News Scan for Feb 25, 2022

COVID-19 orphans
COVID and healthcare workforce
More polio cases as vaccinators slain

Study: More than 5 million kids have lost a parent or caregiver to COVID-19

More than 5 million children have lost a parent or caregiver during the COVID-19 pandemic, according to a modeling study published yesterday in The Lancet Child & Adolescent Health.

The study by an international team used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19 orphanhood and caregiver deaths in 20 countries from Mar 1, 2020 to Oct 31, 2021. Orphanhood was defined as the death of one or both parents, and caregiver death included parental death or death of a custodial or co-residing grandparent. The team's original study had estimated that, from Mar 1, 2020, to Apr 30, 2021, 2,737,300 children had experienced a COVID death of a parent or caregiver.

The updated estimate found that, from Apr 30 to Oct 31, 2021, the number of children affected by COVID-19-associated orphanhood or caregiver death increased 90%, from 2,737,300 children to 5,200,300 children. Over the entire 20-month period, 491,300 children aged 0 to 4 years, 736,800 children aged 5 to 9 years, and 2,146,700 children aged 10 to 17 years were estimated to have experienced COVID-19-associated orphanhood. Globally, 76.5% of those children lost a father, and 23.5% lost a mother.

The total number of orphaned children ranged widely across the 20 countries, from 2,400 children in Germany to 1,917,000 children in India. Per capita, the highest rates of orphanhood were in Peru (8.28 per 1,000 children) and South Africa (7.22).

The study authors say the data suggest the surge of parent and caregiver deaths "must be urgently addressed with sustainable and scalable solutions, and integrated into coordinated and collaborative global, regional, and national strategies."

"Such support should focus on three core components: preventing caregiver death through equitable COVID-19 vaccine coverage, containment, and treatment; preparing families that are safe and nurturing to support affected children (such as through kinship care, foster care, and adoption); and protecting children using evidence-based strategies to reduce risks of poverty, childhood adversity, and violence," coauthor Susan Hillis, PhD, of the Centers for Disease Control and Prevention, said in a Lancet press release.

"These strategies will help save lives now and put the programmatic and financial infrastructure in place on a global scale to secure a better future for children and families around the world."
Feb 24 Lancet Child Adolesc Health study
Feb 24 Lancet press release


Workforce in nursing homes, other healthcare areas shrank amid COVID

US skilled nursing facilities (SNFs) faced sharp employment losses during the pandemic—particularly in counties with a large infection burden—and did not rebound like other healthcare sectors, finds a study today in JAMA Health Forum.

In the study, a team led by RAND Corp. researchers examined the effect of COVID-19 on the US healthcare workforce in 2020 and the first half of 2021, a time of elevated health risks, burnout, and childcare disruptions.

"While federal programs have provided financial assistance to hospitals and institutions, the net effect of these forces on health care employment levels and wages has not been examined," the researchers wrote.

The team analyzed industry- and county-level data from the US Bureau of Labor Statistics Quarterly Census of Employment and Wages to measure changes in employment and average wages among employees of physician and dentist offices, home healthcare, hospitals, SNFs, and combined other facilities.

Healthcare employment fell from 22.2 million in 2019 to 21.1 million in the second quarter of 2020, a 5.2% drop (compared with a 9.0% decline in all industries) but rebounded to 21.8 million in the same period in 2021. Average healthcare wages rose at a lower rate than other industries (5.0% vs 6.7% in 2020 and 1.5% vs 6.9% in 2021).

The largest declines in employment in 2020 were in dentists' offices (10.0%) and SNFs (8.4%), while the smallest declines occurred in hospitals (2.5%) and physicians' offices (4.6%). Other healthcare sectors rebounded to prepandemic employment levels in 2021, but SNFs saw even more declines (13.6% relative to 2019) despite having the largest wage increases (9.5% in 2020 and 6.3% in 2021).

The adjusted 2020 SNF employment level relative to 2019 was 105.2% among counties with the lowest quintile of COVID-19 infections and 90.4% among those in the top 20%.

Counties with the lowest physician-to-population ratios tended to have higher adjusted employment levels in physicians' offices (107.8% vs 97.9%) and dentists' offices (110.1% vs 98.4%).

"Future research is needed to understand if organizations are demanding fewer workers or fewer workers are willing to work at health care positions," the authors wrote. "Overall, our results imply that intensified early efforts are needed to protect the health care workforce in future pandemics."
Feb 25 JAMA Health Forum research letter


Four nations report new polio cases as 8 Afghan polio vaccinators slain

Four countries have confirmed new polio cases, with the Democratic Republic of the Congo (DRC), Nigeria, and Yemen reporting circulating vaccine-derived poliovirus type 2 (cVDPV2)  and Madagascar noting circulating vaccine-derived poliovirus type 1 (cVDPV1), according to an update yesterday from the Global Polio Eradication Initiative (GPEI).

The cases come as United Nations (UN) and World Health Organization (WHO) officials decry the murder of eight polio vaccination workers in Afghanistan.

The DRC reported 2 cVDPV2 cases in Maniema province, with 1 being the first of 2022 and the other from 2021. The number of 2021 cases now stands at 26. Nigeria confirmed 3 cVDPV2 cases, 2 in Borno state and 1 in Kano, which is the first of 2022. Nigeria's 2021 case count has reached 415. Yemen reported 3 new cVDPV2 cases, 1 each in Abyan, Ad Dali, and Al Hudaydah governorates. Yemen has had 13 cVDPV2 cases and 3 cVDPV1 cases in 2021.

Madagascar officials confirmed 1 cVDPV1 case each in Diana and Sofia regions, with 1 being the first of 2022 and the other from 2021, bringing the number of 2021 cases to 12.
Feb 24 GPEI update

The slaying of the eight polio vaccination workers happened yesterday in four separate incidents in northern Afghanistan, according to a UN news release. They are the first such attacks since nationwide immunization campaigns resumed in November 2021 and come after nine polio immunization workers were killed in the country last year. 

One member of a vaccination transit team was killed in Taloqan district in Takhar province, while four members of house-to-house teams were murdered in two separate incidents in Kunduz city. And two vaccinators and a social mobilizer were slain in the Emamsaheb district of Kunduz province. 

In the wake of the killings, the UN immediately suspended the national polio vaccination campaign, which began on Feb 21, in Takhar and Kunduz provinces.

"WHO condemns all attacks on health workers in the strongest terms and appeal to the Taliban Authorities to immediately identify and bring the perpetrators to justice," said Ahmed Al-Mandhari, MD, WHO regional director for the Eastern Mediterranean, in a WHO statement.

"The polio programme supported by WHO, UNICEF, and other partners has made extensive progress in controlling transmission of wild poliovirus in Afghanistan…. In 2021, Afghanistan reported 4 cases of wild poliovirus, and only one case has been reported to date in 2022."

The immunization campaign had planned to target nearly 10 million preschoolers across the country. Four additional campaigns are planned for 2022.
Feb 24 UN news release
Feb 24 WHO statement

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