, line up at movie theaters and pack their bags for summer travel, people are understandably eager to put the pandemic behind them. Yet kids like Na’ryen won’t rebound quickly. Some won’t recover at all.

After more than a year of isolation, and experts say many of the youngest Americans have fallen behind socially, academically and emotionally in ways that could harm their physical and mental health for years or even decades.

“This could affect a whole generation for ,” said Dr. Jack Shonkoff, a pediatrician and director of the Center for the Developing Child at Harvard University. “All kids will be affected. Some will get through this and be fine. They will learn from it and grow. But lots of kids are going to be in big trouble.”

Many kids will go back to school this fall without having mastered the previous year’s curriculum. Some kids have disappeared from school altogether, and educators worry that more students will drop out. Between school closures and reduced instructional time, the average U.S. child has lost the equivalent of five to nine months of learning during the pandemic, according to

Educational losses have been even greater for some minorities. Black and Hispanic students — whose parents are more likely to have lost jobs and whose schools were less likely to reopen for in-person instruction — missed six to 12 months of learning, according to the McKinsey report.

Missing educational opportunities doesn’t just deprive kids of better careers; it can also In study after study, researchers have found that people with less education die younger than those with more.

Schools across the country were closed for an average of in spring 2020, and many provided little to no virtual instruction, said Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at the Seattle Children’s Research Institute. A study he co-authored found the learning that kids missed during that time could shorten an elementary school boy’s life by eight months and a girl’s by more than five months.

The total loss of life would be even larger when factoring in the loss of instructional time in the school year that just ended, Christakis said. “We’ve interrupted children’s education, and it’s going to have a significant impact on their health and longevity,” he said. “The effects will linger a very long time.”

Assaulted on All Sides

The double hit from the pandemic, which has millions of children and deprived them of classroom time, will be too much for some to overcome.

“Living in poverty, even as a child, has health consequences for decades to come,” said Dr. Hilary Seligman, a professor at the University of California-San Francisco. “Children in poverty will have higher risk of obesity, cardiovascular disease and diabetes.”

A growing body of research shows that poverty reshapes the way , altering both the and the . These changes can alter how children react to stress and reduce their and .

“Adversity literally shapes the developing brain,” said Shonkoff, of Harvard. “It affects your memory, your ability to organize information, to control impulses.”

Chronic stress in children can lead to persistent inflammation that damages the immune system, raises blood sugar and accelerates hardening of the arteries. The heart disease that kills someone in midlife can actually begin in childhood, Shonkoff said.

“What happens to children early on doesn’t just affect early language and school readiness, but the early foundations of lifelong health,” he said.

More Kids Going Hungry

The pandemic has deprived millions of children of school-related services that normally blunt the harm caused by poverty.

From March to May 2020, students missed more than that would have been provided in school.

Children who experience even occasional “food insecurity” suffer two to four times as many health problems as other kids at the same income level, said Dr. Deborah Frank, director of the Grow Clinic for Children at Boston Medical Center.

Kids who don’t consistently eat nutritious meals are more likely to develop anemia, more likely to be hospitalized and more susceptible to lead poisoning, Frank said. They also are more likely to behave aggressively and suffer from hyperactivity, depression and anxiety.

The last well into adulthood, she said, increasing the risk of substance abuse, arrest and suicidal thoughts. “There’s going to be educational and emotional fallout that won’t disappear right away,” Frank said. “These kids have endured a year and a half of deprivation. You can’t sweep all that under the rug.”

Kids at the Breaking Point

Young people are already showing signs of strain.

The proportion of emergency room visits related to mental health among kids 12 to 17 , according to the Centers for Disease Control and Prevention.

Although overall haven’t increased during the pandemic, as many feared, teens are making more attempts. ERs treated 50% more adolescent girls and 4% more boys for in February and March 2021 than in those months the year before.

Diagnoses of obsessive-compulsive disorder have soared 41% among girls 12 to 18, according to a . Diagnoses of eating disorders have jumped 38% among girls and 5% among boys.

Many children separated from their peers during the pandemic have been depressed and anxious, said Dr. Lisa Tuchman, chief of adolescent and young adult medicine at Children’s National Hospital in Washington, D.C.

“Mental illness thrives in isolation,” Tuchman said. “The longer the behaviors and thoughts persist, the more entrenched they become and the harder they are to interrupt.”

Falling Behind in School

The loss of educational opportunities has been far more extensive than many realize. Although the majority of students were back in classrooms by the end of the last school year, most spent a large part of the year

And while some students thrive in virtual classes, studies generally find they provide an partly because students are less engaged. Just 60% of students consistently participated in distance learning, recent found.

Test scores show students have fallen behind in math and . And those scores likely underestimate the damage, given that some of the most vulnerable kids weren’t able to report to school for the exams.

An — including those who are homeless or in foster care — received no instruction during the past school year, either because they had no computer or internet access, had to leave school to work or faced other challenges, according to Bellwether Education Partners, a nonprofit that focuses on disadvantaged students.

Less-educated students can expect to earn less after they leave school.

Lost educational time will cost the average child in lifetime earnings, McKinsey concluded. Lifetime earning losses are predicted to be twice as great for Black and Hispanic students as for whites.

“Many of the teens I see have given up on school and are working instead,” said Dr. Sara Bode, a pediatrician at Nationwide Children’s Hospital in Columbus, Ohio. “It’s helping their families in the short term, but what does it mean for their future?”

