AVION SIMON: That first week that everything happened. I was so stressed out. I had so much built up. I was exhausted. I felt like I had the weight of the world on my shoulders.

NARRATION: When Avion Simon’s mom fell sick with Covid last year and went to the hospital, Avion stayed home and cared for his siblings, C.J. and Momo, while juggling his own schoolwork, his job, and football.

AVION SIMON: You could tell how bad she was hurting. I’ve never seen my mom, like, that sick before. And so, I was helping take care of her and the kids. I said everything’s going to be okay. Don’t worry about anything. You know you have me. And I’ll always be there for you all.

They figured out that she had double pneumonia in both of her lungs. And that’s when it got worse. I got to see her, but she couldn’t talk to me or anything. I couldn’t recognize my mom. She didnt look the same as when she left the house that Tuesday. And then that morning at 1:14 she died.

I feel empty. You have to wake up knowing you don’t have any parents. And go to sleep knowing that you have to, you don’t have any parents. That’s the hardest part for me. Why did that happen to me and my family? Like, why mine? I don’t, it just, it don’t, I don’t get it.

NARRATION: Across the country, more than 200,000 children and teens like Avion, C.J., and Momo have lost a parent or caregiver to Covid. Roughly 65% of them are children of color.

CHARLES NELSON (DEVELOPMENTAL NEUROSCIENTIST, HARVARD UNIVERSITY): I think there’s nothing like this that compares to the sheer number of kids that have lost caregivers at, at, basically at one moment in time.

NEWS REPORT: In the last two years, 200,000 children have lost a parent or a primary caregiver because of Covid.

CHARLES NELSON: We have to think, what are their psychological needs going to be? And how will those needs be met? Because otherwise those psychological consequences have physical consequences as well. Long term, these effects could be with them for the rest of their lives.

NARRATION: Over the last 25 years, scientists have come to understand that adversity in childhood can have long term impacts not only on mental health, but also on physical health. That relationship was first discovered back in the 1980s through research Dr. Vincent Felitti started at Kaiser Permanente.

DR. VINCENT FELITTI (CO-PRINCIPAL INVESTIGATOR, ADVERSE CHILDHOOD EXPERIENCES STUDY): We started with a very detailed medical history and comprehensive medical evaluation and then followed for the next 20 years.

VINCENT FELITTI (DISPLAYING THE QUESTIONNAIRE): So this is the female health questionnaire, health appraisal questionnaire.

NARRATION: The landmark study looked at ten kinds of adverse childhood experiences, or ACES, among a group of 17,000 people, ranging from abuse to exposure to a parents mental illness, to divorce.

VINCENT FELITTI (READING FROM THE QUESTIONNAIRE): I have been physically abused as a child, verbally abused as a child.

NARRATION: And matched them to risky health behavior and disease later in life.

VINCENT FELITTI: So we were able to look at specific questions like if a person has any of these adverse childhood experiences, how does that affect the likelihood of their having an autoimmune disease somewhere over the next 20 years or their getting cancer over the next 20 years or becoming diabetic or becoming chronically depressed, et cetera?”

VINCENT FELITTI (READING FROM THE QUESTIONNAIRE): Additional diseases, high blood pressure.

NARRATION: The results stunned Felitti along with his research partner Robert Anda from the Centers for Disease Control.

VINCENT FELITTI: Adverse childhood experiences have a major and profound effect on our most prevalent public health problems. For instance, we found a high relationship to cancer. And our initial thought was, yeah, well, you know, okay. So you have a terrible childhood so you end up smoking two or three packs a day, of course. But that was just a very little piece.

NARRATION: The rest of it was even more shocking even without risky behavior, ongoing or repeated exposure to adversity increased the likelihood of later disease.

VINCENT FELITTI: What struck us was that we suddenly had an explanation for medical problems that have been intractably difficult to deal with.

NARRATION: Felittis findings had vast implications for understanding the risk and for prevention of many common diseases in the U.S.

VINCENT FELITTI: I assumed that that was going to catch on like wildfire in medical circles. It did not. People didnt want to hear about it lest they have to deal with it. The comments that I hear commonly are, you know, if I wanted to be a damn shrink, Id have been a shrink.

