Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study

Abstract

Background The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. MethodsWe used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers.Findings Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10•2 per 1000 children), South Africa (5•1), Mexico (3•5), Brazil (2•4), Colombia (2•3), Iran (1•7), the USA (1•5), Argentina (1•1), and Russia (1•0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers.Interpretation Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children.

COVID-19 in children and the importance of COVID-19 vaccination

“…Furthermore, orphanhood and caregiver deaths have been a hidden consequence of the pandemic owing to COVID-19-associated deaths. Globally, from March 1, 2020, to April 30, 2021, 1.56 million children are estimated to have experienced the death of caregivers [ 34 ]. Such children often face poverty, abuse, and institutionalization and have higher risks of experiencing mental health problems.…”

Child Mortality in England During the First Year of the COVID-19 Pandemic

“…In contrast to emerging data on the mortality seen in adults 20 , the restrictions and adaptations of healthcare delivery placed across England in 2020 to combat COVID resulted in a dramatic reduction of childhood deaths, particularly in the younger children. This effect however is likely to be due to complex processes, and needs to be seen in the context of access to a universal healthcare system, and in low and middle income countries a substantial indirect excess mortality is predicted 21 , alongside substantial broader impacts on the delivery of care 22 , and through impacts on other family members 23 . However, in England, 2020 is likely to be the safest year on record for child deaths; a dramatic reduction from what had been a fairly stable trend over recent years 24 .…”

Global Pediatric Pulmonology Alliance (GPPA) proposal for COVID-19 vaccination in children

“…In addition to directly suffering from COVID-19, children suffer indirectly from the pandemic [ 3 ]. By April 2021, an estimated 860,000 children have been orphaned or have lost a custodial grandparent due to a COVID-19 death [ 4 ]. Many children have been pushed into poverty or have become malnourished as an indirect result of the pandemic [ 1 ].…”