Under the Radar: Global Minimum Estimates for COVID-19-Associated Orphanhood and Deaths Among Caregivers During 2020

Background: The global COVID-19 pandemic and response has focused on prevention, detection, and response. Beyond morbidity and mortality of those infected, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, delayed development, and institutionalization. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods: We use mortality and fertility data to model rates of COVID-19-associated orphanhood and caregiver deaths for 18 countries in Africa, Asia, Europe, and the Americas, and extrapolate global estimates of COVID-associated deaths of parents and grandparent caregivers. Results: We estimate that globally, >1 million children were orphaned or lost a caregiver due to COVID-19-associated deaths during March–December 2020. Countries with higher rates of caregiver deaths included Peru, South Africa, Mexico, Russian Federation, Colombia, Brazil, Islamic Republic of Iran, Argentina, U.S.A., and Spain (range, 1·1–9·8/1000). For most countries, numbers of children orphaned were greater than deaths among those aged 15–44 years; 2–5 times more children had deceased fathers than deceased mothers. Conclusions: Orphanhood and caregiver deaths are a shadow pandemic resulting from COVID-19-associated deaths: we find that over one million children worldwide have lost a parent or caregiver in just ten months. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families nurture children bereft of caregivers and promote their recovery. Strengthening family-based care can help ensure that institutionalization of these children is avoided. These data demonstrate the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding: UK Research and Innovation (Global Challenges Research Fund (GCR), Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, U.S. National Institutes of Health, Imperial College. Declaration of Interests: Dr. Donnelly reports grants from UK Medical Research Council and grants from NIHR during the conduct of the study. Dr. Cluver reports grants from UK Research and Innovation (UKRI) Global Challenges Research Fund, during the conduct of the study. All other authors report nothing to disclose. Ethics: We used modeled aggregate data and publicly available de-identified survey metadata.