As of mid-July, the U.S. reported over 137,000 deaths due to COVID-19. Families are not only dealing with the death of loved ones and friends, but also significant changes to how they grieve, due in part to strict social distancing guidance that discouraged gathering for funerals or memorials.
That’s left some grief and bereavement experts wondering how the pandemic has impacted the way we grieve.
In some ways, said University of Georgia epidemiologist Toni Miles, our relationship with death and dying is receiving some long overdue attention.
“In the U.S., we’ve never been comfortable with talking about death,” said Miles, a professor in the College of Public Health who has been studying how the American culture around grief hurts our health and what can be done to fix it.
COVID-19 has changed the way we grieve, she said, but it’s unclear what the lasting effects may be on our relationship with death and loss.
Let’s start with the culture of grief pre-COVID-19. What did that “normal” look like?
“We’re used to having some kind of gathering, whether that’s a funeral or some kind of celebration remembering the dead,” said Miles. But after a few weeks, the person is still grieving, and most of that initial support goes away.
“We think so much about preventing death that we hardly give much thought to the survivors, the people left in the room,” she said.
This is especially true in the long-term care settings, where COVID-19 has been especially deadly and where Miles has spent years trying to change how facilities respond to death.
“In nursing homes, death was handled through one of two ways – hide the body away or what has been called the ‘trip to Valhalla,’” said Miles. The trip to Valhalla approach, explained Miles, resembled a moving wake where nursing home residents and staff had a chance to say final goodbyes as the deceased was moved out of the building under a sheet.
Nursing homes that chose to covertly remove bodies were trying to shelter residents from unpleasantness, she said, “but they were also removing the opportunity for residents to grieve.”
How have our norms around death and grief changed since the onset of the pandemic? At home? In health care?
“The biggest change obviously is that we are no longer gathering for funerals. That has removed a process by which all of us come to some terms with the loss. The group coping of the situation at hand is healing, but we can’t heal ourselves that way anymore,” said Miles.
In health care settings, especially nursing homes, death has to be handled more carefully – and more openly.
“Hiding the death can’t happen anymore; there’s just too many. The trip to Valhalla can’t happen anymore due to social distancing,” said Miles, though funeral homes are having more virtual funerals.
Miles has also seen services provided by grief counselors or other mental health professionals pivot to virtual settings, but it can be a challenge to deliver counseling through telemedicine.
“Every health care system, whether they were ready or not, had to get into telehealth. We won’t know for a while, is it good enough to talk to someone over Zoom about your anxieties, your depression,” she said.
Do you think our relationship with death, dying and grief will be different? In what ways?
“We were just starting to evolve to the point where we were comfortable being around people who are dying. American culture has had a problem with that for a long time,” said Miles. “With COVID-19, we’re going to take a step backwards, I think.”
Miles foresees a reluctance to be in the room with a dying person and gather family to a loved one’s deathbed, and there will be some fear associated with dead bodies. This makes her worried for the survivors of the deceased.
“How do you help the people who are left behind be less injured by that process?” she said. “I don’t know the answer to that, yet.’
However, Miles notes that data from the Centers for Disease Control and Prevention’s biennial behavioral risk survey for 2019 and 2021 will include the public health impact of loss, which will reflect how our relationship with death, at least in terms of health, have shifted.
What could we learn to do better?
“Be kind. Sometimes you just need to be a quiet presence with that person who’s grieving,” said Miles.
There are many things we can learn to do better to support each other in the face of loss, said Miles, but kindness is key – and patience. “What that person needs changes from minute to minute, and it takes time.”
Our health care system could also stand to handle death more openly, said Miles, beginning with providing more support for the people standing around the deathbed.
And some changes may be on the horizon in Georgia, in part due to a bereavement care program Miles has launched in nursing homes.
“At least, we’re talking more about this now,” she said.