Background

The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation.

Methods

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 considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60–84 years) as 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 used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers.

Findings

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. 1 562 000 children (1 299 000–1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15–50 years. Between two and five times more children had deceased fathers than deceased mothers.

Interpretation

Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children.

Funding

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.

中文翻译：

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全球受 COVID-19 相关孤儿影响的儿童和照顾者死亡的最低估计：一项模型研究

 背景

COVID-19 大流行的优先事项集中在预防、检测和应对。除了发病率和死亡率之外，流行病还带来次要影响，例如儿童成为孤儿或失去照顾者。这些儿童常常面临不利后果，包括贫困、虐待和收容。我们对 COVID-19 造成的这一问题的严重程度进行了估计，并描述了资源分配的需求。

 方法

我们使用死亡率和生育率数据来模拟 21 个国家 18 岁以下儿童的主要或次要照顾者与 COVID-19 相关的死亡率的最低估计值和死亡率。我们将父母和有监护权的祖父母视为主要照顾者，将同居的祖父母或年长亲属（60-84 岁）视为次要照顾者。为了避免计数过多，我们使用 SARS-CoV-2 的估计继发发病率和特定年龄感染死亡率对可能的死亡聚集进行了调整。我们利用这些估计值来模拟全球因主要和次要照顾者因 COVID-19 死亡的儿童人数。

 发现

在全球范围内，从2020年3月1日到2021年4月30日，我们估计有1 134 000名儿童（95%可信区间为884 000-1 185 000）经历了主要照顾者的死亡，其中包括至少一名父母或监护祖父母。 1 562 000 名儿童 (1 299 000–1 683 000) 经历了至少一名主要或次要照顾者的死亡。我们研究中主要看护者死亡率至少为每 1000 名儿童 1 人的国家包括秘鲁（每 1000 名儿童 10·2）、南非（5·1）、墨西哥（3·5）、巴西（2·4）、哥伦比亚 (2·3)、伊朗 (1·7)、美国 (1·5)、阿根廷 (1·1) 和俄罗斯 (1·0)。孤儿人数超过了 15 至 50 岁儿童的死亡人数。已故父亲的儿童数量是已故母亲的儿童数量的两到五倍。

 解释

孤儿和照顾者死亡是由与 COVID-19 相关的死亡引起的隐性流行病。加速公平的疫苗接种是预防的关键。心理社会和经济支持可以帮助家庭抚养失去照料者的儿童，并有助于确保避免将其送入收容机构。这些数据表明我们的应对措施需要一个额外的支柱：预防、检测、应对和照顾儿童。

 资金

英国研究与创新（全球挑战研究基金、工程和物理科学研究委员会、医学研究委员会）、英国国家健康研究所、美国国立卫生研究院和伦敦帝国理工学院。