Worldwide, an estimated 10.5 million children were either orphaned or lost a primary caregiver due to COVID-19, according to a study published Tuesday. 

The study, in JAMA Pediatrics, examined the World Health Organization’s data on excess mortality as of May 2022, finding that the majority of those children – 7.5 million – were orphaned while 3 million children lost a primary caregiver. 

Study authors urged public health officials to address the lasting impacts of grief on children who’ve lost caretakers to the virus, in addition to vaccines and prevention.

“Effective, caring action to protect children from immediate and long-term harms of COVID-19 is an investment in the future and a public health imperative,” the paper said. 

MORE: Caregivers face a host of hurdles taking in their relative children. 

Children experiencing orphanhood or caregiver loss face an increased likelihood of poverty, abuse and mental health challenges, among other obstacles, according to the Centers for Disease Control and Prevention.

“COVID is not just an individual disease, it really is a family disease,” said Terri Powell, an associate professor of American health at Johns Hopkins University who was not involved in the study. “They’re not just people that died, but parents and caregivers — how do we make sure that there’s still a safety net for the kids who are their surviving children?”

More children were affected by caregiver loss in Africa and Southeast Asia compared to Europe and North and South America. The study did not break down totals for individual countries, but it noted children were most affected were India, Indonesia, Egypt, Nigeria and Pakistan.

In fall 2021, an American Academy of Pediatrics study estimated at least 140,000 children across the U.S. had lost a primary or secondary caregiver to COVID-19. That number has since risen to at least 209,000 children, according to a calculator from Imperial College London.