A new study on the number of children who have lost a caregiver to COVID-19 is the latest reminder that the pandemic’s impact will be felt for generations to come.

An estimated 1.5 million children across 21 countries lost a parent or grandparent who lived with them due to COVID-19 between March 2020 to April 2021, according to a study published Tuesday.

The authors of the study, in the peer-reviewed medical journal The Lancet, arrived at that figure using mortality and fertility data to model rates of COVID-19 associated with the loss of a parent or secondary caregiver who lived with a child.

The study was funded in part by the National Institute on Drug Abuse, a branch of the National Institutes of Health. NIDA funded the research because of the close link between losing a parent or secondary caregiver and increased substance use as a result of heightened trauma levels.

“Studies like this play a crucial role in illuminating the COVID-19 pandemic’s long-lasting consequences for families and the future mental health and wellbeing of children across the globe,” said NIDA Director Dr. Nora D. Volkow.

Children in South Africa, Peru, the United States, India, Brazil and Mexico lost the most primary caregivers from COVID-19. The authors of the study defined a primary caregiver as a parent or a custodial grandparent. 

“Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths,” the study authors wrote. “Because COVID-19 can lead to death within weeks, families have little time to prepare children for the trauma they experience when a parent or caregiver dies.”

They added that the institutionalization of children who lose a parent, which the researchers said is a common response even when there is a surviving parent, “can result in developmental delays and elevated abuse.” Other long-term consequences include higher risks of experiencing mental health problems; physical, emotional, and sexual violence; and family poverty, the researchers said.

In every country, COVID-19 associated deaths were greater in men than women, particularly in middle- and older ages, the study reported, adding that “overall, there were up to five times more children who lost a father than who lost a mother.”

Even as more people get vaccinated around the world the pandemic is far from over, especially with the spread of the delta variant, which is responsible for some 83% of new cases in the U.S. currently, according to the U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky.

“[W]e must not forget that the pandemic continues to pose a threat to parents and caregivers — and their children,” said Charles Nelson, a co-author of the study and the director of research at the Developmental Medicine Center within Boston Children’s Hospital.

Globally, some 4.1 million people had died of COVID-19 as of Wednesday, according to Johns Hopkins University data.

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