Learning From Katrina

Experience with and suggests that even relatively short interruptions in education can set children back years, said McKinsey analyst Jimmy Sarakatsannis, co-author of a 2020 report, “”

When Hurricane Katrina devastated New Orleans in 2005, for example, it disrupted the education of .

Katrina left . Although New Orleans students missed an average of of learning, children wound up two years behind peers not affected by the hurricane, said Douglas Harris, professor and chair of economics at Tulane University.

Na’ryen Cayou was just 2 months old when Katrina submerged his house, leaving the family homeless. He contracted whooping cough in an emergency shelter, the first of four moves in eight months. His sister, O’re’ion Lewis, then 4, didn’t attend school at all that year. When she finally began prekindergarten at age 5, the other kids “were already ahead of her,” mom Nakia Lewis said. For a time, teachers even mislabeled O’re’ion as having dyslexia. It took five years — from prekindergarten until fourth grade — before she finally caught up with her peers, Lewis said.

It will be years before researchers know how far behind the pandemic will have left American kids.

After Katrina, 14% to 20% of students never returned to school, . “As kids fall further behind, they feel hopeless; they don’t engage,” said Sarakatsannis, one of its authors.

Under normal circumstances, high school students who miss more than 10 days of school are 36% more likely to drop out. Based on the number of absences during the pandemic, dropout rates could increase by 2% to 9%, with up to 1.1 million kids quitting school, Sarakatsannis said.

Communities need to find ways to repair the damage children have suffered, said Dr. Gabrielle Shapiro, chair of the American Psychiatric Association’s Council on Children, Adolescents and their Families. “How we behave as a society now will determine the depth of the impact on the younger generation.”

Nakia Lewis is hoping for better days.

O’re’ion is now 20 and studying nursing at community college. Although her classes were virtual last year, she expects to attend class in person in the fall.

Lewis recently landed a job as a manager at a Shoney’s restaurant and is looking for an affordable home. She looks forward to reclaiming her furniture, which went into storage — at $375 a month — when she was evicted.

She said she’s relieved that Na’ryen’s mood has improved. He found a summer job working part time at a food market and will begin marching band practice this summer.

“He is happy and I’m happy for him,” Lewis said. “Now I just have to worry about everything else.”

[Correction: This article was revised at 7:15 p.m. ET on July 2, 2021, to correct the name of Children’s National Hospital.]

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Primero, en la primavera de 2020, el hombre de 57 años perdió su trabajo entregando repuestos para una concesionaria de automóviles de Nueva Orleans, cuando la economía local se congeló. Luego, se atrasó en el pago del alquiler. El mes pasado, Toussaint tuvo que dejar su apartamento cuando el propietario, que se para el alquiler con fondos federales, encontró un agujero legal en la .

Toussaint ha tenido problemas para controlar su presión arterial. Con artritis en la espalda y las rodillas no puede levantar más de 20 libras, un gran obstáculo para su trabajo.

Le preocupa lo que sucederá cuando se agoten sus beneficios por desempleo que se otorgaron por la pandemia, lo que podría suceder .

“He estado sin hogar antes”, dijo Toussaint, quien pudo alquilar un cuarto cerca después de su desalojo. “No quiero volver a quedarme sin hogar”.

Con la por coronavirus en el país, muchas personas están ansiosas por dejar atrás la pandemia. Pero ha causado . Además de matar a en los Estados Unidos y afectar a unos 3,4 millones o más con , la pandemia amenaza la salud de las por la , hogares y .

Es casi seguro que proyectará una larga sombra sobre la salud estadounidense, lo que hará que millones de personas vivan más enfermas y mueran más jóvenes debido a las crecientes tasas de , hambre e .

En particular, exacerbará las discrepancias que ya se han visto en el país entre la riqueza y la salud de los estadounidenses negros e hispanoestadounidenses (que pueden ser de cualquier raza), y las de los estadounidenses blancos.

De hecho, una nueva investigación publicada en la revista BMJ muestra cuán grande se ha vuelto esa brecha. La esperanza de vida en todo el país entre 2018 y 2020, el mayor descenso desde 1943, cuando soldados estadounidenses morían en la Segunda Guerra Mundial, según la investigación.

Pero mientras que los estadounidenses blancos perdieron 1,36 años, los estadounidenses negros perdieron 3,25 años y los hispanoestadounidenses, 3,88 años. Dado que la esperanza de vida normalmente varía sólo un mes o dos de un año a otro, las pérdidas de esta magnitud son “bastante catastróficas”, explicó el doctor Steven Woolf, profesor de la Virginia Commonwealth University y autor principal del estudio.

Durante los dos años incluidos en el estudio, la pérdida promedio de esperanza de vida en el país fue casi nueve veces mayor que el promedio en otras 16 naciones desarrolladas, cuyos residentes ahora pueden esperar vivir 4.7 años más que los estadounidenses. En comparación con sus pares en otros países durante este período, los estadounidenses no solo murieron en mayor número sino a edad más temprana.

La del país se disparó casi un 23% en 2020, cuando hubo aproximadamente 522,000 muertes más de las que habría en un año normal. No todas estas muertes fueron directamente atribuibles a covid-19. Los y los aumentaron en 2020, en parte impulsados ​​por el retraso en los tratamientos o la falta de acceso a la atención médica, dijo Woolf.

Más del pospusieron durante los primeros meses de la pandemia, cuando los hospitales estaban colmados, y solo entrar a un centro médico parecía arriesgado. Sin atención médica inmediata, los ataques cardíacos pueden causar insuficiencia cardíaca congestiva; retrasar el tratamiento de los ataques cerebrales aumenta el riesgo de discapacidad a largo plazo.

