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How COVID-19 Complicates Grief

Psychologists say grieving can be more intense, prolonged and disruptive during the pandemic

spinner image Collage of woman and her mother.
Pamela Villalobos of San Diego, California lost her mother to a COVID infection in April.
Courtesy Pamela Villalobos

By now, we all know how difficult COVID-19 has made many aspects of life. What it's also complicated? How we grieve.

The challenges can start with the shock of a relatively swift time line: A loved one gets sick in a hurry, is rushed to an ICU and put on a ventilator. With visitors often barred from the hospital (or nursing home) room, patients often die alone, unaccompanied by those who are most important to them. Final goodbyes may be said over a smartphone or computer tablet held by a health professional in the patient's room.

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This common pandemic scenario, says grief expert Robert Neimeyer, a psychologist and director of the Portland Institute for Loss and Transition in Portland, Oregon, is very unlike the more typical pre-pandemic experience of losing a loved one to a chronic illness like cancer or heart disease. “Those allow us time in the hospital, sitting at the bedside of our loved one, telling stories of our shared experience.” With COVID-19, the opportunity to address life's unfinished business, to mend relationships or say goodbyes is often taken away — all of which can greatly affect our feelings and perspective once a friend or family member is gone.

From there, the collective ritual of a funeral or burial may be postponed, or the mourner unaccompanied. “So we have this broken web of connection, which creates what we psychologists call unfinished business in bereavement,” Neimeyer says.

Other kinds of loss also are linked with COVID — loss of employment or financial security, loss of physical contact with family and friends due to social distancing, loss of freedom of movement or a sense of control. All can contribute to what psychologists call complicated grief, one that's more difficult, intense, prolonged and disruptive than usual.

A tsunami of anguish

With this kind of grief, Neimeyer says, people experience “a tsunami of psychological anguish, yearning, marked disruption in our lives, and social disengagement.” And that disruption might be present for a year or two — or longer — after a loved one's death.

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Under normal circumstances, the rate of complicated or prolonged grief (which defines the same psychological condition) in the general population might be 10 percent of all bereaved people; it's often faced by those dealing with traumatic deaths, such as the loss of a child or the murder of a loved one. “While we don't know yet what the percentages will look like for COVID, we know the risk factors that we have described will be present in vivid ways. People may be struggling with it for years,” Neimeyer says.

Complicated grief's long duration and intensity translates into difficulty with daily functioning — things like sleeping, eating, paying bills, or going to work become real challenges, says Robin Fiorelli, senior director of bereavement and volunteer services for VITAS Healthcare, a national hospice company. Survivors may also feel a sense of guilt, or fear their own exposure to the virus. Being stuck in the same home once shared with someone lost to COVID-19, with few options to get out and visit others, can also make grief more intense.

VITAS, like all hospices, offers bereavement support for the loved ones of patients who were enrolled in its hospice programs, lasting for up to a year after the patient's death. (Like many hospices, it also offers similar support to other grievers in their community.)

Pamela Villalobos of San Diego, California, joined such a group, over a video chat, after losing her mother to a COVID infection in April.

Villalobos was used to visiting her mother six days a week at her memory care unit in an assisted living facility. But when the facility closed to visitors after the pandemic hit, she switched to communicating via FaceTime and GrandPad and making “window visits” with other family members outside the facility. It was during one of these distanced chats that Villalobos noticed her mother had stopped talking, signaling the end was near. She was allowed to make one last in-person visit on the day before her mother died, but funeral plans were put off until the extended family was able to come together again.

Villalobos says her mother's death felt “isolating,” and very unlike her father's final days, a year and a half earlier. Then, she says, there was plenty of time for goodbyes, along with comforting assistance from a hospice chaplain who helped the family create a sacred space at his bedside. With her mother's final days, she says, “it was incredibly painful not to be there to comfort her, though I was grateful that I could be there myself at the end.” Villalobos says she found the virtual grief group's recognition of her profound grief — and the knowledge she was not alone experiencing it — extremely beneficial.

How to adapt to grief now

While you may not be able to be surrounded by your loved ones while you mourn, regularly reaching out to friends and family over the phone or by video chat can be critical for managing, and expressing, your grief. Talking to a professional — perhaps through a telehealth appointment — can also be helpful.

Beyond that, Neimeyer recommends looking for a daily or weekly ritual to honor the memory of the deceased, which can be as simple as speaking to their photo in your home, or visiting a favorite place of theirs on a daily walk in your neighborhood. “All these small ways can actively honor those we have loved and lost,” he says, adding that doing so can help move you from a place of “passive victimhood” to one where you feel more in control and able to cope.

Fiorelli also recommends that you take note of how anxiety — which the pandemic has created plenty of — can compound grief. Along with support groups to manage some of the emotional aspects of grief, “we recommend interventions to mitigate some of the effects of that anxiety — any kind of exercise, yoga, meditation, progressive relaxation,” she says.

For the long term, handling complicated grief requires some acceptance that the time frame may be longer than you, or others, expect, says Patti Anewalt, director of the Pathways Center for Grief & Loss at Hospice & Community Care, Lancaster, Pennsylvania. Reminding yourself that you've faced, and overcome, other challenges and losses in life may help, she says. And so, too, may regularly reminding yourself that — just like the pandemic — your grief eventually will subside.

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