Before he died at Bronson Methodist Hospital in Kalamazoo, Michigan, 30 hours after being physically restrained by staff at his foster care group home, Cornelius Frederick was described by family members as “a boy’s boy”: Hyper and rambunctious, with a penchant for playing jokes and pranks. He was sweet, too.

On April 30, Frederick was put into a hold after throwing a sandwich at Sequel Youth & Family Services’ Lakeside Academy in Kalamazoo, a residential facility that serves at-risk teen boys who need intensive behavioral and mental health therapy. According to the family's attorney, Frederick started yelling "I can't breathe!" before passing out.

After being transported to the hospital, Frederick tested positive for the coronavirus. The other youth at Lakeside were then tested, revealing that nearly 40, plus nine staff members, had the virus.

Frederick’s death – and the realities of trying to social distance in a facility packed with teenagers – highlights one of the many problems facing America’s foster care system amid the pandemic.

Multiple other group homes in the U.S., including in Nevada, New York, Pennsylvania, Michigan and Missouri have also reported outbreaks.

Meanwhile, across the country, foster parents are in short supply, at-risk kids aren’t able to get in-person services they need and courts are closed, leaving adoptions and family reunifications in limbo. Only a handful of states have issued moratoriums on aging out of the system, which means 18 and 21-year-olds could suddenly find themselves without a home or job in the worst economy in decades, with 36.5 millionAmericans filing unemployment claims since March.

Additionally, reports of child abuse have plummeted, which experts suspect is not because abuse has actually declined but because so many at-risk children are not in regular, in-person contact with mandatory reporters such as teachers, school nurses and social workers. They worry there could be an explosion in reports as states re-open and children return to school.

“We are really worried that an already-strained system is going to buckle under the weight of the coronavirus,” says Sandy Santana, executive director of Children’s Rights, a New York-based advocacy organization that works to protect kids in child welfare and juvenile justice systems. “This may drive even more children into the system.”

There are more than 430,000 children living in foster care in the U.S., and about 10 percent of that population – typically older adolescents – lives in group residential facilities, according to Children’s Rights.

In Michigan, Frederick had been a ward of the state since 2014, after his mother passed away and his father’s parental rights were revoked, according to Jon Marko, the Detroit-based civil rights attorney representing Frederick’s family.

In the wake of his death, the Michigan Department of Health and Human services is conducting a licensing investigation into Sequel’s Lakeside program, the Kalamazoo police department is investigating the incident and the Sequel facility has stopped taking new clients.

Nationwide, Sequel services about 10,000 children and adolescents, with 2,000 of those living at facilities full-time, according to Sequel CEO Chris Roussos. Roughly 500of those kids come from out of state. On May 1, Lakeside had 125 residents. But now there are just a few left at the facility, as states have pulled out their children, bringing them home or sending them to other Sequel locations.

It’s unclear how many children in the U.S. foster care system have coronavirus. While children were originally believed to not be especially vulnerable to getting sick, young, otherwise healthy individuals have died of it. And a recent, mysterious virus-related outbreak in New York City that's infected nearly 100 children has parents and doctors worried.

The coronavirus, said attorney Marko, should be "a huge concern” for everyone who has a child in any sort of large foster care facility. Classmates who witnessed Frederick pass out rioted in response and dozens of children fled the facility, adding to the chaos.

“The information we have is that coronavirus was running through this facility and they hid it from parents,” Marko said. “There was a riot in the facility, and many of the kids ran away, and they’re spraying tear gas at these kids, some of whom have COVID-19, they’re spraying chemical agents that restrict people’s breathing. This sounds like something out of a horror movie.

“And now you have a bunch of kids who have been in this tinderbox, who were exposed and are now being sent back home and could possibly spread this disease … these kids are being exposed to serious harm.”

Roussos, Sequel’s CEO, said he was “not aware” of any staff hiding information from families, state agencies or referral agencies at any of the Sequel facilities, including Lakeside. He declined to comment directly on the incident that led to Frederick’s death, except to call the death of any resident “completely unacceptable” and that it “does not reflect who we are as an organization.”

Oregon state Sen. Sara Gelser disagrees.

Oregon had two foster kids at Lakeside, and brought them home immediately after Frederick’s death. Due to privacy laws, the state cannot reveal if either of the children tested positive for the virus, but Oregon Department of Human Services spokesman Jake Sunderland confirmed that the two are quarantined “in accordance with public health guidance from our partners at the Oregon Health Authority.”