Gran parte del devastador impacto en la salud pública durante la pandemia puede atribuirse a la disparidad económica. Aunque los precios de las acciones se han recuperado de la caída del año pasado, y han alcanzado máximos históricos, muchas personas , en especial los afroamericanos y los .

En un , analistas de la economía de McKinsey & Co. predijeron que, en promedio, los trabajadores negros e hispanos no recuperarán su empleo y salarios antes de la pandemia hasta 2024. Y los empleados peor pagos y sin educación secundaria tal vez ni se recuperan para entonces.

Aunque los programas de ayuda federales y estatales han amortiguado el impacto de la pérdida de empleos por la pandemia, el 11,3% de los estadounidenses viven hoy en la pobreza, en comparación con el . Una moratoria federal de desalojos, que ha ayudado a que aproximadamente permanezcan en sus hogares, expira el 30 de junio.

Sin protección contra los desalojos, “millones de estadounidenses podrían caer en un abismo”, dijo Vangela Wade, presidenta y directora ejecutiva del Centro de Justicia de Mississippi, un grupo de defensa sin fines de lucro.

El desalojo erosiona la salud de una persona de múltiples formas. “La pobreza causa mucho y , y esta pandemia ha causado ”, dijo el doctor Otis Brawley, profesor de la Universidad Johns Hopkins que estudia las disparidades en salud. “El efecto de esta pandemia sobre las enfermedades crónicas, como las enfermedades cardiovasculares y la diabetes, se medirá en las próximas décadas”.

recientemente han tenido problemas para poner comida en la mesa. La imposibilidad de pagar , que generalmente son más costosos que los alimentos salados y procesados, puede causar daños tanto a corto como a largo plazo. Por ejemplo, las personas con bajos ingresos tienen más probabilidades de hacia fin de mes, cuando se quedan sin dinero para comprar alimentos.

A largo plazo, la inseguridad alimentaria se asocia con un mayor riesgo de , , , , y otras , especialmente .

“Una vez que haya pasado la fase aguda de esta crisis, enfrentaremos una enorme ola de muerte y discapacidad”, dijo el doctor Robert Califf, ex comisionado de la Administración de Alimentos y Medicamentos (FDA), quien escribió sobre los riesgos para la salud posteriores a una pandemia en un editorial de abril en la revista médica . “Estas serán las otras consecuencias de Covid”.

Menos riqueza, peor salud

La salud estadounidense era mala incluso antes de la pandemia: el 60% de la población padecía , como obesidad, diabetes, hipertensión o insuficiencia cardíaca. Estas cuatro condiciones se asociaron con casi dos tercios de las hospitalizaciones por covid, según un estudio de febrero en el .

Las muertes por algunas enfermedades crónicas comenzaron a aumentar entre los estadounidenses de bajos ingresos en la década de 1990, dijo Woolf. Esa tendencia se vio exacerbada por la Gran Recesión de 2007-09, que socavó la salud no solo de quienes perdieron sus hogares o trabajos, sino también de .

Sin embargo, la Gran Recesión y sus efectos en la salud no afectaron a todos los estadounidenses por igual. Las personas negras controlan hoy menos riqueza que antes de la recesión, mientras que la entre los estadounidenses blancos y negros se ha ampliado, según un artículo de Nonprofit Quarterly publicado el año pasado. Y la tasa de desempleo entre los trabajadores negros a los niveles anteriores a la recesión hasta 2016.

Los investigadores han desarrollado una mejor comprensión en los últimos años de cómo el , causado por la pobreza, la pérdida del empleo y la falta de vivienda, conduce a la enfermedad. El estrés implacable causa que puede dañar los vasos sanguíneos, el corazón y otros órganos.

Las investigaciones muestran que las personas con bajos ingresos viven un promedio de siete a ocho años menos que aquéllas que tienen seguridad financiera. El 1% más rico de los estadounidenses vive casi 15 años más que el 1% más pobre.

Las personas pobres tienden a fumar más; tienen un mayor riesgo de enfermedades crónicas como enfermedades cardiovasculares, diabetes, enfermedades renales y trastornos mentales; y es más probable que sean víctimas de la violencia.

El estrés de la pandemia también ha llevado a muchas personas a fumar, beber y aumentar de peso, aumentando el riesgo de enfermedades crónicas. Las sobredosis fatales de drogas aumentaron un 30% entre octubre de 2019 y octubre de 2020.

Jennifer Drury, de 40 años, ha luchado contra el abuso de sustancias, en particular los analgésicos recetados, desde los 20. Culpa al aislamiento y el estrés de la pandemia por una recaída y por haber perdido amigos a causa de sobredosis.

“El tiempo de inactividad no es bueno para la adicción”, dijo Drury, quien se atrasó en el pago del alquiler y fue desalojada de su casa anterior. Dijo que los traficantes nunca están lejos, especialmente en el motel de Nueva Orleans donde ahora vive con su esposo. “A los traficantes de drogas no les importan las pandemias”.

Mujeres perdiendo terreno

El , que proporciona $1,9 mil millones en ayuda por la pandemia, fue diseñado para ayudar a los trabajadores desplazados y reducir a la mitad las tasas de pobreza infantil. Los beneficios reales de la ley pueden resultar menos amplios.

