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COVID-19-associated Orphanhood – What is Happening Across the US?

December 2, 2021

In a recently released article in Pediatrics, Dr. Susan Hillis and colleagues came together to study the heart-breaking topic of COVID-19-associated orphanhood and grandparent caregiver loss (10.1542/peds.2021-053760). This observational modelling study used data from several sources to build a picture of caregiver loss among children, and associated racial and ethnic disparities, across the US. The topic is a tough one emotionally, but the more we understand, the better we can advocate for policies and approaches that protect the safety of each child and mitigate the mental health impact.

The authors define the main study outcomes as orphanhood, defined as the loss of one parent, or loss of a primary or secondary caregiver, including a parent or grandparent who provides some or all basic needs. The modelling work is complex, but well described. It begins with ascertainment of total “COVID-19-associated deaths,” including deaths directly attributable to COVID-19 as well as those caused indirectly by decreased health care access, obtained from the National Center for Health Statistics and broken down by age, race/ethnicity, and state. The authors next gathered female and male fertility rates from Centers for Disease Control and Prevention (CDC) databases, and grandparent data from the U.S. Census Table, which summarizes American Community Survey data for this topic. (Fertility rates are useful when census birth rates may underestimate the number of children born but orphaned.) Given this information, they were able to estimate the numbers of children orphaned by COVID-19-associated death of parents, as well as the death of primary and secondary caregivers, for each state, by age, race/ethnicity, and gender category.  

In total, the authors found that from April 1, 2020 through June 30, 2021, over 140,000 children in the US experienced the death of a parent or grandparent caregiver. Please read to uncover and understand the differences by race/ethnicity and state – these reveal disparities you might and might not expect. Homes led by single parents and grandparent-headed homes are at highest risk for catastrophe when the primary caregiver dies. In their thoughtful discussion, the authors point out what policies and programs we have in place, and what more we can bring to the table, from vaccines to kinship care, in a national effort to address this crisis. While it’s discouraging to consider this downstream effect of the pandemic, I found it heartening to understand it better, and think about what we CAN do to improve life for children orphaned by COVID-19. I hope you will feel the same!

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