A Vietnamese American mother traveling with her young children wonders if a cashier’s cold stare could turn into a verbal assault. A Chinese American nurse hears a patient refusing to be treated by her. An older Japanese American man gets nervous walking by a group of white men.

Even in cities that haven’t reported a high-profile physical attack on Asian Americans, life has changed in the shadow of rising bigotry during this pandemic. For a community that has often felt invisible in the white and Black politics that dominate the headlines, racist rhetoric has heightened a sense of isolation. It has also galvanized those who had preferred the perceived safety of quiet obscurity to speak out about the toll it’s taken.

Min Liu, a professor of communication studies at Southern Illinois University Edwardsville, says her volunteer service used to center around cultural events in the AAPI community.

“In the past year, I think I’ve subconsciously moved to more of an advocacy position,” she said. “I have definitely become more alert as a community activist.” Liu helped organize a vigil in March that drew hundreds of people locally; she also hosted a “Stop AAPI Hate” webinar and has advised students promoting civic engagement among Asian American youth.

Liu’s shift into advocacy has been fueled by the concerns she’s heard from others in the St. Louis area. She recently met with a group of Chinese American women, who told her they have never felt this unsafe before. One shared the experience of her elementary school-aged daughter, who loved helping her teacher by passing out papers and supplies in class. A classmate told her, “I don’t want you to touch my desk. I don’t want to get the virus.”

The teacher intervened and told the student that was not OK.

Another friend confided that her second grader had seen one of the videos of an elderly Asian woman being beaten. She came to her mother, terrified, and said, “What if someone tries to kill you?” She begged her mom to let her dye her black hair.

Even before the mass shooting in Atlanta that killed eight people, including six women of Asian descent, hate crimes and assaults against those who appear East Asian have been increasing.

“These things cumulatively make people fearful and anxious,” Liu said. And yet there’s a fear that reporting such incidents may invite backlash or alienate those who perceive criticism of racial slurs as “political.”

Katie Xu, a senior at John Burroughs School, is part of the Asian American Civic Scholars, a group that advocates for more Asian American participation in civic life. She said some of her peers used to be hesitant about sharing their experiences because they would say it “felt less significant than the other forms of discrimination that other groups face.”

The past year changed that attitude.

“People my age are speaking out a lot more than I have seen in the past,” she said.

Ron Sakai, 60, is a compliance officer and a third-generation American of Japanese descent. His parents were imprisoned in internment camps in Arkansas in the 1940s: His mother was freed after about 18 months so that she could resume nursing school, and when his father was released, he petitioned to go back in order to rejoin his mother and younger brother. Sakai’s father was drafted into the service once he was released, made to fight for the country that had discriminated against and imprisoned him.

“My parents didn’t talk about it much,” Sakai said. They wanted him to assimilate. He didn’t have many Asian friends growing up, but that’s changed as he’s gotten older and more involved locally.

The rhetoric around the virus perpetuated by some political leaders is a reminder that some will always consider people who look like him foreigners.

The battle against xenophobia is a “centuries-long journey,” he said.

It’s one he plans to keep fighting.

When my cousins in Houston told me last fall that doctors suggested bringing their father home from the hospital and beginning hospice care, I immediately tried to figure out a way to get there.

It would be a complicated and risky trip, though. COVID struck my aunt and uncle in Texas a week after my husband and I got the virus in Missouri.

My uncle -- Abbas taya, my father’s older brother -- is 84 with a history of asthma and respiratory illness, and has struggled with memory issues in recent years. When his blood oxygen level dropped into the 50s -- a normal oxygen saturation is between 95% and 100% -- my cousin called an ambulance.

COVID pneumonia had infiltrated his weakened lungs. Doctors put him on 100% high-flow oxygen. He was a small step away from needing a ventilator, and a half step from the intensive care unit. His prognosis looked bleak.

It’s hard to imagine Abbas taya so sick and frail. When we were growing up, he was the life of the party, exuding joie de vivre and wanting others to enjoy life as thoroughly as he did. The most charismatic person in any room, his energy drew people to him.

I couldn’t bear the thought of him dying alone in COVID isolation.

By the time he became critically ill, it had been nearly two weeks since my positive test. My husband was recovering at home with supplemental oxygen. The St. Louis County Health Department had released us from quarantine. Technically, I could have found a way to travel to Texas.

But it was unclear whether my uncle would be released from his quarantine, or if I had enough protective antibodies to avoid getting sick again. My parents urged me to stay put, as did one of my closest friends, a doctor who has treated COVID patients throughout the pandemic.

My heart ached to be closer to my uncle, but I knew they were right. I prayed for him from a distance and received daily updates from my cousins. His body was weak, but his will to live was still irrepressible.