Gelser says that in January, on a visit to Lakeside, she had a blunt conversation with Roussos about her concerns.

“It’s my belief that a kid is going to die in one of these restraints at your facilities,” Gelser told him, pointing to Sequel’s problematic history of various abuses that have led to the shuttering of multiple facilities.

Roussos brushed off her concerns, Gelser recalls, telling her he disagreed. Roussos declined to comment to USA TODAY about his January conversation with Gelser, but emphasized that his organization has done “some very good things to battle COVID-19,” including staggering recreational time, meals and therapy sessions, and isolating students who test positive. He said he feels confident about Sequel’s “very aggressive response plan” as it relates to coronavirus.

When Gelser’s prediction came true with Frederick’s death, she was horrified.

Oregon has fallen underscrutiny recently for shipping foster kids with intensive therapy needs out of state due to a lack of necessary services in Oregon; critics say this is a result of Oregon not investing in its own programs. Currently, there are 11 children still out of state, according to the Oregon DHS, but the state is working to get them all back in Oregon (they anticipate that by next week, only nine will be out of state).

Gelser acknowledges there are challenges that come with moving any foster kids, from Oregon and elsewhere, amid stay-at-home orders from governors everywhere.

“All of these things are really hard,” Gelser said. “Unless the stakes are really high to move a kid, they can’t do it until test results come back, and we know that all over, it’s hard to get testing if you’re asymptomatic. And then once you’re back, we have to find another foster home, and that increases the danger of spreading COVID.”

At Children’s Rights, Santana is worried there will be an increase in older youth being placed in group homes because those homes have beds available and states are struggling to recruit and vet potential foster parents.

“Group homes are often not the answer in normal circumstances,” Santana says. “Many of these facilities are rife with physical and sexual abuse, and now they’re breeding grounds for this disease, as well. And when you do try to separate kids for social distancing, it can feel to the kid like isolation and abandonment, which compounds their trauma.”

Many residential homes are currently understaffed,he says, as employees fear getting sick. Santana says all of this leads to one obvious solution: child welfare workers should be “really aggressive” in trying to get kids returned to their families when it is safe to do so.

Santana points to sobering stats for youth who age out of foster care: more than 20 percent struggle with homelessness almost immediately after aging out, and by the time they turn 24 years old, half of them will be unemployed.

Children’s Rights and other advocacy organizations are pushing for states to increase payments to foster parents to help mitigate the economic uncertainty for foster care youth. They’re also encouraging governors to halt aging out, and prioritize court appointments that could finalize adoptions and reunifications.

In an already chaotic time, child welfare workers are also having to beat back conspiracy theories that have wormed their way into the mainstream.

In Madera County in central California, a fake letter circulated to everyone who receives some sort of government assistance – such as medicare and food stamps – warning that anyone who tested positive for coronavirus while receiving government assistance would have their children taken away and placed in foster care. That rumor, shared via an online meme, has now made its way up to Oregon, inciting fear within the Latinx community in particular, according to Sunderland at Oregon DHS. Madera County and Oregon DHS officials have vehemently denied the claim.

All of this adds up to increased uncertainty for children who in many cases have already lived a life littered with fear and unpredictability. It’s understandable that could lead to even more challenges, says Sadaf Sheikh, who knows from firsthand experience.

Sheikh, 20, has been a ward of New York state since she was 12. Now a junior at Medgar Evers College in Brooklyn, Sheikh was supposed to officially age out of the foster care system when she turns 21 – which happens Saturday.

She’s not sure what to expect. She already lost her part-time job at K-Mart because of coronavirus-related cuts, but is focused on finishing the school year and graduating in social work as soon as possible. She’s grateful she already secured public housing, at a studio apartment in Brooklyn.

But she says it “hurts my heart a lot” to think about the thousands of kids like her, children who grew up battling tough circumstances and stigma, who now enter an even more unstable world.

“If this pandemic was not in action right now, things would have gone faster,” Sheikh says – things like court appointments and foster placements, and clarity on what it will take to age out of the system gracefully. “So many kids in foster care, they can’t fight, they can’t speak for themselves.”

Who is going to look out for them, she says, in a world struggling to look out for itself as the coronavirus rages on?

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