The availability of new excess mortality data enables us to update global minimum estimates of COVID-19 orphanhood and caregiver death among children. [1][2][3][4] Consequences for children can be devastating, including institutionalization, abuse, traumatic grief, mental health problems, adolescent pregnancy, poor educational outcomes, and chronic and infectious diseases. 4,5 Global totals and country comparisons were previously hampered by inconsistencies in COVID-19 testing and incomplete death reporting. The new orphanhood estimates derived here based on excess deaths provide a comprehensive measure of COVID-19's longterm impact on orphanhood and caregiver loss.Methods | Using previous methodology for combining agespecific death and fertility rates, 4 we use Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) reporting guideline for this epidemiologic modeling study to update COVID-19 estimates of parent and caregiver loss. We computed excess mortality-derived estimates for bereft children in every country, using data from the World Health Organization (WHO), The Economist, and the Institute for Health Metrics and Evaluation (IHME). [1][2][3]6 We replaced COVID-19 deaths in previous logistic models with excess deaths (except when excess deaths were negative) to generate composite deaths for
The new WHO estimates for COVID-19 excess deaths allow us to generate updated and more accurate models of COVID-19 associated orphanhood and caregiver loss. Using methodology established in prior studies, we combine age-specific fertility and excess death estimates from January 2020 to May 2022. We find 10.4 million children have lost a parent or caregiver due to COVID-associated excess deaths, and 7.5 million children have experienced COVID-associated orphanhood. Without supportive intervention, caregiver loss can bring severe risks of poverty, school dropout, sexual exploitation, and mental health distress. It is essential that evidence-based care for these children is integrated into all national response plans as a caring action to protect children from immediate and long-term harms of COVID-19.
Non-pharmaceutical interventions (NPIs) play a central role in infectious disease outbreak response and control. Their usefulness cannot be overstated, especially during the early phases of a new epidemic when vaccines and effective treatments are not available yet. These interventions can be very effective in curtailing the spread of infectious diseases when adequately implemented and sufficiently adopted by the public. However, NPIs can be very disruptive, and the socioeconomic and cultural hardships that come with their implementation interfere with both the ability and willingness of affected populations to adopt such interventions. This can lead to reduced and unsteady adherence to NPIs, making disease control more challenging to achieve. Deciphering this complex interaction between disease dynamics, NPI stringency, and NPI adoption would play a critical role in informing disease control strategies. In this work, we formulate a general-purpose model that integrates government-imposed control measures and public adherence into a deterministic compartmental epidemic model and study its properties. By combining imitation dynamics and the health belief model to encode the unsteady nature of NPI adherence, we investigate how temporal variations in NPI adherence levels affect the dynamics and control of infectious diseases. Among the results, we note the occurrence of multiple epidemic waves as a result of temporal variations in NPI adherence and a trade-off between the stringency of control measures and adherence. Additionally, our results suggest that interventions that aim at increasing public adherence to NPIs are more beneficial than implementing more stringent measures. Our findings highlight the necessity of taking the socioeconomic and cultural realities of affected populations into account when devising public health interventions.
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