Veinticinco estados han optado por eliminar los , citando preocupaciones de que estos generosos beneficios pagan a las personas más por quedarse en casa de lo que pueden ganar trabajando.

Muchas mujeres dicen que les gustaría volver a trabajar pero que no tienen a nadie que se ocupe de sus hijos. Casi la han cerrado y otros han reducido el número de niños que atienden.

El concluyó que “la recuperación económica depende de la disponibilidad de cuidado infantil”. Un informe de marzo del estima que “las mujeres han perdido una generación de ganancias en la participación en la fuerza laboral”, lo que podría dejarlas a ellas y a sus hijos en desventaja financiera durante años.

Ruth Bermúdez es una de las que se alejaron de la fuerza laboral el año pasado. Bermúdez, quien fue despedida de su empleo como trabajadora social de salud conductual en Nueva Orleans, dijo que sus necesidades de cuidado infantil le han impedido encontrar trabajo. El cuidado de su hija de 6 años se convirtió en su trabajo de tiempo completo después de que la pandemia cerrara las escuelas.

Aunque su hija ha regresado a clases, Bermúdez dijo que los cierres escolares debido a los brotes de covid han sido frecuentes e impredecibles.

“Tuve que ser maestra, hacer el almuerzo, conducir, todo al mismo tiempo”, dijo Bermúdez, de 27 años. “Es agotador”.

Desalojos que cambian la vida

James Toussaint tuvo solo dos semanas para encontrar un nuevo lugar para vivir después de que un juez ordenara su desalojo. No pudo estar con su familia.

“Tengo familia, pero todos tienen sus propios problemas”, dijo Toussaint, quien tuvo que tirar toda su ropa y muebles porque se habían infestado de chinches. “Todos están haciendo todo lo posible para ayudarse a sí mismos”.

Toussaint ahora alquila una habitación en una pensión sin cocina y un baño compartido por $160 a la semana. Tuvo que comprar artículos de limpieza con su propio dinero para desinfectar el baño, que, según dijo, a menudo no se puede usar de lo sucio que está.

Compartir el espacio común a menudo es insalubre y aumenta el riesgo de estar expuesto al coronavirus, dijo Emily Benfer, profesora visitante en la Escuela de Derecho de la Universidad de Wake Forest. Incluso mudarse con la familia presenta riesgos, dijo, porque es imposible aislarlo o ponerlo en cuarentena en hogares abarrotados.

Benfer coescribió un que encontró que las tasas de infección por covid crecieron dos veces más en los estados que levantaron las moratorias sobre los desalojos, en comparación con los estados que continuaron prohibiéndolos. Aproximadamente el se han retrasado en el pago del alquiler, el doble de la tasa antes de la pandemia.

El contrato de arrendamiento anual de Toussaint expiró durante la pandemia, por lo que tuvo que alquilar mes a mes. Si bien algunos estados requieren que los propietarios muestren una “causa justa” para el desalojo, los propietarios de Louisiana pueden desalojar a los inquilinos por cualquier motivo una vez que haya vencido su contrato de alquiler anual.

Los dueños de propiedades han solicitado más de durante la pandemia en solo los cinco estados y las 29 ciudades rastreadas por el Laboratorio de Desalojos de la Universidad de Princeton. Un conjunto de pruebas cada vez mayor muestra que el desalojo es y causa y a largo plazo que aumentan el riesgo de muerte.

Estudios muestran que las personas desalojadas tienen más probabilidades de tener problemas de salud general o de salud mental .

“Este evento singular altera el curso de la vida para peor”, dijo Benfer. “Si no intervenimos” para evitar los desalojos masivos cuando finalice la moratoria, “será catastrófico para las generaciones venideras”.

Los daños causados ​​por el desalojo se pueden medir en todas las etapas de la vida:

Cuando las mujeres embarazadas son desalojadas, sus recién nacidos tienen más probabilidades de ser o muy pequeños, y tienen un mayor riesgo de . Las mujeres que son desalojadas tienen más probabilidades de sufrir , dijo Benfer.

Los niños que son desalojados corren un mayor riesgo de intoxicación por plomo en viviendas deficientes, dijo Benfer. También son más propensos que otros a ser hospitalizados.

Los adultos desalojados reportan una peor salud mental y tienen más probabilidades de ser hospitalizados por una crisis de salud mental, . También tienen mayores tasas de mortalidad por suicidio. Aunque las causas de adicción son complejas, las investigaciones muestran que los condados con tasas de desalojo más altas tienen tasas significativamente más altas de muertes relacionadas con drogas y alcohol.

Las personas que son desalojadas a menudo se mudan a viviendas deficientes en vecindarios con índices de criminalidad más altos. Estos lugares a veces están plagados de moho y cucarachas, no tienen calefacción suficiente o tienen tuberías que no funcionan. Los propietarios no tienen ningún incentivo para hacer reparaciones a los inquilinos que están atrasados ​​en el pago del alquiler, dijo Benfer. De hecho, los que denuncian peligros o piden reparaciones corren el riesgo de ser desalojados.

Aunque los estadounidenses de clase media dan por sentado sus cocinas y dependen de ellas para cocinar comidas saludables, más de 1 millón de hogares carecen de cocinas completas, según la .

