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Disclosures: The authors report no relevant financial disclosures.
August 03, 2021
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More than 1 million kids have experienced death of primary caregiver during pandemic

Disclosures: The authors report no relevant financial disclosures.
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A significant number of children experienced the death of a primary caregiver during the first 14 months of the COVID-19 pandemic, according to results of a modeling study published in The Lancet.

“Because most COVID-19 deaths occur among adults, not children, attention has been focused, understandably, on adults,” Susan D Hillis, PhD, of the CDC COVID-19 Response Team, and colleagues wrote. “However, a tragic consequence of high numbers of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19, as occurred during the HIV/AIDS, Ebola and 1918 influenza epidemics. Our goal is to shine a bright light on this urgent and overlooked consequence that is harmful for children.”

infographic showing child holding knees, number of children who experienced death of a caregiver during COVID-19 pandemic
Infographic data derived from: Hillis SD, et al. Lancet. 2021;doi:10.1016/S0140-6736(21)01253-8.

The researchers sought to estimate the magnitude of this problem during the COVID-19 pandemic and elucidate the need for resource allocation. Using mortality and fertility data, they modeled minimum estimates and rates of deaths linked to COVID-19 among primary or secondary caregivers for children aged younger than 18 years across 21 countries. They defined primary caregivers as parents and custodial grandparents and secondary caregivers as co-residing grandparents or older kin aged 60 to 84 years. They used an estimated secondary attack rate and age-specific infection–fatality ratios for SARS-CoV-2 to adjust for possible clustering of deaths and thus avoid overcounting. Further, the researchers used these estimates to model global extrapolations for the number of children who have experienced deaths of primary and secondary caregivers linked to COVID-19.

Between March 1, 2020, and April 30, 2021, Hillis and colleagues estimated 1,134,000 children across the world experienced the death of primary caregivers, including at least one parent or custodial grandparent, and 1,562,000 children experienced the death of at least one primary or secondary caregiver. They noted primary caregiver death rates of at least one per 1,000 children in nine countries, which included Peru (10.2 per 1,000 children), South Africa (5.1), Mexico (3.5), Brazil (2.4), Colombia (2.3), Iran (1.7), the U.S. (1.5), Argentina (1.1) and Russia (1). According to the researchers, numbers of children orphaned were greater than numbers of deaths among those aged 15 to 50 years. Children were between two and five times more likely to have deceased fathers than deceased mothers.

“Now is the time to focus on a group that will continue to grow as the pandemic progresses: the more than 1 million children who have lost a parent and another half a million

children who have lost a grandparent caregiver living in their own home,” Hillis and colleagues wrote. “These unnamed children are the tragic overlooked consequence of the millions of pandemic dead.”

In a related press release, Nora D. Volkow, MD, director of the National Institute on Drug Abuse, highlighted the importance of developing interventions for this population.

“Studies like this play a crucial role in illuminating the COVID-19 pandemic’s long-lasting consequences for families and the future mental health and wellbeing of children across the globe,” Volkow said. “Though the trauma a child experiences after the loss of a parent or caregiver can be devastating, there are evidence-based interventions that can prevent further adverse consequences, such as substance use, and we must ensure that children have access to these interventions.”