As the COVID-19 pandemic enters its third year, the death toll continues to rise and with it, the number of children who may be left without anyone to care for them.
By Oct. 31, 2021, more than 5 million people worldwide had died from COVID-19, and about 5.2 million children had lost a parent or caregiver, according to new research published in the Lancet Child and Adolescent Health.
Of particular note, wrote the authors, was how the number of affected children surged during the latter part of their study period. During the first 14 months of the pandemic (March 1, 2020, to April 30, 2021), 2,737,300 children were affected by COVID-19-related caregiver death. But that number jumped by 90% during the next 6 months, from April 30 to Oct. 31, 2021, to 5,209,000. Essentially, the number of children who were affected nearly doubled, compared with those observed during that first year.
To put these numbers into perspective, study author Charles Nelson, PhD, professor of pediatrics and neuroscience and professor of psychology in the department of psychiatry at Harvard Medical School, Boston, compared it to the HIV/AIDS pandemic. “The current worldwide estimate is now approaching 6 million,” he said. “For HIV, it took 10 years before the number of orphans hit 5 million but for COVID it took 2 years. This should provide some perspective.”
Dr. Nelson pointed out that there are many other differences between the two pandemics. “There was no vaccine for HIV/AIDS, in contrast to the last year or so for COVID, when illness and death could largely be prevented,” he explained. “The politics surrounding HIV-related deaths seemed ‘relatively’ apolitical compared to COVID.”
Another major difference is that children whose parents had HIV were allowed to visit their parents, but for COVID-19, isolation was in place so many children could not see their parents before they died.
There is also more misinformation versus lack of information about COVID-19, compared to HIV/AIDS. “As an example, one young girl who lost her father to COVID was told by her classmates that her father hadn’t really died, he just abandoned the family,” Dr. Nelson said.
Minority communities face heaviest loss
A “companion study” was conducted by the Centers for Disease Control and Prevention, which looked at parental/caregiver death just within the United States. During the period between April 1, 2020, through June 30, 2021, the researchers found that more than 140,000 children under the age of 18 years had lost a parent, custodial grandparent, or grandparent caregiver because of COVID-19. In addition, there were significant racial, ethnic, and geographic disparities in COVID-19–associated death of caregivers, and the highest burden of death was observed in the Southern states along the U.S.-Mexican border for Hispanic children, Southeastern states for Black children, and in states with tribal areas for American Indian/Alaska Native populations. Overall, almost two-thirds (65%) of the children who lost a primary caregiver belonged to a racial or ethnic minority.
But as with the international data, the number of affected children has continued to rise since the end of the original study period. “Seth Flaxman, at Imperial College London, has updated the figures as of end of December for the U.S.,” said Dr. Nelson. The 140,000 has increased to 222,718 who lost a primary or secondary caregiver.
In addition, 192,449 lost a primary caregiver, 175,151 lost a parent, and 30,269 lost a secondary caregiver.
The rate, unfortunately, remains disproportionate to minorities. These data do reflect the inequities that have been observed since the beginning of the pandemic, as COVID-19 unequally affected many racial and ethnic minority groups and put them at a higher risk of severe illness and death. “Native Americans are four times more likely than Whites to be orphaned, and Black and Hispanic children 2.5 times more likely,” said Dr. Nelson.
The COVID Collaborative, a diverse group of leading experts from a wide range of disciplines including health, education, and economics, is working to develop consensus recommendations on pandemic-related issues such as vaccination of children who have lost caregivers. In December 2021, they released Hidden Pain: Children Who Lost a Parent or Caretaker to COVID-19 and What the Nation Can Do to Help Them, a report providing estimates of the number of children who lost a caregiver and concrete recommendations to support them.
“The death of an adult caregiver is life-altering for any child regardless of the circumstances or cause,” said Dan Treglia, PhD, associate professor of practice at the University of Pennsylvania, Philadelphia, and a contributor to Hidden Pain. “Traumatic grief is more common in sudden deaths like accidents where support systems are unable to mobilize in anticipation of the death and COVID-19 patients who die are typically in the hospital for barely a week before they pass.”
This suggests that responses to COVID-19 deaths may be more typical of sudden deaths than those of chronic illness such as cancer, he noted, adding that the pandemic has hindered the systems that children and their caregivers would normally rely on for support.
“Social distancing, for example, has limited informal community relationships critical for emotional health and in the current National Emergency in Children’s Mental Health, as noted by the American Academy of Pediatrics, among others, formal community-based and clinical services are overwhelmed,” said Dr. Treglia.
The authors of Hidden Pain note that the children most likely to lose a parent or other caregiver are generally the most likely to have faced “significant previous adversities that hinder their ability to successfully adapt to new experiences of adversity or trauma.” Studies have now revealed the magnitude of COVID-19–associated parent and caregiver death, and Dr. Treglia pointed out that action is needed from federal, state, and local policymakers to help children who have lost a caregiver to COVID-19.