Nueva Orleans no requiere que las unidades de alquiler incluyan estufas, dijo Hannah Adams, también abogada de Southeast Louisiana Legal Services. La nueva habitación de Toussaint está equipada con microondas y nevera pequeña, pero no tiene fregadero, horno ni fogones. Lava los platos de la cena en el baño. Su casero no permite que los residentes tengan cocinas eléctricas, por lo que la mayoría de sus comidas incluyen cereales fríos, sándwiches de fiambres o comidas que puede calentar en el microondas. Su médico ha instado a Toussaint, que es prediabético, a perder peso, comer con menos sal y dejar de fumar.

Toussaint, que vivió en la calle durante dos años, dijo que está decidido a no regresar allí. Espera solicitar un seguro por discapacidad, que le proporcionaría un ingreso si su artritis le impide encontrar un trabajo estable.

Woolf dijo que espera que los estadounidenses no se olviden del sufrimiento de personas como Toussaint a medida que disminuyen los casos de covid.

“Mi preocupación es que la gente sienta que la crisis ha quedado atrás y todo está bien”, dijo Woolf. Su investigación, que conecta cuatro décadas de oportunidades económicas con la baja en la esperanza de vida, muestra que “estamos ante un gran problema, y ​​eso era cierto antes de que supiéramos que se avecinaba una pandemia”.

La pandemia no tiene por qué condenar a una generación de estadounidenses a la enfermedad y la muerte prematura, dijo el doctor Richard Besser, presidente y director ejecutivo de la Fundación Robert Wood Johnson.

Al abordar problemas como la pobreza, la desigualdad racial y la falta de viviendas asequibles, el país puede mejorar la salud de los estadounidenses y revertir las tendencias que causaron el sufrimiento de las comunidades de color. “La forma en que la pandemia afectará la salud futura de las personas depende de lo que hagamos después de esto”, dijo Besser. “Se necesitará un esfuerzo intencional para compensar las pérdidas que se han producido durante el año pasado”.

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First, the 57-year-old lost his job delivering parts for a New Orleans auto dealership in spring 2020, when the local economy shut down. Then, he fell behind on his rent. Last month, Toussaint was forced out of his apartment when his landlord — who refused to accept — found a loophole in the

Toussaint recently has had trouble controlling his blood pressure. Arthritis in his back and knees prevents him from lifting more than 20 pounds, a huge obstacle for a manual laborer.

Toussaint worries about what will happen when his pandemic unemployment benefits run out, which could happen

“I’ve been homeless before,” said Toussaint, who found a room to rent nearby after his eviction. “I don’t want to be homeless again.”

With falling in the U.S., many people are eager to put the pandemic behind them. But it that won’t easily heal. In addition to killing in the United States and afflicting an estimated 3.4 million or more with , the pandemic threatens the health of vulnerable people by the , and It will, almost certainly, cast a long shadow on American health, leading millions of people to live sicker and die younger due to increasing rates of , hunger and .

In particular, it will exacerbate the discrepancies already seen in the country between the wealth and health of Black and Hispanic Americans and those of white Americans. Indeed, new research published Wednesday in the BMJ shows just how wide that gap has grown. Life expectancy across the country  from 2018 to 2020, the largest decline since 1943, when American troops were dying in World War II, according to the study. But while white Americans lost 1.36 years, Black Americans lost 3.25 years and Hispanic Americans lost 3.88 years. Given that life expectancy typically varies only by a month or two from year to year, losses of this magnitude are “pretty catastrophic,” said Dr. Steven Woolf, a professor at Virginia Commonwealth University and lead author of the study.

Over the two years included in the study, the average loss of life expectancy in the U.S. was nearly nine times greater than the average in 16 other developed nations, whose residents can now expect to live 4.7 years longer than Americans. Compared with their peers in other countries, Americans died not only in greater numbers but at younger ages during this period.

The U.S.  in 2020, when there were roughly 522,000 more deaths than normally would be expected. Not all of these deaths were directly attributable to covid-19. Fatal Ìý²¹²Ô»åÌý both increased in 2020, at least partly fueled by delayed treatment or lack of access to medical care, Woolf said. More than  put off  during the early months of the pandemic, when hospitals were stretched thin and going into a medical facility seemed risky. Without prompt medical attention, heart attacks can cause congestive heart failure; delaying treatment of strokes raises the risk of long-term disability.

Much of the devastating public health impact during the pandemic can be chalked up to economic disparity. Although stock prices have recovered from last year’s decline — and have recently hit all-time highs — financially, especially . In a , economic analysts at McKinsey & Co. predicted that, on average, Black and Hispanic workers won’t recover their pre-pandemic employment and salaries until 2024. The lowest-paid workers and those with less than a high school education may not recover even by then.

And while federal and state relief programs have cushioned the impact of pandemic job losses, 11.3% of Americans today live in poverty — compared with . A , which has helped , expires June 30. Without protection from evictions, “millions of Americans could fall off the cliff,” said Vangela Wade, president and CEO of the Mississippi Center for Justice, a nonprofit advocacy group.

Being evicted erodes a person’s health in multiple ways. “ and and this pandemic has said Dr. Otis Brawley, a professor at Johns Hopkins University who studies health disparities. “The effect of this pandemic on chronic diseases, such as cardiovascular disease and diabetes, will be measured decades from now.”

recently have had trouble putting food on the table. The — which is usually more expensive than salty, starchy fare — can cause both short-term and long-term harm. People with low incomes, for example, for low blood sugar toward the end of the month, when they run out of money for food.

In the long term, food insecurity is associated with an increased risk of , , and

“Once the acute phase of this crisis has passed, we will face an enormous wave of death and disability,” said Dr. Robert Califf, former commissioner of the Food and Drug Administration, who wrote about post-pandemic health risks in in Circulation, a medical journal. “These will be the aftershocks of covid.”