NARRATION: But over the years, the idea that early adversity can lead to disease has firmly taken root, as researchers have made strides in understanding how the brain and the body respond to chronic stress. In the face of a perceived threat, the body’s stress response system turns on and the brain releases hormones like cortisol and adrenaline that flood the body. The heart rate speeds up, and blood pressure increases. Normally, the system switches off when the threat recedes.

ERNESTINE BRIGGS-KING (CLINICAL COMMUNITY PSYCHOLOGIST, DUKE UNIVERSITY): But when those systems are repeatedly left on, they don’t shut off, it begins to have a negative impact. It’s altering your physiology. Immune systems become weakened. And the likelihood of chronic disease, cancers and heart disease, go way up.

NARRATION: Beyond the original ten ACES, researchers are exploring whether a wide array of childhood experiences, like poverty, community violence, and racism, can affect the body in the way that abuse or a parents divorce can.

NEWS REPORT: Kids growing up in low-income families are especially vulnerable to toxic stress. Today that’s nearly half the children under 6 in America.

ARCHIVAL (KQED, 2-8-14):
NEWS REPORT: When children are regularly exposed to the stress of poverty, violence, and substance abuse, it can have a lasting impact on their mental and physical health.

NARRATION: Researchers are also looking at how to turn off, or calm down the bodys stress response system.

CHARLES NELSON: There are protective factors and things that we can do to help those children not develop those psychological and physical health consequences.

NARRATION: It can sometimes be as simple as creating a supportive environment, or providing comfort to a child.

CHARLES NELSON: The reason this has such a big effect on a child’s biological makeup is that easing a child’s anxiety, helping them negotiate and manage stress reduces stress hormones and reduces the physiological consequences of stressful experiences. It kind of calms things down. And as a result, the body doesn’t suffer as much.

NARRATION: But as Covid-19 spread, killing a million Americans, children often lost the very person who played that role.

CHARLES NELSON: The rug has been pulled out from underneath them. And that buffering relationship isn’t there. And the question is, what is a substitute for that buffering relationship? We need to think of this as a national disaster that needs our attention right now. The longer we wait, the greater the risk these kids will wind up suffering for years and years to come.

NARRATION: Without an effective national strategy to help children who have lost caregivers to Covid, families around the country are making do as best they can.

ERNESTINE BRIGGS-KING: There are things that we know work and work well, that minimize the impact of these traumas. Having connections, being connected to someone else, a teacher, a coach, a family member, may help you navigate a loss such as that.


NARRATION: Over six months have passed since Avion’s mom died. Two years before that, in 2019, Avion’s stepfather died. Now, Avion helps care for his siblings who have moved in with their grandmother. But there wasn’t room for Avion, so he lives now with his best friend’s family nearby.

AVION SIMON: Theyre strong and smart babies. But, yeah. I have noticed changes in them. Mo, she gets sad sometimes. She’ll call me and I’ll just talk to her at night. She just says, I miss mama and stuff like that. And I just tell her I miss her too. And I just talk to her about, like, how her day went and stuff and get her off the topic and make her, like, go to sleep.

C.J. SHELBY (SPEAKING TO AVION): Do you want some salad, bub?

AVION SIMON: Uh-uh, Im fine. Thank you.

NARRATION: C.J. and Momo started seeing a counselor at school, who helps them work through their grief. Avion turns to his friends and working out.

AVION SIMON: When I get like, really, like, like, to like, explode, I just go to the gym and let it out with working out. It’s somewhere where I feel safe. Football, it’s another getaway place. I can just let loose and I don’t have to think about anything. I just play my game and do what I need to do.

NARRATION: Avion is going to college next year fulfilling a dream he and his mother shared. Then, he plans to return home, get an apartment, and raise C.J. And Momo.

AVION SIMON (DISPLAYING HIS PHONE): I put this photo on my lockscreen so I could wake up in the morning and see her face every day. Really. And it keeps me motivated, keeps me going.

If I have to struggle for a little bit for them to be, for them to have what they want, that’s what I’m going to do because that’s what my mom and dad did for me when I was growing up. I just want them to be happy and not have to worry about anything else the rest of their lives.