An estimated 1.5 million children worldwide have lost a parent, grandparent, or caregiver due to COVID-19, according to a new study published in The Lancet on Tuesday. 

The study, which was conducted by international researchers, including scientists from the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and the University of Oxford, offers the first global estimates of the secondary impacts of the pandemic on children.

Worldwide, the COVID-19 pandemic caused over 190 million cases and four million deaths. Beyond morbidity and mortality, the pandemic carries indirect impacts, such as robbing children of their caregivers. 

Children who lose a primary caregiver have a higher risk of experiencing mental health problems; physical, emotional and sexual violence; and family poverty. These raise the risk of suicide, adolescent pregnancy, infectious diseases, and chronic diseases, such as heart disease, diabetes, cancer, or stroke. 

Children that go into institutional care can experience developmental delays and abuse.

Modelling to Estimate Magnitude of Hidden Impact of Pandemic on Children

The researchers used mortality and fertility data to model minimum estimates of COVID-related deaths of primary and secondary caregivers of children younger than 18 years of age in 21 countries. The data collected accounted for nearly 76.4% of global COVID deaths as of late April. 

A primary caregiver was defined as parents and custodial grandparents and secondary was considered co-residing grandparents or older kin. Caregivers provide psychosocial support; feeding, teaching, or supervising; and financial support.

In 21 countries, the researchers estimated that by April 2021, 862,365 children had been orphaned or lost a custodial grandparent due to COVID-19-associated death. Of these, 788,704 children lost one or both parents; 73,661 lost at least one custodial grandparent; and 355,283 lost at least one co-residing grandparent or older kin. 

South Africa, Peru, the US, India, Brazil, and Mexico were the countries with the highest numbers of children losing primary caregivers. In Peru, 14.1 children lost a primary or secondary caregiver per 1000 children, compared to 6.4 children in South Africa and 5.1 children in Mexico.

In India, the researchers estimated a 8.5-fold increase in the number of children newly orphaned between March 2021 and April 2021. This was associated with India’s catastrophic surge from the end of March to mid-June. 

COVID-related deaths were more common in men than women, particularly in middle-aged and older parents, leaving a greater number of paternal versus maternal orphans. 

Between two and five times more children had deceased fathers than mothers. 

The model was used to extrapolate global figures. 

Over a Million Children Globally Left Behind by COVID Deaths

Between March 1, 2020 and April 30, 2021, the researchers estimated that 1.5 million children experienced the death of primary or secondary caregivers, 1.13 million experienced the death of primary caregivers, and 1.04 million were orphaned by their parents. 

“For every two COVID-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver,” said Dr Susan Hillis, one of the lead authors of the study and senior advisor to the CDC. 

“By April 30, 2021, these 1.5 million children had become the tragic overlooked consequence of the 3 million COVID-19 deaths worldwide, and this number will only increase as the pandemic progresses,” said Hillis.

A rapid escalation in the study estimates was observed between March 2021 and April 2021, with the total number of children that lost a caregiver increasing by 220,000. This coincides with third waves of the pandemic across Europe and Southeast Asia. 

The more transmissible SARS-CoV2 variants are driving the current global increase in both cases and deaths, after the world saw a nine consecutive week decline in the number of weekly deaths. 

“Our study establishes minimum estimates…for the numbers of children who lost parents and/or grandparents. Tragically,…the true numbers affected could be orders of magnitude larger,” said Dr Juliette Unwin, a lead author and member of the Imperial College COVID-19 response team. 

The under-reporting of deaths around the world could underestimate the number of at-risk children.

For instance, in Brazil, the actual number of deaths at the start of the pandemic are estimated to be 33.5% higher than the officially reported deaths. 

“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,” said Unwin. 

The increase in orphanhood associated with COVID adds to the existing 140 million orphans worldwide, who are in need of global health and social care prioritisation, said the authors.

The adverse psychosocial consequences of children bereft of caregivers can be compounded by the COVID mitigation measures, leading to school closures, isolation, and disruptions to bereavement practices. 

Solutions to the ‘Hidden Pandemic of Orphanhood’

The study authors called for urgent investment in services to support children who lost their caregivers, specifically focusing on strengthening family-based care. Programmes should combine economic interventions, positive parenting, and education support, said the authors. 

“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,” said Hillis. 

“We need to support extended families or foster families to care for children, with cost-effective economic strengthening, parenting programmes, and school access,” said Lucie Cluver, study author and Professor of Child and Family Social Work at Oxford University and the University of Cape Town.

In addition, deaths of caregivers can be prevented by accelerating equitable access to diagnostics, therapeutics, and vaccines.

“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,” said Cluver. 

The global community needs to capitalise on the momentum from the pandemic to mobilise resources and implement systemic, sustainable support for bereaved youth around the world, said the authors. 

“The hidden pandemic of orphanhood is a global emergency, and we can ill afford to wait until tomorrow to act,” said Dr Seth Flaxman, one of the study’s lead authors and a lecturer in statistics at Imperial College London.

Image Credits: Unicef.