Less Wealth, Poorer Health

American health was poor even before the pandemic, with 60% of the population suffering from a , such as obesity, diabetes, high blood pressure or heart failure. These four conditions were associated with nearly two-thirds of hospitalizations from covid, according to a February study in the

Deaths from some chronic diseases began rising in lower-income Americans in the 1990s, Woolf said. That trend was exacerbated by the Great Recession of 2007-09, which undermined the health not just of those who lost their homes or jobs but . Still, the Great Recession, and its resultant health effects, did not affect all Americans equally. Black people in the U.S. today control less wealth than they did before that recession, while the  security between Black and white Americans has widened, according to a Nonprofit Quarterly article published last year. And the unemployment rate among Black workers .

Researchers have developed a better understanding in recent years of how — such as that caused by poverty, job loss and homelessness — leads to disease. Unrelenting stress causes that can damage blood vessels, the heart and other organs.

Research shows that people with low incomes live than those who are financially secure. The richest 1% of Americans than the poorest 1%.

People who are poor tend to ; have such as , and ; and are more likely to become .

The stress of the pandemic also has led many people to , and increasing the risk of chronic disease. Fatal drug overdoses from October 2019 to October 2020.

Jennifer Drury, 40, has struggled with substance abuse, particularly prescription painkillers, since her 20s. She blames the isolation and stress of the pandemic for causing her to relapse — and leading several of her friends to fatally overdose.

“Idle time is not good for addiction,” said Drury, who fell behind on rent and was evicted from her previous home. She said drug dealers are never far away, especially at the New Orleans motel where she and her husband are now staying. “Drug dealers don’t care about pandemics.”

Women Losing Ground

The , which provides $1.9 trillion in pandemic relief, was designed to help displaced workers and cut child poverty rates in half. The actual benefits of the law may prove less sweeping.

Twenty-five states have opted to , citing concerns that such generous benefits pay people more to stay home than they can earn by working.

Many women say they would like to return to work but have no one to take care of their children. and others have reduced the number of children they serve.

The concluded that “economic recovery depends on child care availability.” A March report from the estimates “women have lost a generation of labor force participation gains,” which could leave them and their children financially disadvantaged for years.

Ruth Bermudez is one of who have left the workforce in the past year. Bermudez, who was laid off from her job as a behavioral health caseworker in New Orleans last year, said her child care needs have prevented her from finding work. The care of her 6-year-old daughter became her full-time job after the pandemic closed schools.

Although her daughter has returned to class, Bermudez said school shutdowns due to covid outbreaks have been frequent and unpredictable.

“I had to be the teacher, the lunch lady, the school bus driver, all at one time,” said Bermudez, 27. “It is exhausting.”

Life-Altering Evictions

James Toussaint had just two weeks to find a new place to live after a judge ordered him evicted. His family was unable to take him in.

“I’ve got family, but everybody has their own issues and problems,” said Toussaint, who had to throw away all his clothes and furniture because they had become infested with bedbugs. “Everyone is trying their best to help themselves.”

Toussaint is now renting a room in a boarding house with no kitchen and a shared bathroom for $160 a week. He’s had to buy cleaning supplies with his own money in order to sanitize the bathroom, which he said is often too dirty to use.

Sharing communal space is often unsanitary and increases the risk of being exposed to the coronavirus, said Emily Benfer, a visiting professor at Wake Forest University School of Law. Even moving in with family poses risks, she said, because it’s impossible to isolate or quarantine in crowded homes.

Benfer co-wrote that found covid infection rates grew twice as high in states that lifted moratoriums on evictions, compared with states that continued to ban them. About have fallen behind on rent — double the rate before the pandemic.

Toussaint’s annual lease expired during the pandemic, leaving him to rent on a month-to-month basis. While some states require landlords to show “just cause” for eviction, Louisiana landlords can evict tenants for any reason once their annual lease has expired.

Property owners have filed for during the pandemic in just the five states and 29 cities tracked by Princeton University’s Eviction Lab. A growing body of evidence shows that eviction is , causing that increases the risk of death.  Studies show that evicted people are more likely to be in poor general health or have mental health concerns

“This singular event alters the course of one’s life for the worse,” Benfer said. “If we don’t intervene” to prevent mass evictions when the moratorium ends, “it will be catastrophic for generations to come.”

Eviction’s harms can be measured at every stage of life:

When pregnant women are evicted, their newborns are more likely or and have a Women who are evicted are more likely to Benfer said.

Kids who are evicted are at greater risk of from substandard housing, Benfer said. They’re also

Evicted adults report worse mental health and are more likely to be hospitalized for a mental health crisis, . They also have higher mortality rates from suicide. Although the causes of addiction are complex, research shows that counties with higher eviction rates have significantly higher rates of drug- and alcohol-related deaths.

People who are evicted often move into substandard housing in neighborhoods with higher crime rates. These homes are sometimes plagued by mold and roaches, lack sufficient heating, or have plumbing that doesn’t work. Landlords have no incentive to make repairs for tenants who are behind on their rent, Benfer said. In fact, tenants who request repairs or report safety hazards risk eviction.

