Cassandra Gentry, 68, has lupus and takes medications that suppress her immune system. She is also raising two grandchildren, and she’s been especially worried since Monday, when a pharmacist handed her medications to her and urged her to lie low: As an older person with underlying health conditions, she is at high risk of dying of the novel coronavirus if she contracts it.

“It seems like it’s targeted at the older generation,” said the District resident, who lives with her 9-year-old granddaughter, whose father died a few years ago, and her 14-year-old grandson, whom Gentry has raised since infancy.

As the coronavirus ravages the world, older people and those with health problems are being warned to self-isolate to avoid catching the virus that causes covid-19, which is exceptionally lethal for them. Children, on the other hand, are believed to be less seriously affected but may play a major role in spreading the virus. And so, like millions of grandparents across the United States who are primary or critical caretakers for their grandchildren, Gentry faces a quandary: Caring for herself is at odds with caring for them.

And it raises a horrible question.

“If something happens to us,” she said, “what happens to our children?”

More than 6 million children in the United States live with a grandparent, and about 2.4 million live in a household headed by grandparents without a birth parent in the home, according to Generations United, a national organization that advocates for multigenerational families.

One in four children under 5 are looked after by grandparents while parents work or attend school, according to a report based on data from the 2010 Census.

And many of these families have relied on now-shuttered school systems to provide both care and food for children during the day.

“We’ve seen the advice that grandparents should stay away from grandchildren and they should connect through technology — but if they’re living with them, they can’t,” said Donna Butts, the organization’s executive director.

Gentry has been leaving her apartment at Plaza West, an apartment complex in the District dedicated to grandparents raising their grandchildren, to buy groceries and take her grandchildren to pick up free lunches from school. She is grateful she has them with her and is not isolated alone at home. But she realizes this could put her at higher risk of exposure.

“Now they’re saying, ‘Don’t hug your kids,’ that’s all over my website this morning,” she said. She looked over at her 9-year-old granddaughter, Jada, who was wearing a green St. Patrick’s Day headband.

“She was in her room last night but when I woke up this morning she was in the bed up under me,” she said. “That’s a hard one. We’re so close.”

Filling a critical gap

The fact that grandparents and relatives across the country fill a critical gap for parents who can’t afford the high costs of child care reflects a failure in the system, said Vicki Shabo, a senior fellow at New America’s Better Life Lab and an expert on gender equity and work.

“The reality is that until Congress acts and passes the emergency legislation that they’re thinking about or are considering to help parents deal with school closures, many parents may have no alternative but to risk the health of grandparents and send them there,” Shabo said.

“[It] just shows the ways in which our care infrastructure and our work infrastructure need to be brought into line with what families are facing.”

The nation’s opioid crisis has increased the ranks of grandparents providing care. Magdalena Andreozzi of West Warwick, R.I., has been raising her 6-year-old granddaughter since she was 18 months old as her daughter has battled addiction. On Friday afternoon, she was stunned to learn that school was closing because of the coronavirus.

“I’m just getting over an eight-week stint of walking pneumonia and then I’m hit with this,” said Andreozzi, 57. “Honestly, I’m scared. . . . How do I take care of my grandchild without compromising myself?”

Andreozzi runs a nonprofit called Grands Flourish that supports people raising grandchildren in the state, where she said around 14,000 children are being cared for by grandparents.

“We’ve had an onslaught of calls from grandparents who have questions and concerns and I don’t have a lot of direction to give them because I don’t have a lot of direction myself,” she said. “School is respite care in a way; it allows them six or seven hours a day to do part-time jobs, to go shopping.”

Many of them are fostering or in the process of adopting their grandchildren, which may make them hesitant to seek care if they get sick, as government authorities can remove children in an environment they deem unsafe.

“It may be that grandparents won’t be as forthcoming about how they’re feeling because they’re worried they’re not able to offer a safe, clean environment,” Andreozzi said.

