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The Hidden Pandemic Behind COVID-19

National Domestic Violence Hotline: 1-800-799-7233 (SAFE). Text 'LOVEIS" to 22522. Chat online at
In the U.S. and abroad, cases of domestic violence have tracked upward on the heels of the coronavirus. As prolonged social isolation and breakdowns in normal reporting have worsened conditions, experts say, clinicians are often the last line of defense. Cases of domestic violence, child abuse and sexual exploitation in the time of COVID-19 apear to be on the rise in emergency rooms and health clinics across the country since March, experts said in a recent HRSA webcast.

While official abuse complaints filed by victims in recent months have tapered off, reports from providers on the ground have risen sharply, said Dr. Kimberly Chang, a staff physician at a federally qualified health center in Oakland, California,​​ and a leading national voice for victims of intimate partner violence, child abuse and human trafficking.

"COVID-19 has worsened all of these things and it's showing up much more starkly in the clinical setting," Chang told more than 1,000  isteners in a recent webcast co-hosted by HRSA's Office of Women's Health, the Office of Regional Operations staff in ​San Francisco and the HHS Administration for Children and Families.

The Office of Women’s Health leads HRSA's Intimate Partner Violence strategy (PDF - 428 KB).

"In terms of exploitation, financial situations are making everything harder for patients already living precariously on the edge," Chang said, adding that doctors, nurses and other providers are often the only people in whom patients can confide.

Kimberly S.G. Chang, MD, MPH. Family Physician, Human Trafficking and Healthcare Policy Fellow, Asian Health Services (Oakland, CA). Vice Speaker of the House, Executive Board of Directors, National Association of Community Health Centers. Committee on Women's Rights, American Public Health Association.

Experts agree that with many business offices and state and local agencies closed or short-staffed, fewer surveillance and monitoring agencies are available to detect and report suspected domestic violence.

Leiana Kinnicutt of Futures Without Violence – a 35-year-old non-profit funded by HRSA and other HHS agencies  – reported that street-level caseworkers are taking extraordinary measures to pierce the veil of quarantine.

From wearing purple scarves – the official color of the movement – to slipping business cards into grocery bags and sticking outreach information on pizza boxes, advocates are seeking to reach women, children and men in distress.

Domestic violence hotline "calls are up from March and April, and about 50 percent are from minors asking for help and information," she added. "This suggests that violence is escalating and increasing for many. There is a need for us to get creative in our responses."

From left, Elizabeth Darling of the Administration on Children, Youth and Families; Leiana Kinnicutt and Anna Marjavi of Futures Without Violence.
From left, Elizabeth Darling of the Administration on Children, Youth and Families; Leiana Kinnicutt and Anna Marjavi of Futures Without Violence.

Commissioner Elizabeth Darling of the Administration on Children, Youth and Families noted that her agency funds some 1,600 emergency shelters, crisis hotlines and state and local counseling programs under the Family Violence Prevention and Services Act of 1984. Dedicated to underserved communities, it is a leading ​source of federal funding for domestic violence shelters and programs, and a natural partner of HRSA.

Together with the Bureau of Primary Health Care and Office of Women's Health, she said, her agency is attempting to build local coalitions that more closely link caseworkers, clinicians, police, shelter operators, counselors and housing authorities to deal with the crisis at home and at large.

Speakers agreed that health centers are one of the few places that people are still allowed to go under shelter-in-place restrictions, and telehealth opens new avenues for those being abused to discretely report violence behind closed doors.

"Healthcare providers really might be the first and perhaps only person reaching out to a patient, or the first person the patient has been allowed to speak to outside of their home," said Anna Marjavi of Futures Without Violence. "You might also be the only person who has shared a kind word with the patient in the past few weeks or months."

From a patient's perspective, added Dr. Chang, the desperation has been quietly mounting throughout the COVID-19 pandemic – from immune-compromised patients "petrified to go out for supplies and medication" for fear of contracting the virus, to kids going hungry with the shutdown of school meal programs.

Language can also be a barrier to reporting domestic violence. The clinic where she works serves 50,000 patients in the East Bay area who speak more than 14 languages. Many are elderly, or they're essential workers at grocery stores. They're delivery drivers, warehouse clerks, nursing assistants, "and they can't lose their job because their boss disallows sick leave."

"Issues of isolation … are all magnified during this time," she added.

In Oakland, as in many other communities across the country and around the world, the day-to-day pressure fueled by COVID-19 too often ignites domestic violence.

Experts have characterized...domestic violence
during the COVID-19 crisis as a "ticking time bomb"
or a "perfect storm" felt around the globe. 

-U.S. Council on Foreign Relations.

An estimated 42 million adults in the U.S. -- including 1 in 4 women and 1 in 10 men -- are affected by domestic violence in their lifetime, the CDC has reported.  The economic toll of the violence HRSA Exit Disclaimer is likewise enormous: an estimated $3 trillion over the course of victims' lifetimes in lost productivity, housing transience, behavioral health issues and more.

Partner violence has been linked to a range of chronic health conditions, substance use disorders and suicide. Studies also have shown an association between pregnancy-related homicides and intimate partner violence.

For those who are in immediate need of confidential help or want to learn more, contact the National Domestic Violence Hotline HRSA Exit Disclaimer, or call 1-800-799-7233.

HRSA's Intimate Partner Violence initiative is a collaboration between the agency and the department's Administration for Children and Families, the Office of Adolescent Health and the Office on Women's Health, in partnership with HHS grantee, Futures Without Violence – which runs the National Health Resources Center on Domestic Violence HRSA Exit Disclaimer.

Listen to the webcast: Sheltering In Place, Violence, and the Healthcare Response HRSA Exit Disclaimer.

National Domestic Violence Hotline: 800-799-SAFE (7233)

800-799-SAFE (7233)
Text LOVEIS to 22522
Chat at HRSA Exit Disclaimer

National Runaway Safeline: 800-RUNAWAY (786-2929)

800-RUNAWAY (786-2929)
Email Form: HRSA Exit Disclaimer
Chat: HRSA Exit Disclaimer
Discussion Forum: HRSA Exit Disclaimer

Stronghearts Native Helpline: 844-7NATIVE (762-8483)


844-7NATIVE (762-8483) HRSA Exit Disclaimer

National Human Trafficking Hotline: 1-888-373-7888

Text HELP to 233733 (BEFREE)
Chat at HRSA Exit Disclaimer

Date Last Reviewed:  June 2020