COVID-19’s long-term impact on orphanhood and caregiver loss

In a recent study published in JAMA Pediatrics, researchers performed epidemiologic modeling to update coronavirus disease 2019 (COVID-19)-associated caregiver and parent loss estimates.

Background

COVID-19–associated deaths have left millions of children bereaved of their caregivers and parents across the globe. Caregiver and parent loss can lead to devastating long-term outcomes, including abuse, institutionalization, traumatic grief, adolescent pregnancy, poor educational outcomes, chronic infectious illnesses, and mental health problems.

While huge investments have been made to prevent COVID-19-associated mortality, little has been done for the care of bereft children. Investments to support orphans who lost their parents to acquired immunodeficiency syndrome (HIV AIDS) exemplify successful solutions that can be replicated for improving the lives of orphaned children due to COVID-19.

Inter- and intra-country comparisons have been hampered previously due to inconsistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, associated mortality reporting, and access to new data of excess COVID-19-associated mortality enable updating minimum COVID-19 death estimates of caregiver and parent loss.

About the study

In the present study, researchers provided an update on SARS-CoV-2 infection-associated caregiver and parent loss estimates.

Excess COVID-19 deaths-derived estimates were computed for bereft children in each nation, based on data provided by The Economist, IHME (institute for health metrics and evaluation), and the WHO (World Health Organization). COVID-19-associated deaths in previously used logistic models were substituted with excess COVID-19-associated deaths (with an exception for cases with negative excess deaths), and composite deaths were calculated for the periods between 1 January 2020 and 31 December 2021 and between 1 January 2020 and 1 May 2022.

Bootstrapping was performed to calculate uncertainty for death estimates arising from mortality and fertility data. National and regional death estimates were calculated based on WHO-based methodology since the WHO findings showed higher conservatism than those of The Economist and IHME. The study was conducted in accordance with the GATHER (guidelines for accurate and transparent health estimates reporting) guidelines.

Results

By using WHO-based methods for excess COVID-19-associated mortality, the team estimated that 10,500,000 children were bereaved of their caregivers or parents, and 7,500,000 children were orphaned due to COVID-19 by 1 May 2022. Composite deaths reported by the Economist, IHME, and WHO by 31 December 2021 were 18, 18.3 and 15.6, respectively. The corresponding composite deaths through 1 April 2022 were 21.3, 20.5, and 17.5, respectively.

The estimated values for orphanhood and primary caregiver loss provided by the Economist, IHME, and WHO by 31 December 2021 were 9.7, 10.3, and 7.2, respectively. The corresponding values for orphanhood and primary caregiver loss by April 1, 2022, were 11.6, 11.2, and 7.9. respectively. The estimated values for orphanhood and loss of primary and/or secondary caregivers reported by The Economist, IHME, and WHO by 31 December 2021 were 12.3, 12.9, and 9.5, respectively. The corresponding values for orphanhood and primary and/or secondary caregiver loss by 1 April 2022 were 14.8, 14.1, and 10.5, respectively.

Greater numbers of COVID-19-associated orphanhoods due to loss of primary and/or secondary caregivers were noted in Southeast Asia WHO regions (41%) and Africa (24%), in comparison to the Eastern Mediterranean regions (15%), American regions (14%), Western Pacific regions (1.8%) and European regions (4.7%) by 1 May 2022. Likewise, national-level variations in death estimates were observed, and nations such as India, Egypt, Nigeria, and Pakistan were affected the most through 1 May 2022, the death estimates for which were 3,490,000, 450,000, 430,000, and 410,000, respectively.

Among the most affected WHO regions in Southeast Asia, the highest counts of orphaned children were observed in nations such as India, Bangladesh, Indonesia, Nepal, and Myanmar. The most affected regions in the African continent were the DRC (Democratic Republic of Congo), Kenya, Ethiopia, South Africa, and Nigeria.

Conclusions

Overall, the study findings showed that considerable SARS-CoV-2 infection-associated loss of parents and caregivers has occurred globally, warranting urgent care for orphaned children. Urgently required global responses to the COVID-19 pandemic can amalgamate equitable vaccinations with life-transforming programs for orphaned children.

However, epidemiological modeling estimates cannot provide a true picture of COVID-19-associated orphanhood as modeling estimates are not precise measures of the actual counts of bereaved children, and further SARS-CoV-2 pandemic surveillance programs must include such pediatric populations to help in mitigating the long-term adverse consequences of COVID-19-associated orphanhood.

The development of effective vaccines and anti-SARS-CoV-2 therapeutic drugs must be accelerated, and the enforcement of COVID-19 containment measures could help prevent COVID-19-associated mortality of parents and caregivers. Bereaved children must be protected via economic aid, violence prevention, parenting aid, and increasing accessibility to schools and education.  

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.