TY - JOUR T1 - ‘Hidden pandemic’: orphanhood and loss of caregivers in the COVID-19 pandemic JF - BMJ Paediatrics Open JO - BMJ Paediatrics Open DO - 10.1136/bmjpo-2022-001604 VL - 6 IS - 1 SP - e001604 AU - Nick Spencer AU - Georgina Warner AU - Jamile Marchi AU - Sahar Nejat Y1 - 2022/09/01 UR - http://bmjpaedsopen.bmj.com/content/6/1/e001604.abstract N2 - The WHO estimates that there were 14.9 million excess deaths (deaths associated with COVID-19 directly due to the disease or indirectly due to the pandemic’s impact on health systems and society) in 2020–2021.1 COVID-19-associated excess deaths have occurred mainly among adults with rates increasing with age. Child deaths have been relatively rare; however, children have been affected by what has been described as a ‘hidden pandemic’ of orphanhood and loss of primary and secondary caregivers.2 Initial global estimates, based on mortality and fertility data from 21 countries, showed that approximately 1.5 million children had experienced loss of at least one primary or secondary caregiver to SARS-CoV-2 infection between 1 March 2020 and 30 April 2021; however, updated estimates, modelled on COVID-19-associated excess deaths up to 1 May 2022, show greatly increased numbers with 10.4 million children having lost a parent or caregiver and 7.5 million children having experienced orphanhood.2The consequences for children who have been orphaned or have lost primary or secondary caregivers are potentially severe. The effects are likely to stretch beyond initial grief and bereavement to increased risk of experiencing institutionalisation, developmental and mental health problems, family poverty and subsequent suicide and chronic diseases.2 In low/middle-income countries, the risk of dying before reaching adulthood for children whose mother died is significantly elevated: almost five times for an infant and twice for children over 6 months, compared with children whose mother lived.3The right of children to live with their parents is enshrined in Articles 9 and 18 of the United Nations Convention on the Rights of the … ER -