Two years after the World Health Organization declared COVID-19 a global pandemic, many Americans are peeling off their masks, booking vacations, and moving on with their lives.
But for many others‚ the landscape is permanently altered.
In Natick, 49-year-old Brettany Barnett continues to grapple with the shock of losing her husband to COVID last April. A big teddy bear of a man, Clifton Barnett ran a successful upholstery shop and delighted in cooking feasts for friends and family. Now, the couple’s 21-year-old son, who cut short a budding Army career to return home and help out, struggles to keep his father’s business afloat. The couple’s 12-year-old daughter is despondent, still sometimes texting her late father.
Like Barnett’s children, more than 5 million young people around the world have lost a parent or caregiver from COVID since March 2020, including at least 200,000 in the United States, according to recent studies.
In Massachusetts, more than 23,000 people have died from COVID, including more than 1,700 in their prime parenting years.
Even in Massachusetts, with its world-class hospitals and nearly universal health care coverage, those deaths disproportionately fell on people of color — like Barnett, who was Black — just as they have across the country, according to a new analysis by researchers at Boston University’s School of Public Health that was conducted at the Globe’s request.
The analysis found that across every adult age group, Hispanic and Black people in Massachusetts died at higher rates than white people. Differences were especially pronounced among those in the prime of their lives. Among Hispanic people age 20-49, the death rate was nearly three times higher than for non-Hispanic white people. Among non-Hispanic Black people, the rate was 2.5 times higher.
In contrast, the death rate was lower in all age groups for Asians, compared to white people. (The analysis did not include American Indian and other racial/ethnic groups because of insufficient data.)
“Some of these disparities are breathtaking,” said Dr. Jonathan Levy, who chairs the department of environmental health at BU’s School of Public Health.
Levy’s team analyzed state data obtained by the Globe through a public records request.
On Thursday, the Baker administration announced it will update the way it counts COVID deaths starting next week. That change is likely to decrease the state’s COVID death toll by about 3,700, but officials said it will not significantly change the distribution of deaths by age, race, or ethnicity.
In some neighborhoods of color, community leaders say, dozens of young families have been left without a father, a mother, or both parents.
“We have close to 50 members who have lost their breadwinners,” said Dinanyili Paulino, chief operating officer of La Colaborativa, a social services agency in Chelsea.
Those deaths reverberate across generations.
Maria Machado, 76, lost her daughter, Liz, 43, in January. The two lived together in New Bedford with Liz’s son, Julian, 10, who has autism.
Until Liz’s death, her ex-husband, Julian’s father, had helped with the mortgage and child support. Now he has full custody of Julian — Maria Machado has him on weekends — and the father no longer pays any mortgage, so Machado is struggling with the monthly $1,700 bill. Terrified of losing her home, she has barely slept since her daughter’s death.
“I don’t even go to bed. I sit on the couch and fall asleep a little bit but I have not been able to stay asleep,” she said through a Portuguese translator.
She is on a waiting list for elder housing in New Bedford, but the list is long and she worries her money will run out before then.
After his mom died, Julian would cry endlessly, “I miss Mommy,” said Machado.
She went to his school and pleaded for help, and he saw a school therapist, but she feels he needs more specialized counseling.
“I ask him questions and he says, ‘Don’t worry about me, I am OK,’ ” Machado said.
But she said she knows, just by looking at him, that he is not able to verbalize his deep pain.
Researchers, community leaders, and health experts say the impact of those deaths on families places them at higher risk for poverty, mental health problems, and challenges in maintaining adequate housing and food.
“These are the ripples that are going to happen and it’s worrying because we seem to have such a short attention span,” said Charles A. Nelson, a pediatrics professor at Harvard Medical School and Boston Children’s Hospital, and a coauthor of the study that estimated the number of children orphaned from COVID.
Shortages of mental health professionals were widespread before COVID, but the pandemic created an avalanche of anxiety and depression, exacerbating the need, especially for culturally diverse therapists.