Although middle-class Americans take their kitchens for granted — and rely on them to cook healthful meals — more than 1 million homes lack complete kitchens, according to the

New Orleans doesn’t require that rental units include stoves, said Hannah Adams, also a lawyer with Southeast Louisiana Legal Services. Toussaint’s new room is equipped with a microwave and small refrigerator, but no sink, oven or stove. He washes dinner dishes in the bathroom. His landlord doesn’t allow residents to have electric hot plates, so most of his meals involve cold cereal, deli sandwiches or meals he can heat in the microwave. His doctor has urged Toussaint, who is borderline diabetic, to lose weight, eat less salt and starch, and stop smoking.

Toussaint, who lived on the street for two years, said he’s determined not to return there. He hopes to apply for disability insurance, which would provide him with an income if his arthritis prevents him from finding steady work.

Woolf said he hopes Americans won’t forget about the suffering of people like Toussaint as cases of covid decline. “My worry is that people will feel the crisis is behind us and it’s all good,” Woolf said. His research connecting four decades of declining economic opportunity with falling life expectancy shows “we are in really big trouble, and that was true before we knew a pandemic was coming.”

The pandemic doesn’t have to doom a generation of Americans to disease and early death, said Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation. By addressing issues such as poverty, racial inequality and the lack of affordable housing, the country can improve American health and reverse the trends that caused communities of color to suffer. “How the pandemic will affect people’s future health depends on what we do coming out of this,” Besser said. “It will take an intentional effort to make up for the losses that have occurred over the past year.”

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Shalondra Rollins, 38, was struggling to breathe as covid overwhelmed her lungs. But before the doors closed, she asked for her cellphone, so she could call her family from the hospital.

It was April 7, 2020 — the last time Rollins would see her daughter or hear her voice.

The hospital rang an hour later to say she was gone. A chaplain later told Rollins that Shalondra had died on a gurney in the hallway. Rollins was left to break the news to Shalondra’s children, ages 13 and 15.

More than a year later, Rollins said, the grief is unrelenting.

Rollins has suffered panic attacks and depression that make it hard to get out of bed. She often startles when the phone rings, fearing that someone else is hurt or dead. If her other daughters don’t pick up when she calls, Rollins phones their neighbors to check on them.

“You would think that as time passes it would get better,” said Rollins, 57, of Jackson, Mississippi. “Sometimes, it is even harder. … This wound right here, time don’t heal it.”

With nearly — now a leading cause of death — researchers estimate that more than , including children who have lost a parent.

The pandemic — and the political battles and economic devastation that have accompanied it — have inflicted on mourners, making it harder than with a typical loss, said sociologist Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care.

The scale and complexity of pandemic-related grief have created a public health burden that could deplete Americans’ for years, leading to more depression, substance misuse, suicidal thinking, sleep disturbances, and impaired immune function.

“Unequivocally, grief is a public health issue,” said Prigerson, who lost her mother to covid in January. “You could call it the grief pandemic.”

Like many other mourners, Rollins has struggled with feelings of guilt, regret and helplessness — for the loss of her daughter as well as Rollins’ only son, Tyler, who died by suicide seven months earlier.

“I was there to see my mom close her eyes and leave this world,” said Rollins, who was first interviewed by KHN a year ago in a story about covid’s disproportionate effects on communities of color. “The hardest part is that my kids died alone. If it weren’t for this covid, I could have been right there with her” in the ambulance and emergency room. “I could have held her hand.”

The pandemic has prevented many families from gathering and holding funerals, even after deaths caused by conditions other than covid. Prigerson’s research shows that families of patients who die in hospital intensive care units are seven times more likely to develop than loved ones of people who die in home hospice.

The polarized political climate has even pitted some family members against one another, with some insisting that the pandemic is a hoax and that loved ones must have died from influenza, rather than covid. People in grief say they’re angry at relatives, neighbors and fellow Americans who failed to take the coronavirus seriously, or who still don’t appreciate how many people have suffered.

“People holler about not being able to have a birthday party,” Rollins said. “We couldn’t even have a funeral.”

Indeed, the optimism and has blinded many Americans to the deep sorrow and depression of those around them. Some mourners say they will continue wearing their face masks — even in places where mandates have been removed — as a memorial to those lost.

“People say, ‘I can’t wait until life gets back to normal,’” said Heidi Diaz Goff, 30, of the Los Angeles area, who lost her 72-year-old father to covid. “My life will never be normal again.”

Many of those grieving say celebrating the end of the pandemic feels not just premature, but insulting to their loved ones’ memories.

“Grief is invisible in many ways,” said Tashel Bordere, a University of Missouri assistant professor of human development and family science who studies bereavement, particularly in the Black community. “When a loss is invisible and people can’t see it, they may not say ‘I’m sorry for your loss,’ because they don’t know it’s occurred.”

“You would think that as time passes it would get better. Sometimes, it is even harder. … This wound right here, time don’t heal it.”

Cassandra Rollins, of Jackson, Mississippi

Communities of color, which have experienced disproportionately and from covid, are now carrying a heavier burden.

Black children are more likely than white children to lose a parent to covid. Even before the pandemic, the combination of higher infant and maternal mortality rates, a greater incidence of chronic disease and shorter life expectancies made Black people a close family member at any point in their lives.

Rollins said everyone she knows has lost someone to covid.

“You wake up every morning, and it’s another day they’re not here,” Rollins said. “You go to bed at night, and it’s the same thing.”

A Lifetime of Loss

Rollins has been battered by hardships and loss since childhood.

She was the youngest of 11 children raised in the segregated South. Rollins was 5 years old when her older sister Cora, whom she called “Coral,” was stabbed to death at a nightclub, according to news reports. Although Cora’s husband was charged with murder, he was set free after a mistrial.

