![]() ![]() © 2021 World Health Organization licensee Elsevier. UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. Accelerating equitable vaccine delivery is key to prevention. Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Between two and five times more children had deceased fathers than deceased mothers. Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. ![]() Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. The COVID-19 pandemic priorities have focused on prevention, detection, and response. 15 Department of Mathematics, Imperial College, London, UK Department of Computer Science, University of Oxford, Oxford, UK.14 Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA.12 World Bank Group, Washington, DC, USA.11 Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA.10 Prevention of Violence Unit, WHO, Geneva, Switzerland.9 CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA. ![]() 8 MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.7 MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK Department of Statistics, University of Oxford, Oxford, UK.6 Maestral International, Minneapolis, MN, USA.5 Institute of Global Health, University College London, London, UK.4 Department of Social Policy and Intervention, University of Oxford, Oxford, UK Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.3 Department of Mathematics, Imperial College, London, UK.Electronic address: 2 MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK. 1 CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA. ![]()
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