“I am reaching out through the schools, through my insurance company, for help for my daughter, and my son needs [counseling], too,” said Barnett, an assistant nursing director at a rest home. She has managed to stay ahead of the mortgage since her husband’s death. But things are tight.
“I would pay out of pocket. I would go into debt as any parent who loves their child would,” said Barnett. “But I haven’t found one person taking new clients.”
Early in the pandemic, as COVID was racing through the rest home where Barnett worked, she was terrified she might infect her daughter, so she sent her to live with an aunt for five months.
“She is traumatized from being sent away, traumatized from COVID, and traumatized by losing her father,” Barnett said. “And I’m not available because I’m working.”
Across Massachusetts, initiatives are underway aimed at mitigating the mountain of need COVID created for many of these families, from child care and affordable food to mental health counseling. Organizations are also learning lessons from the heavy losses sustained during the pandemic and trying to close gaps in the health care system that led to such disparate outcomes.
The child mental health task force for the Massachusetts chapter of the American Academy of Pediatrics is meeting with leaders from all the mental health training programs in the state and discussing what needs to be done — such as bolstering tuition assistance or college loan forgiveness — to help recruit more applicants, especially culturally diverse ones, said Dr. Michael Yogman, a pediatrician at Cambridge Health Alliance, who chairs the task force.
“It’s so important in mental health care to see a provider who understands your culture, who has that kind of sensitivity and lived experience,” Yogman said. “Talk about a gap throughout the health care workforce, but most accentuated in child mental health.”
Other initiatives to help young families are focusing on food as prices soar, especially for nutritious fruits and vegetables.
“The pandemic created this tremendous set of challenges,” said Greg Wilmot, chief executive of the East Boston Neighborhood Health Center, which serves several Hispanic communities.
The organization, which prepares, packages, and delivers over 100,000 meals a year to seniors, recently bought a new building to double, and perhaps triple, the operation so it can extend the service to working families by providing weekly nutritious frozen meals.
At La Colaborativa in Chelsea, the food pantry is pivoting from just providing to teaching, too. It also recently bought a new building that will house kitchens for cooking classes to help residents, largely Hispanic, learn how to cook healthier meals — a lifeline for families who have lost a parent, especially those now led by teenagers.
“So, if we have donations of spinach, our members will understand what to cook and how to cook it,” said Paulino, La Colaborativa’s chief operating officer.
The initiative may also help lower rates of obesity and diabetes, which are higher in the Hispanic community, and place people at higher risk of severe illness from COVID and other health problems.
Researchers at BU who analyzed the state’s COVID deaths did not have sufficient data to assess the root causes of the significant disparities they found. But they said differences in underlying health conditions, unequal access to medical care, and more exposure to the virus as many in communities of color worked the front lines in health care, transportation, and retail could, in part, explain the disproportionate death rates.
To improve access to medical care, organizations that serve communities of color often tapped clergy and trusted community leaders to knock on doors and talk one-on-one with people to bolster trust in the health care system, including COVID testing and vaccinations.
They now hope to expand that approach to other diseases.
“Think about that same approach if we did that with diabetes, asthma, colorectal and breast cancer screening,” said Manny Lopes, chair of the Boston Public Health Commission Board and an executive vice president at Blue Cross Blue Shield of Massachusetts.
Dr. Charles Anderson, president and chief executive of the Dimock Center in Roxbury, said he is seeing a renaissance of public and private partnerships in Massachusetts, born from the darkest days of the pandemic.
“There are a lot of big business owners and foundations who understand the interconnectedness of all of us,” Anderson said. “I am having conversations with individuals who want to make sure we seize this moment, and that we have initiatives that are big and bold and transformative so this doesn’t happen again.”
Wilmot, from the East Boston Neighborhood Center, sums it up this way: “If we know where the deaths have been, and the trickle-down effect, hopefully we can avoid some of the issues we know are going to come.
“If we are proactive enough,” he said, “we get to change the way this story ends.”