The deadly epidemic that isn't over

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For Americans under 20, an epidemic much deadlier than COVID-19 has raged over the last three years. Deaths among those aged 1 to 19 surged 20% — driven by an increase in car crashes, suicide, homicide and drug overdoses.

The combined toll of behavior-related deaths on children and teens hit home after a March report by the Center on Society and Health at Virginia Commonwealth University. Last week, a Wall Street Journal story fleshed out that data with stories — a mother finding her teenage son dead from fentanyl poisoning, an honor student taking a bike ride with friends and being fatally gunned down.

How much of this is a result of the pandemic — or the government's disruptive reaction to it? Teen suicides and drug overdoses had been on the rise over the past decade, but that rise accelerated during the pandemic. Deaths on the road had been decreasing, but since 2020 they rose more sharply than any other time on record. And gun deaths overall — not only of minors — rose an astonishing 50% during the pandemic years.

Many of us have witnessed more recklessness and speeding on the roads. This casual disregard for life feels at odds with the early "all in this together" pandemic phase. But it fits a pattern seen in other kinds of disasters, said Seattle University psychologist Kira Mauseth, who specializes in helping people in disaster-torn areas.

She's gained expertise in disasters by working in war zones and studying Haiti after the 2010 earthquake reduced much of Port-au-Prince to rubble. She said that about six months after a disaster, a disillusionment phase sets in, during which mental health deteriorates and dangerous behavior increases.

In the first few weeks after a disaster, she said, people go through what are called a heroic phase and a honeymoon phase, when people come together and celebrate those who make sacrifices. The disillusionment phase comes when people realize all their efforts can't fix the problem. It's during this phase that some people start to rely more on the brain's limbic system — a center of emotion and instinct — leading to more impulsive, unthinking behavior.

This is something that can affect both children and adults — and since the pandemic, impulsive adult behavior has led to some of the deaths of minors for car crashes and gun violence.

With COVID-19, the disillusionment phase was especially acute. Families and groups of friends were torn apart over disagreements about holiday gatherings and weddings or travel plans. Social media drove people apart more often than it acted as a substitute for real social interaction. Bitter political polarization intensified.

And we didn't get just one disillusionment phase. Mauseth calls the pandemic a disaster cascade. The first disillusionment period came around Thanksgiving of 2020, she said — compounded by lonely holidays, darker days and a new winter surge in the virus. Hope that the vaccine would finally end the crisis was followed in the summer of 2021 by a devastating letdown as the delta wave surged, and thousands of vaccinated people caught the virus. Another wave of disillusionment hit in early 2022 with the omicron wave.

Mauseth said this was all harder for young people — staying isolated for six months might feel like an eternity to a 14-year-old. And in many parts of the US, it wasn't just six months. The isolation period was instead open-ended. Public health officials often said we could go back to normal once the virus was "under control" — a vague goal. That made it hard to move from disillusionment to the final phase, recovery. One of the key ingredients needed for recovery: connecting to others.

Stanford University psychologist Keith Humphreys, an expert on addiction, worries that some people even now are remaining isolated out of habit. And isolation is a big risk factor for mental health problems and drug abuse.

Other factors are fueling the rise in teen overdose deaths, he said, including an ever-growing supply of illegal drugs and pills that are spiked with fentanyl. He said we need more mental health services, more control over supply, and more community activities where people can connect in person. Attendance at public meetings, civic organizations and houses of worship have long been in decline, leaving a need for other ways to bring people together.

The good news is that for many people, the recovery phase has finally arrived. People have resumed the activities needed for connection. But that's not enough to turn around the pandemic's impact on child mortality. Instead, we'll need a concerted effort to curtail the proliferation of guns, illicit drugs and reckless driving. Kids are counting on it.

Faye Flam is host of the "Follow the Science" podcast.