Miraculously, his lungs began to clear. His improvement left his doctors dumbfounded. After nearly three weeks in the hospital, he was transferred to a rehab facility, where he stayed for another two weeks. The severity and length of his illness atrophied his muscles to the point where he could no longer walk or stand.

He came home needing full-time care for the most basic life functions, and his road to recovery has been rough. He ended up back in the hospital twice, both times with pneumonia.

With more than 30 million cases of COVID in America, there’s no telling how many Americans are suffering from long-term complications or have become permanently disabled from this virus. There’s no exact tally of these COVID “long haulers,” but it’s likely in the tens of thousands.

In normal times, I see my uncle and aunt twice a year when I go home to visit my family. With the pandemic, I hadn’t seen them in more than a year.

Separation is harder when you know a loved one is suffering.

When we finally visited for spring break in March, I was fully vaccinated, as were they. I was excited to see them again, but also preparing myself for a notable decline in my uncle’s health.

When we arrived, he was asleep in his reclining chair in the family room. I chatted with his health aide, who told me my uncle had been able to stand briefly using his walker recently, after months of being immobile. That’s encouraging.

I knew that after my visit, his aide would have to help him into a wheelchair and take him to his bed. The virus has fundamentally changed the quality of his twilight years.

Destruction even in the wake of survival.

When he woke up, he peered at me across the room and asked who I was.

“It’s me, Aisha,” I said, as I walked closer to him.

His face lit up with recognition. We both laughed with joy as I hugged him. We joked, recalled old memories and swapped COVID survivor stories.

With more people getting vaccinated, there will be a wave of these emotional reunions.

It was a moment I didn’t think I would have again.

If your child’s mental health has tanked during the pandemic, there’s little comfort in knowing you’re not alone.

News reports have been sounding alarm sirens: rising numbers of suicidal children in emergency rooms, more children needing in-patient care after suicide attempts, teens and young adults suffering mental health crises at levels health professionals haven’t seen before, American students failing classes at record levels. High-achieving kids who have never struggled socially or at school are now failing, withdrawn, overwhelmed and unmotivated.

Many parents are desperate for help that has been harder to access. In talking to parents stressed about their kids’ anxiety and depression over the past year, I’ve heard how difficult it is to get a timely appointment with a therapist or psychiatrist since the demand has spiked.

“Everyone is seeing huge influxes,” said Nancy Spargo, CEO of Sparlin Mental Health in St. Louis. “We can’t hire more people because more people aren’t available.”

Instead, they have had to turn away some people seeking help.

“There’s nothing worse for a parent than not being able to help your kid, to watch your kid struggle,” she said.

Parents are also exhausted and emotionally tapped out at a time when maintaining an emotional connection with their children is critical. It’s past time for our country to invest resources in this generation’s mental health recovery.

President Joe Biden’s pandemic relief bill delivers $4.25 billion for mental health services, the largest amount behavioral health groups have received in a spending bill. But this may still be far from the amount needed to address historic levels of deteriorating mental health across the country.

Teens and young adults have been among the hardest hit in terms of mental health, so how do we help them heal?

Nance Roy, chief clinical officer at the Jed Foundation, a nonprofit that works to prevent suicide among children and young adults, says the long-term mental health effects of the pandemic will ripple for the next several years. This has to be a long-term effort.

“It’s not all over once we are all vaccinated and back in school,” she said.

Schools must conduct a proper needs assessment: surveying students and parents about their mental health status and needs, destigmatizing conversations about it, and filling gaps in resources, access and training. Students need to know where they can easily access direct clinical services at school. Educators need to adjust expectations for students who will struggle as they return to the classroom structure.

Dr. Shannon Farris with the CHADS Coalition for Mental Health, a St. Louis-based nonprofit providing suicide prevention programming and crisis counseling, says the organization has continued to provide its “SOS: Signs of Suicide” prevention program to middle and high school students virtually during the pandemic. One local district decided to go even further, after a student-led survey suggested a catastrophic level of anguish. A survey done by the students at Lafayette and Marquette high schools in the Rockwood School District found that 65% of 852 students surveyed said they had considered suicide. Of 667 students asked, 160 said they had made an attempt to take their own lives.

Even in an informal student survey, these kinds of answers require an emergency response.

Students pleaded for the district to take immediate action, and school officials responded. They have also contracted with CHADS to train 16 more adults in a long-term prevention and awareness program. Farris advocates for training all the faculty and staff in a building, along with students, parents and community members. Ideally, the conversation about mental health continues long after the training ends.

It will take an all hands on deck to restore what so many adolescents have lost this past year.

“A lot of compassion and patience will go a whole, long way,” Spargo said.

NOTE: If you or someone you know needs help, text “HOME” to the Crisis Text Line (741741). You can also call the National Suicide Prevention Lifeline at 800-273-8255.