At a St. Louis hospital in early April, a baby was admitted with 15 broken ribs. Physicians believed the injuries likely resulted from repetitive stomping, by a much larger adult. The case was deemed child abuse. The infant died. 

At the same hospital, Dr. Jamie Kondis provided care to five children with traumatic head injuries over the span of a week and a half. Two died, and two were deemed severe cases with grim outcomes. While Dr. Kondis, a child abuse pediatrician at Washington University in St. Louis, typically sees one or two serious head traumas in a month, she says cases are more severe since the Covid-19 pandemic forced families behind closed doors in March. 

Studies have shown a pattern of increased child abuse after natural disasters, such as the spike in sexual violence after Hurricane Katrina. Abuse and neglect also heightened after the 2008 recession, resulting in a surge of infant head traumas. National crises compounded by food insecurity and widespread anxiety trigger abuse in homes. “We know that rates of abuse go up during really stressful periods,” says Dr. Kondis. “We’re already seeing that again now.”

As physicians cope with more deaths and more severe cases of abuse in hospitals, the concern is how many cases are not being brought in for care. Emergency room visits have dropped 50 percent at New York Health + Hospitals, likely due to fear of Covid-19 exposure. Medical professionals believe they are only catching the very worst of injuries. “I’m sure there’s a lot more minor physical abuse and sexual abuse going on that we’re just not seeing,” Kondis says. “The concern is that people aren’t reporting it.”

While child abuse hotline reports are down nationwide— in New York City, reports to the Administration of Child Services (ACS) plunged 54 percent— this is likely because educators are the primary source of reports. 

Crisis hotlines differ from reporting hotlines, in that they help with finding resources and safety planning; reporting is an option, but these are not the hotlines intended solely for law enforcement response. In stark contrast to the decline in ACS reports, the crisis hotline provided by the Rape, Abuse, and Incest National Network (RAINN) is currently receiving the highest recorded number of reports from young people: over half of incoming calls are from minors. 67 percent have identified their abuser as a family member and 79 percent were living with that person. Camille Cooper, RAINN’s VP of Public Policy, says that in 1 of 5 cases, the abuse is severe enough that immediate police action needs to be taken. “That’s really concerning,” she says. 

Barring face-to-face contact with counselors and teachers, survivors are not always sure where to go; RAINN provides information on how to report crimes and find a safe place to shelter. On May 19, a bipartisan group of Congress members cited the hotline stats in a letter to Betsy DeVos, urging the Secretary of Education to add a reporting function to online learning platforms. 

At the virus’s epicenter, severe cases could continue to climb. In New York City, 1.1 million public school students are staying home, and summer youth programs are canceled. Children in dysfunctional homes often rely on oases like libraries, museums, and public pools during June and July; these are also closed. With programming no longer available, at-risk children are losing the resources they rely on for relief— and their suffering remains invisible. 

Even in non-pandemic times, abuse prevention is difficult. Cooper draws a distinction between sexual abusers, who are prone to reoffending, and those who abuse and neglect children.  When it comes to the latter, Kondis says, at least one preventative measure can be taken. “The only thing that’s been shown by research to really be preventative is home visitation programs— and those things are suspended right now.” While virtual programs are functional in some ways, there is no proven evidence yet that they can work in the same way for child services workers. “You can’t undress or weigh a child virtually,” Kondis says. Remote visits also may not paint a full picture of a situation in a home— and crowded quarters could dissuade victims from speaking candidly of a precarious situation. 

Limited access to technology is also a threat. In New York City, tech disparities were unveiled as education department officials struggled to provide iPads for students. In April, Gothamist found that five weeks after New York City moved to remote learning, 19,000 students were still without the devices they had requested.

Perhaps the most unique threat presented by Covid is the difficulty providing basic human services in the absence of human contact. When disaster strikes, on-the-ground strategies are seemingly imperative; during natural disasters, childrens’ service workers are able to address basic needs, providing medicine and alternative places to live. But the pandemic makes these physical connections much more risky.

Scientists worry the pandemic could lead to a collective physiological post-traumatic stress response in the future. For children suffering from heightened Covid-related abuse, combined with the lack of intervention and rehabilitation resources, long-term implications could be worse. As the country begins to re-open, Cooper says officials are also anticipating an influx in reports. “Children are going to be outside the home and having more access to their support system, and you’re going to see an uptick in formal reports to law enforcement.” 

In a time when life for all has been completely unhinged, children are among the most vulnerable. Kondis advises community members to continually check in on youth. “People need to be really vigilant right now if they think anyone’s being abused. Don’t hesitate to report it. If they were being abused before, they’re still being abused now.”

RAINN Crisis Hotline: 800-656-HOPE