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Two years into the pandemic, an estimated 6.7 million children have lost at least one of their parents or caregivers because of COVID-19, according to updated research, marking a grim milestone in what officials have dubbed “the hidden pandemic.” That toll includes more than 180,000 children in the United States.

The figures come from new modeling published in the journal The Lancet Child & Adolescent Health, which estimated figures for orphanhood over the course of the pandemic through October 2021. At that point in time, the study estimated more than 5.2 million children had lost a parent or caregiver to COVID, and the number has continued to grow since then.

In the United States, a “real-time calculator” from the study’s authors estimates that more than 180,000 children have lost a parent or caregiver to the pandemic. The American toll ranks above all but two other large countries — India and Mexico — which also recorded heavy losses from deadly waves of the virus. 

“When we started this work, there were roughly 140 million children in the world that were orphaned. And that’s about 8 million a year who are orphaned. Now with our updated estimates, we know that those numbers are increasing by about 30% a year,” says Susan Hillis, now a senior research officer at the University of Oxford and a lead author on the paper.

Hillis helped lead the study while she worked for the Centers for Disease Control and Prevention’s COVID-19 response, updating initial modeling they had published with the World Health Organization and others in July 2021. 

Though the researchers were able to refine their estimates based on new data documenting the pandemic’s deaths, they caution the global modeling remains “drastically underestimated.”

“For example, WHO estimates accurate data for COVID-19 deaths in Africa are limited, and the real estimates are likely to be 10 times higher than what is currently being reported,” Imperial College London’s Dr. Julie Unwin said in a release. 

The study’s figures combine deaths “directly by COVID-19” and excess deaths caused indirectly by the pandemic, like from “decreased access to health services.” 

More than 5.9 million COVID-19 deaths have been officially reported to date around the world, according to the latest tally by Johns Hopkins University. The CDC has recorded more than 930,000 reported deaths in the U.S. from the disease, though total excess deaths since the beginning of the pandemic have already passed 1 million nationwide.

Beyond recalculating their original modeling, the study’s authors added estimates of orphanhood by age groups. Globally, they found that the largest share of children losing a caregiver were ages 10 and older. In the U.S. during the study period, 81,100 children ages 10 and older were estimated to have seen a death, also more than in younger age groups.

“We determined not only was it critically important to update the numbers because of the rapid pace of increase, but it was critical important to expand the kind of data we were describing so that every country in the world would have what they needed to integrate care for children into the very core of their COVID response plans,” said Hillis. 

Hillis and her team also previously helped lead research published in December that examined orphanhood within the U.S. through June 2021 by state. At the time, that study had found rates of orphanhood varied significantly by race and ethnicity, with American Indian and Alaska Native children hit hardest. 

How those disparities might translate to longer-term inequities remains unclear, adding to a myriad of concerns already raised by advocates around the pandemic’s impact on the welfare of American children and their mental health

For example, while federal data published in November found 2020 was the third straight year for declining totals of children in foster care nationwide, officials cautioned the impact of the pandemic was “not yet clear.” One report funded by the Annie E. Casey Foundation found an uptick in racial disparities in one foster care program, even as overall children declined. 

A letter sent to President Biden last month by the nonprofit COVID Collaborative urged the White House to “shape a comprehensive response” to support children who have lost a parent to the pandemic. Signed by dozens of prominent health experts, including a former White House COVID-19 official, the group warned that the loss has “disproportionately affected communities of color and other populations least equipped to respond.” 

Hillis has previously called for the Biden administration to prioritize studying and addressing the issue, adding another pillar to the country’s COVID-19 efforts domestically and abroad. She said the U.S. could “integrate a coordinated response” among government agencies and organizations.

“In the history of PEPFAR, we have helped support as the United States people, through the generosity of the American taxpayer, about 7 million children orphaned by AIDS in Africa who have really needed economic support, educational support, health support, psychosocial support in order to survive, and recover, and thrive,” said Hillis. 

“It’s ironic that we have roughly the same number of children now that we have yet to do anything to help,” Hillis added.