1.5 million children worldwide lost a parent or guardian to COVID-19

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Around 1.5 million children globally experienced the death of a parent, grandparent, or caregiver due to COVID-19, a new study has estimated.

Using COVID-19 mortality data from March 2020 through to April 2021, researchers estimated that over one million children experienced the death of one or both parents during the first 14 months of the pandemic, with another half a million experiencing the death of a grandparent or caregiver living in their own home.

The findings have been published in The Lancet.

Urgent support needed

Following these findings, the researchers have called for urgent action to address the impact of caregiver deaths on children in COVID-19 response plans.

Dr Susan Hillis, one of the lead authors on the study, from the U.S. Centers for Disease Control and Prevention COVID-19 Response Team, said: “For every two COVID-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver. By April 30 2021, these 1.5 million children had become the tragic overlooked consequence of the three million COVID-19 deaths worldwide, and this number will only increase as the pandemic progresses. Our findings highlight the urgent need to prioritise these children and invest in evidence-based programmes and services to protect and support them right now and to continue to support them for many years into the future – because orphanhood does not go away.”

Before the pandemic, there were an estimated 140 million orphaned children worldwide. These children have greater risks of mental health problems, family poverty, and physical, emotional, and sexual violence. They are also more likely to die by suicide or develop a chronic disease, such as heart disease, diabetes, cancer, or stroke.

A child loses a caregiver to COVID-19 every 12 seconds

Study author Professor Lucie Cluver, from Oxford University, UK, and the University of Cape Town, South Africa, said: “We have strong evidence from HIV and Ebola to guide solutions. We need to support extended families or foster families to care for children, with cost-effective economic strengthening, parenting programmes, and school access. We need to vaccinate caregivers of children – especially grandparent caregivers. And we need to respond fast because every 12 seconds a child loses their caregiver to COVID-19.”

This report is the first to present global figures quantifying the number of children affected by the loss of a caregiver during the COVID-19 pandemic, either directly (due to the virus) or indirectly (due to another condition that was exacerbated due to the pandemic).

Implementing methods similar to those used by the UNAIDS Reference Group on Estimates, Modelling and Projections for estimating the number of children orphaned by AIDS, the authors based the COVID-19 orphanhood estimates on mortality data from 21 countries that account for 77% of global COVID-19 deaths. The analysis included both reported COVID-19 deaths between 1 March 2020 and 30 April 2021 and the number of excess deaths (when such data were available), during the same time period, to account for variations in country-specific reporting systems.

The researchers linked COVID-19 death rates to fertility data for males and females from those 21 countries to estimate the number of children who had lost a parent as a consequence of COVID-19. Loss of both parents was accounted for so that children were not counted twice.

The researchers extended their analysis to include deaths of grandparents or other older adults aged 60 to 84 years who were living in the same household as the children, based on United Nations Population Division’s statistics on household composition. These figures take into account custodial grandparents (living with grandchildren in the absence of parents), who have primary responsibility for their grandchildren’s care, as well as co-residing grandparents and other older family members who live in the same household (with grandchildren and parents), and have secondary, but not primary caring responsibilities.

Mathematical modelling was used to extrapolate the findings from these 21 countries to the rest of the world, using country-level data on COVID-19 deaths and fertility rates. The model showed a high correlation between female fertility rate and the ratio of orphans to deaths.

The findings suggest that at least 1,134,000 children experienced the death of their mother, father, or custodial grandparents, as a consequence of COVID-19. Of these, an estimated 1,042,000 lost their mother or father, or both. Overall, 1,562,000 children are estimated to have experienced the death of at least one parent or a custodial or other co-residing grandparent (or other older relative).

Countries with the highest rates of children losing their primary caregiver (parent or custodial grandparent) included: Peru (one child per 100, totalling 98,975 children), South Africa (five children per 1,000, totalling 94,625 children), Mexico (three children per 1000, totalling 141,132 children), Brazil (two children per 1,000, totalling 130,363 children), Colombia (two children per 1,000, totalling 33,293 children), Iran (>one child per 1,000, totalling 40,996 children), USA (>one child per 1,000, totalling 113,708 children), and Russian Federation (one child per 1,000, totalling 29,724 children). For almost every country, deaths were greater in men than women, particularly in middle and older ages. Overall, up to five times more children lost their fathers than lost their mothers.

Dr Seth Flaxman, one of the study’s lead authors, from Imperial College London, UK, said: “The hidden pandemic of orphanhood is a global emergency, and we can ill afford to wait until tomorrow to act. Out of control COVID-19 epidemics abruptly and permanently alter the lives of the children who are left behind. Tomorrow is too late for the child institutionalised in an orphanage, who will grow up profoundly damaged by the experience. We urgently need to identify the children behind these numbers and strengthen monitoring systems, so that every child can be given the support they need to thrive.”

Likely an underestimation

The researchers say their findings are likely underestimates because figures for a number of countries included in the study were based on COVID-19 mortality only and excess death data were unavailable. COVID-19 deaths may be underreported because of variability in SARS-CoV-2 testing and reporting systems.

Dr Juliette Unwin, another lead author from Imperial College London, UK, added: “Our study establishes minimum estimates—lower bounds—for the numbers of children who lost parents and /or grandparents. Tragically, many demographic, epidemiological, and healthcare factors suggest that the true numbers affected could be orders of magnitude larger. In the months ahead, variants and the slow pace of vaccination globally threaten to accelerate the pandemic, even in already incredibly hard-hit countries, resulting in millions more children experiencing orphanhood.”

The authors note some limitations to their results, including that the study is based on the best available data, but many countries do not have robust reporting systems for deaths or fertility. Additionally, data on country-specific prevalence of orphans before the pandemic was lacking, so their estimates of double orphans are limited to deaths of both parents during the pandemic.

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