Preliminary data shows that reports of child abuse around the nation have plunged during the coronavirus pandemic and lockdown, according to an NBC News analysis, while experts are concerned there could be an unseen surge in abuse behind closed doors due to COVID-19 related unemployment and financial strain.

An NBC News analysis of data from 43 states and Washington, D.C., found that reports of abuse and neglect in April 2020 dropped by an average of 40.6 percent in each state from the levels reported in the same month of 2019.

Experts predicted the drop in reporting when the coronavirus pandemic was declared, noting that school closures keep children out of the view of the adults who make a fifth of all child abuse reports — teachers and school officials. At the same time, they fear the rising unemployment and other economic stresses linked to the outbreak have increased the risk of abuse and neglect. The absence of reports, however, means there’s no way to confirm a surge, despite alarming anecdotes from emergency rooms, pediatricians and hotlines.

Researchers and advocates say this lack of clarity has added urgency to a movement to put more resources into prevention, reforming a system that has long prioritized intervention and relied on mandatory reports of children who have already been hurt.

“The system that we have is reactive,” said Steven Olender, senior policy associate at the Children’s Defense Fund. “We’re suddenly very worried that everyone is at risk, instead of [having] a system where we know that we have infrastructure in place to help support and take care of families.”

What the data does — and doesn’t — show

Comparing 2019 to 2020 by month, the data shows that the monthly state totals of child abuse reports were an average of 14.2 percent lower in March 2020, 40.6 percent lower in April and 35.1 percent lower in May.

Most schools across the country closed to curb the spread of COVID-19 on March 16, and nearly all states mandated or recommended closure by the following week.

By the end of that week, half the country’s states had enacted shelter-in-place orders and 3.3 million people had filed for unemployment following business closures and layoffs. Studies conducted after the 2008 recession showed that the similarly sudden rise in unemployment was linked to an increase in child abuse.

Whether a surge in child abuse has occurred during the COVID-19 pandemic is unknown. But a June study by data-analysis organization Mathematica suggests that as reports of suspected maltreatment dropped, the children who were reported were on average at a higher risk of actually having faced abuse or neglect.

During the first two months of the lockdown, March and April, pediatricians across the country reported treating more severe injuries caused by abuse, along with an increase in fatalities.

When three-year-old Amari Boone was rushed to the hospital from his home in Fort Worth, Texas on April 10, his ribs were fractured, each of his fingers and arms were broken, and he was suffering from a brain injury.

Two days later, Amari became the fourth child to die of abuse in Fort Worth this year, a city that police say sees an average of two such cases in a year. The hospital that treated him said nine children were admitted for abuse-related injuries between March 17 and the days following Amari’s death.

“They really had horrible, horrible inflicted injuries,” said Dr. Jamye Coffman, medical director of Cook Children’s Medical Center’s Center for Prevention of Child Abuse and Neglect. Amari Boone and the three other Fort Worth children who suffered fatal injuries each died at Cook Children’s.

When Amari’s foster parents brought him to the hospital a few weeks later, his injuries were so severe he was put on life support as soon as he arrived, until the bleeding in his brain put him past recovery.

Amari’s death was ruled a homicide, but his case is still under investigation and no arrests have been made. His grandmother, Kiceshi Iaymon, blames his foster parents for Amari’s death, but they deny harming him. Deondrick Foley, one of his caregivers, said he doesn’t know how Amari was injured. Foley said he saw the injuries after picking Amari up from daycare, and then took him to the hospital.

As official reports of abuse dropped across the country, calls to the Childhelp National Child Abuse Hotline increased. The 24/7 anonymous hotline saw an increase in calls by 31 percent in March, 17 percent in April and 43 percent in May when compared to 2019, according to Chief Communications Officer Daphne Young. Childhelp is not affiliated with protective services agencies and takes calls from anywhere in the U.S.

“We’re getting much more intensified calls, more abuse disclosure, and stories of sexual abuse and much higher anxiety calls from people who are suffering,” Young said.

If there was a rise in the severity of abuse cases during state shutdowns, it isn’t reflected in state agency data. In most states, reports to child protective agencies that meet the state’s definition for abuse or neglect have to be selected or “screened in” for investigation. These more serious reports dropped by nearly the same amount that total reports did, NBC News’s analysis showed.

Investigations into maltreatment can take months, meaning agencies don’t yet have complete data on how many substantiated cases of abuse occurred this spring, even for cases that were reported.

“We don’t know what we don’t know,” Coffman said.

Moving toward prevention

The lack of information surrounding abuse and neglect during the pandemic adds urgency to what experts called a ‘paradigm shift’ happening in the child welfare field: shifting resources away from intervention and more toward prevention.

“Our systems are designed to produce the results that they produce,” said Melissa Merrick, CEO and president of Prevent Child Abuse America. “If we redesign our system, meaning we transfer our investments that are meant for treatment, after-the-fact services, into prevention … that would necessarily produce a different outcome.”

The shift began in 2018, when the Family First Prevention and Services Act was passed, they said. The law allowed states to allocate federal funds that could previously only be used for foster care services instead toward mental health and substance abuse prevention and treatment services for children who are at risk of being removed from their homes.

Implementation of the Family First legislation is still in its early phases, and not all prevention programs are eligible for reimbursement under the law, including child care. Programs that more directly alleviate financial burdens can reduce maltreatment, experts say, especially since so many cases are of neglect, rather than abuse.

One study showed that raising minimum wage by $1 reduced reports of child maltreatment by nearly 10 percent. Directing funds to food pantries, baby pantries and childcare subsidies, Merrick said, are some ways to further reduce neglect.

“We can learn from COVID-19 that the best way to stop what we call child abuse and neglect is to focus on poverty,” said Richard Wexler, executive director of the National Coalition for Child Protective Reform. “Instead of a massive system of investigation, focus on concrete help to ameliorate the worst effects of poverty.”

With the pandemic putting agencies at risk of tightening their budgets, line items that are not reimbursable by the federal government are usually the first to go, Olender said, which is why it’s so important for federal funds to be available for prevention programs.

Another way to work toward prevention is to expand the places and agencies mandatory reporters can make referrals to beyond protective services, suggested Olender and Amy Templeman of the Alliance of Strong Children and Families. If teachers and others instead reached out to a home visitation program or a food bank, Templeman said, they can avoid unnecessarily subjecting children to extensive investigations or separating families. The growing use of the Childhelp hotline, Young said, may be because it was treated as a “a soft landing space” for incidents that may not need to be reported to child protective services.

Iaymon, Amari’s grandmother, says that his death could have been prevented. Amari was already under Texas’s legal custody when he died, the state’s Department of Family and Protective Services (DFPS) confirmed. After his parents and other family members were unable to care for him, Iaymon said, he was taken in by foster parents in January. Weeks before he died, however, his mother saw bruises on his body and sent photos to DFPS.

DFPS maintains it conducted background checks and home visits on his caregivers before they were approved, though it declined to confirm whether any home visits occurred after his mother reported suspected abuse. Foley said DFPS visited unannounced, two or three times a week, in the weeks preceding Amari’s death. Iaymon said that’s not enough.

“If a child had been abused, why would you keep him in that home?” Iaymon said. “They failed my grandson.”

Note on methodology: NBC News’s analysis of statewide data includes seven states that recorded data on a weekly basis, so exact numbers for each month are estimated. Data from one state is inexact and was estimated from a line graph.