Before the pandemic stripped the world of millions of people, there were about 140 million orphaned children globally. Now, an additional 1.5 million kids have lost their parents, grandparents or other caregivers to COVID-19, a new study estimates. Of those children, nearly 114,000 are from the U.S., according to the paper published Tuesday in The Lancet. The U.S. ranks fourth with the most kids orphaned by COVID-19 deaths, behind Mexico, Brazil and India. And as data has shown throughout the pandemic, more men have died from the disease than women in nearly every country. Because of this, up to five times more kids have lost their fathers than their mothers.

Based on what researchers have learned from the Ebola and HIV epidemics, orphaned children face high risks of short- and long-term negative effects on their health, safety and well-being after losing caregivers. Consequences include poverty, mental health problems, sexual violence, teenage pregnancy and higher risks of suicide, heart disease, diabetes, cancer or stroke. That’s why the researchers say experts need to respond quickly; every 12 seconds a child under the age of 18 loses their caregiver to COVID-19.

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“The hidden pandemic of orphanhood is a global emergency, and we can ill afford to wait until tomorrow to act. Out of control COVID-19 epidemics abruptly and permanently alter the lives of the children who are left behind,” study co-lead author Seth Flaxman, a senior lecturer of statistics at Imperial College London in the U.K., said in a statement. “Tomorrow is too late for the child institutionalized in an orphanage, who will grow up profoundly damaged by the experience. We urgently need to identify the children behind these numbers and strengthen monitoring systems, so that every child can be given the support they need to thrive.” The team created mathematical models using estimates on data from 21 countries that make up 77% of global COVID-19 deaths from March 2020 to April 2021. The researchers then linked this information to fertility data from the same countries to estimate the number of kids who lost their caregivers. More than 1 million children lost one or both of their parents to COVID-19 during the first 14 months of the pandemic, the study estimates; another half a million lost their grandparents who served as their caregiver living in their home.

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The countries with the highest number ofchildren who lost their caregiver were Mexico (about 141,100), Brazil (about 130,300), India (about 119,200), United States (about 113,700), Peru (about 98,900), South Africa (about 94,600), Iran (about 41,000), Colombia (about 33,300) and Russia (about 29,700).

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In April 2021, India alone experienced about an 8.5-fold jump in the number of newly orphaned children (43,139 kids) compared to the month prior (5,091). On top of it all, the researchers say their findings are likely underestimated because not every country’s COVID-19 death data were available. Not to mention the variability in coronavirus testing and reporting. “Our study establishes minimum estimates — lower bounds — for the numbers of children who lost parents and /or grandparents. Tragically, many demographic, epidemiological and healthcare factors suggest that the true numbers affected could be orders of magnitude larger,” study co-lead author Dr. Juliette Unwin, a member of the Imperial College’s COVID-19 response team, said in a statement. “In the months ahead variants and the slow pace of vaccination globally threaten to accelerate the pandemic, even in already incredibly hard-hit countries, resulting in millions more children experiencing orphanhood.”

This story was originally published July 21, 2021 1:13 PM.