Abstract
Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations. We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.
Highlights
High COVID-19 mortality rates may have severe unrecognized consequences: large-scale death of parents and caregivers for children[1, 2]
States with highest disparities for children in COVID-19-associated death of caregivers We identified states with the greatest racial/ethnic disparities for children affected by death of caregivers to help inform evidence-based responses focused on children at greatest risk, in states most affected
From April 1, 2020 through June 30, 2021, COVID-19-associated deaths accounted for the loss of parents and caregivers for over 140,000 children; the lives of these children are permanently changed by the deaths of their mothers, fathers, or grandparents who provided their homes, needs, and care
Summary
High COVID-19 mortality rates may have severe unrecognized consequences: large-scale death of parents and caregivers for children[1, 2]. Little attention has focused on children who suffer COVID-associated death of parents and co-residing grandparents serving as caregivers – and the attendant loss of salient nurturing, financial support, and care[1, 2, 5]. The definition includes children losing one parent, because they have increased risks of mental health problems, abuse, unstable housing, and household poverty[7,8,9]. Most COVID-19 deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. A tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19associated deaths
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