Lost lives: grief in a time of Covid

This gives us all the opportunity to reflect not just on those who have passed away, but those they leave behind. Recent American research suggests that each Covid victim leaves an average of nine close relatives behind (a figure that does not include friends).  This brings the bereaved to 1,155,519 and counting.

But that does not include all the other people who died during the year, and those they left behind all of whom were subjected to the same restrictions that the pandemic necessitated.  Adding those in brings us 697,000 dead and  6.27 million close relatives in mourning.

These are not mere statistics – even though the televised official updates present them as curves on a graph - they are lost lives and their mourners.

And to the grief of those losses we can add the more generalised loss felt by all of us of the world that was left behind when the pandemic struck.

Last April as Covid-19 began to bite Scope speculated about the impact it would have on the bereaved and called for a renewed focus on bereavement services.

Now seems an appropriate time to re-examine this issue in the light of the appalling scale of the tragedy that has unfolded.

First we should remember that death is both natural and inevitable. It comes to us all. And when a loved one dies it causes intense pain which can feel overwhelming. Guilt or anger, shock, disbelief and denial and combinations of all of these feelings are common and normal.

It is therefore important not to medicalise grief. It’s not just normal it is necessary. It’s not something you can recover from or somehow “get over”. Mourning is about learning to accommodate and live with loss.

However in some cases painful emotions are so long lasting and severe that those who suffer them have trouble recovering from the loss and resuming their lives, with debilitating mental and or physical repercussions. This is what the professionals call Complicated Grief.

Even before the pandemic researchers were estimating that around one in ten of bereaved people suffer from Complicated Grief.

With the first Covid-19 deaths occurring around 12 months ago it is still a little early to say what the impact of the scale of this problem is likely to be.

However there have been many research papers published in the past few months that suggest it will be severe.

For example one study carried out in Brazil explored the impact of curbing funeral rituals on bereaved families. It makes for a harrowing read.

The daughter-in-law  of one of the victims told researchers: “I hope you never have to stay home inert, while your relative is being cremated without any relative to say goodbye or pay honour.”

A clear finding was that during the pandemic mourners felt that paying last tributes to a loved one was important to make amends and reconcile with life and the restrictions around funerals and burials disturbed rather than comforted them meaning they could not share their grief and get social support at their time of need.

It concluded: “From the moment in which family members are prevented from performing farewell rituals due to the restrictions imposed by the pandemic, the mourning may become even more painful and even incomplete. It may trigger psychological distress that tends to go on indefinitely, providing raw material for the development of complicated grief.”

Perhaps even more troubling is the conclusion: “To mitigate the impact of these problems, which humanity will have to learn to live with from now on in predictable new epidemic outbreaks, it is imperative to innovate how funeral rituals are performed, certainly making them safer to minimize the risk of contamination by the novel coronavirus, and even shortening these events, however, without emptying their meaning.”

This opens up the disturbing notion that post-pandemic societies will need to reinvent often ancient rituals around death.

An English research team studied 218 papers into previous pandemics. They were unable to find any that focused on bereavement, which in itself is revelatory about the lack of attention to this critical issue in the past. It came to similar conclusions to the Brazilian study: “The multiplicity of loss associated with pandemics impacts upon cultural norms, rituals, and usual social practices related to death and mourning, potentially increasing the risk of complicated grief. Innovative ways to promote connection with people before and after the death and recognition of the need to adapt rituals and mourning practice to honour the dead and provide comfort to survivors are recommended.”

The most recent published research which came out earlier this month is a survey of bereavement care in the UK and Ireland during the pandemic. A silent epidemic of grief

It points out that Covid-19 deaths are typically associated with a number of factors already known to increase the risk of Complicated Grief, such as sudden and unexpected deaths, deaths in intensive care units, patient isolation and severe symptoms including breathlessness at the end of life. It also reminds us all that the issues around social isolation and their impacts on contact with the dying and funeral and burial arrangements are shared by all bereaved people not just those whose loved ones died of Covid-19 – an important matter which hints at even greater potential problems.

It added: “Emotional support was reported to have been significantly disrupted. Physical distancing, the use of personal protective equipment (PPE) and use of remote support were restricting non-verbal communication such as facial expressions and body language which were felt to be important in developing trusting relationships: ‘The use of staff PPE has made communication more complex, limiting non-verbal communication and making staff and families feel uncomfortable’ 

And: “Not being able to ‘see the journey’ of the dying patient meant bereaved families often had questions following a death, with reports of increased queries from family members about the care received, including anger at restrictions and feelings of unfairness, leading to difficulties in accepting the death.”

All this has been exacerbated not just by families not being able to see the bodies of their loved ones but also of possessions being returned.

It concludes: “Bereavement care is a central aspect of the work of a wide range of health and social care professionals yet remains a low priority within healthcare policy. The COVID-19 pandemic has highlighted this important area of patient care, creating both major challenges to bereavement support provision and opportunities for practitioners and policymakers to address this neglected aspect of clinical care. Bereavement is one of the long-term impacts of COVID-19: if left unaddressed it may lead to significant physical and mental health morbidity and create a further burden on health and social care services.”

There are many claims on health spending as we prepare for recovering from the pandemic. This one must not be forgotten.

There is also a role for all of society to show compassion, kindness and support to the bereaved.  And when we do so we should not confine our efforts to the loved ones of those who died from Covid, but for all the dead, whatever the cause. Otherwise we risk adding further pain to many more whose experiences were every bit as traumatic.