In 2020, the number of kids who lost a parent was 20% higher than normal.

We have passed through a year of bereavement, a year of grief. The latest numbers, published in a research letter in JAMA found that the excess mortality in the United States from March 1st, 2020 to January 2, 2021 totaled 522,368 individuals. Deaths were 22% higher than expected over that period – the typical yearly variance is about 2% in either direction.

Each of those deaths ripple through the lives of those left behind. A simulation study in the Proceedings of the National Academy of sciences found that each COVID-19 death left nine close family members bereaved.

I think the most succinct way I’ve heard the effect of the death of a loved one described came from C.S Lewis who wrote “The death of a beloved is an amputation”.

It’s an apt metaphor. Not just because of the profound loss, but because of how it changes your life forever – how, though normalcy may return to some extent, the loss is ever-present, shaping how you interact with the world.

For children who lose a parent, the loss is life-alerting and can be life-defining. Kids who lose parents at a young age are substantially more likely to have depression, poor educational outcomes, death from suicide and even unintentional death.

According to this research letter, published in JAMA Pediatrics, from February 2020 to February 2021 37,337 children in the US lost a parent to confirmed COVID-19 disease. If we look at excess mortality during the pandemic, that number rises to 43,027.

Some children, of course, have lost both parents.

43,027 kids growing up without a parent. The authors calculate that’s about 20% higher than the number of kids who lose a parent during a typical year.

Like many things in this pandemic, the grief is not distributed evenly. Black children comprise 14% of children in the US, but 20% of those who have lost a parent to COVID-19.

As providers of healthcare, we have a responsibility is to those left behind. How will we care for these kids who, in this past year, have faced a fractured educational system, social isolation, and the worst loss any of them could imagine? The authors call for the creation of a national child bereavement cohort – to support these kids as they grown and develop.

Let’s also remember that the pandemic is far from over. With highly transmissible variants in a race against highly-effective vaccines, its hard to predict where the case counts may go in the future, but one prediction is certain: there are children out there right now who will lose a parent to COVID-19. Preventing new infections and new deaths may save more lives than we appreciate.

A version of this commentary first appeared on medscape.com.