The Hidden US COVID-19 Pandemic: Orphaned children

More than 140,000 U.S. children have lost a primary or secondary caregiver as a result of the COVID-19 pandemic.

An American child loses a parent or caregiver for every four COVID-19 deaths, reveals a new modeling study published today in Pediatrics. The findings illustrate orphanage as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and highlight that identifying and caring for these children as they develop is a necessary and urgent part of the pandemic response – both as long as the pandemic continues, as well as in the post-pandemic era.

From April 1, 2020 to June 30, 2021, data shows that more than 140,000 children under the age of 18 in the United States have lost a parent, custodial grandparent, or grandparent caregiver who takes care of the child’s home and basic needs, including love, safety, and Daily care. Overall, the study shows that about 1 in 500 children in the United States have experienced the COVID-19-associated orphanage or death of a grandparent caregiver. There were racial, ethnic and geographic disparities in COVID-19-associated carer deaths: 65% of those who lost a primary caregiver due to the pandemic accounted for 65% of racial and ethnic minority children.

Children’s lives are permanently changed by the loss of a mother, father or grandparent who took care of their home, basic needs and care. The loss of a parent is one of the negative childhood experiences (ACEs) associated with mental health problems; shorter training; lower self-esteem; sexual risk behavior; and an increased risk of substance abuse, suicide, violence, sexual abuse and exploitation.

“Children orphaned as a result of COVID is a hidden, global pandemic that sadly has not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious short- and long-term consequences of this problem for generations to come. Addressing the loss these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

“The magnitude of the young people affected is a sobering reminder of the devastating impact of the past 18 months,” said Dr Alexandra Blenkinsop, co-principal investigator from Imperial College London. “These findings really highlight those children who have been made most vulnerable by the pandemic, and where additional resources should be directed.”

The analysis used mortality, fertility and census data to estimate COVID-19-associated orphanage (death of one or both parents) and deaths of custodial and cohabiting grandparents between April 1, 2020 and June 30, 2021 for the US overall and for every state. “COVID-19-related deaths” refers to the combination of deaths directly caused by COVID-19 and deaths indirectly caused by related causes, such as lockdowns, restrictions on gatherings and movement, reduced access or quality of healthcare and of treatment for chronic diseases. The data was also separated and analyzed by race and ethnicity, including white, black, Asian and American Indian/Alaska Native populations, and Hispanic and non-Hispanic populations.

The study authors estimate that 120,630 children in the US have lost a primary caregiver (a parent or grandparent responsible for housing, basic needs, and care) as a result of COVID-19-associated death. In addition, 22,007 children have experienced the death of a secondary caregiver (grandparents who provide housing, but not most basic needs). In total, an estimated 142,637 children have experienced the death of at least one parent, or a caregiver or other live-in grandparent caregiver.

“The death of a parent figure is a huge loss that can change a child’s life. We must ensure that all children have access to evidence-based prevention interventions that can help them cope with this trauma to support their future mental health and well-being,” said NIDA Director Nora D. Volkow, MD. “At the same time, we need to address the many underlying inequalities and health disparities that put people of color at greater risk of contracting COVID-19 and dying from COVID-19, putting children of color at greater risk of becoming a parent or caregiver and associated adverse effects on their development.”

Racial and ethnic differences in COVID-related caregiver loss

There were significant racial and ethnic disparities in health care provider deaths from COVID-19. White people represent 61% of the total US population and people of racial and ethnic minorities represent 39% of the total population. Still, research findings indicate that non-Hispanic white children made up 35% of those who lost a primary caregiver (51,381 children), while children of racial and ethnic minorities made up 65% of those who lost a primary caregiver (91,256 children).

Looking at both primary and secondary caregivers, the study found that the findings varied widely by race/ethnicity: 1 in every 168 American Indian/Alaska Native children, 1 in every 310 Black children, 1 in every 412 Hispanic children , 1 in every 612 Asian children and 1 in 753 White children have experienced the orphanage or death of caregivers. Compared to white children, American Indian/Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver, black children were 2.4 times more likely, and Hispanic children were nearly 2 times (1.8) more chance.

Overall, the high-population states—California, Texas, and New York—had the highest number of children experiencing COVID-19-related deaths from primary caregivers. However, when analyzed by geography and race/ethnicity, the authors were able to map out how these deaths and inequalities varied at the state level.

In southern states along the US-Mexico border, including New Mexico, Texas and California, between 49% and 67% of children who lost a primary caregiver were of Hispanic ethnicity. In the Southeast, in Alabama, Louisiana and Mississippi, between 45% and 57% of children who lost a primary caregiver were black. And American Indian/Alaska Native children who lost a primary caregiver were more likely to be represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%), and Arizona (18%).

The current study ties in closely with a similar study published in July 2021 in The Lancet, which found that more than 1.5 million children around the world lost a primary or secondary caregiver during the first 14 months of COVID-19. pandemic. In both the global and US studies, researchers used the UNICEF definition of orphanage, including the death of one or both parents6. The definition includes children who lose one parent because they are at increased risk of mental health problems, abuse, unstable housing and household poverty. For children raised by single parents, the COVID-19-related death of that parent can mean the loss of the person primarily responsible for providing love, security and daily care.

“We often think of the impact of COVID-19 in terms of the number of lives claimed by the disease, but as this study shows, it is critical to address the broader impact as well – both in terms of those who died as those left behind,” said co-author Charles A. Nelson III, PhD. who studies the effects of adversity on brain and behavioral development at Boston Children’s Hospital. “We need to ensure that children who have lost a parent or caregiver have access to the support services they need, and that this additional impact of the COVID-19 pandemic is comprehensively addressed in both our rapid response and our overall response to public health.”

There are evidence-based responses that may improve outcomes for children experiencing the COVID-associated death of their caregivers:

Maintaining children in their families is a priority. This means that families deprived by the pandemic need to be supported and those in need of relatives or foster care should get help quickly. Children’s resilience can be strengthened through programs and policies that promote stable, nurturing relationships and address children’s adversity. The main strategies are: Strengthening economic support for families. Quality childcare and educational support. Evidence-based programs to improve parenting skills and family relationships. All strategies should be age-specific for children and sensitive to racial and structural inequalities. They need to reach the children they need the most.

In the closing words of the paper: “Effective action to reduce health inequalities and protect children from direct and secondary harm from COVID-19 is a public health and moral obligation.

Reference: “Covid-19-Associated Orphanhood and Caregiver Death in the United States” by S Hillis, et al., Oct. 7, 2021, Pediatrics.
DOI: 10.1542/peds.2021-053760