The night before I was able to get Ivonne on the phone, she was dealing with a patient in crisis: A young teenager had tried to commit homicide against his little sister. The patient’s brother had attempted suicide weeks earlier. While Ivonne, a pediatrician in Central Texas who for professional reasons declined to give her last name, works with low-income and middle-class patients, she explained this troubled family is part of the latter: a two-family household, stable before the COVID pandemic hit. Things for the two brothers weren’t perfect by any means — they were already struggling with mental and behavioral health concerns — but the pandemic exacerbated all of these issues for them and so many more.

I spoke to Ivonne on her way home from work, her only free moment in the day to have a conversation about what the pandemic has done to her practice and her patients, from the tiniest babies to teenagers. Ivonne’s patients are part of a larger phenomenon that is only starting to become clear.