Rollins gave birth to Shalondra at age 17, and the two were especially close. “We grew up together,” Rollins said.

Just a few months after Shalondra was born, Rollins’ older sister Christine was fatally shot during an argument with another woman. Rollins and her mother helped raise two of the children Christine left behind.

Heartbreak is all too common in the Black community, Bordere said. The accumulated trauma — from violence to chronic illness and racial discrimination — can have a weathering effect, making it harder for people to recover.

“It’s hard to recover from any one experience, because every day there is another loss,” Bordere said. “Grief impacts our ability to think. It impacts our energy levels. Grief doesn’t just show up in tears. It shows up in fatigue, in working less.”

Rollins hoped her children would overcome the obstacles of growing up Black in Mississippi. Shalondra earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs. Shalondra, who had been a second mother to her younger siblings, also adopted a cousin’s stepdaughter after the child’s mother died, raising the girl alongside her two children.

Rollins’ son, Tyler, enlisted in the Army after high school, hoping to follow in the footsteps of other men in the family who had military careers.

Yet the hardest losses of Rollins’ life were still to come. In 2019, Tyler killed himself at age 20, leaving behind a wife and unborn child.

“When you see two Army men walking up to your door,” Rollins said, “that’s unexplainable.”

Tyler’s daughter was born the day Shalondra died.

“They called to tell me the baby was born, and I had to tell them about Shalondra,” Rollins said. “I don’t know how to celebrate.”

Shalondra’s death from covid changed her daughters’ lives in multiple ways.

The girls lost their mother, but also the routines that might help mourners adjust to a catastrophic loss. The girls moved in with their grandmother, who lives in their school district. But they have not set foot in a classroom for more than a year, spending their days in virtual school, rather than with friends.

Shalondra’s death eroded their financial security as well, by taking away her income. Rollins, who worked as a substitute teacher before the pandemic, hasn’t had a job since local schools shut down. She owns her own home and receives unemployment insurance, she said, but money is tight.

Makalin Odie, 14, said her mother, as a teacher, would have made online learning easier. “It would be very different with my mom here.”

The girls especially miss their mom on holidays.

“My mom always loved birthdays,” said Alana Odie, 16. “I know that if my mom were here my 16th birthday would have been really special.”

Asked what she loved most about her mother, Alana replied, “I miss everything about her.”

Grief Complicated by Illness

The trauma also has taken a toll on Alana and Makalin’s health. Both teens have begun taking medications for high blood pressure. Alana has been on diabetes medication since before her mom died.

Mental and physical health problems are common after a major loss. “The mental health consequences of the pandemic are real,” Prigerson said. “There are going to be all sorts of ripple effects.”

The stress of losing a loved one to covid increases the risk for , also known as , which can lead to serious illness, increase the risk of domestic violence and steer marriages and relationships to fall apart, said Ashton Verdery, an associate professor of sociology and demography at Penn State.

People who lose a spouse have a roughly over the following year, a phenomenon known as the Similar risks are seen in people who lose a child or , Verdery said.

Grief can lead to a temporary condition in which the heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively, Verdery said.

From final farewells to funerals, the pandemic has robbed mourners of nearly everything that helps people cope with catastrophic loss, while piling on additional insults, said the Rev. Alicia Parker, minister of comfort at New Covenant Church of Philadelphia.

“It may be harder for them for many years to come,” Parker said. “We don’t know the fallout yet, because we are still in the middle of it.”

Rollins said she would have liked to arrange a big funeral for Shalondra. Because of restrictions on social gatherings, the family held a small graveside service instead.

Funerals are important cultural traditions, allowing loved ones to give and receive support for a shared loss, Parker said.

“When someone dies, people bring food for you, they talk about your loved one, the pastor may come to the house,” Parker said. “People come from out of town. What happens when people can’t come to your home and people can’t support you? Calling on the phone is not the same.”

While many people are afraid to acknowledge depression, because of the stigma of mental illness, mourners know they can cry and wail at a funeral without being judged, Parker said.

“What happens in the African American house stays in the house,” Parker said. “There’s a lot of things we don’t talk about or share about.”

Funerals play an important psychological role in helping mourners process their loss, Bordere said. The ritual helps mourners move from denying that a loved one is gone to accepting “a new normal in which they will continue their life in the physical absence of the cared-about person.” In many cases, death from covid comes suddenly, depriving people of a chance to mentally prepare for loss. While some families were able to talk to loved ones through FaceTime or similar technologies, many others were unable to say goodbye.

Funerals and burial rites are especially important in the Black community and others that have been marginalized, Bordere said.

“You spare no expense at a Black funeral,” Bordere said. “The broader culture may have devalued this person, but the funeral validates this person’s worth in a society that constantly tries to dehumanize them.”

In the early days of the pandemic, funeral directors afraid of spreading the coronavirus did not allow families to provide clothing for their loved ones’ burials, Parker said. So beloved parents and grandparents were buried in whatever they died in, such as undershirts or hospital gowns.

“They bag them and double-bag them and put them in the ground,” Parker said. “It is an indignity.”

Coping With Loss

Every day, something reminds Rollins of her losses.

April brought the first anniversary of Shalondra’s death. May brought Teacher Appreciation Week.

Yet Rollins said the memory of her children keeps her going.

When she begins to cry and thinks she will never stop, one thought pulls her from the darkness: “I know they would want me to be happy. I try to live on that.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).