Adding to the stress is the fact that children in such households are often emotionally vulnerable. “They are more likely to have lived through traumatic times,” Butts said. “They may have mental health issues or physical disabilities. Given the tone in the country where people are reacting with deep concern, the children’s anxiety levels go up. It’s tough because they have to be calming themselves and calming their children at the same time.”

The danger to grandparents isn’t equal across the board; families must consider the age and the health of the grandparents and the independence level of the children, Butts said. “Some grandparents are 50 years old and healthy. Some are 45 and compromised. Some are 85. Some kids are younger, some are older.”

Keith Lowhorne, 63, and his wife, Edie Lowhorne, 56, have been raising their three grandchildren outside Huntsville, Ala. Their daughter was a heavy drug user, and all three children, now ages 6, 5 and 3, were born addicted to opioids. The grandparents adopted them.

For the past two decades, Keith Lowhorne has battled sinus infections and bronchitis that turn into pneumonia, putting him at higher risk for a more serious case of the coronavirus. “If Keith were to get sick, I couldn’t go visit him at the hospital,” Edie Lowhorne said. “I’d be here taking care of the kids by myself.”

The children have stayed inside since schools closed, but the oldest has ongoing therapy appointments to treat post-traumatic stress disorder and other mental health issues. Edie Lowhorne has called the office begging to do the appointments over the phone, but the office staff has said the child must continue to attend in person.

“I’m like, well, do I just strip us down in the garage and wipe us down in hand sanitizer and we both run to different showers?” she said.

Limited services are a worry

Grandparents in neighborhoods with limited access to services are at increased risk, said Marla Spindel, co-founder and executive director of DC KinCare Alliance, which advocates for relative caregivers raising at-risk children. Most of the approximately 200 families they serve live in Wards 7 and 8 and face a shortage of grocery stores and gaps in access to health care and pharmacies.

“I‘m worried about their ability to get food,” Spindel said. “They don’t necessarily have transportation. A lot of them don’t have cars. They can’t just go to another suburb to see if another grocery store has food.”

Her organization pushed for changes to an emergency D.C. Council bill to help with subsidies for grandparents, and waive the six-month eligibility period for the Grandparent Caregiver and Close Relative Caregiver Programs, which provide monthly financial assistance to District residents raising their grandchildren or relatives. But the recommendations were not included in the measure that passed Tuesday.

Some grandchildren old enough to understand the gravity of the disease are worried for their grandparents.

Dyante Long, 22, of the District is concerned about his 63-year-old grandmother, who helped raise him and took full custody of his 10-year-old brother, Zion, when their mother died two years ago.

“She mingles with all the grandparents, and you never know where they’re coming from or who they’re interacting with,” he said, adding that his grandmother has also continued to go into work cleaning a downtown building where there has been talk that people tested positive for the coronavirus. “I probably need to have a conversation with her.”

Seventy-two people in the District had tested positive as of Thursday evening; limited information was available on where many of them may have contracted the virus.

Even for families who can figure out a way to isolate the grandparents, the separation can be stressful. Koch’s father-in-law lives two blocks away from their home in the District and typically spends several hours each day caring for their 5-year-old son. But he has asthma, and the family has decided to isolate.

“This morning we talked to him on FaceTime and my son really just melted down that we couldn’t see him in person,” she said.

In Los Angeles, Laura Plotkin, 74, had been picking up her grandson from preschool three days a week while her son-in-law and her daughter are at work. About a week ago, her daughter “fired” her from the job for her own good.

“It’s been really frustrating because I’m retired and I could really help out, but I can’t,” Plotkin said. But Plotkin has been fighting bronchitis, and her daughter was worried.

“I thought she was being slightly overly concerned,” she said. “We weren’t quite there yet, and then I started realizing when I read more that she was 100 percent right.”

On Friday night, when the extended family normally gets together for Shabbat, Plotkin and her husband joined via live video, as did their son-in-law’s father, whose wife died recently of West Nile virus. “He’s of course in grandpa jail, too,” she said.

So they held up the iPhone and said prayers together, the separated grandparents were able to see each other’s images on the phone screens held by their children.

“When we got off the phone I just had tears in my eyes.”