A hidden catastrophe
The pandemic hadn’t yet hit Zambia in spring 2020, but Remmy Hamapande worried as he watched COVID-19 ravage the world. As country director of the nonprofit Forgotten Voices, which works in several countries in southern Africa, Hamapande knew a deadly pandemic would be dire for children there who had already lost their parents to AIDS and were living with grandparents who were especially vulnerable.
“If COVID comes here and takes out the grannies, we would have no one left to care for the orphans,” Hamapande recalls thinking. “Then these orphans become orphaned twice.”
Hamapande called Hillis to raise the alarm. During her decades-long career as a researcher at the US Centers for Disease Control and Prevention, Hillis studied children orphaned by health crises. By August 2020, she had convened a team of researchers to assess how many children were affected, beginning with the United States and Brazil.
In just two weeks, preliminary data “was shocking and heartbreaking,” Hillis says. For every two reported COVID-19 deaths in those countries, estimates suggested at least one child was left behind. As the Delta variant drove surges across the world, that number grew to one orphan for every COVID-19 death—and two orphans for each death in Africa as of the end of October 2021.
Despite the staggering losses, the COVID-19 orphan crisis has gotten relatively little attention; it’s a pandemic hidden inside a pandemic. Rachel Kidman, a social epidemiologist focused on childhood adversity at Stony Brook University, says COVID-19 is perceived as a disease affecting older people, so the toll on children left behind is overlooked.
Yet as many as 38 percent of children globally are raised in multigenerational households, according to the Pew Research Centre. In Zambia and much of the rest of sub-Saharan Africa, more than 30 percent of children live in “skipped-generation” households—meaning they live with grandparents, not parents.
Moreover, Kidman points out that COVID-19 is not just killing grandparents. The uneven distribution of COVID-19 vaccines has left people of all ages more vulnerable in some parts of the world, and it’s disproportionately fatal for people with poor access to healthcare.
(Rread all of National Geographic’s COVID-19 coverage.)
“There are now substantial numbers of people below 65 who have passed away due to COVID. Those are people who are in parenting years,” Kidman says.
In Zambia, Hamapande has seen siblings split up and villagers struggling to feed their own families who have taken in children of neighbours. Counseling is virtually non-existent and Hamapande has seen signs of trauma from bed-wetting to a spate of suicides.
“Imagine a child losing their caregiver and then basically not having anywhere to run to,” he says, adding that mental health assistance is desperately needed.
How to protect orphaned children
Past crises have taught scientists what may work, and what doesn’t, to soften the trauma.
One thing not to do? Put children in orphanages—or at least not the facilities where neglected kids are packed in like sardines. Landmark studies of Romanian orphanages—which became notorious in the 1990s for their deplorable conditions—found institutionalization significantly altered infants’ brain structure. Every year in an orphanage resulted in developmental and cognitive delays compared to children raised in foster families.
Fortunately, these effects can be mitigated if a child is moved into a loving home. In 2012, one study showed that children who moved from orphanages to foster families were able to catch up developmentally with their peers.
Children need family—of any sort—to provide structure in their lives, says Lucie Cluver, a professor of social work at both the University of Oxford and University of Cape Town. Ensuring that a child can go to school, has enough to eat, and feels loved is what “determines the impact of the death, not the death itself.”
Even orphans who are well cared for need extra help. Cluver, who was part of the Hillis team, convened to determine global estimates for COVID-19 orphans, says the top three interventions that make a difference are economic support, parenting support, and staying in school.
Making sure families have enough money and food is fundamental. When parents aren’t working multiple jobs, they have time to listen to and support their kids. When children have enough to eat and can stay in school, they’re less vulnerable to other risk factors. Giving money to impoverished families has been shown to significantly decrease the risk of girls and young women being forced into or resorting to sex work for payment.
Abuse is another risk. Parental stress can lead to violence in vulnerable families, and arming caregivers with practical coping skills is critical when grief causes a caregiver or a child to act out. Studies have shown that parenting programs can significantly reduce physical, sexual, and emotional violence in families.
Finally, it’s important to make sure that orphaned children can still go to school. Attending school helps traumatized children regain a sense of normality. It’s also proven to reduce poverty, delay a child’s first sexual encounter, and integrate them into society.
Is help on the way?
In late September 2021, Calandra Cook was a month into her senior year at Georgia State University when she suddenly had to withdraw to plan her mother’s funeral. With no other close family to help, the 21-year-old was suddenly responsible for everything which she did in a daze.
Doctors had warned Calandra that her mother’s lungs were getting weaker, her heart rate was too high, and her oxygen levels were too low. But Yolanda Meshae Powell’s death still came as a shock to Calandra and her three younger siblings, who couldn’t talk to or even hug their mother before she died. “I had to say goodbye to my mom through a glass window,” Calandra says.
Then came the daunting challenge of finishing college. Georgia State’s financial aid office informed Calandra that she’d exhausted her student loans and would have to pay out of pocket—and she couldn’t move back home to save money.
“When my mom died, my safety net died with her,” Calandra says.
Earlier this year, the COVID Collaborative—a group of leading US experts in public health, education, and the economy—established Hidden Pain, an online platform that connects grieving families to resources including funeral assistance, discounted internet service, and bereavement and mentoring groups . In California, lawmakers are considering a state-funded trust fund for COVID orphans. But there was little movement at the national level.
The world also has yet to act to help orphans on the scale that was seen under PEPFAR, the US President’s Emergency Plan for AIDS Relief. It took 13 years to enact PEPFAR after researchers first raised the alarms about AIDS orphans—and, by then, 903,000 AIDS orphans had grown to 15 million.
“I’m just hoping and praying we don’t wait 13 years,” Hillis says. “This tsunami is going to envelop us as variant after variant emerges.”
Calandra is frustrated that the world seems to have moved on from the pandemic—even the people who had comforted her when her mother first died. “As time goes on, people go away,” she says. “Grief is something you kind of deal with on your own.”
It’s a bittersweet milestone: Yolanda was so excited for her daughter to get a degree that she used to call her three times a day to gush about it.
Calandra knows it’s going to be hard to walk across that stage on graduation day without her mother in the audience. “People say that she’ll be there in spirit but that doesn’t make you feel better,” Calandra says. She’s going to take some of her mother’s favorite advice. “I can hear her telling me to put my big-girl panties on. My mom taught me everything.”