One million orphans, so far: the hidden COVID crisis we need to talk about much more

All the focus on children over the last year has been about lost education, keeping them busy and the impact of isolation. Right now, it is holidays and exams. But we should be more worried – a lot more worried.

Lucie Cluver, Oxford Professor of Child and Family Social Work, says Dr Susan Hillis, from the US Centers for Disease Control and Prevention,  was so worried, she could not sleep. The thing is, children may not be dying from COVID-19, but millions have already or will lose parents and caregivers before the pandemic ends, creating an epidemic of orphan-hood in the wake of the virus. And that was keeping Dr Hillis awake at night.

Children may not be dying from COVID-19, but millions have already or will lose parents and caregivers before the pandemic ends, creating an epidemic of orphan-hood in the wake of the virus.

‘The global response has focused on adults, because that is who the disease is striking,’ says Professor Cluver. ‘But there has been no thought at a global scale about the impact of COVID deaths on children. This needed a concerted effort.’

Not long after that phone call, an international team of academics and policymakers came together, and the results of their work is published in the Lancet.

It is obvious when you think of it. Just as with AIDS and Ebola, the virus was going to leave children around the world without parents – and/or grandparents. Devastating for families and children and very costly for countries, in every sense. COVID-19 is far from over.

The global response has focused on adults, because that is who the disease is striking...But there has been no thought at a global scale about the impact of COVID deaths on children. This needed a concerted effort...we needed robust evidence

Professor Lucie Cluver

Dr Hillis emphasised they needed to work swiftly. But, before they could ask for help, they needed to know the size of the problem – and the locations.

'We needed robust evidence before we could ask for a strong response,’ says Professor Cluver.

What they really needed was the world’s best modellers, to work out the scale of the crisis. Professor Cluver had a not-entirely-scientific thought: maybe a dad at her children’s nursery in St Anne’s College could help? In normal times, you might ask a toddler’s dad for a playdate. But Dr Seth Flaxman was also a statistician at Imperial College, part of the team crunching COVID numbers, and soon to come to Oxford’s Department of Computer Science. So it was not quite as outlandish as it sounds.

As soon as he understood, Dr Flaxman brought together a team to work on the problem at Imperial and Oxford – including Professor Christl Donnelly, who works at both universities. Their series of papers, looking at the impact of COVID on countries around the world and at the fallout from new variants, were guiding national responses.

In previous studies, on disease burden, they had calculated global estimates, by combining dozens or hundreds of national surveys. But no surveys were being undertaken on children affected by the deaths of their parents or caregivers, so demographic methods were needed to combine data on average family sizes with COVID death information.

Given the heavy burden of deaths among older age groups, Professor Cluver says, ‘We needed to think about grandparents as well. There has been a huge increase over the last decade in children being looked after by grandparents. In many households, they are primary caregivers, and provide essential financial support.’

We focused on 21 countries with the highest numbers of COVID deaths, looked at age and fertility patterns and extrapolated to the rest of the world to find minimum estimates of the number of children affected

Dr Seth Flaxman

Dr Flaxman explains, ‘We focused on 21 countries with the highest numbers of COVID deaths, looked at age and fertility patterns and extrapolated to the rest of the world to find minimum estimates of the number of children affected.’  

Alongside the calculations, the project has brought together international institutions including the CDC, the WHO, the World Bank, and USAID. They are leading today’s publication of the research and accompanying report, calling for immediate action from global governments.

The team is well aware what is at stake... According to Professors Lorraine Sherr and Charles Nelson, research shows, institutions are really terrible for children...it is much better to support the extended family to care for them. 

The team is well aware what is at stake. With memories of the impact of the AIDS epidemic in Africa, when there was a rush to put orphans into institutions, they are concerned this does not result in a rush to separate children from families again.

UCL’s Professor Lorraine Sherr and Harvard Professor Charles Nelson insist, ‘Research shows, institutions are really terrible for children...it is much better to support the extended family to care for them. Almost every child has a family member who could do that.’

On a purely financial basis, the cost of institutionalising the COVID orphans is seven times greater than the cost of keeping them at home. With today’s Lancet release, Dr Flaxman and Professor Cluver hope policymakers will act to avoid the crisis becoming a long term catastrophe. It means taking country-by-country action to keep children out of institutions and with their families.

On a purely financial basis, the cost of institutionalising the COVID orphans is seven times greater than the cost of keeping them at home.

Dr Flaxman and Professor Cluver hope policymakers will act to avoid the crisis becoming a long term catastrophe

‘There needs to be support for children,’ says Professor Cluver. ‘But there are effective and affordable responses. If we make sure that families have some financial support, that children can go to school, and that they have help with parenting in these difficult circumstances, then children do better in many important aspects of their lives. But we need to act fast.’

There are some steps everyone can take. If parents and grandparents are vaccinated, then their children are protected too. When each of us gets our vaccination, we can donate to the World Health Organisation’s COVID solidarity response fund. 

But help also needs to come from the international community, and both Dr Flaxman and Professor Cluver are optimistic about the prospects.

This is a call to action to support children who have lost loved ones. Our calculations can help policymakers turn good intentions into appropriately scaled help where it is needed most

Professor Christl Donnelly

‘Even small amounts of support help,’ says Professor Cluver. ‘A grant of $21 a month can benefit a family... a phone-based parenting program with support is $6 per child. The costs are manageable.’

Dr Flaxman’s  open-source online calculator shows minimum estimates for the numbers of orphaned children per country and a country graph indicates the increase in numbers during the pandemic. At the time of writing, the numbers already orphaned in South Africa, for instance, was 101,400. There are about 10,000 in the UK who had lost at least one care giver. 

There are already one million orphans, and 1.8 million children who have lost a caregiver...But with most of the developing world not expected to get vaccines until 2025, there could be five to seven million by the time the pandemic is over...since we submitted the paper, the numbers of orphaned children keep going up and up

Professor Cluver

‘There are already one million orphans, and 1.8 million children who have lost a caregiver’ Cluver explains. ‘But with most of the developing world not expected to get vaccines until 2025, there could be five to seven million by the time the pandemic is over.’

She adds, ‘It’s been a race against time. Even since we submitted the paper, the numbers of orphaned children keep going up and up. Something needs to be done - urgently.’

Professor Donnelly explains, ‘This is a call to action to support children who have lost loved ones. Our calculations can help policymakers turn good intentions into appropriately scaled help where it is needed most.’

Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study. (Published Online July 20, 2021). Available once the link goes live: at https://doi.org/10.1016/S0140-6736(21)01253-8)

prepared by the Global Reference Group on Children Affected by COVID-19: Joint Estimates and Action: Susan D Hillis*, H Juliette T Unwin*, Yu Chen*, Lucie Cluver, Lorraine Sherr, Philip S Goldman, Oliver Ratmann, Christl A Donnelly, Samir Bhatt, Andrés Villaveces, Alexander Butchart, Gretchen Bachman, Laura Rawlings, Phil Green, Charles A Nelson†, Seth Flaxman†